[Optimization of endosurgical treatment of women with stress urine incontinence]. / Optimizatsiia éndokhirurgicheskogo lecheniia zhenshchin s nederzhaniem mochi pri napriazhenii.

Stress urine incontinence was treated in 79 women with Burch laparoscopic colposuspension, 75 (94.9%) of them had chronic urinary infection. 42 females of group 1 received postoperative extracorporeal hemocorrection, 37 females of group 2 received conventional postoperative therapy. In group 1 the treatment reduced leukocyturia, bacteriuria was detected in 9 (21.4%) patients, recurrent incontinence occurred in 2 (5.9%) women. In group 2 leukocyturia enhanced, bacteriuria and incontinence recurrence were observed in 23 (62.2%) and 8 (23.5%) patients, respectively. The results of the study show that combined use of laparoscopic colposuspension by Burch and extracorporeal hemocorrection improves the results of the treatment of stress urine incontinence.

A histological and immunohistochemical study of neuropeptide containing somatic nerves in the levator ani muscle of women with genitourinary prolapse.

BACKGROUND: To evaluate the changes occurring in the somatic innervation throughout the levator ani muscle in women with genitourinary prolapse and stress urinary incontinence (SUI). METHODS: Thirty-four patients with genital prolapse entered the study and ten subjects with non-malignant pathologies acted as a control group. All patients were evaluated by urodynamic investigation and an electromyographic study of pelvic floor muscles to define the type of urinary incontinence. Biopsy samples were obtained from both groups of patients: the site of muscle biopsies were left and right part of perirectal pubococcygeus muscle. The evaluation of immunoreactivity was semiquantitative and based on staining intensity and distribution. RESULTS: In all cases, S-100 protein and NSE immunoreactivities were found in nerve fascicles running throughout the striated muscle. NPY and VIP positivities were more intense and diffuse, whereas SP immunoreactivity was quite scanty. The different patterns of NPY and VIP expression changed in relation to degree of genital prolapse and to the presence of SUI. CONCLUSIONS: Our immunohistochemical study shows the presence in the pelvic floor of neurons that are able to synthesize neuropeptides. The lower immunoreactivity score of same neuropeptides (VIP, NPY) observed among patients with third degree genital prolapse and with SUI could be related to biochemical damage of the neurons with subsequent lower production of chemical messengers.

Evaluation of antibody class in response to bovine collagen treatment in patients with urinary incontinence.

PURPOSE: Contigen Bard Collagen Implant (CI), made of highly purified bovine dermal type I collagen (BDC), is used as a bulking agent for the treatment of urinary stress incontinence. The humoral immune response to placement of this material in the urinary sphincter was evaluated. MATERIALS AND METHODS: In a prospective clinical study, patients were treated with CI in the urinary sphincter, and blood was collected at various timepoints following injection. Approximately 28% of the patients treated with BDC demonstrated specific antibodies against bovine type I collagen. Serum samples from 27 patients from this cohort were evaluated. The class specificity of circulating antibodies against bovine collagen was characterized by an indirect enzyme-linked immunosorbent assay. RESULTS: In all patients demonstrating an antibody response to bovine collagen, the predominant immunoglobulin class was IgG, found in 100% of sera samples. Immunoglobulin A was produced in approximately 40% of these patients, and IgM was seen in approximately 0.6%. No specific IgE was detected against bovine collagen in any serum sample. The highest concentrations of IgG and IgA antibody classes were observed 4 to 5 months after the initial treatment with CI. In the multicenter clinical trial, adverse events were reported in approximately 40% of all patients treated with CI (19). There was no correlation found between the production of a specific immunoglobulin class and the onset of any clinical adverse events. CONCLUSIONS: In all sera from patients treated with CI for urinary stress incontinence, antibodies to bovine dermal collagen always were predominantly IgG. Immunoglobulin A was seen in less than half of the sera samples, and IgE was not observed. In addition, no change in the humoral response to CI over time was noted in patients demonstrating presensitization to bovine dermal collagen at the time of initial treatment. Clinical adverse events reported for patients demonstrating pretreatment antibodies against bovine dermal collagen did not differ in type or number when compared with patients having no presensitization.