Vol 49, No 5S (2000)

Nowadays, urinary incontinence in women is not only a medical but also a serious social and hygienic problem. A variety of methods are used to eliminate this pathology, including surgical treatment. In the Russian Federation, 30,000 female patients per 1 million female population require surgical correction of urinary incontinence (Krasnopolsky V.I. et al., 1997). The anatomical and functional condition of the lower urinary tract, pelvic diaphragm and the degree of genital prolapse influence the choice of surgical technique. In cases of minimal prolapse of the bladder neck with a significant degree of urinary incontinence, suprapubic suspension surgeries are performed.

Aim: The recurrent course of chronic lower urinary tract infections in more than 10% of women is caused by variants of the external urethral opening, such as vaginal ectopy and hypermobility. This creates conditions for retrograde infection of the urethra during sexual intercourse. The aim of the study was to improve the treatment outcomes of women with recurrent lower urinary tract infection with vaginal ectopia or external urethral hypermobility.

Aim: Preservation of functioning kidneys after obstetric and gynecological operations complicated by ureteral fistulas.

One of the main causes of stress urinary incontinence is post-traumatic changes of the pelvic organs, usually occurring after a complicated delivery. Hormonal dyscorrection in the perimenopausal period may also be an etiological factor of this pathology. The neurogenic form of urinary incontinence in which only conservative treatment is possible cannot be overlooked. Infectious diseases of the urinary tract also often lead to urinary disorders.

By minimally invasive methods of surgical treatment we mean benefits performed under endoscopic, transvaginal or percutaneous access without extensive opening of the skin, aponeurosis, and abdominal cavity. The development of minimally invasive surgery is currently the most promising trend in all fields of medicine, gynecology in particular. The advantages of minimally invasive technologies manifest themselves most fully at surgeries in hard-to-reach for traditional surgery areas, such as the cervical space of the small pelvis and the urethrovesical segment area. This fact together with high frequency of genital prolapse and dissatisfaction with the results of earlier proposed methods of treatment determined our interest in this problem.

The aim of the present study was to evaluate the efficacy of loop (sling) surgery using a short skin flap taken from the anterior abdominal wall in patients with urinary incontinence of the second and third types.

Aim of the study: Optimization of preoperative preparation, surgical treatment and rehabilitation of patients with prolapse and prolapse of the vaginal and uterine walls.

We analyzed the long-term results of surgical treatment in 77 patients with genital prolapse. Of them, 35 had stress urinary incontinence. General clinical, endoscopic, urodynamic methods of investigation and ultrasound scanning were performed.

Neurogenic disorders of bladder function are caused by disruption of the reflex arc of urination. Identification of the main pathological link is a diagnostic task that involves neurologists, urologists, neurosurgeons, etc. In addition, complex diagnostic equipment is required, which is not always available in the clinic.

Lower urinary tract dysfunction manifested by urinary incontinence occurs in 10-30% of women. They lead to a significant decrease in the quality of life of these patients, which has a significant social significance. Improving the effectiveness of treatment of patients with urinary incontinence remains a very urgent problem. An accurate diagnosis of the type of dysfunction is necessary for choosing the optimal treatment tactics. In this case, urodynamic methods of investigation have the greatest diagnostic value.

Aim: Urethral instability in some cases leads to urinary incontinence depending on the nature, amplitude, and combination of fluctuations of the maximum intraurethral pressure and bladder pressure, which allows us to distinguish two types of urethral instability.

Obstructive urination in women is a very rare and difficult to recognize symtomocomplex.
The aim of this study is to familiarize readers with this problem and to present the results of examination of patients suffering from this urinary disorder.

216 women with stress, imperative and mixed forms of urinary incontinence were examined. Priority was given to anamnesis, physical examination, summary evaluation of urinary diary and traditional microbiological information.

Urinary incontinence in women is common in all age groups and differs in the severity of symptoms. A distinction is made between mild, moderate and severe urinary incontinence. Unfortunately, patients suffering from mild urinary incontinence very rarely visit a specialist.
The aim of this work is to evaluate the possibility of using minimally invasive treatment methods in patients with mild to moderate urinary incontinence.

The final link in the pathology responsible for involuntary urine loss during physical exertion is a disturbance of the mechanism of adequate transmission of the impulse of increased intra-abdominal pressure to the urethra and bladder. The conditions leading to the occurrence of transmissive disorders are decreased resistance of the urethra and its upper half leaving the zone of hydraulic protection.

We studied some etiological and pathogenetic factors of tension urinary incontinence (TUI) in 132 female patients. The cause of the disease in 78 (59.5%) of them was fast or prolonged labor, heavy physical work; trauma in 26 (19.7%) and hormonal disorders in 19 (14.3%) patients. All the patients were subjected to a comprehensive examination that included cytological examination of vaginal smears with determination of the caryopycnotic index, cystourethroscopy, retrograde cystourethrography, and urodynamic studies.

Universal "markers" of estrogen deficiency developing in menopause are not only vasomotor disorders and emotional and psychological discomfort typical for perimenopause, but also atrophic changes in the urogenital tract: atrophic vaginitis, cystourethritis, urinary control disorders.
The aim of the study: to identify different variants of urinary disorders in women in the menopausal period.

Considering that the increased frequency of urogenital disorders in women in the menopausal period is caused by the development of marked atrophic changes in the vaginal and urethra mucosa on the background of estrogen deficiency, the presence of numerous contraindications to the use of pharmacological estrogenic drugs, we studied the possibilities of tissue therapy in the correction of urogenital disorders.

Vesicovaginal fistulas are a complicated problem in urology due to their frequent recurrence.
Aim. To study five-year experience in the treatment of patients with vesicovaginal fistulas.

Data on the dynamics of sexual function recovery in patients who underwent successful fistuloplasty were obtained by questionnaire survey. We interviewed 123 women with an average age of 41.6 years. Sexual function was restored in 71 (57.7%) patients without a history of hysterectomy 4.8 months after fistuloplasty. In 52 (42.3%) women who had undergone uterine extirpation, sexual function recovered only by 8 months after fistuloplasty.

Currently, one of the serious problems in urogynecology remains the problem of vaginal and vaginal fistula treatment. Up to 85% of fistulas develop after gynecological surgeries. Direct damage to the bladder wall during surgical treatment is the main cause of bladder-vaginal fistula formation. On the other hand, impaired blood supply to the bladder wall is believed to play a role in the genesis of fistula development.

The urological department of the Janedze Research Institute of Emergency Medicine. From 1996 to 2000, 14 women with ureteral injuries after obstetric and gynecologic surgeries were treated in the urological department of Janelidze Research Institute of Emergency Medicine.

The problems of surgical treatment of patients with bladder-vaginal fistulas are largely determined by the nature and localization of bladder injuries during gynecological operations and obstetrical procedures. In this regard, the prevention of lower urinary tract injuries in obstetric and gynecological practice remains a topical issue.

Obstetric traumas of the pelvic floor, perineum and urogenital diaphragm are the most frequent complications of childbirth and, according to domestic and foreign authors, account for 10.3-39%. Vaginal and perineal tears are the consequence of many causes depending on the mother and fetus, but, as a rule, they are the companions of pathological childbirth.

The problem of treatment of nonspecific inflammatory diseases of the female genitalia in pregnancy remains one of the most difficult in obstetric practice. This is due to a number of reasons: changes in the metabolism in the body of a pregnant woman - which affects the pharmacokinetics of drugs, the emergence of drug resistance of microbes, restrictions on the prescription of antimicrobial drugs for pregnant women.

The subjects were 27 couples with infertility in a marriage of 3 to 10 years, aged 25 to 39 years. At microbiological examination, Chlamidia trachomatis was detected in 11 (40.7%) husbands and their wives by culture and PCR, half of them had ATJg G r titers to Chlamidia trachomatis within 1:32 and 1:64. Four patients had second sexual partners infected with Chlamidia trachomatis. Ureaplasma urealiticum was detected in 9 (33.3%) couples, 3 of their wives had early miscarriages, and the remaining 7 couples had mixed mycoplasma-ureaplasma infections.

Vaginal candidiasis (the most common clinical form of genital candidiasis) is a common disease. Its frequency has doubled in the last decade and makes up 45% in the structure of infectious pathology of the lower female genitalia. It is especially alarming that the increasing number of patients with genital candidiasis poses a threat to the health of women, as well as to the fetus and the newborn baby, really increasing the threat to the health of the future generation.

Urethritis is the most common disease of the urethra in women aged 20 to 50 years.
The aim of our study was to investigate the etiology of urethritis in women. A total of 122 women diagnosed with urethritis (75 pregnant and 47 non-pregnant women) were examined.

Inflammatory diseases of the pelvic organs of various etiologies are detected in 60-65% of gynecological patients who come to the women's consultation clinic, of which 20-30% require inpatient treatment. Many inflammatory diseases of the female genitalia are of a sterile nature, without pronounced signs of intoxication. The existing methods of diagnosing pelvic inflammatory diseases (ultrasound, bacteriological examination, determination of antibody titers of the pathogen, laparoscopy) require a long time, many methods are invasive and do not always meet the requirements of urgent gynecology.

In prepubertal girls, the incidence of both genital and extragenital infections remains high up to the present time, and primarily concerns the urinary tract. The close anatomical and physiological connection of the urogenital tract, the frequent excretion of identical microflora from the urine and genital organs indirectly confirm the etiopathogenetic relationship of pyelonephritis, cystitis and vulvovaginitis.

Of 163 women aged 16 to 42 years who suffered from acute pyelonephritis during pregnancy, 80 patients (the main group) received 3-5 centrifugal plasmapheresis (PA) operations combined with 5-7 sessions of laser blood irradiation in the course of treatment (infusions, antibacterials, etc.). The remaining patients (83) constituted the control group.

Pregnancy is considered a risk factor for pyelonephritis (PN). However, the occurrence of this pathology largely depends on the qualitative properties of the microorganisms infecting the kidneys. Especially significant among them are persistence characteristics providing resistance of bacteria in contact with human immunity effectors.
Aim of the study. To analyze the species composition and persistence characteristics of bacterial microflora isolated from urine of pregnant women with PN.

The aim of the study was to detect sexually transmitted diseases (STDs) in pregnant women with chronic urogenital infection and to develop tactics for the prevention and treatment of possible complications. Methods: general clinical examination, examination of blood, swabs and cervical canal secretions by bacteriological, immunofluorescence and enzyme immunoassay methods.

The problem of postpartum infection remains one of the most important problems in obstetrics. The occurrence of postpartum purulent-septic complications is a consequence of the manifestation of an infectious factor in labor. In analyzing the individual charts of 60 pregnant women and labor histories, we identified factors that contributed to the development of infectious complications. The examined women were aged 18-38 years. Chronic foci of infection were detected in 54% of the pregnant women (31% had chronic pyelonephritis, 23% had chronic tonsillitis).

Inflammatory diseases account for the largest percentage of all complications of medical abortion. An irrational approach to the treatment of this pathology leads to the impairment of female reproductive function. The search for new informative technologies and methods of treatment efficacy evaluation is quite reasonable.

Aim: to show the pathogenetic validity of the use of non-medicinal methods of treatment in patients with symptoms of pelvic floor muscle relaxation, as well as in women who are a risk group for these diseases.

Overactive bladder is one of the most common urinary disorders. The main clinical symptoms of overactive bladder are rapid urination, urgency (the feeling that urination will start immediately and any delay will end with involuntary urination), and urge urinary incontinence. Unfortunately, no optimal treatment for this condition has been developed at present.

Genital malformations account for 4% of all congenital anomalies. Absence of the vagina occurs with a frequency of 1 per, 4-5 thousand newborns. The problem of vaginal formation in congenital aplasia has long attracted the attention of many specialists.

Aim: Analysis of cystometry results in women with complaints of urinary incontinence in order to determine its cause.

We examined 89 patients with vaginal wall prolapse and urinary incontinence before and after surgical treatment. The course of the postoperative period was uncomplicated (sanogenetic) in all women. The mean age of the women was 55.5±10.6 years, body weight was 71.4±1.2 kg, and height was 162.0±0.53 cm.

The validity of loop surgery for tension urinary incontinence in women using both the body's own tissues and various synthetic materials is generally recognized. However, currently known techniques do not always satisfy physicians. For example, when a skin loop is used, a scar remains after the flap is formed, which is certainly a negative moment for patients. When synthetic materials are used, there is a high risk of erosion of the loop bed and long-term infection in the surgical area.

Aim: During the analysis of treatment of 192 patients with isolated forms of stress urinary incontinence, the immediate and long-term results were evaluated. The efficiency of suprapubic, vaginal and sling surgeries was compared.

Urodynamic studies are widely used in patients with various urinary disorders. However, the standard urodynamic study performed within 30-50 minutes often does not allow for evidence-based assessment of the accumulation and evacuation phases, which leads to various diagnostic errors.
The aim of this paper is to acquaint the readers with the results of examination of women suffering from various forms of dysuria using urodynamic monitoring.

Aim. In the present paper we decided to introduce readers to a rare clinical group of patients whose examination revealed a combination of several clinical and urodynamic symptoms of the disease manifestation not coinciding with the results of additional examinations.

The aim of the study: to determine the effectiveness of different types of therapy for urinary dysfunction in menopausal women.

According to recent epidemiological studies, more than 50% of postmenopausal women suffer from urogenital symptoms, the frequency of which increases with age. Atrophic changes in the mucous membranes of the urogenital tract are caused by the loss of trophic function of estrogen, which leads to cessation of proliferative processes in mucous membranes, their thinning, increase in pH of the vaginal contents, dominance in the microbiocenosis of aerobic and anaerobic opportunistic pathogenic microflora.

The aim of the study was to investigate the state of vaginal microecology in postmenopausal women and to evaluate the microbiological efficacy of HRT for vaginal atrophy (VA).

The main goal of the diagnostic process for various diseases is to obtain comprehensive information, allowing you to choose the best treatment option. Taking into account the necessity to assess the anatomical relations of the damaged urogenital organs and the results of plastic surgery for vaginal-vaginal fistulas, we used modern methods of radiological and ultrasound diagnostics in our work. 

Aim: to analyze the clinical results of diagnosis and treatment of vaginal fistulas (VVF), the problem of which, despite the repeated coverage of this issue in the literature and in scientific and practical discussions, remains unsolved, because the number of patients with this disabling pathology is not decreasing, and the treatment results are not always satisfactory to surgeons.

One of the most complicated problems of modern urogynecology is the damage of the urinary system organs. The high prevalence of instrumental interventions, the expansion of indications for operative delivery on the one hand, and the increased volume and number of radical operations performed by gynecologists are objective prerequisites for the occurrence of urinary system injuries.

The aim of this report is to acquaint the readers with the peculiarities of ureteric and bladder trauma after laparoscopic interventions, their diagnosis and treatment.

In modern conditions, the operation of caesarean section in the lower segment has become one of the leading methods of operative delivery, and the frequency of its use, according to some authors, reaches 12-15%. The procedure is performed both in term pregnancies and to terminate pregnancy in the second trimester (small caesarean section). One of the complications of the postoperative period is uterine suture separation, requiring relaparotomy and uterine extirpation.

Bacterial vaginosis is the most common form of dysbiotic disorders of the vaginal microecology during pregnancy. Treatment of bacterial vaginosis requires awareness of the etiology and pathogenesis of this disease and strict individualization in the choice of methods and means.

The aim was to study the incidence of infectious and inflammatory diseases of the genitals in women with various forms of endocrine infertility.

Today one can already consider as an axiom the very essential role of the lactoflora of the vagina, first described more than a hundred years ago by A. Dunderlein and V.V. Stroganov. Stroganov, in the protection of the female body from all kinds of infections. Probiotics (eubiotics) from lactobacilli are also well known. However, a very significant increase in the incidence of infectious and inflammatory diseases of the genitourinary organs observed these days makes us look for ways to further improve the quality of the relevant drugs.

Among the causative agents of urogenital infections, ureas and mycoplasmas currently occupy the largest share. They cause inflammatory diseases of the genitals 2-3 times more often than gonorrhea and syphilis.

Bacterial vaginosis (BV) is the most common infectious disease among women of reproductive age. Patients with BV are at risk for infectious complications during pregnancy, during childbirth, and after genital surgery.

A characteristic feature of chronic urogenital pathology of chlamydial etiology is predominantly asymptomatic and asymptomatic course. The dysuric syndrome often occurs in women with unchanged clinical urinalysis and absence of bacterial flora in cultures.

Chronic pyelonephritis is one of the most frequent infectious-inflammatory complications of pregnancy, leading to adverse pregnancy outcomes and fetal pathology.
The aim of this study was to characterize changes in the immune status parameters of pregnant women during the development of an exacerbation of chronic pyelonephritis.

The period of adaptation to extrauterine existence is characterized by many parameters, among them the problem of primary microbial colonization is almost the most important. The most important factors in the formation of normal microflora in the newborn are the microbiological landscape of the maternal birth canal, natural feeding and hospital strains.

Despite the fact that pregnancy failure does not tend to decrease, it is one of the main types of obstetric pathology, occupying a significant place among the causes of adverse outcomes for the mother and fetus.
Our study was aimed at identifying the effect of urogenital infection in early termination of pregnancy. The study was based on the examination of 111 women with threatening termination of pregnancy of unclear etiology.

The aim of our work is to improve the effectiveness of treatment of gestational pyelonephritis (GP) in pregnant women based on the study of changes in the immune system of the body and their correction.

Currently, the problem of teenage pregnancy remains a topical issue worldwide. Teenage pregnancies occur outside of wedlock, are unwanted and usually end in a medical abortion. More often medical abortion in adolescents is performed in the second trimester, which is associated with late attendance to a doctor. Artificial termination of pregnancy in the second trimester entails significantly more complications than in the first trimester. The risk of complications of medical abortion increases in the presence of chronic somatic and gynecological diseases of inflammatory genesis.

Neurogenic urinary disorders are characterized by polymorphism of clinical manifestations. The type of urodynamic disorders depends on the degree of damage to the sympathetic, parasympathetic or somatic components of the urinary reflex arc.

Aim: The degree of vagotonin and detrusor tone in patients with urethral syndrome against the background of increased sensitivity to any fraction of estrogen or progesterone was evaluated on the basis of intradermal hormonal tests. It is well known that endocrine function and autonomic nervous system are interconnected. The reciprocal stimulation is noted between estrogens and parasympathetic nervous system, luteal hormones and sympathetic nervous system.