[Sacral magnetic stimulation in overactive bladder syndrome: comparative analysis of protocols with a frequency of 1 and 5 Hz]

Peripheral magnetic stimulation (pMS) has shown its effectiveness in the treatment of lower urinary tract symptoms, such as symptoms of an overactive bladder (OAB). The perineal region (pelvic floor) and the sacral roots area (projection S3 of the root) are used as the locus of stimulation. The published literature presents protocols with different parameters of stimulation, while each of them reliably demonstrates clinical efficacy, however, no comparative studies have been found to select priority stimulation modes when analyzing available sources.

OBJECTIVE

To compare the efficacy and safety of different frequency - 1 and 5 Hz - modes of sacral MS in patients with symptoms of OAB.

MATERIAL AND METHODS

A single blind prospective randomized comparative clinical study included 59 patients with OAB symptoms. The patients were divided by simple randomization into the group 1 (n=30), which received MS 3 times a week for 5 weeks with a frequency of 1 Hz per sacral root area (S2-S4), and the group 2 (n=29), in which stimulation was performed at a frequency of 5 Hz, while the remaining parameters and duration of therapy were identical to group 1.

RESULTS

Sacral pMS with different frequency modes (1 and 5 Hz) is reliably equally effective against the clinical symptoms of OAB, which is confirmed by the absence of significant intergroup differences. In patients receiving MS with a frequency of 5 Hz, there was a more pronounced increase in maximum cystometric capacity, normalization of the maximum and average urine flow velocity and regression of the residual urine volume (p<0.001, p=0.007, p=0.011 and p=0.012 compared with group 1). The greatest difference in indicators was observed in the increase in the maximum cystometric capacity - +31±25 ml at MS with a frequency of 1 Hz and +109±96 ml at MS with a frequency of 5 Hz (p<0.001). MS is a safe procedure and is well tolerated by patients.

CONCLUSION

pMS when exposed to the area of S2-S4 roots for 20 minutes 3 times a week with a course for 5 weeks is reliably effective against the clinical symptoms of OAB at different frequency modes (1 and 5 Hz). At the same time, MS with a frequency of 5 Hz may have an advantage over stimulation of 1 Hz in terms of its effect on urodynamic parameters (maximum cystometric capacity, peak and average urine flow velocity and residual urine volume), which may be associated with a large inhibitory effect on detrusor.

[Vaginal access pelvic organ prolapse repair at the high-volume center: evolution of implants from XL to XS]

INTRODUCTION

The use of large vaginal meshes for the treatment of pelvic organ prolapse (POP) combined with insufficient surgeon experience are the important risk factors for serious postoperative complications.

AIM

To find the most safe and effective method of surgical treatment of POP.

MATERIALS AND METHODS

To evaluate the efficiency of surgical techniques, a retrospective study of 5031 medical records from an electronic database was carried out. As the primary endpoint, we assessed the duration of the procedure, the volume of blood loss and the length of stay. As a secondary endpoint, the number of intra- and postoperative complications was assessed. In addition to objective data, we assessed subjective measures using the validated PFDI20 and PISQ12 questionnaires.

RESULTS

The best results in terms of blood loss were shown by unilateral hybrid pelvic floor reconstruction and three-level hybrid reconstruction (33+/-15 ml and 36+/-17 ml, respectively). Patients who underwent the three-level hybrid pelvic floor reconstruction technique had the highest result: 33+/-15 points of the PISQ12 questionnaire, 50+/-28 points of the PFDI20 questionnaire, which was significant in comparison with other techniques (p<0.001). The number of postoperative complications was also significantly lower for this procedure.

CONCLUSION

Three-level hybrid pelvic floor reconstruction is a safe and effective technique for the treatment of pelvic organ prolapse. In addition, this procedure can be done in a specialized hospital with the appropriate skills of surgeons.

[Cellular regulation of the lower urinary tract as a cause of the bladder overactivity and reduced efficiency of pharmacotherapy]

Overactive bladder (OAB) is a polyetiological nosology. Its symptoms are often characterized not only with detrusor hyperactivity, but also with the increased sensitivity of afferent fibers, which is clinically manifested as urgency. In addition, the disorders at the level of receptors expression and the synthesis of mediators lead to the development of bladder pain syndrome (BPS), which also significantly reduces the quality of life of patients. In recent years, the experimental animal studies achieved significant progress in understanding of the pathogenesis of lower urinary tract dysfunction. In particular, the broad understanding of the sensor properties of urothelium was obtained, which significantly increased the popularity of the urothelial theory of the development of idiopathic detrusor hyperactivity, as well as hypersensitivity and bladder pain. According to this theory, the pathological release of biologically active substance in the transitional epithelium in response to an extension of the bladder wall leads to clinical manifestations of the described conditions. In addition, due to the studies of the properties of receptors, ion channels, and mediators, the suggestion about the reduced efficiency of muscarinic receptor antagonists have been made in a large number of patients. Besides the acetylcholine control of the lower urinary tract, more and more attention is paid to other significant mechanisms of pathological conditions. The purpose of this part of the lecture is to systematize the available materials of basic research on the functioning of the lower urinary tract at the cellular level, as well as the mechanisms of action and questions of the effectiveness of pharmacological therapy for urinary disorders.

[Characteristics of the neural regulation of the lower urinary tract as a cause of the development of an overactive bladder: current state of the problem]

An overactive bladder (OAB) is a constellation of lower urinary tract symptoms, including urgency, increased frequency of urination during the day and/or night (nocturia), and, in some cases, urge incontinence. This syndrome can be caused by different conditions, and currently no universal pathogenetic treatment has been developed. In addition, there are virtually no Russian-language publications providing information on the neurophysiology and neuroanatomy of the lower urinary tract. At the same time, the importance of this topic can hardly be overestimated. Often, a patient with a neurogenic dysfunction of the lower urinary tract has different comorbidities, which requires to deeply understand the mechanisms of development of certain symptoms. Considering an absence of clear data about the peripheral bladder innervation, role of the structures of the central nervous system and importance of neurotransmitters, it is rather difficult to provide high-quality specialized care. However, in recent years, a lot of new facts and theories have been described in basic researches. This lecture is dedicated to the current data on the pathogenesis of OAB. The purpose of the lecture is to summarize the results of fundamental and clinical studies on the pathogenesis of OAB.

[A comparative evaluation of the anti-ischemic action of verapamil in different models of myocardial ischemia]

The effectiveness of the anti-ischemic effect of verapamil was studied on models of coronary spasm (the test with dihydroergotamine) and microthrombosis of the coronary arteries (the test with ADP). The results of the performed studies showed that verapamil exerts the anti-ischemic effect at administration of dihydroergotamine and ADP. The most pronounced effect of verapamil was demonstrated on the model of myocardial ischemia due to coronary spasm.

[The anti-ischemic properties of verapamil and its effect on myocardial functional potentials in coronary artery occlusion]

The effect of verapamil on the functional state of the ischemic myocardium, the myocardial tolerance to ischemia and the processes of urgent adaptation of the heart in the coronary artery occlusion was investigated in the experiments on anesthetized open-chest cats. Verapamil was shown to exert the dose-dependent anti-ischemic action, to increase the myocardial tolerance to ischemia, to suppress the response to the physiological saline infusion and not to change adrenoreactivity of the ischemic myocardium at the coronary artery compression.

[The effect of N-acetylaspartic acid on the processes of memory and learning in rats]

The effects of a neurospecific substance N-acetyl-aspartic acid on memory and learning processes were investigated after intraperitoneal and oral administrations in rats. N-acetyl-aspartic acid was shown to restore the passive avoidance reaction in electroshock and scopolamine amnesias as well as in natural extinction. Chronic injections of N-acetyl-aspartic acid improved the learning in water maze but exerted no effect on the acquisition and retention of the active avoidance reaction in the shuttle box.

[Pharmacological correction of ketamine-impaired spatial memory of rats]

Ketamine in dose 10 mg/kg increased the number of erroneous choices of rats with spatial strategy and didn't effect searching accuracy of rats with non-spatial strategy in 8-arm radial maze. Ketamine in doses 1 and 5 mg/kg disrupted rat short-term memory in delayed response reaction. Physostigmine and aspartic acid, but not haloperidol, diminished ketamine amnesia, therefore ketamine impaired the interaction of cholinergic and glutamate/aspartatergic neurons of hippocampal areas.

[Method of studying the effects of pharmacological substances on work capacity of animals in hypobaric hypoxia]

The method of the study of medical agent influence and biological active substances on duration of small laboratory animals swimming has been worked out excluding the air. For this purpose the animals were placed into altitude chamber, filled with water by 1/3 (one-third) of its volume being in antiorthostatic position on dipping into water. It has been established that at the altitude of 4000 (four thousand) meters high the rat swimming duration became shorter in comparison with their work under normal pressure in 2.5-4 times. Bemitil stimulating work in hypobaric hypoxia depresses it sharply. Bemitil stimulating influence on the rat efficiency did not appear with rising. Antioxidant substance ionol increased efficiency in normal conditions and in hypoxia AKS-85 adaptogenic compound increased swimming in the height duration to a greater degree, mildronat substance for efficiency restoration produced actoprotective influence.

[The effect on gastric secretion and the anti-ulcer action of imidazo[1,2-A]benzimidazole derivatives]

The experiments on rats showed that of 16 studied imidazo [1,2-a]benzimidazole derivatives only the compounds with phenyl at the second carbon atom and nitrogen-containing radical of the ninth nitrogen atom inhibit the gastric acid secretion. The binding of oxymethyl group to phenyl, its substitution through adamantyl, displacement of nitrogen-containing substitute to the first nitrogen atom or its substitution were found to decrease or stop the inhibiting action of these substances on the gastric parietal cells. Dihydrochloride 2-phenyl-9 (beta-diethyl-aminoethyl)imidazo [1,2-a]denzimidazole was more potent than cimetidine and omeprazole in inhibiting the gastric acid secretion, pepsin output and antiulcer action.

[An experimental study of the cardio- and hemodynamic effects of the carboxyl ionophore monensin]

The effect of ionophore monensin on the main parameters of cardio- and hemodynamics was studied in the experiments on anesthetized cats. Monensin (0.075-0.375 mg/kg) administered intravenously in the increasing doses was shown to produce the dose-dependent elevation of arterial blood pressure, the increase of myocardial contractility and the total peripheral resistance. A single administration of monensin (0.375 mg/kg) was found to exert the two-phase action on the parameters of cardio- and hemodynamics.

[An experimental study of the psychotropic effects of aspartic acid from the aspect of age]

After acute injections to adult and 90-day old rats aspartic acid in doses of 100-500 mg/kg increased the locomotor and exploratory activity during the open-field test and in a dose of 100 mg/kg exerted the antidepressant effect during the forced swimming test. Following treatment for 10 days the amino acid in a dose of 10 mg/kg disrupted acquisition of passive avoidance reaction of young rats and in a dose of 100 mg/kg inhibited learning of active avoidance reaction in adult rats.

[Psychotropic effects of glutamic acid diethyl ester in mice]

In 1 hour after intraperitoneal injection glutamic acid diethyl ester (GED) in doses 200 and 500 mg/kg decreased locomotor activity and exploratory patterns of mice in "open field" test. GED in doses 100 and 200 mg/kg diminished the immobilization period of animals in forced swimming test, that proves the reversal interaction of glutamatergic and catecholaminergic systems in CNS. Glutamate receptors antagonist--GED in doses 100-200 mg/kg disrupted passive avoidance reaction at 30 min before acquisition and retrieval, therefore glutamate receptors are involved into fixation and retrieval of memory engram.

[Comparative study of the effect of picamilone and piracetam on learning in rats in a radial maze]

During four weeks rats were learned to visit consequently 4 baited arms in the 8-armed radial maze. Picamilone (nicotinoyl-GABA) in a dose of 10 mg/kg daily accelerated rats to reach 80% level of learning (to 20-28 trials). After picamilone injections rats obtained the maximal level of short-term memory as just 3-5 trials. Piracetam in a dose of 200 mg/kg daily exerted no effects on long-term and short-term memory of rats in the radial maze.

[Mechanism of the vascular action of verapamil and a crown ether derivative]

The effects of verapamil and benzyl-aza-15-crown-5 on pressor reactions of blood pressure and perfusion pressure in the femoral artery after administration of noradrenaline, tyramine, angiotensin amide and stimulation of the femoral nerve were studied in acute experiments on anesthetized cats (pentobarbital sodium, 50 mg/kg). Verapamil (0.5 mg/kg) and benzyl-aza-15-crown-5 (9 mg/kg) suppressed pressor reactions to the nerve stimulation and produced no changes at administration of noradrenaline, tyramine and angiotensin amide. One can suggest that the mechanism of the vasodilating action of verapamil and benzyl-aza-15-crown-5 is due to their inhibitory effect on calcium-dependent release of noradrenaline from terminals of the sympathetic nerves. The search of vasodilating agents in the series of crown-ether derivatives is promising.

[Cardio- and hemodynamic effects of a crown ether derivative and an analysis of its cardiotropic action in an experiment]

The cardio- and hemodynamic effects of the derivative of aza-15-crown-5 was studied in acute experiments on anesthetized (ethaminal sodium, 50 mg/kg) cats. At intravenous administration the compound was found to induce hypotension, to dilate arterial vessels, to exert negative ino- and chronotropic effects, to decrease the cardiac output. The pharmacological analysis suggests that the mechanism of the cardiotropic action of the compound is due to its intervention in calcium ion metabolism.

[Role of the GABAergic system in the mechanism of the stress-regulating action of phenibut]

Disturbances in GABA-ergic inhibitory system were noted upon the exposure of thalamus and hypothalamus of experimental animals to stress of 18 hours and longer duration but not of 3 hours duration. Phenibut (I mg/kg) eliminates the symptoms of GABA-system disturbances revealed upon exposure to stress, decreases the tension of stress reaction and hyperglucocorticoidemia which causes hyperglycemia. In the bodies of intact rats phenibut causes "switching on" of adaptive GABA-system function, which is more physiological than the one appearing on short-term stress.

[Effect of fenibut on cardiac hemodynamics in experimental hypertension from the aspect of age]

The effect of phenibut on cardiodynamics in 6-7-week-old rats and 14-16-week-old rats with spontaneous, renal and situational hypertension was studied in a 14-day chronic experiment. Phenibut in doses of 25 (young rats) and 50 (adult rats), mg/kg orally was found to exert the pressor effect in the first week and the hypotensive effect in the second week. In both age groups of rats with situational hypertension phenibut decreased arterial blood pressure.

[Effect of tranquilizers on myocardial function in stress injury]

Experiments on rats were performed to evaluate the action of diazepam (1 mg/kg), phenazepam (1 mg/kg), meprotan (25 mg/kg), mebicar (500 mg/kg), and phenibut (25 mg/kg) on myocardial function under stress-induced injury. Diazepam, phenazepam and phenibut protected the myocardium from stress by raising the functional reserves of the heart. Meanwhile meprotan and mebicar produced no stress-protective action on the heart under similar conditions.

[Effect of tranquilizers on the course of myocardial ischemia and on myocardial resistance to hypoxia in coronary artery occlusion]

It was shown that meprobamate and phenazepam protect the myocardium from hypoxia and decrease myocardial ischemia during coronary occlusion. Phenibut and mebicar reduce the tolerance to ischemia and increase the degree of ischemic injury to the heart. Diazepam has no effect on these processes.

[Effect of gamma-aminobutyric acid and its analogs on the smooth muscle of veins]

Effect of gamma-aminobutyric acid (GABA) and its agonists, phenibut, phenylpyrrolidone and LGPI-29, on contractility of smooth muscle cells was studied on an isolated rat vena porta. The contractility was recorded by a rapidly operating 6MH-1B mechanotrone to show that the solutions of GABA and those of phenibut (to a less extent) exert a distinct inhibitory effect on smooth muscle cells of the rat vena porta at a concentration of 10--20 mM. Phenylpyrrolidone and LGPI-29 did not decrease vascular tone. Depolarization of the cell membrane did not interfere with the inhibitory effect of GABA and its agonists on smooth muscle cell contractility of the rat vena porta.