MODERN APPROACHES TO THE DIAGNOSTIC AND TREATMENT OF THE UROGENITAL SYNDROME

(Оглядова стаття)

Abstract

Perimenopausal disorders in the modern world is a significant problem of the female population from the point of view of increasing life expectancy and high activity of modern women of perimenopausal age. More than a third of women in perimenopause have urogenital disorders in the form of various manifestations of vaginal and cystourethral atrophy. The multicomponent complex of urogenital symptoms affects the lower third of the genital area, and the common origin of steroid-dependent areas explains the synchronicity of the disorders. In recent years, the peculiarities of the distribution and density of steroid receptors in the UG tract have been actively studied. Significant age-related changes were found in the density of nuclear receptors ERβ, ERα.

One of the most important factors that determines the nature and time of menopause is inhibin A and B. In the reproductive age, it supports the gonadotropin steroidal balance, the development of the dominant follicle. A decrease in the level of inhibin B is an early marker of the onset of menopause, and an increase in FSH is a secondary phenomenon, which indicates a long-term fading of the ovaries. The sequence of involution processes is pathogenetically associated with hemocirculation disorders, subsequent ischemia, dystrophy, a decrease in the proliferative activity of the epithelium, a glycogen deficiency, an increase in pH, and a violation of microbiocinosis. As a result, this is blue colpitis and dyspareunia. A decrease in collagen in the structures of the vagina and pelvic ligaments leads to prolapse of the bladder, urethra and stress incontinence. A change in the sensitivity and composition of muscarinic receptors of the urinary bladder and urethra also leads to the appearance of dysuric phenomena and urinary incontinence.

The diagnosis of patients with UGS depends on the patient's complaints. Gynecological examination, colposcopy, microscopic, microbiological examination - with symptoms of vaginal atrophy. Use of the Barlow scale to specify the degree of UGR-atrophy, assessment of the type, degree of urinary incontinence. Uroflowmetry - to assess the speed of bladder emptying, profilometry - reveals the presence of sphincter disorders.

Therapy of UG disorders has several directions. Local anti-inflammatory - taking into account the condition of the mucous membrane, the presence of flora, consists in the appointment of antiseptic baths, antibiotics in the form of creams, suppositories. Ozone-oxygen vaginal insufflation is aimed at improving microcirculation, rheological properties of blood, oxygenation of tissues, stimulation and regeneration of the epithelium, normalization of vaginal microbiocinosis, and improvement of immune status. The method allows to achieve high anti-inflammatory and pain-relieving effects, activates the body's own reserves. It is important to use hormonal preparations in the form of local forms of estriol, with fairly low doses, but a pronounced proliferative effect on the epithelium of the genitourinary tract, which are complemented by a gradual restoration of microflora, an angioprotective effect, improvement of muscle tone, and hyaluronization of ligaments.

Operative conservative methods are provided for patients with urinary incontinence. Training the muscles of the pelvic floor according to A. Kegel's technique – with a mild degree of stress urinary incontinence. Urethrocystocervicopepsies are operations used for cystocele and urethral hyperactivity. The average degree of stress incontinence is effectively corrected before the urethral injection of forming drugs. Severe stress incontinence requires sling urethropexic operations. Treatment of urge incontinence consists of muscarinic receptor antagonists to relax the detrusor, increase bladder filling, and decrease voiding frequency. Electrical stimulation of the pudendal nerve is used for overactive bladder with detrusor hypertonus. Sacral neuromodulation for urge incontinence stimulates regional conduction pathways, depresses the detrusor and improves pelvic floor muscle contractility.