Andryeyev S. Morphofunctional basement of surgical treatment of recurrent postcoital disuria in women.

The thesis is devoted to the issue of Clinical Urology - improving the quality of life of women with recurrent sex induced dysuria by pathogenic study of conservative and surgical treatment ways for preventing the urethral reflux and ascending infection of the urinary tract. The thesis proves that the pathogenetic basis of recurrent postcoital disuria (RD) in women of reproductive age is nonspecific reflux-urethritis caused by pathological vaginal secretions that have low acidity and saprophytic bacterial component and are injected into the urethra during the coitus, which is stimulated by individual anatomical features of the vestibule of the vagina, reliable and pathognomonic of which is vaginal ectopia and excessive mobility of the distal urethra in presence of UGL. A pathogenetic model of the disease had been proposed. To diagnose the anatomic predisposition to the postcoital dysuria in women the method of measurement for the amount of the urethra, clitoral interval had been developed and tested. This method has a balanced sensitivity, specificity and predictive value comparing to the traditional criteria based on visual assessment of the location of the external opening and test of the urethra mobility. The principles and algorithm of preventive care for women with RD were provided. These principles are based on measures for prevention of the urethral reflux, including the consistent application of behavioral prevention, and in case of its' inefficiency - surgical correction, which provides recovery or significant clinical improvement in 70,4% (32,0+38,4%) and 100,0% (84,4+15,6%) respectively (p<0,001).