Chabanov P. Diagnosis and treatment of patients with neurogenic disorders of urination with combined pathology of the distal colon.

The thesis is devoted to the study and the scientific substantiation of the treatment of patients with combined neurogenic pathology of the lower parts of the urinary system and distal colon parts on the basis of detrusor and distal colon tone and the development of the detrusor and distal colon electrostimulation with the help of the corresponding frequency - amplitude characteristics. The study was based on the results of a complex examination and treatment of 252 patients with combined neurogenic pathology of the lower parts of the urinary system and distal colon parts, which formed 4 groups: 1) with a reduced tone of all the neuromuscular structures, 57 patients (22.6%), 2) with an increased tone of the neuromuscular structures of the hyperkinetic type - 70 patients (27.8%), 3) with a relatively increased tone of the neuromuscular structures of the hypokinetic type - 68 patients (27.0%), 4) mixed - 57 patients (22.6%).The results of the treatment were assessed by symptom changes by assessing the complaints typical of the lower urinary dysfunction of the RVS scores (own view of the bladder condition) recommended by ICS, a questionnaire of subjective assessment of the severity of symptoms of lower gastrointestinal dysfunction Colorectal-Anal Distress Inventory 8 CRADI-8), diary of urination, dynamics of objective parameters of uroflowmetry (volume and time of urination, maximum (Qmax), average speed of urination (Qave), time to reach maximum speed of urination (TQmax)), electromyography (estimations of average values of total bioelectric activity of the detrusor, the distal colon and their internal and external sphincters, indicators bulbocavernous latent period of the reflex). Evaluation of these parameters was carried out before the treatment and after the 1st, 3rd and after the 6th courses.On the basis of the study of the state of the lower urinary tract using urodynamic and electromyographic methods of investigation, in the patients with combined neurogenic pathology of the lower parts of the urinary system and the distal parts of the colon, two states of detrusor and distal colon tones - with reduced tone and with increased tone - were determined. Depending on this, different methods of electrostimulation treatment were prescribed. Electrostimulation was prescribed in the absence of contraindications.It has been proved that the effectiveness of treatment of patients with combined neurogenic pathology of the lower parts of the urinary system and distal parts of the colon depends on determining the tone of detrusor and distal colon and methods of treatment. A positive effect was noted in 87.1% of cases.