The dissertation is devoted to solving the urgent problem of clinical urology - improving the quality of diagnosis and treatment of patients with idiopathic overactive bladder by assessing the role of autonomic regulation of the function of the lower urinary tract and pathogenetic substantiation of the modern concept of strategy and treatment tactics.
A large-scale sociological study was carried out aimed at identifying the prevalence of overactive bladder (OAB) among the population of the southern region of Ukraine. Among 1100 male and 4582 female respondents, OAB was found in women (19.8%) and in men (14.3%). The severity in the clinical course of pathology in women was observed at the age of 60-69 years (32.4%), in men aged 70 and older (38.9%). The study showed the ambiguity of the influence of the main risk factors in the occurrence of idiopathic overactive bladder (IOAB) in the examined patients. The predictability of risk factors for assessing the ratio of the chances of the occurrence of IOAB for men was established: overweight (OR-2,000), enuresis in childhood (OR-3.157), dysfunction of the digestive system (OR-3.365), history of pelvic surgery (OR-2.527), systematic alcohol use (OR - 1.330) for women: vaginal delivery (OR - 2.195), menopause (OR - 3.320), history of urinary infection (OR - 4.008), emotional overload (OR - 6.843) and history of pelvic surgery (OR - 2.062). The variability of the absolute concentrations, proportions and correlation interactions of essential microelements has been studied. An imbalance of iodine (in 100% of patients), manganese (in 100%), selenium (in 90% of patients), copper (in 80%), zinc (in 60%), calcium (in 40% of patients with hypo- and in 60 % of patients - hyperelementosis). It was found that urgent urination during IOAB was triggered by the following urodynamic symptoms or their combination: a decrease in the maximum cystometric capacity - 171 (86.80%), a decrease in the sensitivity threshold (hypersensitivity) - 139 (70.55%), detrusor overactivity - 71 (36, 04%). Vegetative dystonia was diagnosed in 93.88% of patients with IOAB. Vegetative failure occurs with impaired sweating (66.47%), thermoregulation (34.71%), a tendency to face reddening (57.94%), dysfunction of the cardiovascular (47.98%) and respiratory (50.85%) systems, and also in 69.92% psycho-vegetative syndrome and vegetative-vascular crises were revealed. Monotherapy with a competitive antagonist of m-cholinergic receptors in patients with IOAB without detrusor overactivity is implemented by reducing the frequency of urination by 37.55%, the frequency of urinary incontinence by 52.14% and the intensity of urgency by 14.8%. The symptoms of urgent urination are partially weakened in 22.58% of patients and fully only in 9.67%, which confirms the feasibility of developing a concept before effective urological rehabilitation. Comprehensive treatment of IOAB is provided by a personalized approach to the choice of pathogenetically targeted drugs that affect the intensity of urgent urination (mertazapine and gabantin) with a positive effect in 84.12% of patients and an effect on pain syndrome (sertraline hydrochloride and gabantin) with a decrease in pain intensity by 62, 20 %. The introduced method of treating IOAB with a competitive antagonist of M-cholinergic receptors (tolterodine tartrate) in combination with a cyclic structural analogue of GABA (gabapentin) reduces the frequency of pollakiuria by 64.06%, nocturia by 82.09%, episodes of urgency by 81.06% and urinary incontinence by 80.05%, providing a good score of 40.29% and a satisfactory score of 35.82%. The method of biofeedback in combination with EMG - trigger electrical stimulation of the pelvic floor muscles of functional disorders of the NSS in IOAB helps to restore control of the micturition process, makes it possible to form an optimally physiological type of maximal muscle contraction and regulation of conscious control over the act of urination by restoring the function of the pelvic sphincters by 50% 69.23% of patients. The volume of filling of the bladder with a physiological urge to urinate increased by 43.18%, with a pronounced urge by 48.03%, the maximum cystometric capacity of the bladder increased by 31.68%. The developed method for correcting urodynamic disorders associated with IOAB, which provides for the course use of combined therapy with an antidepressant and an anticonvulsant for 6-12 months, allows to achieve remission of 80.85% - 78.72% with IOAB without detrusor hyperactivity; in 69.76% - 67.44% with IOAB with urinary incontinence in 59.45% - 56.52% with IOAB with pain syndrome, versus 31.57% - 26.31% in the comparison group and reduce the likelihood of progression of atrophic changes detrusor.
