Puchko M. Features of stress urinary incontinence management in women of late reproductive and premenopausal age

This thesis is devoted to the evaluation of the effectiveness and pathogenetic substantiation of laser technologies application in the therapy of stress urinary incontinence in women of late reproductive and premenopausal age. The problem of stress urinary incontinence is very relevant in modern gynecological practice. Therapeutic approaches to the correction of this condition, regulated by modern guidelines, demonstrate insufficient effectiveness. At the same time, in Ukraine, the number of women suffering from stress urinary incontinence continues to grow steadily, and this problem has moved from a purely medical one to a medical-social one. In the modern clinical practice of treating stress urinary incontinence, laser technologies are increasingly used, which are more effective, well accepted by patients and have a longer effect after treatment. The purpose of this work is to improve the quality of life of women of late reproductive and premenopausal age with stress urinary incontinence through pathogenetically justified laser therapy application. Objectives of the research: 1. To conduct a clinical and statistical analysis of medical records of patients aged 45 to 55 years with stress urinary incontinence. 2. To determine the features of connective tissue, exchange of trace elements and vitamins in women aged 45 to 55 years with stress urinary incontinence. 3. To determine the state of hormonal and metabolic homeostasis in women aged 45 to 55 years with stress urinary incontinence. 4. To determine the characteristics of the quality of life in women aged 45 to 55 years with stress urinary incontinence. 5. To investigate the state of the urinary system and mycobiocenosis of the genital tract in women aged 45 to 55 years with stress urinary incontinence. 6. To develop, pathogenetically substantiate and evaluate the effectiveness of a complex of diagnostic and therapeutic and preventive measures in women aged 45 to 55 years with stress urinary incontinence by using laser therapy. 7. To assess changes in stress urinary incontinence symptoms, quality of life features, and impact on sexual function and recurrence rates following conservative, laser, and combined therapy at baseline, 4, and 8 months after initiation of treatment. At the first stage, 189 women were involved in the study, who underwent a full clinical and statistical examination, during which attention was paid to the peculiarities of the body constitution, the state of somatic and gynecological health, with the identification of conditions that are phenotypic signs of undifferentiated connective tissue dysplasia , parity, and also a complication during childbirth. At the second stage, a complex clinical and laboratory study was carried out, which included determination of: the state of fibrous connective tissue, concentrations of the main microelements and vitamins, assessment of: hormonal and metabolic balance, life quality, vaginal biocenosis, urinary function, ultrasound: of the kidneys and of the bladder with determination of the volume of residual urine, and for women with existing residual urine – uroflowmetry and cystometry of filling.