Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Emergency drainage of the upper urinary tract for obstructive uropathy and/or acute pyelonephritis in pregnant women is a vital operation. Objective-to compare complications due to internal and external drainages of the upper urinary tract in pregnant women with obstructive uropathy in order to choose the most optimal method. Subject and methods. Among 48 treated pregnant women (28 patients with obstructive uropathy and 20 with acute pyelonephritis), 41 patients underwent follow-up, examination, and treatment and were divided into 2 groups. Group 1 included 21 pregnant women with obstructive uropathy at 12-32 weeks' gestation, in whom double-J upper urinary tract stenting was chosen as a drainage procedure; group 2 consisted of 20 pregnant women with clinical signs of acute pyelonephritis at 22-23 weeks' gestation who had percutaneous needle nephrostomy. All emergency surgical interventions were performed within 24 hours of admission and antibiotic therapy. Results. It was established that Group 1 undergoing upper urinary tract stenting showed the largest number of complications (stent dislocation and encrustation, vesicoureteral reflux, and reflux pyelonephritis), which required the highest number of therapeutic measures. In Group 2, the complications were associated with drainage dysfunction (salt-induced obstruction, spontaneous drainage discharge) and were observed much less frequently. Contraindications to ureteral stenting and indications for contact ureterolithotripsy, minimally invasive surgery, were developed. Percutaneous needle nephrostomy is a universal method of upper urinary tract drainage, which can be used at any gestation period and for any reason of obstruction. Conclusion. The high rates of drainage-associated complications necessitate a differentiated approach to choosing a drainage method for obstructive uropathy or acute pyelonephritis in pregnant women and to preventing catheter-associated complications in previously performed stenting.

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Обязательным условием лечения больных, в том чис-ле беременных женщин, с обструктивным пиелонефри-том и мочекаменной болезнью (МКБ) является восста-новление оттока мочи из почки [1][2][3][4][5]. Цистоскопия с ка-тетеризацией мочеточника позволяет ликвидировать об-струкцию, но после удаления мочеточникового катетера через несколько дней обструкция мочеточника может по-вториться, поэтому рассматривать катетеризацию моче-точника обычным катетером или наружным катетером-стентом в качестве самостоятельного операционного по-собия нельзя. Другим вариантом дренирования почки в этой ситуации является установка внутреннего мочеточ-никового катетера-стента (ОUble-J) [6][7][8] Внутреннее дренирование верхних мочевых путей катетером-стентом у беременных с мочекаменной болезнью при острой обструкции мочеточника является общепринятой операцией. Между тем вопросам профилактики осложнений при установке катетера-стента в практике урологов и акушеров не уделяется должного внимания, не прослеживается согласо-ванность действий между врачами смежных специальностей. Подробно представлены два клинических примера развития и лечения подобных осложнений как с урологической, так и с акушерской стороны, намечены мероприятия по совер-шенствованию мультидисциплинарного подхода в ведении таких беременных, профилактики осложнений стентирования.Авторы информируют об отсутствии конфликта интересов. External upper urinary tract drainage using a stent is a universally accepted procedure for urolithiasis in pregnant women with acute ureteral obstruction. At the same time urologists and obstetricians give no due regard to the prevention of complications in their practice when placing the stent; there is no consistency of acts between the physicians of related professions. The paper details two clinical examples of the development and treatment of these complications in both urological and obstetrical standpoints and defines measures to improve a multidisciplinary approach to managing such pregnant women, as well as the prevention of stenting complications.The authors declare no conflicts of interest.

Частота инфекции мочевыводящих путей (ИМП) значительно повышается у беременных с хронической болезнью почек (ХБП), при которой выявление истинной бактериурии соответствует, по нашим данным, 38,2% [1]. Наиболее часто рост микроорганизмов выявляется у бере-менных с вторичным хроническим пиелонефритом на фоне МКБ и врожденных аномалий мочевой системы, где этот показатель соответствует 70,2% и почти в 2 раза пре-вышает таковой при хроническом гломерулонефрите -45%.Согласно Дренирование верхних мочевых путей у беременных при острой обструкции мочеточника является неотложной опера-цией. Описаны способы дренирования мочевыводящих путей и преимущества каждого из них. Особое внимание уделено наиболее часто применяемому способу дренирования -установке в верхних мочевыводящих путях катетера-стента. Описаны как акушерские, так и урологические осложнения стентирования, а также способы профилактики этих ослож-нений. В тактике ведения беременных с обструктивными уропатиями необходимо применение мультидисциплинарного подхода, включающего консультации и наблюдение целой команды специалистов: врачей функциональной диагностики, акушеров, анестезиологов, урологов, неонатологов, который и определяет в конечном счете благоприятный акушерский исход.Авторы информируют об отсутствии конфликта интересов. Upper urinary tract drainage is an emergency operation in pregnant women with acute ureteral obstruction. The paper describes urinary tract drainage procedures and the advantages of each of them. Particular emphasis is placed on the most common drainage procedure -stent placement in the upper urinary tract. Both urological and obstetrical stenting complications and procedures for their prevention are described. The management tactics for pregnant women with obstructive uropathies necessitate the multidisciplinary approach encompassing the consultations and follow-ups of an entire team of specialists, such as functional diagnosticians, obstetricians, anesthesiologists, urologists, and neonatologists, which finally determines a favorable obstetrical outcome.The authors declare no conflicts of interest.

In recent years, the frequency of operations for genital prolapse and urinary incontinence has been steadily increasing. Neurogenic disorders of urination can be the first manifestations of the disease of extragenital pathology. Neurogenic bladder is bladder dysfunction (lethargy or spasticity) caused by neurogenic damage. Any disease in which the afferent or efferent innervation of the bladder is damaged can lead to a neurogenic bladder.Purpose. To study the features of urinary disorders in women with severe extragenital diseases and to improve the methods of rehabilitation of patients after reconstructive plastic surgery for various types of urinary incontinence.Materials and methods. 153 patients aged 50-70 years (mean age 55.1 ± 6.3 years) and duration of postmenopause from 2 to 5 years (7.6 ± 4.1 years) were examined at the outpatient department of the of Moscow Regional Research Institute of Obstetrics and Gynecology, Russian Federation, who applied for various manifestations of urination disorders. All patients were offered the method of biofeedback in combination with electrical stimulation of the pelvic floor muscles as a treatment. When overactive detrusor therapy was detected, therapy was combined with medicamentous (solifenacin 5 mg [Vesicar] or myrobegron 50 mg [Betmiga] in the morning) in combination with estriol (cream or suppositories) 0.5 mg intravaginally 2 times a week. In the presence of symptoms of climacteric syndrome in the absence of contraindications, menopausal hormonal therapy was prescribed.Results. Subjectively, 150 (98.1 %) patients noted an improvement in their condition, 3 (1.9 %) patients did not notice the effect of treatment. The results showed a significant improvement in all OABSS and bladder diary scores, including frequency of urination during the day and at night, urgency and number of urge incontinence episodes, and urine volume. Analysis of the -hour pad test showed that the volume of urine lost, which averaged 16.5 g before treatment, was negative after treatment in patients who noted the effect. In 2 patients who did not notice the effect, no changes were found. Investigation of the intraurethral pressure profile in 23 (17.6 %) women before treatment revealed insufficiency of the internal sphincter of the urethra, leading to urinary incontinence during stress. After treatment, in 19 (82.6 %) patients, the insufficiency of the internal sphincter was not determined. In 3 (13.0 %) patients, intraurethral pressure remained in the range of 60 to 80 cm of water column and did not lead to urinary incontinence during stress. In 1 (4.3 %) patient, the insufficiency of the urethral closure persisted, which required repeated surgery.Conclusions. In patients with severe extragenital diseases against the background of vulvovaginal atrophy, an overactive bladder and a mixed form of urinary incontinence prevail. Extragenital pathology of various origins, especially concerning various parts of the central nervous system, obesity and diabetes significantly worsens the course of urination disorders in both conservative and surgical and combined treatment and requires additional treatment methods: pelvic floor muscle training, biofeedback therapy in combination with electrical stimulation of the pelvic floor muscles, local hormonal therapy, the use of M-anticholinergics, B-adrenomimetics.

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