The relevance of this study is due to the high prevalence of stress urinary incontinence in women of different age groups and the search for effective conservative treatment methods. The aim of this study was to present scientific data based on modern evidence on the effectiveness of conservative treatment methods and their safety in the treatment of stress urinary incontinence in women. A review of the literature (original articles, systematic reviews) on the use of conservative therapy for the treatment of stress urinary incontinence in women was carried out. Depending on the severity of stress urinary incontinence in women, their age and concomitant diseases, the options for the proposed treatment may vary. For the conservative treatment of the disease, along with lifestyle modification and the use of hygiene products, it is possible to use training and electromyostimulation of the pelvic floor muscles, innovative laser technologies, and drug therapy. The first line therapy is to train ones pelvic floor muscles. The best effect of the training is observed in younger patients with mild to moderate severity of the disease using stationary biofeedback simulators under the supervision of medical staff. An alternative to this type of treatment is to conduct training of the pelvic floor muscles in the biofeedback mode with portable simulators remotely under the supervision of specially trained personnel. In connection with the coronavirus pandemic, this therapy is gaining wide popularity, as every patient should be offered acceptable and effective treatment options.
BACKGROUND:The study is relevant due to the widespread prevalence of stress urinary incontinence in women and the search for minimally invasive and safe treatment methods. AIM:The aim of this study was to present data based on modern evidence-based information on the effectiveness of urethral bulking agents and their safety in stress urinary incontinence treatment in women. MATERIALS AND METHODS:A review of the literature (original articles, systematic reviews) on the use of urethral bulking agents for stress urinary incontinence treatment in women was carried out. RESULTS:Urethral bulking agents for stress urinary incontinence treatment are effective due to the creation of additional bulk in the paraurethral area without fibrosis or because of inflammation followed by fibrous tissue formation. The efficacy and complications depend on the properties of the used urethral bulking agents. Since the performed studies are heterogeneous and the methods for evaluating the use of bulking fillers in stress urinary incontinence treatment vary, it is difficult to comparatively characterize urethral bulking agents to determine the most effective one. The search is being conducted for an ideal proper filler, which should be biocompatible and non-immunogenic and maintain a long-term therapeutic effect. CONCLUSIONS:Urethral bulking injections are an alternative therapy for women with stress urinary incontinence who are informed about its short-term effect and are expecting to avoid the risk of possible complications after surgery. Promising is to be regarded as the use of new urethral bulking agents based on hyaluronic acid with an optimal choice of concentration, degree of crosslinking and type of crosslinking agent to ensure maximum duration of action and minimum side effects.
BACKGROUND: Stress urinary incontinence in women is a common condition that can develop at a young age and, even with mild severity, disrupts the quality of life. The first line of treatment for stress urinary incontinence is pelvic floor muscle training, which is the most effective in biofeedback mode. The low effectiveness of self-study is often associated with irregular and incorrect exercise. AIM: The aim of this study was to evaluate the effectiveness of remote pelvic floor muscle training using the Tyulpan laser vaginal simulator under medical supervision in the treatment of mild and moderate stress urinary incontinence in women of reproductive and perimenopausal age, and to develop a predictive model for evaluating the effectiveness of treatment by this method. MATERIALS AND METHODS: We examined 48 patients aged 41.3 6.8 years (2655) with complaints of mild to moderate stress urinary incontinence. After general clinical and special studies (analysis of seven-day urination diaries, Kings questionnaire and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire (PISQ-12), urethrovesical segment ultrasound examination), a remote course of treatment was started using the Tyulpan laser vaginal simulator under medical supervision via videoconference for 35 patients within three months. The participants were re-examined one, three and four to six months after the start of the pelvic floor muscle training course. RESULTS: The training course was fully completed by 25 participants. After one month of remote pelvic floor muscle training, according to urination diaries, a decrease in the number of stress urinary incontinence episodes was noted by 64.0% of patients and the absence of stress urinary incontinence episodes by 28.0% of patients (p 0.001); after three months of remote pelvic floor muscle training, by 32.0% and 68.0% of patients, respectively (p 0.001). A negative cough test after one month was detected in 62.5% of the participants (p = 0.002) and, after four to six months with the continuation of independent pelvic floor muscle training, in 81.9% of patients (p = 0.003). According to the ROC-analysis, the absence of stress urinary incontinence episodes was predicted when the amplitude of the simulator laser beam was greater than or equal to 90 cm (sensitivity 84.0%, specificity 96.0%; p 0.001). Distance learning under medical supervision had a positive impact on the quality of life and relationships with a partner and improved the womens psychological well-being (p 0.001). CONCLUSIONS: Remote pelvic floor muscle training is effective in women of reproductive and perimenopausal age with mild to moderate stress urinary incontinence who are able to contract their pelvic floor muscles and perform regular exercises. The effectiveness of the training course is 68.0% according to urination diaries and 81.9% according to the cough test. The absence of stress urinary incontinence episodes is predicted when the amplitude of the simulator laser beam is greater than or equal to 90 cm.
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