This article is devoted to the treatment of urodynamic disorders in women with the genitourinary syndrome by using a fractional CO2-laser. Nowdays, the development of genitourinary syndrome is an urgent problem among women of different ages. Genitourinary disorders are a complex of symptoms associated with the development of atrophic and dystrophic processes in the estrogenic tissues (the urethra, lower third of the uterus, pelvic floor ligaments and muscles). The objective: to determine the pathogenetic effectiveness of CO2 laser in the treatment of urodynamic disorders in premenopausal women with genitourinary syndrome.Materials and methods. The study covered 130 female patients with symptoms of the genitourinary syndrome. The patients were divided into two groups depending on their treatment. The main group consisted of 56 women using CO2 laser therapy. The comparison group consisted of 74 women who were treated with local application of hormone. To assess the efficacy of treatment and the functional status of the lower urinary tract, a comprehensive pre-treatment and post-treatment urodynamic examination were performed.Results. The average age of the patients in the examined groups was 47.2±2.5 years. After the treatment, the urodynamic examination showed an increase of the maximal intraurethral pressure from 16.8±17.9 to 26.7±21.2 mm Hg in the main group (p<0.01). The urethral closure pressure increased from 15.3±13.2 to 26.8±18.5 mm Hg (p<0.01). These changes were found upon examination of the functional length of the urethra, which increased from 2.0±0.3 to 3.0±0.4 cm, and thus reached normative values for healthy women. At the same time, the pre-treatment and post-treatment indicators did not statistically differ in comparison group.Conclusions. The results of the study show that the MonaLisaTouch method of laser fractional ablation of vaginal and vulva epithelium is highly effective compared with local hormonal therapy and can be recommended as a monotherapy for urogenital disorders and pelvic floor dysfunction.
INTRODUСTION Unfavorable ecology, demographic situation in Ukraine, somatic and oncologic diseases frequency increase, immunity and living standard decrease have predetermined the increase of number of women with endometrial hyperproliferative processes who stand for 5-20% obstetric-gynecologic profile, according to the statistical data [2, 6, 14, 16, 19]. Nowadays regardless of the scientific achievements, diagnostics, surgery and curative methods improvement, the problem of intrauterine pathology treatment still remains topical in the medical and social aspects which is determined by the high risks of neoplastic transformation and steady tendency towards the recurrence frequency increase (proportional transformation into atypia), which according to the homeland and foreign authors stands for 26 to 78% among women [1, 3, 15, 17-19, 22]. High recurrence frequency serves the ground for the repeated surgical operations [10, 12, 18, 21, 23], and sometimes they are not limited with traditional approaches possibilities, that is increases the topicality study of the main aspects of disease. Relevance of the problem is determined by the probability of the endometrial hyperplastic processes transformation into the endometrial cancer. Numerous researches prove the probability of the oncological processes development with the background of endometrial polyposis from 4% up to 67.2% of patients [13, 24, 25]. The endometrium polyposis treatment methods are standard ones and foresee the polyp's ablation followed by the hormonal therapy, nevertheless the recurrence value remains rather high standing for 25.9% to 78% [4, 5, 11]. The disease's etiopathogenesis complexity, different trends in its stages' interpretation, tactical approaches ambiguity (with and without considering the hormonal disorder individual specific features) constitute definite difficulties while choosing the pathogenetically treatment. These are the circumstances to determine the increased scientific and practical interest in the endometrial polyposis treatment and management [7, 8, 9, 22]. The topicality of our research has been determined by the controversial point of view on the uterus polyps pathogenesis, high recurrence frequency after hormonal therapy, immune system dysfunction and inflammation role in the endometrial polyposis genesis. The purpose of research: to increase the treatment effectiveness of patients with endometrium local hyperplasia (endometrium polyposis) by applying of the new endoscopic technologies and pathogenetically substantiated post-surgery therapy. MATERIALS AND METHODS 66 women aged 24-43 years participated in the research. The treatment algorithm consisted of four stages in accordance with Order of the Ministry of Health or Ukraine No. 676 dated by 31.12.2004. Stage І-hysteroscopic mutated endometrial and polyp ablation followed by the morphological research and the following determination of tactics depending on the pathology type along with the complex anti-inflammatory, anti-bacterial and anti-viral treatment. Stage II-horm...
Research objective: to improve the effectiveness of diagnosis and prognosis of complications in women of reproductive age with atypical squamous cells of undetermined significance/cervical intraepithelial neoplasia (ASCUS/CIN) of the cervix in Trichomonas and papillomavirus infection by studying the main biochemical and immunological parameters of vaginal contents. Materials and methods. 200 women of reproductive age with ASCUS/CIN of the cervix were examined against the background of papillomavirus infection associated with trichomoniasis, who were divided into three main groups according to the results of the PAP-test. Group I consisted of 50 patients with ASCUS, II – 118 women with LSiL, III – 32 patients with HSiL. The control group included 50 healthy non-pregnant women. The analysis of biochemical parameters of vaginal contents was carried out, which included determining the concentration of total protein, urea, studying mineral and lipid metabolism, glucose, enzyme activity, as well as factors of non-specific resistance – secretory immunoglobulin A and hydrogen peroxide.Results. There was a 2.6-fold increase in the amount of discharge from the genital tract and their pathological nature in patients with urogenital trichomoniasis and ASCUS/CIN against the background of papillomavirus infection, an increase in acidity by 1.2 times, the indicator of the amine test by 13 times, protein concentration by 2.3 times, compared with similar indicators in healthy women. Analysis of mineral metabolism in this contingent of patients revealed a decrease in the concentration of copper ions by 1.7 times, iron by 1.9 times, and calcium by 1.6 times. Evaluation of the enzyme activity revealed an increase in the level of alkaline phosphatase by 3.7 times, creatine phosphokinase by 10.6 times, AST by 6.5 times, ALT by 9.1 times, lactate dehydrogenase by 5.4 times, and α-amylase by 3.3 times compared to women in the control group. A decrease in the average value of sІgA content in patients with ASCUS/CIN on the background of HPV and Trichomonas invasion was found than in healthy women by 1.7, 1.9 and 2 times, respectively, in the I, II and III main groups, which can serve as a predictor of the development of post-trichomonas vaginal dysbiosis.Conclusions. Analysis of the results of studies of vaginal contents in women with ASCUS/CIN against the background of human papillomavirus and Trichomonas invasion revealed significant changes in biochemical parameters and factors of non-specific resistance, determining the corresponding pathological changes in the functional activity of the vaginal epithelium and the composition of the vaginal biotope.
Cholestatic hepatosis of pregnant women complicates approximately 0.2% to 2% of pregnancies and may increase the risk of pregnancy and fetal pathology. The article provides information on diagnosis, treatment methods and possible risks to pregnant women and the fetus associated with cholestatic hepatosis of pregnancy. The diagnosis of cholestatic hepatosis of pregnant women is usually based on clinical (itching) and laboratory (elevated bile acid levels) signs. Other markers that reflect liver function, such as alanine aminotransferase and aspartate aminotransferase, are also often elevated, and this requires a differential diagnosis with other pathological conditions leading to liver dysfunction. Cholestatic hepatosis of pregnant women causes an increased risk of premature birth, fetal distress, respiratory distress syndrome of the newborn and stillbirth. There is evidence that with increasing levels of bile acids increases the risk of adverse effects for newborns. Ursodeoxycholic acid therapy reduces maternal symptoms, but this therapy has not been shown to reduce risks to the fetus. Women diagnosed with cholestatic hepatosis in pregnant women have a high risk of recurrence during subsequent pregnancies and hepatobiliary disease later in life. Keywords: cholestatic hepatosis of pregnant women, intrahepatic cholestasis of pregnant women, obstetric cholestasis.
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