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5
International Journal of Medical Sciences And Clinical Research
(ISSN
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(2021:
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1121105677
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Servi
ABSTRACT
This article presents the results of scientific work on the effectiveness of complex treatment methods for
premenopausal women with urinary incontinence at the Department of Obstetrics and Gynecology No. 1 of
Samarkand State Medical University. The study was conducted on women who applied to the gynecology department
during 2019-2020. According to the method of treatment, women were divided into 2 groups: the main group was
prescribed complex treatment, and the comparison group was prescribed only medical treatment. As a result, the
effectiveness of the complex treatment method was determined.
KEYWORDS
Urinary incontinence (UI), stress urinary incontinence, overactive bladder syndrome (OABS), premenopausal age,
biofeedback (BFB) therapy, BTL premium 4000 G, treatment with physiotherapy methods, detrusor botulinum
therapy.
INTRODUCTION
Research Article
PHYSIOTHERAPEUTIC
TREATMENT
METHODS
AND
URINARY
INCONTINENCE
Submission Date:
February 07, 2023,
Accepted Date:
February 12, 2023,
Published Date:
February 17, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue02-02
Tilavova Sitora Amirzoda
Assistant Of The Department Of Obstetrics And Gynecology №1 Samarkand State Medical University
,
Uzbekistan
Khudoyarova Dildora Rakhimovna
DC
S, Head of the Department of Obstetrics and Gynecology №1 Samarkand State Medical University
,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 02-2023
6
International Journal of Medical Sciences And Clinical Research
(ISSN
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Publisher:
Oscar Publishing Services
Servi
The lack of information on the pathogenesis of the
occurrence of UI in premenopausal women leaves its
mark on the choice of conservative and surgical
treatment tactics, the lack of a single algorithm for the
treatment and diagnosis of such patients, the
procedure for conducting these patients could be
carefully determined, and the lack of a clear pattern of
both conservative and surgical treatment is the main
reason for ineffective surgical corrections in the
treatment of UI.
In recent years, the problem of urogenital diseases has
taken a leading place in the symptomatology of
menopausal diseases, which is associated with their
clear negative impact on the quality of life of
postmenopausal women. The frequency of age-related
urogenital diseases reaches 30%. In the premenopausal
period, urogenital diseases occur in 10% of women, and
up to 50% in the group of women aged 55-60. By the
age of 75, 2/3 of women experience urogenital
discomfort, and after the age of 75 it is difficult to meet
a woman who has not experienced individual
symptoms of urogenital diseases.
Studies conducted by foreign authors show that the
prevalence of ST in elderly women in the USA is 37%,
and in continental Europe - 26%, in Great Britain - 29%
and in Japan - 27% [7, 11, 14, 17].
Urodynamic research is currently the only objective
method of qualitative assessment of urinary disorders.
Urodynamic examination of patients with mixed
urinary incontinence reveals signs of urinary
incontinence in stressful situations combined with
overactivity of the detrusor. But it is known that the
clinical diagnosis is not always confirmed by
urodynamic tests [7]. In the studies of foreign authors
[13, 14], when 950 patients with urinary incontinence
were examined, the prevalence of clinical symptoms of
the disease was 51%, while the diagnosis was made
during urodynamic examination in only 12% of cases.
A complex and unsolved problem of urinary
incontinence in women is the management of urinary
incontinence (UI). Many methods of correcting stress
urinary incontinence are described in the available
literature [3, 7, 8, 11, 18, 22]. Modern methods of
treating urinary incontinence are divided into
conservative and surgical treatment. Surgical
treatment is more commonly used for stress urinary
incontinence and is aimed at strengthening the
musculoskeletal system of the pelvis or restoring the
function of the internal urethral sphincter. However,
any surgical intervention carries a certain degree of risk
due to the occurrence of a number of serious
complications, and is often considered a mandatory
measure rather than an optimal choice.
Therefore, it is important to treat urinary incontinence
using modern methods and prescribe these methods
to premenopausal women and analyze the results.
The purpose of the study is complex treatment of
urinary
incontinence
using
physiotherapeutic
treatment methods.
Materials and research methods. The study was based
on the clinical and laboratory examination of 128
women with urinary disorders in the premenopausal
period who were under observation and admitted for
treatment to the gynecology department of the 1st
multidisciplinary clinic of the Samarkand State Medical
University in 2019-2020. . The comparison group
included 45 (35.2%) women treated with traditional
methods of diagnosis and treatment, and the main
group included 83 (64.8%) patients treated with
complex therapy.
Volume 03 Issue 02-2023
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The age of the examined women was between 45 and
56 years. The average age of women in the comparison
group was 50.5±1.6 years, and in the main group it was
51.0±2.2 years.
During the study, in addition to general clinical and
laboratory analyses, special tests were conducted,
while the hormonal background indicators and the
amount of relaxin-2 were determined. A standard
electromyograph from the "Kolibri BeFit PRO"
complex was used for BFB-training. The course of
treatment included 10-15 procedures based on the
patient's indications. Among the physiotherapeutic
methods, vaginal and rectal electroimpulse therapy
was performed once a day for 20 minutes using the
BTL-4000 G PREMIUM (Russia) device.
Research results. We used 3 types of tests to evaluate
and diagnose UI:
The Valsalva test was positive in 23 (51.1%) women in
the comparison group and 58 (69.8%) in the main
group;
the cough test was positive in 22 (48.9%) women in the
comparison group and 65 (78.3%) in the main group;
Diaper test was positive in 22 (48.9%) and 49 (59.03%)
groups, respectively.
These tests were negative in women of the control
group. One of the modern methods of examination of
the study was to determine the amount of Relaxin-2 in
the blood. In the control group (almost healthy women
of premenopausal age), this indicator was on average
1.3±0.1 IU/ml. The average amount of relaxin-2 in
women of the main group was 0.35±0.02 IU/ml, and in
women of the comparison group it was 0.38±0.04
IU/ml.
In premenopausal women, the level of estradiol was
reduced by 44.0% in patients in the comparison group
and by 57.9% in patients in the main group.
Progesterone levels were reduced by 17.5 times in
patients in the main group, and by 20.3 times in
patients in the comparison group (Table -1).
Table 1
Tested women's steroid hormone levels
Groups
estradiol,
nmol/l
AMH
ng/ml
Progeste
rone
nmol/l
Relaxin
ME/ml
LH
ME/ml
FSH
mME/ml
Control
(n=25)
48,0±0,1
1,5±0,1
35,1±0,1
1,3±0,1
6,2±0,1
3,2±01
Main (n=83)
27,7±2,0
***
0,3±0,02
***
2,01±0,0
2***
0,35±0,0
2***
22,0±0,0
2***
23,0±0,02*
**
Volume 03 Issue 02-2023
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Comparison
(n=45)
26,9±0,3
***
0,20±0,0
02***
1,73±0,0
2***
0,38±0,0
4***
20,4±0,2
***
20,0±0,2*
**
Note: * - there is a significant difference compared to the data of the control group (* - P<0,05, ** - P<0,01, *** -
P<0,001)
Drug therapy was prescribed according to the type of urinary incontinence. All women were classified according to
stress, overactive bladder and mixed type of UI (diagram 1).
Diagram 1. Separation of main and comparison group patients according to UI type
For the treatment of urinary incontinence in
hyperactive bladder syndrome, we used drugs of the
M-cholinoblockers group. In the treatment of detrusor
hyperactivity, two types of M-cholinoblockers,
differing in chemical structure, are used - tertiary and
quaternary amines (oxybutynin, trospium chloride),
which are the first-line drugs for hyperactive bladder
syndrome and UI. Oxybutynin was prescribed in a dose
of 2.5 to 5 mg 3-4 times a day (maximum dose 20
mg/day).
The drug duloxetine from the group of M-
cholinoblockers increases muscle tone in the free state
and increases the force of contraction of the urethral
sphincter. But there are side effects from the
gastrointestinal tract and central nervous system, so
Hyperactive
bladder syndrome
Stressful UI
Mixed UI
Main group
20
31
32
Comparison group
12
15
18
0
5
10
15
20
25
30
35
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patients often refuse to take it, although this is noted
within 1 week after taking it. In our observations, the
effect of this tool is expressed by the early recovery of
urinary retention in the types of stress and mixed
urinary incontinence.
If therapy with M-cholinoblockers was ineffective, then
the dose was increased or replaced with an alternative
drug - beta3-adrenoceptor agonist (Mirabegron) or
their combination (beta3-adrenoceptor agonist + M-
cholinoblockers) was used. To stop UI events,
mirabegron, an agonist of beta3-adrenoceptors, was
prescribed in HABS as the main method of treatment in
women with UI, as well as in case of ineffectiveness of
M-cholinoblockers
and
uncontrolled
arterial
hypertension.
Beta-3-adrenomimetics (beta (b)-adrenostimulators,
beta (b)-agonists) - biological or synthetic substances
that lead to the stimulation of β
-adrenoreceptors have
a significant effect on the main functions of the div
and binding to β
-receptors as a result, it leads to the
separation of β1
-
and β2
-adrenomimetics.
In total, 32 women with UI in HABS (12 comparison
group and 20 main group) were prescribed beta-3-
adrenomimetics with M-cholinoblockers in the first
period of treatment. As a result, only 4 (12.5%; 3.12%) of
32 women had a therapeutic effect and a positive result
was obtained.
For the treatment of overactive bladder syndrome
urinary incontinence, we used a new method of
treatment - detrusor botulinum therapy - in the main
group of 20 women diagnosed with UI in the HABS. In
this case, injection treatment with botulinum toxin
type A, according to registered indications, is indicated
in women with urinary incontinence and urge
incontinence, if medical treatment is ineffective or
serious side effects occur caused secretions (the most
serious side effect was an increase in residual urine
volume, which increased the risk of urinary tract
infection), was administered by intradetrusor injection
at a dose of 100 ME. The effectiveness of this method
was shown in 10 women (50%, 12.05%) when the survey
was conducted after 1 month, there was no UI
symptoms at all and the tests were negative. Positive
dynamics were observed in the remaining 10, but
complete remission was not achieved.
Women with the stressful form of UI were prescribed
antidepressants as a conservative treatment and the
result was evaluated after 1 month. 15 women (33.3%)
in the comparison group, and 31 (37.3%) women in the
main group had UI of this form. At the same time as
conservative treatment, BFB training and BTL-4000
PREMIUM G preium also used physiotherapeutic
treatment methods for the women of the main group.
The efficacy of this treatment was positive in only 1
woman in the comparison group (6.67%; 2.22%),
compared to 18 women in the main group (58.1%;
21.7%). At this stage, we can see that the effectiveness
of complex treatment is several times higher than that
of conventional treatment.
For mixed and stressful forms of UI, the main group of
patients underwent rehabilitation in the form of
special BTL-4000 PREMIUM G courses to strengthen
pelvic floor muscle tone to achieve stable
compensation or stable remission of UI.
Compared to comparison group women (6.67%) who
did not receive BFB-therapy, 25 (28.9%) patients with
mixed-type UI in the main group led to treatment
(P<0.01).
Hormonal therapy was prescribed to 39 women
(86.7%) in the comparison group and to 28 women
(33.7%) in the main group. After using this therapy,
complete remission of symptoms of UI was not
Volume 03 Issue 02-2023
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observed in anyone in the comparison group, but the
use of hormonal therapy against the background of
conservative therapy of UI led to a reduction of
symptoms and improvement of the general condition
in 64.4% (29). It led to remission of UI symptoms in 12%
(10) of women in the main group, and positive
dynamics in the remaining 18 (21.6%).
Analysis of the dynamics of the results of examinations
of women with urinary incontinence before and after
treatment using non-invasive special tests showed that
after complex treatment 58 (69.9%) patients did not
have spontaneous urine discharge during the tests, 20
(24, 1%) patients did not fully recover, but positive
results were noted in terms of general disease
symptoms. In 6 (13.3%) patients in the comparison
group, spontaneous urinary excretion was not
observed at all, and in the remaining 29 (64.4%)
patients, the number of excretions decreased, but
complete recovery was not observed, and in 10 (22.2%)
patients, the total change was not before or after
treatment.
СONCLUSION
To achieve stable compensation or stable remission of
UI, we use the BTL-4000 PREMIUM G physiotherapy
device and BFB-training to strengthen the pelvic
muscles, and in the main group, this effect is 78.3%
complete remission and In 21.7% of cases, it was
reflected in the improvement of the general condition
and positive dynamics of UI. The use of detrusor
botulinum therapy, which we considered a new
method of treatment for urinary incontinence in HABS,
led to complete remission in 10 out of 20 patients.
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