Method for predicting severity degree of urinary incontinence syndrome in women

FIELD: medicine, gynecology.

SUBSTANCE: the diagnostics should be fulfilled due to inoculating the urine under testing onto the surface of different media followed by selecting bacterial colonies to detect their capacity to destruct colicin V. After calculation one should detect the severity degree of the disease mentioned. The present innovation enables to diagnose both light and severe degrees of the disease in question.

EFFECT: higher accuracy of diagnostics.

3 ex

 

The invention relates to medicine and can be used in forecasting, early diagnosis and treatment of the syndrome urinary incontinence (NM) in women.

Syndrome urinary incontinence is a social and hygienic problem. Research shows that similar problems occur in women of any age group. In Russia urinary incontinence affects more than 30% of women. The condition of retention of urine is positive gradient urethral pressure: the maximum pressure in the bladder exceeds the pressure in the bladder. When urination NM and the gradient becomes negative. The process of emptying the bladder depends on the contractility of the detrusor, the influence of intra-abdominal pressure, the degree of opening of the cervix and the switching apparatus of the bladder, as well as obstructions to the flow of urine in the neck and urethra.

Distinguish between true and false NM. False NM is associated with congenital or acquired defects of the ureters, bladder or urethra. To birth defects include bladder exstrophy, as well as defects of the urethra and the mouths of the ureter. Acquired defects, leading to false NM, usually due to trauma, which disrupted the integrity of the urinary tract. True NM is not due is a violation of the integrity of the urinary tract or with the above-mentioned anomalies, and caused by the failure of the sphincter of the bladder. Identified and classified the risk factors that cause syndrome NM. These include heredity, anatomical features, childbirth, surgery, radiation, bowel dysfunction, the level of physical activity, excess body weight, obstructive lung disease, the elderly and senile age, menopause, mental status.

For the diagnosis of the disease are information survey (questionnaires, tests, diaries), physical examination (laboratory tests, including urine culture to determine microbial numbers and sensitivity to antibiotics), objective visual examination to determine the degree of cystocele, conducting cough test and samples with a straining effort, and instrumental methods of diagnosis. These methods are described in detail in the book: Gasiewski, Agility "Incontinence due to stress in women", "ELBI-SPb", St. Petersburg, 2000, and also in the manual for doctors "Stress urinary incontinence in women". Publisher H-L, Saint-Petersburg, 2003 Allowance issued by the Institute of obstetrics and gynecology. Doota RAMS, Saint-Petersburg state medical University named after academician I.P. Pavlov.

All known diagnostic techniques allow us to differentiate variants for which Alemania - functional or anatomic possible and miscellaneous diseases.

Depending on the results of diagnostics, treatment is medical or surgical.

When medication is required prolonged use of expensive drugs (oxybutynin, trospium chloride, avestin).

The most effective drug for the treatment of overactive bladder recognized by triptan (oxybutynin hydrochloride). The treatment with this drug is described in detail in al-Shukri SH "Overactive bladder: pathogenesis, diagnosis, treatment" in proceedings of the international Symposium "Modern methods of drug therapy of urological diseases", Yaroslavl, 23.05.2001,

Comparative analysis of the use of triptan and other well-known drugs are in the same collection in the article Lopatkin N.A., etc. "Pharmacotherapy of overactive bladder. Experience in the use of triptan". The use of triptan and other well-known drugs of similar action aimed at the correction of functional disorders of the lower urinary tract, i.e. to restore their contractile function.

However, the use of drugs designed for a long term (3, 4 months) and require re-treatment courses. Drugs for such treatment of the road that constantly when the treatment is a significant amount. In addition, the effectiveness of such treatment is not significant and leads eventually to the need for surgery.

Alternative surgical intervention was injection therapy - periuretralnuu the introduction of various substances, collagen, Teflon paste, homogenized autogiro (see Schadia "urinary Incontinence in women", Zh. "Medical assistance", №5 in 1999).

Studies in recent years showed that all previously known methods of treatment of NM women don't give good results and often lead to relapse. The most effective methods of treatment are surgical.

The closest source of information for the proposed solution is the above article haciyeva's Z.K.

Conducted by the author in the examination of patients with the syndrome NM allowed us to identify in the process laboratory urine of patients with new bacteria that have the ability to destroy the contractile protein of muscle tissue - actin. They are atypical in nature properties of lactobacilli, diphtheroids, micrococci and Acinetobacter baumanii. Similar bacteria were detected in 96% of cases the syndrome NM. In addition, it was found that the resulting bacteria are modified versions of drugs that are used in the treatment of various uropeltis - piela is efetov, cystitis and other Experiments have shown that, for example, furazolidone is one of the drugs nitrofuranovye series, widely used in the treatment of uropeltis, converts through L-shaped normal bacteria in microorganisms capable of enzyme actinase to destroy the contractile protein of muscle tissue - actin. The presence in the body of a woman identified bacteria, studies have shown that provokes the emergence of the syndrome NM. The treatment of a disease known methods do not resolve the specified causes of the disease, but brings only a temporary improvement in the condition and often leads to relapse.

The objective of the proposed solutions - improving the efficiency of diagnosis, prevention and treatment of syndrome urinary incontinence in women.

To solve the problem in the process of the microbiological examination of urine of a patient suffering from syndrome NM, reveal the presence actinotrocha bacteria, determine the sensitivity actinotrocha bacteria to antimicrobial agents and conducting a course of antimicrobial therapy based on identified from actinotrocha bacteria sensitivity.

The presence actinotrocha bacteria revealed by sowing 5 ml of urine on the surface of 2% nutrient agar with 5% horse serum and on the surface of blood agar and 0.1 ml of urine on the surface of 1.5% nutrient agar is 5% horse serum with lincomycin (20 μg/ml) and on the surface of 1.5% nutrient agar with 5% horse serum with furatsilina (0,005 µg/ml), subsequent selection of colonies of bacteria and determination of their ability to destroy colicin V.

Course of antimicrobial therapy is carried out with the use of ampicillin, amoxicillin combined with doxycycline or ciprofloxacin.

When handling patient complaints syndrome NM, as a rule, carried out the microbiological examination of urine of the patient - urine culture to determine microbial numbers and sensitivity to antibiotics. But have never tried out for the presence of bacteria, destroying specific by using enzyme actinase contractile protein of muscle actin. Such bacteria as applied to urology "niche" were not known. The destruction of the actin muscle tissue leads to poor functioning of the urinary sphincter apparatus and, as a consequence, incontinence of varying severity. The author was the first to isolate and describe such bacteria (see SF Fedorova "Detection of proteases that specifically cleave actin, revertants L-forms Sh.flexneri", Zh. "Bulletin of experimental biology and medicine", t, No. 7, 1990). In some cases it was found the presence of a large number of these microorganisms in the urine of the patient with the absence of any concomitant microflora.

Further the sequence revealed the following actinotrocha bacteria: Lactobacillus, showing the ability to grow on nutrient agar, micrococci - sensitive to polymyxin, diphtheroids, forming a striking white pigment, Acinetobacter baumanii, showing signs of growing into the environment and the formation of yellow-brown pigment.

The study revealed microorganisms has revealed the existence of a relationship between the number of these microorganisms and disease severity.

The author was able to detect these microorganisms in the urine of patients after pyelonephritis and cystitis. This allowed us to predict and warn of an impending threat to the development of the syndrome NM.

The process of identifying bacteria, destroying actin, simple to implement.

In the primary urine culture on media by identifying the characteristics of selected bacterial colonies, and then reveal their ability to destroy colicin V-a protein similar in structure to actin. Correlation V-kalicinski and actinase abilities are installed on the experimentally obtained actinotrocha bacteria isolated from patients with NM confirming the destruction of the actin directly on the actin - electrophoretic - detection of fragments formed at its proteolysis.

Found drugs for treatment of identified bacteria is ampicillin and amoxicillin, which previously for the treatment of syndrome NM was not used.

In contrast to the known methods of drug therapy syndrome NM proposed method differs shorter course of treatment (5-7 days) and use a cheaper drug.

In addition, the proposed method of treatment more effective and likely eliminates the possibility of relapse.

The proposed method is implemented as follows.

When handling patient complaints NM carried out the microbiological analysis of urine samples for the detection of bacteria, destroying actin. These include bacteria: Lactobacillus, micrococci, diphtheroids, and Acinetobacter baumanii. Material for research is the middle portion freely released urine. Urine in an amount not less than 5 ml is sown on the surface of 2% nutrient agar pH of 7.2 to 7.4 with 5% horse serum and on the surface of blood agar. In addition, there is a urine culture in a volume of 0.1 ml on the surface of 1.5% nutrient agar with 5% horse serum with lincomycin (20 μg/ml) and on the surface of 1.5% nutrient agar with 5% horse serum with furatsilina (0,005 µg/ml). Sowing is done in Petri dishes with bacterial loop, the conventional sectorial crops. Crops are incubated in a thermostat at a temperature of 37 degrees Celsius for 2 days, and then incubated in the light at room temperature for 3 days.

the cognitive characteristics of these microorganisms are:

1. Colony S,SR,R - shape in size from 1 to 4 mm, usually with pigment - white, yellow, yellow-brown. Possible growth with signs of growing into the environment.

2. The morphology of the cells (Gram+, Gram-): rod-shaped, ovoid, filamentosa, coccoid.

3. On blood agar frequent characteristic of these organisms is the blackening of the medium in the growth zone of the colonies.

Allocate actinotrocha diphtheroids, lactobacilli, micrococci and Acinetobacter baumanii. Bacteria are identified on the basis of generally accepted taxonomic traits. These bacteria were known previously, but not in urology "niche". In addition, it was not known that they disrupt actin. All identified actinotrocha bacteria differ slightly from the typical diphtheroids, lactobacilli, micrococci and Acinetobacter baumanii. So, micrococci are uncharacteristic of a typical gram the cocci sensitivity to polymyxin. Diphtheroids form a striking white pigment. Lactobacilli find the ability to grow on simple nutrient agar. Acinetobacter baumanii increases with the penetration into the environment and produces an intense yellow-brown pigment.

Microorganisms are excreted from the urine of patients with syndrome urinary incontinence with a high frequency (96% of those surveyed) and not stand out from the urine of women without violating the act of urination. In the urine of patients they are the large quantities (100 to 10000 in 1 ml of urine), and in the greatest quantities actinotrocha bacteria have been detected in patients with the most severe pathology, and found among them actinozoa activity is particularly highly expressed.

The ability of bacteria to destroy the actin is set on the basis of a diagnosis ability to destroy colicin V (a protein similar in structure to actin). Correlation capabilities installed on experimentally obtained actinotrocha bacteria and confirmed during random testing of bacteria isolated from women with NM by checking actinotrocha ability directly on the actin.

To determine the ability to destroy the actin tested strain sow prick in thickness nutrient agar with 5% horse serum pH 7,2-7,4 in two Petri dishes, one of which contains 1 mm EDTA (specific inhibitor of actinase). Then at a distance of 5-10 mm from the first sowing sow prick producing strains of kolicina V, seeding incubated at 37 degrees Celsius for 2 hours, treated with vapors of chloroform, after which the surface of the medium sow bacterial strain sensitive to kolicina V. The account after incubation at 37 degrees Celsius during the day by the presence of the growth indicator of the culture around microcolony of the test strain. The presence of growth on nutrient medium without EDTA and its absence is as a medium with EDTA indicates production test strain actinase.

All identified women with the syndrome NM actinotrocha bacteria sensitive to ampicillin and amoxicillin. Most of the strains were susceptible to doxycycline and some to ciprofloxacin. The sensitivity is set generally accepted disco-diffusion method. Antimicrobial therapy designed for these microorganisms held in individual patients has a positive result, as can be seen from clinical samples.

Clinical examples

Example No. 1. Patient C. (45 years) had complained of involuntary leakage of urine when coughing, sneezing, noted a slight amount of losing urine (linen was slightly damp), the symptoms consistent with the syndrome urinary incontinence mild. Onset links with the past (2002) cystitis, treatment which was applied furadonin, 1 tablet 2 times a day for 6 days.

Microbiological examination of urine found lactobacilli (atypical variant grows on simple nutrient agar)disrupting actin, in the amount of 100 to 1 ml, when the total number of microorganisms in the urine - 1000 in 1 ml. Actinozoa activity of the detected microorganisms expressed weakly.

Was held antimicrobial therapy designed for these microorganisms. A positive result was obtained, which was reflected in ice is novenia signs of incontinence.

Example No. 2. Patient b (age 50) filed a complaint for involuntary leakage of urine in any physical activity, as well as in the change of body position, this marks the loss of a significant amount of urine, commensurate with the volume of the bladder. The symptoms corresponds to the syndrome urinary incontinence severe. Any cause of the disease together can not. Notes long-term course of the disease (suffers from 1995) and increased symptoms after each exacerbation of chronic pyelonephritis, treatment of which regularly took furadonin 1 tablet 2 times a day for 7 days, nitroxoline 1 tablet 3 times a day for 7 days.

Microbiological study found Micrococcus destructive actin (diphtheroid - atypical variant is sensitive to polymyxin), the number 10000 in 1 ml of urine and Corynebacterium (diphtheroid - atypical variant - education accented white pigment) in the amount of 10000 in 1 ml of urine. Actinozoa activity in microorganisms is expressed intensely.

Was held antimicrobial therapy designed for these microorganisms. A positive result was obtained, which was reflected in the disappearance of signs of incontinence.

Example No. 3. Patient K. (38 years old) asked in February 2003 with complaints of leakage of urine when coughing, inability to hold urine in a crowded m the key bubble, the number of losing urine, was assessed as insignificant, lingerie had become slightly damp. Signs of urinary incontinence connected with transferred in November acute cystitis, about which took furadonin 1 tablet 2 times a day for 4 days and levomycetin, 1 tablet 3 times a day for 3 days. Microbiological study found Acinetobacter baumanii (atypical variant ingrowth into the environment, the formation of yellow-brown pigment)having actinase activity. The number of these bacteria was 100 in 1 ml of urine, when the total number of microorganisms in the urine 1000 in 1 ml.

After 1.5 years, the patient again complained of involuntary leakage of urine when coughing, sneezing, running, in a crowded bladder urine does not hold, is a stress that varies 4-5 times a day, changing pads are wet. The symptoms corresponds to the syndrome urinary incontinence severe. Microbiological research in the urine was identified 100000 actinotrocha microorganisms in 1 ml, with a strong actinase activity, with almost complete absence of concomitant microflora. Was held antibacterial therapy, designed for these microorganisms. A positive result from the treatment, which was reflected in significantly the reduction of the frequency and the amount lost in urine. In the control of microbiological examination of urine, conducted 10 days after antibiotic therapy, actinotrocha microorganisms were not found.

The examples show a clear involvement actinotrocha microorganisms to the development of urinary incontinence in women and allows us to offer a diagnostic procedure, the prevention of disease and new method of treatment of this pathology.

The procedure of preventing the disease is to conduct microbiological testing for the presence in the urine actinotrocha microorganisms after each case of transfer of urinary tract infections - pyelonephritis, cystitis treated with antimicrobial drugs, the determination of the sensitivity of these bacteria to antimicrobial agents and conducting appropriate antimicrobial therapy with the aim of eliminating data bacteria from the body.

A new method of therapy of the syndrome NM is as follows:

1. Conducting the same research and therapy at all from slightly to selenopyran signs NM.

2. The use of antimicrobial therapy in these States ampicillin and amoxicillin, and the optimum use of each of these drugs in combination with doxycycline or ciprofloxacin (depending on the sensitivity of the strain) drug, known on esteem on bacteria, inside the cells of the body.

The basis for this therapy are evidence of ability actinotrocha bacteria to reside not only in the intercellular substance, but inside eukaryotic cells. These observations made on experimentally obtained actinotrocha bacteria.

3. The inclusion of preoperative preparation of patients with the syndrome NM surveys on the presence in the urinary tract (middle portion Svobodnoye urine) actinotrocha bacteria to carry out a subsequent antimicrobial therapy. This measure is intended to prevent postoperative recurrence of the disease.

Criteria for evaluating the effectiveness of the proposed treatment are:

- significant improvement of the clinical condition of the patient (up to the complete disappearance of signs NM),

- no actinotrocha microorganisms in the urine, taken on the 7th day after the end of antimicrobial therapy.

Thus, the above study revealed new properties of known bacteria to develop elective environment, to find the conditions of cultivation of the bacteria and to determine the qualifying features for identication actinotrocha bacteria. This allows us to offer a new method of diagnosis, prevention and treatment of syndrome naderi the of urine.

The way to diagnose the severity of the syndrome urinary incontinence in women, including the procedure for the microbiological examination of urine of the patient, characterized in that the urine revealed the presence actinotrocha bacteria by seeding 5 ml of the analyzed urine on the surface of 2% nutrient agar with 5% horse serum and on the surface of blood agar and 0.1 ml of urine on the surface of 1.5% nutrient agar with 5% horse serum with lincomycin (20 μg/ml) and on the surface of 1.5% nutrient agar with 5% horse serum with furatsilina (0,005 µg/ml), followed by selection of colonies of bacteria and by determining their ability to destroy colicin V, and if present in quantities of from 100 to 10000 in 1 ml of urine diagnosed with mild disease, and the presence of microorganisms in the number of 10000-100000 in 1 ml diagnose severe course of the disease.



 

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