[Imperative and obstructive urination disorders in patients with chronic inflammatory diseases of the urinary tract]

The estimation of functional parameters of the lower urinary tract in 116 patients with chronic cystitis and 51 patients with chronic nonobstructive pyelonephritis was performed. Urethral instability was revealed in 53 (45.68%) patients with chronic cystitis (mean age, 40.72 +/- 14.45 years), detrusor overactivity--in 10 (8.62%, mean age, 45.55 +/- 13.45 years) patients. Variations in detrusor pressure were 22.16 +/- 15.8 cm H20. Combination of urethral instability and detrusor overactivity was diagnosed in 26 (22.4%) patients of the study group (mean age, 65.16 +/- 10.49 years). The maximum urethral pressure was 75.5 +/- 21.44 cm H2O, variations in urethral pressure--37.45 +/- 17.44 cm H2O. Reduction in the maximum urinary flow rate less than 15 ml/s was detected in 47 (40.5%) patients. Signs ofdetrusor-sphincter dyssynergia were observed in 29 (25%) patients. After processing the urodynamic studies of patients with non-obstructive pyelonephritis, 20 (39.21%) patients with severe detrusor hypotension, 18 (35.29%)--with detrusor overactivity, 26 (50.98%)--with urethral instability were identified. Based on the results of the study, it was concluded that women's chronic inflammation in the bladder and kidneys may not be the cause but the consequence of functional disorders of the lower urinary tract infections associated with the disorders of the nervous regulation of these organs. Inflammation in the bladder wall against the background of dysfunction of the lower urinary tract, in turn, can support a dysfunction of the bladder and/or urethra. Drugs affecting the function of the sympathetic and parasympathetic elements of the autonomic nervous system can be used for the elimination of functional disorders of the lower urinary tract and improvement the functioning of these organs. Thus, the pathogenetic treatment of chronic cystitis should be based on the disruption of "vicious circle" dysfunction--inflammation. In view of these data, and due to the frequent detection of imperative and functional obstructive urination disorders, in addition, based on the neurophysiological concept of their occurrence, the use of alpha-adrenoblockers and M-anticholinergics agents is important in the treatment strategy with regard to patients with chronic recurrent cystitis and non-obstructive pyelonephritis.