Vol 20, No 6 (2018)

Objective - to evaluate the structural features of the external and internal genital organs in girls with aplasia of the vagina and uterus. Materials and methods. The study included 64 adolescent girls aged 15-18. The examination included a general and gynecological with an assessment of the structural features of the perineum, external genital organs and urethra, including using a specially designed measurement scheme for anatomical landmarks. An ultrasound study was performed with the aiming assessment of uterine horns and, when identifying signs of functioning, laparoscopic removal of them with histological study. In order to optimally assess the type of tissue lining the vaginal fossa zone, an analysis was carried out of the material obtained by scraping from the studied zone using liquid cytology. Results. Every third patient (34.3%) was diagnosed with urinary system pathology. In most patients, the external opening of the urethra was typical. Almost everyone had hymen (95%). Gynecological examination showed that in the vast majority of patients in the area of intended vaginal entry, was a blindly ending vaginal fossa (95.3%). The length of the fossa was on the average 1.7±0.1 cm. According to the smear scrapings from the vaginal fossa, flat cells of the superficial, intermediate, and parabasal and basal types were present. Representatives of the lactobacillus and coccal microflora were revealed. A topographic-anatomical analysis of the orientations of the perineum in girls with aplasia of the vagina showed that the depth of the vaginal fossa weakly depended from the age of the patients and did not depend on any of the suggested guide points. According to the results of instrumental methods of investigation of the pelvic organs, 68.75% of the girls had a muscular cord at the uterus place. Moreover, 22% of girls had signs of the functioning of rudimentary horns. Ovaries, as a rule, were located high, at the entrance to the small pelvis. Laparoscopy was performed in all patients with cyclic pain syndrome and closed functioning uterine rudiments, removal of the uterine horns with fallopian tubes were prefered. Histological examination of the obtained preparations was characterized by the detection of endometrial stroma and active endometrial glands. Summary. The authors emphasize that a multilateral examination of this cohort of patients is extremely important for the diagnosis and optimized treatment.

The purpose of the review - presentation of clinical scientific data based on current evidence of information on the management of patients with stress urinary incontinence, the effectiveness and safety of periurethral injections of various bulking substances. Material and methods. А review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, in particular the injection method. Results. The review presents data of the etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, depending on the severity of the pathology. Analyzed the data of periurethral injection of various bulking materials, their effectiveness and safety.

The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods.

Currently, the urgency of the problem of chronic endometritis is of medical and social importance, since it leads to impaired reproductive function. Among the risk factors there is a predominance of intrauterine devices and inflammatory complications after childbirth and abortion. Prolonged persistence of infectious agents in the endometrium in chronic endometritis leads to marked changes in the structure and function of the tissue, causes proliferative disorders, as well as disorders in cyclic transformation. Morphofunctional damage to the endometrium is not only the cause of infertility, unsuccessful attempts of in vitro fertilization (IVF) and embryo transfer (PE), miscarriage, and a decrease in the quality of life of women due to chronic pain, dyspareunia, uterine bleeding and discharge from the genital tract. Timely and accurate diagnosis is key to the success of the restoration of reproductive function. Treatment of chronic endometritis is a complex, phased process. One of the new methods is photodynamic therapy, which leads to the development of a photochemical reaction that destroys bacterial and tumor cells, and also has an antiviral effect.

Material and methods. The study included patients (n=164) in peri- and postmenopause, having a laboratory-confirmed picture of the genitourinary menopausal syndrome - atrophic vulvovaginitis and suffering from recurrent lower urinary tract infections (UTI) - cystitis and urethritis. All patients underwent standard antibacterial therapy (ABT) UTI in accordance with the results of bacteriological urine culture according to Russian clinical guidelines on urology. Against the background of ABT, 164 patients received additional therapy with Trioginal® (the study group - SG) containing estriol, micronized progesterone and Lactobacillus casei rhamnosus Doderleini 35 (LCR 35) lactobacillus strain. Trioginal® was administered intravaginally in two stages: for 20 days, 2 capsules per day, then for 10 days, 1 capsule per day. In the comparison group - CG (n=67) with ABT, Ovipol Klio® (estriol monopreparation) was additionally intravaginally used in two stages: for 14 days, 1 suppository per day, then for 2 weeks, 1 suppository 2 times a week. The control group consisted of 30 patients receiving only standard ABT UTI, local hormone therapy for vulvovaginal atrophy (VVA) was not performed. The observation period was 12 months after the end of the course of therapy. At all stages of treatment, a subjective and objective assessment of the severity of urination disorders and urogenital atrophy (UDI-6 questionnaire), their impact on the quality of life of patients (questionnaire IIQ-7), indicators of bacteriuria, bacterial urine culture and vaginal biocenosis, frequency of undesirable phenomena were carried out. According to the initial characteristics of the group of patients were comparable. Results. At all stages of the study, in the group of patients who received therapy with the use of the Trioginal® drug, there was a significant improvement in the clinical picture of urination disorders compared to the CG and the control (main) group - MG (in SG - 18% at the end of therapy versus 100% before the start of therapy; CG - 26 % versus 100% respectively; Ledger - 58% versus 100% respectively; p<0.05); quality of life indicators - IIQ-7 score (SG - 67±6.8 at the end of therapy versus 96±8.1 before the start of therapy; TOS - 68±5,6 against 93±7.2, respectively; MG - 66±4, 3 against 41±4.4, respectively; p<0.05); symptoms of BBA (IG - 39% at the end of therapy versus 100% before starting therapy; HS - 62% versus 71%, respectively; HA - 96% versus 100%, respectively; p<0.05); indices of vaginal biocenosis (in SG, normocenosis was observed in 69% after termination of therapy versus 56% before its beginning; HS - 51% versus 57%, respectively; HA - 56% versus 61%, respectively; p<0.05). The most significant criterion was a significant reduction in the growth of pathogenic flora (in SG - 4% at the end of therapy versus 100% before the start of therapy; HS - 12% versus 100%, respectively; MG - 26% versus 100%, respectively; p<0.05). At the time of inclusion in the study, in all three groups, 100% of the patients with urinary tract infections - UTI (cystitis, urethritis) had a recurring nature - at least 3 episodes of relapses in the last year. During the period of treatment and observation (12 months), no episodes of recurrence of UTI were observed in MG in 100% of patients; in the CG, 47% of patients had a recurrence of UTI during the observation period; in GK, recurrence of UTI was noted in 62% of patients. Conclusions. Thus, the use of the drug Trioginal® in the complex therapy of recurrent cystitis and urethritis in women with peritoneal and postmenopausal VVA improves the outcomes of treatment with UTI and improves the symptoms of VVA, reduces the frequency of relapses and can be recommended for use in complex therapy of recurrent lower UTI (cystitis and urethritis ) in women with symptoms of genitourinary menopausal syndrome in peri- and postmenopausal periods.

Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.