OBJECTIVE To study diagnostic capabilities of somatosensory evoked potentials (SSEP) in clarifying the mechanisms of formation of urinary disorders. MATERIAL AND METHODS The authors studied the characteristics of nerve impulses during stimulation of the pudendal and tibial nerves in patients with neurogenic urinary retention and cerebral ischemic stroke in the parietal lobes (4 patients), spinal ischemic stroke (10 patients), myelitis at the level of thoracic segments (7 patients), spinal cord cauda equina tumors (3 patients). RESULTS AND CONCLUSION The study of SSEPs made it possible to determine the localization and nature of damage to the structures of the central nervous system and to establish the neurogenic cause of urinary disorders.

Nerve-sparing radical prostatectomy remains the optimal curative treatment of prostate cancer in patients who want to maintain erectile function. Since its development, there has been a gradual decline in its effectiveness concerning the prevention of ED, which was associated with the currently more objective assessment of erectile function at both the pre- and post-operative stage. There is a knowledge gap in the precise understanding of which specific neural structures should be preserved with the nerve-sparing technique. At the same time, there have been proposed effective methods for visualizing the elements of the preserved vascular-neural bundle and estimating the degree of nerve-sparing.

We described the clinical features of urination apraxia as oneof post-stroke cortical neurogenic disturbances of bladderfunction. Neurological and urological symptoms and the dataof urodynamic and neurophysiological studies in a patient withurination apraxia resulting from the right-hemispheric lesionin the projection of cingulate gyrus are demonstrated. Thedifferential diagnosis was carried out with the case of motordetrusor atony after stroke in the right temporal lobe and theinsula, and with the case of imperative urination after stroke inthe left frontal lobe in the projection of cingulate gyrus.

The paper describes the main pathogenetic mechanisms of forming persistent neurogenic voiding and sexual function in patients with acute and chronic cerebrovascular disease. Neuroanatomy and neurophysiology described urination and sexual function in normal and vascular disease of the brain. Possibilities different centers urination brain to reorganize functions by associative or contralateral areas of innervation. The role of lower urinary tract symptoms and sexual disorders in the diagnosis level and nature of damage to the central nervous system. Revealed the most important clinical and pathogenetic correlation between urinary and reproductive disorders, the most common in acute and chronic ischemia centers urination and sexual function. The possible common ways of pharmacological correction of functional disorders.

Abstract. The paper discusses the main etiological, phenomenological and pathogenetic mechanisms of forming the syndrome of overactive bladder (OAB) in patients with acute and chronic cerebrovascular diseases. Describes the role of melatonin, arginine vasopressin (AVP) and corticotropin-releasing factor hormone (CRFH) in maintaining the rhythms of urination, urine formation and retention of urine in norm and abnormalities in these systems in acute and chronic vascular pathology of the brain. Described phenomenology OAB syndrome in vascular diseases of the brain. Shows a differentiated approach to pharmacological correction in patients with different clinical variants of urinary disorders and urine formation in the framework of the OAB syndrome with the use of neurotransmitter therapy and hormonesensitive.

The results of the present study provide materials for the characteristic and the comparative analysis of the methods for electrical stimulation applied for the treatment of neurogenic disorders of urination and illustrate the up-to-date requirements to this therapy taking into consideration the neuroanatomical and neurophysiological features of micturition. One of the most advanced non-pharmacological methods is electrical stimulation and neuromodulation of the urinary bladder function and pelvic floor muscles. The objective of this three-step research was to elucidate the mechanisms of action of electrical stimulation and to compare the effects of tibial and pudendal neuromodulation in 22 patients presenting with ischemic lesions in the brain. The first step included the comprehensive clinical and neuroimaging investigations designed to determine the role of functional asymmetry of cortical and subcortical micturition regulatory centers during the recovery process following the ischemic lesions. At the second stage, afferent and central regulation of micturition was investigated by the method of tibial and pudendal somatosensory evoked potentials in the patients presenting with overactive bladder and acute or chronic cerebral ischemia. At the final step, the optimal parameters of neuromodulation were chosen depending on the form of the urination disorder. It is concluded that the study gave evidence of the high therapeutic effectiveness of tibial and pudendal neuromodulation for the treatment of overactive bladder associated with neurological disorders (including ischemic lesions in the brain).

The literature data on the urgent neurological problem - overactive bladder (OAB) are summarized. The OAB prevalence, current conceptions on the physiology and pathophysiology of urination and pathogenetic mechanisms of OAB development are presented. Main groups of pharmacological agents used in OAB treatment are described. Special attention is drawn to rationale of using anticholinergic (antimuscarinic) drugs. The authors present the results of their own comparative analysis on the efficacy and tolerability of these drugs in treatment of patients with cerebral vascular diseases including the use of solifenacin succinate (VESIcare).

В статье обобщены данные литературы по актуальной для неврологии проблеме — синдрому гиперактивного мочевого пузыря (ГАМП). Приведены данные о распространенности синдрома, современные представления о физиологии и патофизиологии мочеиспускания и патогенетических механизмах формирования ГАМП. Охарактеризованы применяемые для лечения синдрома ГАМП фармакологические группы препаратов. Особое внимание уделено рациональности применения антихолинергических (антимускариновые) лекарственных средств, в том числе представлены результаты собственного сравнительного анализа их эффективности и переносимости у пациентов, страдающих сосудистыми заболеваниями головного мозга, включая опыт использования солифенацина сукцината (везикар). Ключевые слова: гиперактивный мочевой пузырь, сосудистые заболевания головного мозга, антихолинергические лекарственные средствасолифенацина сукцинат. The literature data on the urgent neurological problem — overactive bladder (OAB) are summarized. The OAB prevalence, current conceptions on the physiology and pathophysiology of urination and pathogenetic mechanisms of OAB development are presented. Main groups of pharmacological agents used in OAB treatment are described. Special attention is drawn to rationale of using anticholinergic (antimuscarinic) drugs. The authors present the results of their own comparative analysis on the efficacy and tolerability of these drugs in treatment of patients with cerebral vascular diseases including the use of solifenacin succinate

Published data concerning drugs currently used for the treatment of overactive bladder (OAB) syndrome were reviewed. Modern notions about the physiology and pathophysiology of micturition were considered and data on the pharmacological properties, tolerance, and therapeutic efficiency of anticholinergic drugs (antimuscarinic agents), the first-line drugs for treating OAB, were presented. Data on drugs with a different mechanism of action that are currently used to treat OAB were reviewed. Information on the principal directions of new drug development, in particular, β3-adrenoreceptor agonists, compounds affecting KCNQ/Kv7-channels, vitamin D receptors, etc., was summarized.

The diagnosis of neurogenic and psychogenic dysurias is the most difficult and controversial problem of modern urology, the solution of which requires a differentiated approach based on the comparison of neurological, psychic, and urologic symptoms. The basis for their diagnostic search is the method of substitution of found symptoms in the schemes of known urologic, neurological diseases and psychopathological states in the direction from the general to the particular, i.e. by the method of deductive reasoning. The results of diagnostic tests and pharmacological analysis only clarify the details of final diagnosis. When one patient has an organic lower urinary tract lesion concurrent with neurogenic dysuria is the most difficult diagnostic case. The diagnosis of such conditions necessitates the performance of ultrasound, neurophysiological, neuroimaging, and urodynamic studies. The neurogenic disorders are characterized by a concomitance of neurological and urologic symptoms that generally occur at the same time, by a change in urodynamic parameters, and by a positive effect of specific therapy encompassing anticholinergic, sympatholytic, and other neurotropic agents. Psychogenic dysurias are not attended by neurological deficit and the instrumentally signs of organic urinary tract lesion, but is always accompanied by the psychopathological symptoms of anxiety or depression. Moreover, there is a positive effect of psychotropic drugs (anxiolytics or antidepressants) and indifference to the use of neurourologic agents.

Disorders of urination, along with motor and cognitive disorders, are characteristic of different forms of chronic cerebral vascular diseases (CCVD). Irritation symptoms are more frequent in subcortical arteriosclerotic encephalopathy (SAE) and multi infarct hypertonic encephalopathy (MIHE). Overactive urine bladder syndrome (OUBS) caused by neurogenic detrusive hyperactivity manifests itself in frequent urination, nocturia and imperative enuresis and thus decreases quality of life and results in disability of patents with CCVD. At the same time, the character of symptoms points indirectly to the localization of lacunar infarction or the extent of severity of leukoareosis. It is the most frequent form of disorders of urination in the first years of disease that significantly aggravates its course and needs timed diagnosis and pharmacological treatment. Competitive antagonists of muscarinic receptors M2, M3 subtypes are the most effective drugs for treatment of OUBS comorbid to CCVD.

Published data concerning drugs currently used for the treatment of overactive bladder (OAB) syndrome are reviewed. Modern notions about the physiology and pathophysiology of micturition are considered and data on the pharmacological properties, tolerance, and therapeutic efficiency of anticholinergic drugs (antimuscarinic agents) are presented. These drugs are still the first-line of OAB treatment, although they often poorly control the disease and induce a number of side effects. Progress in the knowledge of physiology and pathophysiology of micturition is a basis for the development of new promising treatments for the management of OAB symptoms, including β 3 -adrenoceptor agonists, agonists of vitamin D receptor, drugs influencing KCNQ/Kv7 channels, and some other.

Overactive bladder (OAB) is observed in such brain diseases as stroke, hypoxic ischemic encephalopathy, Parkinson's disease (PD), multiple sclerosis (MS). Trospium chloride (spasmex) was used in OAB patients with MS (n = 87), stroke (n = 83), encephalopathy (n = 47) and PD (n = 36) in doses from 15 to 45 mg/day in 2 to 36 month courses. The response with minimal side effects was achieved in 94% patients. In addition to basic effects, trospium chloride relieved spastic constipation in patients with stroke, hypersalivation in PD and anal incontinence in MS.