Influence of therapy by а-adrenoblockers and anti-ischemic complex on the involvement of detrusor hypertrophy and its dysfunctions after elimination of infravesical obstruction
The aim of the study is to determine the significance of severe detrusor hypertrophy, induced infravesical obstruction (IVO), in the formation of its dysfunction in the course of experimental and clinical studies, and the possibility of reverse development of morphological and functional changes after the elimination of IVO with the use of drug therapy. Research material and methods. 30 chronic experiments were performed on female rats, in which IVO was induced by applying a narrowing ligature to the urethra for a period of 1 month, followed by removal of the ligature and investigation of the severity of detrusor hypertrophy and bladder function after 1 month. In the 1st series, no therapy was performed. In the 2nd series, after the elimination of IVO, the animals received doxazosin at a dose of 40 mg / kg / day, and in the 3rd series they received a complex of anti-ischemic drugs (a-tocopherol acetate 10 mg / kg, meksidol 5 mg/kg, pentoxifylline 4 mg/kg and diltiazem 2 mg / kg per day). The clinical study analyzed the medical history of 76 patients operated on for BPH, who according to ultrasound revealed severe detrusor hypertrophy (wall thickness >5 mm, bladder mass index >100 ed.). 24 patients did not receive specific therapy after surgery, 26 received tamsulosin, and 26 patients received treatment with a complex of anti-ischemic drugs. Results. The creation of IVO in rats with the development of severe detrusor hypertrophy was accompanied by the formation of its hyperactivity. After IVO was eliminated, detrusor hypertrophy and hyperactivity persisted in 60% of the animals. Doxazosin therapy did not significantly reduce the severity of detrusor hypertrophy, but it normalized the function of the bladder in all animals. During treatment with anti-ischemic drugs, detrusor hypertrophy decreased to a greater extent, when the bladder function was normalized. In a clinical study it was shown, that drug therapy (as tamsulosin and antiischaemic drugs), in the early postoperative period, accelerated reverse development of hypertrophy of the detrusor and improve functional results of operations: in patients not treated with therapy, complete normalization of urination (QoL=0-1) has been reached at 45.8% with poor functional outcomes (QoL=4) at 16.7% of cases, whereas drug therapy, these figures amounted to 69,2-73,0% and 7.7%, respectively. Conclusion. Severe detrusor hypertrophy is a factor that negatively affects the restoration of bladder function after IVO elimination, and therapy with a-blockers or anti-ischemic drugs contributes to a more complete restoration of urination function.