MORPHOFUNCTIONAL FEATURES OF OVERACTIVE BLADDER IN THE SETTINGS OF RAPID BODY GROWTH

Abstract

Overactive bladder is a pathological condition characterized by a combination of alarming symptoms of different etiology: frequent urination, urgency, sometimes urinary incontinence, painful bladder, which are not caused by infections of the genitourinary system. This condition is still the subject of collisions between morphologists and urologists in the whole world. Some scientists consider overactive bladder to be a variant from the norm in adolescence. Overactive bladder in Ukraine is diagnosed in 1 of 10 patients who sought medical attention with the symptoms mentioned above. The lack of a single point of view regarding this condition induces further research. Therefore, the aim of the study was to analyze the level of diagnosis of overactive bladder among males aged 12-18 in Lviv region for the last five years and to study the morphofunctional features of this condition in patients of the specified age group and sex. Birth defects were found to be the most common ones on the basis of the analysis of statistical data of urinary tract diseases for the period of 2012-2016 among the male population aged 12-18 in Lviv region (according to the Lviv Regional Medical Informational and Analytical Center); overactive bladder was relatively rare. Overactive bladder occurs almost three times more often than other illnesses in King County (Washington, USA), which is similar by area and population. Since the disease has no specific geographical or obvious genetic background, the following information may indicate only one thing: low level of diagnosis of overactive bladder is observed even in those regions of Ukraine, where the level of medical services is quite high (particularly in Lviv region). With a detailed study of case history of six patients selected by gender and age, treated for overactive bladder/ neurogenic overactive bladder, their height was found to increase for more than 9-25 cm over the past 6 months. There was a frequent urination (more than 20 times a day) and urgency in 100% of cases, nocturia - in the majority (83.3%), a symptom of painful bladder - in 2/3 of cases. Retention and pollakiuria were observed in half of the group. One patient did not have nocturia, but there was frequent urination before bed. Ultrasonography results showed that thickening of the bladder walls and their reduced elasticity was observed in almost all patients under study. Weak bladder filling also took place. One patient had a urologic spur diagnosed by ultrasonography, the removal of which led to a disruption of continuity of the bladder muscles, resulting in the development of overactive bladder after surgery. According to the cystometry data, increased detrusor pressure by 1.2-1.8 times occurred in 4 patients; one patient had this parameter within normal values and another - somewhat reduced. Decreased peak flow rate was observed in 4 patients and excessive residual urine volume occurred in 3 people. The course of the disease was complicated by erythroplasia of Queyrat in two patients. Thus, the results of the conducted statistical analysis indicate a low rate of overactive bladder diagnosed by domestic urologists in males aged 12-18 (10%), which can lead to incorrect treatment and further complications. Ultrasonography results showed that all patients had weak bladder filling, thickening of its walls, and decrease of their elasticity. There were sudden changes in cystometry in all patients. Increased detrusor pressure, decreased peak flow rate, and excessive residual urine volume occured most often. The nature of the overactive bladder is most often caused by the inadequate development of it in adolescents who rapidly gain in their height. It may also be post-operative or neurogenic.

Keywords

• overactive bladder
• ultrasonography
• cystometry