Assessment of quality of life after hysterectomy with uterine myoma

Hysterectomy, performed in reproductive age, undoubtedly causes a decrease in all parameters of quality of life and contributes to the development of imbalance of hormonal homeostasis, psycho-emotional, vegetative-neurotic symptoms, increasing sexual and urogenital dysfunction, impeding psycho-social adaptation in the family,the professional and intellectual spheres of a woman’s life. This aspect is often overlooked by surgeons when evaluating the effectiveness of treatment, although it has a significant impact on recovery from surgery. The article presents data on experimental psychological research, evaluation of the severity of urogenital dysfunction using a standardized POP-Q system, characteristics of quality of life parameters both at the stage of preoperative observation and within 1, 3 and 5 years after surgery in 80 women of reproductive age with uterine fibroids who have undergone vaginal hysterectomy. The comparison group included 60 patients with hysterectomy performed by abdominal access. According to the results of this study, in women of reproductive age after radical surgery for fibroids, it was determined that the leading violations of quality of life after hysterectomy are general somatic symptoms, psycho-emotional disorders, genitourinary and sexual disorders. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, among which the most important are urinary incontinence and prolapse, the clinical manifestations of which have a negative impact on, including the psychosocial sphere, while reducing quality of life. Today there is no consensus on the degree of impact of radical surgery for uterine fibroids on the versatility of metabolic and hormonal homeostasis, the formation of psychovegetative symptom complex, and as a consequence, the impact on quality of life, which necessitates a validated method of quality of life optimization of the rehabilitation program with personalized consideration of the leading factors of status comorbidity when planning surgical treatment. Keywords: uterine fibroids, hysterectomy, quality of life parameters.

Palliative care in non-malignant neurological disease

This chapter covers the palliative care aspects of non-malignant neurological diseases, including multiple sclerosis, Parkinson’s disease, motor neurone disease, multiple system atrophy, progressive supranuclear palsy, and Creutzfeldt–Jakob disease. MS is a disease characterized by inflammation and demyelination affecting the central nervous system and ultimately injury and gliosis. Parkinson’s disease (PD) is the commonest neurodegenerative disease after Alzheimer’s disease, with an estimated incidence of 2/1000. It affects just under 1% of people over the age of 65 years. PD is probably not one disease but several with common clinical features. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by Parkinsonian features, plus autonomic dysfunction in the form of orthostatic hypotension, and/or urogenital dysfunction in the form of incontinence and incomplete bladder emptying. At times it can also include cerebellar symptoms. It is not hereditary, and affects adults usually in the fourth or fifth decade. Post-mortem studies of patients diagnosed with PD indicate that 10–25% had multiple system atrophy.

Spread of pathological α-synuclein from urogenital nerves initiates multiple system atrophy-like symptoms

Multiple system atrophy (MSA) is a fatal adult-onset movement disorder with autonomic failures, especially urogenital dysfunction. The neuropathological feature of MSA is the accumulation of misfolded α-synuclein (α-Syn) in the nervous system. Here, we show that misfolded α-Syn exist in nerve terminals in detrusor (DET) and external urethral sphincter (EUS) of patients with MSA. Moreover, α-Syn preformed fibrils inoculated into the EUS or DET in TgM83+/− mice initiated the transmission of misfolded α-Syn from the lower urinary tract to brain, and these mice developed α-Syn inclusion pathology through micturition reflex pathways along with urinary dysfunction and motor impairments. These findings indicate that spreading of misfolded α-Syn from the autonomic control of the lower urinary tract to the brain via micturition reflex pathways induces autonomic failure and motor impairments. These results provide important new insights into the pathogenesis of MSA as well as highlight potential targets for early detection and therapeutics.

Urogenital dysfunction in patients with multiple sclerosis

The occurrence of urogenital dysfunction as an isolated early symptom in multiple sclerosis (MS) is rare, but the prevalence thereof becomes high with progression of disease. Lower urinary tract dysfunction may add to the cause of death (particularly through urinary infections), but both urinary and sexual dysfunction significantly affect quality of life of patients.Both storage and evacuation of urine may be affected by MS, and ultimatively the functional diagnosis can only be made by urodynamic testing. As upper urinary tract affection is, however, rare (and can be prevented by timely ultrasound imaging), a first stage diagnostics in the MS center by the neurologist and specialized nurse is appropriate. History, urine tests and post void residual urine determination (preferably by ultrasound) should provide necessary data for treatment of infections, and also symptomatic management of frequency, urgency and incontinence by bladder training, anticholinergics, and intermittent self catheterization (as indicated); the referral to urologist may be reserved for patients who fail first line treatment. Treatment in the late stages of MS is as yet little researched, but eventually a suprapubic catheter is the preferred method of bladder emptying. Sexual dysfunction should be actively sought in MS patients (in men erectile and ejaculation dysfunction, in women deficient lubrication and genital hyper- or hyposensitivity are frequent). Clinical examination contributes little to clarification of neurogenic sexual dysfunction, but defines the extent of other deficits due to MS, which may be relevant for sexual counseling (spasticity, sensory loss). Sildenafil has been demonstrated to be effective in treatment of men, but not in women. Other management options exist, and the doctor and nurse in the MS center should be proactive in providing first line counseling and management.