MODERN VIEW ON THE PROBLEM OF DIAGNOSIS AND TREATMENT OF THE GENITOURINARY SYNDROME

Abstract

The article highlights the current approach on the problem of genitourinary syndrome (GS) diagnosis and treatment in the perimenopausal period patients. Recent studies indicate a significant role of undifferentiated connective tissue dysplasia (UDCTD), which is manifested by a violation of the collagen and the main matrix of connective tissue structure (CT). Nowadays, there is no unified approach on the GS diagnosis and treatment in perimenopausal period women, which determined the purpose and objectives of our research.The purpose of the research: pathogenetically justify CO2 -laser application in the complex treatment of genitourinary syndrome in perimenopausal period patients.Materials and methods of research. We examined 132 women aged 45-55 years with clinical manifestations of GS, who, depending on the proposed therapy, were divided into the main group – 56 women and the comparison group – 76 women. In addition to the General clinical examination patients of the both groups were examined for the contents of CT markers of synthesis (Total P1 NP, P3 NP, Total) and resorption (deoxypiridinolin Pyriliks – D). In order to determine the severity of GS symptoms and to identify sexual dysfunction index we used PFDI-20 and FSFI questionnaires. Women of the main group received therapy that involved the application of 4 sessions of CO2 - laser at an interval of 30-45 days in combination with local application of estradiol-based cream for 7 months. Women of the comparison group received only therapy involving local application of estradiol-based cream for 7 months.The results of the study and their discussion. The average age of patients in the examined groups was 47,3±2,4 years. For women with GS manifestations, the average value of the type I collagen synthesis marker was decreased by 58,5% (the main group) and by 65,2% (the comparison group) from the physiological norm. At the same time, the average value of the marker of III type collagen synthesis in women of the study groups was increased by 52,2% (the main group) and by 36,0% (the comparison group) from the physiological norm. The average value of the connective tissue resorption marker Pyriliks-D in women of the main and the comparison groups, did not differ significantly. According to the PFDI-20 questionnaire, there was a significant decrease in the median score from 55 to 18 in women of the main group during 8 months of treatment. According to FSFI questionnaire, a significant increase in the index of sexual function in women of the main group (the median score before treatment was 25, after treatment – 46; p<0,05) was noticed. Determination of the average Total P1 NP marker concentration in the dynamics of treatment after 4 months demonstrated a significant increase by 72,8% in women who received CO2 -laser therapy in combination with local estradiol treatment. The average Total P3 NP marker concentration in women who received CO2 -laser therapy in combination with local treatment significantly decreased compared to the base value by 62,4%. Against the background of CO2 -laser therapy in combination with local estradiol treatment in women of the main group and the comparison group, there was no significant difference in the indicators of the connective tissue resorption marker Pyriliks-D.Conclusions. The inclusion of CO2 -laser therapy to the complex treatment of genitourinary syndrome can significantly reduce the manifestations of genitourinary disorders, which is confirmed by a significant decrease in the median score from 55 to 18 in women of the main group according to the results of PFDI-20 questionnaire (p<0,05). The positive therapeutic result of the CO2 -laser, from our point of view, occurs due to the effect on the etiopathogenetic mechanisms of the syndrome complex – an age-related imbalance of markers of synthesis and resorption of connective tissue. An increase in the concentration of I type collagen synthesis marker contributed to a synergistic decrease in the concentration of III type Total P3 NP marker in women of the main group and stabilization of its value in the dynamics of treatment. From our point of view, a study of the hormonal status of women with genitourinary syndrome to improve the tactics of etiotropic treatment and prevention of relapse, offers the greatest promise.