medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-4-121-126medsovet-6099Research ArticleУРОЛОГИЯUROLOGYГиперактивный мочевой пузырь: концепция заболевания и подходы к лечениюHyperactive bladder: concept of disease and paradigms in the treatmenthttps://orcid.org/0000-0001-6433-4219КривобородовГ. Г.KrivoborodovG. G.

Кривобородов Григорий Георгиевич, доктор медицинских наук, профессор, профессор кафедры урологии и андрологии лечебного факультета, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; заведующий отделением урологии, Российский геронтологический научно-клинический центр

117997, Россия, Москва, ул. Островитянова, д. 1,

129226, Москва, ул. 1-я Леонова, д. 16

Grigory G. Krivoborodov, Dr. Sci. (Med.), Professor of the Department of Urology and Andrology, Faculty of General Medicine, Pirogov Russian National Research Medical University; Head of the Department of Urology, Russian Gerontological Research and Clinical Center

1, Ostrovityanov St., Moscow, 117997,

16, 1st Leonov St., Moscow, 129226

dr.krivoborodov@yandex.ruТурЕ. И.TurE. I.

Тур Елена Ивановна, кандидат медицинских наук, врач-уролог, врач-резидент

53100, Сиена, ул. Виале Браччи, д. 16

Elena I. Tur, Cand. Sci. (Med.), Urologist, Resident Physician

16, Viale Bracci, Siena, 53100

amadeymozart@yandex.ruhttps://orcid.org/0000-0002-9037-5580ШиринД. А.ShirinD. A.

Ширин Денис Александрович, врач-уролог отделения урологии

129226, Москва, ул. 1-я Леонова, д. 16

Denis A. Shirin, Urologist, Department of Urology

16, 1st Leonov St., Moscow, 129226

dok_shirin@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University; Russian Gerontological Research and Clinical CenteRussian FederationКлиника «Санта-Мария-алле-Скотте» университета СиеныРоссияSiena University Clinic Santa Maria alle ScotteRussian FederationРоссийский геронтологический научно-клинический центрРоссияRussian Gerontological Research and Clinical CenteRussian Federation20211904202104121126Copyright © Кривобородов Г.Г., Тур Е.И., Ширин Д.А., 20212021Кривобородов Г.Г., Тур Е.И., Ширин Д.А.Krivoborodov G.G., Tur E.I., Shirin D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6099

Согласно данным мировых исследований, распространенность гиперактивного мочевого пузыря (ГМП) на сегодняшний день колеблется в среднем у 11–16% населения Земли и встречается одинаково как у мужчин, так и у женщин. При этом ГМП является диагнозом исключения. В статье рассмотрены две большие группы причин патологии: неврологические и неневрологические. К первым относятся различные заболевания и состояния, которые приводят к комплексному нарушению механизма мочеиспускания, а именно к непроизвольным сокращениям детрузора и повышению внутрипузырного давления. Наиболее распространенными из них являются спинальная травма, инсульт головного и  спинного мозга, рассеянный склероз, болезнь Паркинсона и  др. Вторая группа причин  – это неустановленные факторы, в  результате которых возникает ургентное учащенное мочеиспускание, и тогда речь идет об идиопатической детрузорной гиперактивности (ИДГ). В данном случае пациент может иметь указанные симптомы на фоне полного здоровья без какого-либо неврологического анамнеза. Согласно существующим современным рекомендациям, лечение ГМП включает в себя трехступенчатый алгоритм и предполагает изменение образа жизни, медикаментозную терапию и, наконец, малоинвазивные способы лечения. Исторически основными препаратами для лечения симптомов ГМП являются М-холиноблокаторы. Однако в связи с выраженными побочными эффектами, которые часто встречаются у пожилых людей, прием лекарственных веществ данной группы зачастую невозможен. В отличие от М-холиноблокаторов, препарат Мирабегрон – единственный на сегодняшний день агонист β3-адренорецепторов, который продемонстрировал высокий профиль эффективности и безопасности в результате проведенных широкомасштабных плацебо-контролируемых клинических исследований.

World studies have shown that the mean prevalence of overactive bladder (OAB) ranges today from 11 to 16% of the global population and is common in both men and women. In addition, OAB is a diagnosis by exclusion. The article discusses two large groups of the causes of pathology: neurological and non-neurological. The former includes various diseases and conditions that lead to a complex abnormality in the urinary mechanism, namely, involuntary detrusor contractions and increased intravesical pressure. Spinal trauma, brain strokes and spinal strokes, multiple sclerosis, Parkinson’s disease, etc. are the most common of them. Unidentified factors constitute the second group of causes resulting in urgent frequent urination, and what is meant here is idiopathic detrusor hyperactivity (IDH). In this case, a patient may have these symptoms amidst full health without any neurological history. According to the available current guidelines, the treatment of OAB includes a three-step algorithm and suggests lifestyle changes, drug therapy and, finally, minimally invasive methods of treatment. Historically, M-anticholinergics are the main drugs for the treatment of OAD symptoms. However, administration of drugs from this group may often be impossible due to prominent side effects, which are more commonly reported among elderly patients. Unlike M-anticholinergics, Mirabegron is the only β3-adrenergic receptor agonist today that has shown a high efficacy and safety profile based on the results of large-scale placebo-controlled clinical trials.

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The authors declare that there are no conflicts of interest present.