medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-4-129-134medsovet-6100Research ArticleУРОЛОГИЯUROLOGYРоль вакцинопрофилактики в терапии рецидивирующих инфекций мочевых путей у женщин в менопаузеThe role of vaccine prophylaxis in the treatment of recurrent urinary tract infections in menopausal womenhttps://orcid.org/0000-0002-6629-051XЕрмаковаЕ. И.ErmakovaE. I.

Ермакова Елена Ивановна, кандидат медицинских наук, старший научный сотрудник отделения гинекологической эндокринологии

117997, Москва, ул. Академика Опарина, д. 4

Elena I. Ermakova, Cand. Sci. (Med.), Senior Researcher of the Department of Gynecological Endocrinology

4, Academician Oparin St., Moscow, 117997

ermakova.health@mail.ruНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation20211904202104129134Copyright © Ермакова Е.И., 20212021Ермакова Е.И.Ermakova E.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6100

Рецидивирующие инфекции мочевых путей (РИМП) являются одними из самых распространенных проявлений генитоуринарного менопаузального синдрома и встречаются более чем в 20% случаев у женщин в пери- и постменопаузе. Наиболее частым фактором риска возникновения РИМП у женщин в пери- и постменопаузе является дефицит половых стероидов. Мочевой и  генитальный тракты имеют общее эмбриональное происхождение, что объясняется наличием α- и β-эстрогеновых рецепторов, рецепторов к прогестерону и андрогенам во всех структурах урогенитального тракта: нижней трети мочеточников, мочевом пузыре, сосудистых сплетениях, уротелии, мышцах тазового дна, связочном аппарате малого таза. Лечение пациенток с РИМП проводится в два этапа: лечение обострений и профилактика рецидивов. В период обострений назначаются краткосрочные курсы антибактериальной терапии с  учетом чувствительности бактериального агента. При невозможности выполнения микробиологического исследования образцов мочи антибактериальные препараты подбираются эмпирически с учетом наиболее распространенных возбудителей ИМП. Ведущим методом предупреждения рецидивов ИМП является вакцинопрофилактика. Эффективность и безопасность применения бактериального экстракта E. сoli доказаны в ходе многочисленных РКИ. Вакцина Уро-Ваксом достоверно сокращает частоту возникновения рецидивов циститов, снижает необходимость использования антибактериальных препаратов и  в  связи с  этим улучшает качество жизни женщин с РИМП в менопаузе. Вакцинопрофилактика в  менопаузе может назначаться в  качестве монотерапии или в  комбинации с  локальной терапией эстрогенами, которая также играет положительную роль в лечении инфекций мочевых путей.

Recurrent urinary tract infections (RUTI) are one of the most common manifestations of the genitourinary menopausal syndrome and occur in more than 20% of peri- and post-menopausal women. The most common risk factor for RUTI in peri- and post-menopausal women is sex steroid deficiency. The urinary and genital tracts share a common embryonic origin due to the presence of α- and β-estrogen receptors, progesterone and androgen receptors in all structures of the urogenital tract: lower third of the ureters, urinary bladder, vascular plexus, urothelium, pelvic floor muscles, pelvic ligamentous apparatus. Patients with RUTI are treated in two stages: treatment of exacerbations and prevention of relapses. During exacerbations, short courses of antibiotic therapy are administered according to the sensitivity of the bacterial agent. If microbiological testing of urine samples is not possible, antibiotics are selected empirically, taking into account the most common pathogens of a UTI. Vaccine prophylaxis is the leading method of preventing a UTI recurrence. The efficacy and safety of E. coli bacterial extracts have been proven in numerous RCTs. The Uro-Vaxom vaccine reliably reduces the incidence of cystitis recurrence, reduces the need for antibacterial drugs, and therefore improves the quality of life of menopausal women with RUTIs. Vaccine prophylaxis in menopause can be administered as monotherapy or in combination with topical estrogen therapy, which also plays a positive role in the treatment of urinary tract infections.

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