Myths and misconceptions

 

Unfortunately, patients often perceive the onset of urinary disorders or urinary problems, especially in patients of the older age group, as well as unsuccessful attempts at treatment and self-medication as a sign of an incurable disease or a condition inherent to their age, and abandon attempts to seek specialized help. A feeling of shame, low medical literacy and lack of awareness leads to a situation where urinary disorders remain unrecognized – according to statistics, no more than a third of patients with dysuric disorders seek help, and less than 10% of patients receive specialized treatment. 

Meanwhile, in most cases, diseases manifested by problematic urination are very treatable. Timely contact with a specialist is the key to effective treatment.

In most cases, the ineffectiveness of treatment indicates an insufficiently complete diagnosis. The volume of medical knowledge in the specialty of urology is vast, and specialists in all areas of this knowledge and in all areas of this specialty actually do not exist. Even eminent doctors, when faced with problems that they do not understand, refer the patient to specialists who are more specialized or have more experience in this urinary problem. Interpretation of urodynamic data, assessment of urinary diaries, urethrocystoscopy, functional and instrumental tests, selection of treatment for a patient with an overactive and neurogenic bladder, interstitial cystitis, detrusor-sphincter dyssynergia, paruresis and urinary incontinence – all this and much more requires special knowledge, skills and experience, expert-class equipment, trained nursing staff and very specific laboratory and medicinal products. 

Of course, effective treatment is not only about competent specialists, high-quality equipment and the right prescriptions. In many ways, the effect of treatment is the result of a full and trusting doctor-patient contact, the informed motivation of the patient, and his focus on the ultimate goal of the treatment program.

Unfortunately, many patients do this. This behavior is the reason for a huge number of cases of self-medication, chronic bacterial, fungal and viral infections and the progression of diseases that are completely treatable.

Regardless of the level of intelligence and the depth of study of materials on the problem, a person who does not have specialized knowledge, skills and experience, in 90% of cases, is not able to adequately assess the symptoms and make the correct diagnosis, much less select an adequate treatment. In addition, consciousness is inherently biased in subjectively assessing information that relates to the personality of the person himself determines a significant difficulty in the correct interpretation of data, often underestimating clinical symptoms and anamnesis, ignoring examination data that seem unrelated to the problem. By the way, this is one of the reasons why competent doctors never examine or treat themselves.

It is relatively easy to treat only acute bacterial cystitis – an acute inflammation of the bladder mucosa that occurs suddenly (usually after hypothermia, vigorous sexual activity, poor diet), often caused by strains of E. coli and accompanied by frequent painful urination with pain. Antispasmodics and antibacterial agents usually relieve the symptoms of this pathology within a few days. The high frequency of occurrence (0.5-0.7 episodes of cystitis per 1 woman per year) in the population of sexually active women is the reason why up to 70% of women, when urinary disorders of any origin occur, self-medicate “cystitis”, without finding out the true causes of urinary problems and uncontrollably taking the first one they come across or recommended by someone antibacterial drug. Meanwhile, even “having hit the target,” repeated courses of antibiotics for a recurrent disease often only aggravate the problem, disrupting local immunity, changing the biocenosis of mucous membranes, provoking the expansion of fungi and protozoa and determining the risk of repeated relapses of the pathology. Academician Amosov spoke on this topic: “Self-medication is a type of suicide.”

Indeed, in all areas of medicine there are diseases that cannot be completely cured. However, even in such situations, in the vast majority of cases it is possible to control the symptoms and manifestations of such a pathology. But the only thing that can be stated absolutely unequivocally is that those who are not treated cannot be cured…

It should be remembered that not every pathology of the bladder is infectious (bacterial, viral, fungal) in nature, and the treatment of dysuric disorders does not always come down to eliminating the infectious agent(s) and inflammatory manifestations. Chronic, often recurrent course of urinary disorders, prolonged urogenital discomfort or pelvic pain, ineffectiveness or low effectiveness of treatment initiatives for urinary disorders are likely signs that the treatment vector is not selected accurately enough.

It is no secret that many such patients spend a long time going from doctor to doctor, the gynecologist refers them to a urologist, the urologist refers them to a neurologist, the neurologist refers them to a psychiatrist, the circle closes, while the true nature of the disease remains unidentified. As a rule, patients undergo many courses of antibacterial therapy for supposed cystitis or prostatitis, simultaneously receiving treatment for all kinds of infectious agents, bacteria, fungi, viruses and protozoa, and often take tranquilizers or antidepressants. Symptoms of the disease resume shortly after the course of treatment and the patient gradually loses hope of recovery. Often, the characteristics of the disease of such patients require interdisciplinary integration, the efforts of doctors of different specialties and specific methods of diagnosis and treatment.

Seriously speaking, modern medicine does not know the variant, type and form of prostatitis that could be cured in one day (or even in several days). Excluding treatment of obviously healthy people. 

In common parlance and with the light hand of advertising, “adenoma” and “prostatitis” mean any pathology in men that determines urination and sexual activity, from gonorrheal urethritis to prostate cancer. And the number of men who, in order to save money on “overpriced doctors”, take the widely advertised “Gentos” and “Prostamol-Uno” (by the way, very good drugs from respected companies) with or without reason is truly the talk of the town in urological circles. 

Unfortunately, today self-medication is a persistent problem in our society, and experts annually note an increasing number of advanced forms of prostate pathology in men. 

It should be remembered that it is absolutely necessary to contact a urologist for every patient with urinary disorders, regardless of age. Only in such a situation will diagnosis be complete and treatment effective. Ignoring the key points of qualified diagnosis is a common reason for identifying advanced forms of prostate cancer. Often this is a summary of a story where a patient has been “treating prostatitis” for many years. And the common situation looks completely absurd when treatment for “prostatitis” is prescribed by a gynecologist of the patient’s wife or partner, a family doctor, a dermatovenerologist, a therapist, or even people without any medical education at all – pharmacists, pharmacists, healers of all stripes. 

Many patients are absolutely convinced that the main role in the development and course of their disease is played by some unidentified or untreated infectious factor (bacteria, virus, fungus, protozoa) and methodically bypass diagnostic laboratories one after another, independently performing studies of all biological fluids of the body for antigens and nucleic acids of various infectious agents, mainly the STI group (sexually transmitted infections) and systematically trying to eliminate the often completely harmless Staphylococcus epidermidis from the mucous membranes, in the hope of solving the problem with the bladder (prostate gland, pelvic pain, urinary incontinence…) once and for all. At the same time, microorganisms identified during bacterial culture are called the source of all troubles, and the results of the antibiogram are called weapons of mass destruction. 

We have more than once encountered the complexity of dialogue with such patients – having lost faith in any result, armed with popular materials on the problem available on the Internet, traveling through forums with “experienced advice”, rereading periodicals in the spirit of “The People’s Doctor”, such patients often forget that superficial knowledge, even in excess, is by no means fundamental medical science, the magazine “Babushka” is not an authoritative source, but the criteria of modern evidence-based medicine (which 99% of “experienced” people do not know about) define a qualitatively different approach to the treatment of EVEN infectious-caused inflammatory pathology than the “scorched earth” tactics using all available means of combating the “harmful pathogen”. Which, in many cases, only finds decent conditions for development in the tissues of the macroorganism due to the FAVORABLE PREREQUISITES for its life formed by the disease (decreased local immunity, impaired urodynamics and stagnation of urine, impaired glycosaminoglycan layer of mucous membranes, etc.). Harmful in quotes, because most often it is not a problem, and treatment should be carried out by eliminating those functional or organic causes that created and support the preconditions for its life.

In medicine you can never say never. But nevertheless, the entire civilized medical world has long been taking into account only the results of controlled, double-blind, randomized studies, i.e. when the result of taking the treatment method under study is assessed in an unbiased, objective manner in statistically representative samples of patients, while neither the patients nor the doctors in contact with them know what exactly they are receiving – a real remedy or a dummy placebo. And only under such conditions, if from the standpoint of medical statistics the therapeutic effect has been confirmed, and better in several studies (meta-analysis), the method can be recommended for clinical practice. 

At the same time, neither the opinion of the doctor nor even the team in evidence-based medicine stands close to such studies. Needless to say, 90% of new-fangled products are not properly researched and, at best, benefit only their authors. Although there are very pleasant exceptions…

And a placebo, coupled with trusting contact with a doctor and competent motivation of the patient, sometimes brings wonderful results.