[Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city].

THE PURPOSE OF THE STUDY: to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm. MATERIALS AND METHODS: The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests. RESULTS: During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies. CONCLUSION: As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.

[Urological complications of N.A. Nekrasovs disease].

OBJECT: to study the medical history of N.A. Nekrasov and to determine the nature of his urological disease. The work was carried out from 1977 till 2021. He studied 2616 sources related to the biography of N.A. Nekrasov and medical history. The work was carried out in the archives of Moscow, St.Petersburg, Yaroslavl, Karabikha from 1998 till 2020. The Russian poet N.A.Nekrasov had an illness, which ended in death, during 3 years, from December 1874 till December 27, 1877. He was treated by famous doctors S.P. Botkin, N.V. Sklifosovsky, E.I. Bogdanovsky, N.A. Belogolovy and an operation was performed by Theodore Bilroth. Retrospective analysis revealed the following diagnosis of N.A. Nekrasov: rectal cancer at the stage of T4NXMOP4 with invasion of the sacrum, bladder and compression of the pelvic parts of both ureters, bilateral ureterohydronephrosis with the loss of the left kidney function, chronic renal failure, purulent cystitis, partial intestinal obstruction, suppuration of the wound after colostomy performed on April 12, 1877, Acute purulent paraproctitis, paranephritis, phlegmon of the left retroperitoneal space, purulent effusion to the thigh, phlegmon of the buttock area and the left thigh, sepsis, cerebral stroke. Urological complications of the rectal cancer accelerated the lethal outcome of the poet N.A. Nekrasov who died of sepsis and uremia.

[Phenazopyridine and fosfomycin for the acute cystitis treatment: results of multicenter randomized study].

AIM: To evaluate the analgesic effect, efficacy and tolerability of phenazopyridine in combination with fosfomycin for the treatment of acute uncomplicated cystitis in working-age female. MATERIAL AND METHODS: A total of 152 women with acute uncomplicated cystitis were included in multicenter, randomized, open-label study which were carried out in 5 polyclinics of the Perm Territory. All the patients were divided into 2 groups of 76 people each, depending on the treatment. In the main group, women received oral phenazopyridine 200 mg 3 times a day for 2 days (a total dose 1200 mg) and fosfomycin trometamol in a dose of 3 g once. In the control group, patients received a single dose of fosfomycin trometamol (3 g) and drotaverin 80 mg 3 times a day for 2 days. A visual analogue scale (VAS) was used for evaluation of pain intensity. The symptoms of cystitis were assessed using the ACSS scale. In addition, urinalysis, urine culture and other methods were done. The results were evaluated after 6, 12, 24, 48 hours, 3 and 6 days. RESULTS: In the main group, the severity of pain according to the VAS decreased from the initial 7.2+/-0.5 points to 1.6+/-0.2 points after 12 hours, to 0.4 +/- 0.05 points after 24 hours. Pain syndrome completely disappeared in all patients after 48 hours. In the control group, at all time points, a significant less pronounced analgesic effect was seen (p<0.001). The overall ACSS score in the main group decreased from the 12.0+/-0.5 points to 2.1+/-0.3 after 3 days and to 0.28+/-0.04 points after 6 days (p<0.001), which indicated a more rapid resolution of symptoms compared to the control group. The symptomatic effect of phenazopyridine (relief of pain, dysuria and discomfort) provided a more pronounced improvement in the well-being in the main group in comparison to the control group, which was confirmed by Dynamics domain of the ACSS scale (p<0.001). The combination of fosfomycin and phenazopyridine was more effective than the combination of fosfomycin and drotaverine. The clinical and microbiological cure rate in the main group was 97.4% and 96.9%, respectively. Leukocyturia was resolved earlier, and the duration of treatment decreased by 30.1%. An undesirable effect of phenazopyridine (nausea) was detected only in 1 (1.3%) patient. CONCLUSION: Phenazopyridine has a pronounced analgesic effect and is proved to be an effective and safe drug in patients with acute uncomplicated cystitis.

[Foreign body in the urinary bladder intrauterine device].

The article provides a rare observation of a 34-year-old woman who, 12 years before admission to a urological clinic, a gynecologist installed an intrauterine contraceptive device (IUD). The subject migrated into the abdominal cavity, and after 10 years the patient developed dysuria and hematuria. In October 2017, ultrasound and cystoscopy revealed the migration of IUD into the bladder. A foreign body was removed from the bladder - an IUD of a T-shape with the formation of a stone on it with a maximum size of 4.5 cm. During a follow-up examination after 2 years, pathology was not established.

[Sexual dysfunction in patients with chronic prostatitis and its treatment].

AIM: to study the frequency and type of sexual disorders in patients with chronic prostatitis (CP) and to evaluate the efficiency of Vitaprost and the biologically active complex NeuroDose in treating sexual dysfunctions. MATERIALS AND METHODS: The study was conducted in 2015-2019 and consisted of two stages. STUDY DESIGN: At the first stage, the frequency and type of sexual disorders were evaluated in 422 patients with CP. Standard methods for examining patients with CP included Loran-Segal questionnaire of male copulative function (MCF), International Index of Erectile Function (IIEF-5), ICEF-5, criteria of premature ejaculation, Treatment Satisfaction Visual Analogue Scale of orgasm quality and Hospital Anxiety and Depression Scale (HADS). Patients received standard 6-week complex therapy for CP. After that, at the second stage, 244 patients with sexual dysfunction (premature ejaculation, decreased intensity of orgasm) received Vitaprost and the NeuroDose biocomplex for 2 months. RESULTS: Sexual disorders were detected in 77% of patients with CP. The main disorders were premature ejaculation (60.9%) and decreased intensity of orgasm (43.8%), which often occurred simultaneously. Two-month therapy of sexual dysfunction with Vitaprost and NeuroDose was effective in 94.3% of patients. Good results were observed in 80.3% of cases, while satisfactory results were obtained in 14% of patients. According to MCF, total copulative function increased by 46%, the duration of sexual intercourse increased from 1.1+/-0.4 min to 4.1+/-0.4 min (p<0.001) with an absence of premature ejaculation in 81.6% of patients, the intensity of orgasm increased from 3.8+/-0.4 to 8.0+/-0.5 (p<0.001) points, and the number of patients with neuropsychiatric symptoms associated mainly with sexual dysfunction decreased by 69.3%. CONCLUSION: Premature ejaculation and decreased intensity of orgasm are the most common sexual disorders in CP, and the combination of Vitaprost and dietary supplements NeuroDose is highly effective for their treatment.

[Treatment of acute uncomplicated cystitis in women with antibiotic allergy or intolerance].

AIM: A comparative evaluation of the efficacy and safety of Canephron N and Cystone as monotherapy in women with acute uncomplicated cystitis and antibiotic allergy or intolerance was performed. MATERIALS AND METHODS: A prospective, randomized, controlled study of drug Canephron N as monotherapy for acute uncomplicated cystitis in 51 women with a history of antibiotic allergy or intolerance was carried out in 3 urological centers in Perm from 2016 to 2019. In the main group, patients received Canephron N for 30 days, while in comparison group, Cystone was prescribed. The Acute Cystitis Symptom Score (ACSS), microscopic study of urine sediment, urine culture and other methods were used. Results were evaluated 3, 6, 30 days and 1 year after the start of treatment. RESULTS: In the main group, monotherapy with Canephron N for 30 days resulted in a decrease in the total ACSS score from the baseline 12.9 to 0.3 points, while in Cyston group, changes of ACSS score were less pronounced, from baseline 12.8 to 1.4 points (p<0.01). Clinical cure rate in the main and comparison group was 88.5% and 68%, respectively. In another 3.8% and 1% of patients in the main and comparison group, an improvement was seen. The number of patients with leukocyturia in the Canephron N group decreased to 11.5% compared to 28% in Cyston group (p>0.05). Bacteriuria rate in the main group was 7.7%, which was less than in the comparison group (20%, p>0.05). Number of sick days in the main group was 4.9+/-0.4, compared to 7.4+/-0.6 days in Cyston group. In the Canephron N group, 1-year recurrence rate was only 7.7%, while in the Cyston group the recurrence was seen in 16% of patients. CONCLUSION: According to the results, Canephron N is an effective and safe drug as monotherapy for acute uncomplicated cystitis, and can be considered as drug of choice for the treatment of women with antibiotic allergy or intolerance.

[The History of the F. Ch. Graal Perm Municipal Clinical Hospital, One of the Oldest Hospitals of the Ural Region].

The article presents the history of becoming and development of F. Ch. Graal Perm municipal clinical hospital, founded on October 17, 1915. In 1928 A. V. Lunacharsky characterized this hospital as "The pearl of Ural". V. N. Derevenko, the surgeon-in-ordinary of the Royal Family, is its first director. Famous national scientists, such as academician E. A. Wagner, professors D. P. Kuznetsky, V. N. Parin, B. V. Parin, I. A. Ivanov, V. F. Simonovich, J. S. Zimmerman and others worked in this hospital. They made a significant input into development of medical science and health care of the Ural Region.

[Comparative assessment of Canephron N and ciprofloxacin as monotherapy of acute uncomplicated cystitis in women].

The study aimed to compare the efficacy and safety of Canephron N and ciprofloxacin as monotherapy in the management of mild forms of acute uncomplicated cystitis in women of working age. MATERIALS AND METHODS: A prospective, randomized study of Canephron N and ciprofloxacin for treating mild forms of acute uncomplicated cystitis (ACSS score less or equal 10) comprising 160 women aged 18-55 years was conducted from 2015 to 2017. Group I consisted of 80 women, who received oral Canephron N 2 tablets 3 times daily for 30 days. Group II included 80 women who took oral ciprofloxacin 0.5 g twice daily for 3 days. The results were assessed using the ACSS scale, urinalysis by microscopy, bacteriological examination of urine, etc. The outcomes were evaluated at 3, 6 and 30 days, and one year after the treatment initiation. RESULTS: In group I, monotherapy with Canephron NH resulted in a marked improvement in symptoms, a decrease in the ACSS scores from 7.9 at baseline to 0.1 at day 30. The indicator of clinical efficacy (recovery) was 93.75%, bacteriological efficiency was 91.3%, relapse of cystitis within one year was observed in 5% of patients; no side effects were registered. In group II, the symptoms and bacteriuria decreased more rapidly in the early periods, but after 30 days the results of clinical and bacteriological efficacy did not differ from the group I (93.75 and 91.3%, respectively). Side effects and cystitis relapses were noted in 18.8% and 12.5% of patients, respectively. CONCLUSION: The findings of the study show that Canephron N is an effective and safe alternative to treating mild forms (ACSS score less or equal 10) of acute uncomplicated cystitis in women, allowing the use of antibiotics to be reduced. In our opinion, patients with more severe forms of acute uncomplicated cystitis should be treated with traditional antibiotic therapy.

[A giant fecalith complicated by acute urinary retention, hydronephrosis and acute obstructive pyelonephritis].

The article reports a rare case of a 30-year-old man with Hirschsprung's disease, who developed a giant fecalith in the rectum and sigmoid (weight 3.5 kg, the largest diameter 20 cm). The fecalith impaired urine flow by compressing urinary tract, thereby causing acute urinary retention and right-sided hydronephrosis with acute obstructive pyelonephritis. Removing fecalith resulted in the patient recovery and normal functioning of genitourinary system.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men].

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[PROSPECTIVE SYNTHETIC MATRICES FOR THE RECONSTRUCTION OF TRACHEAL DEFECTS IN CANCER PATIENTS].

A replacement of major defects of the trachea remains a challenge despite numerous attempts to use for this purpose various options of autologous and allogeneic implants as well as synthetic matrixes. The most prospective direction is to create tracheal matrixes based on biocompatible porous or fibrous materials that mimic native tissues and provide the proliferation of multipotent cells. This review summarizes current data regarding the development of experimental research and clinical testing of biocompatible tracheal matrixes, which were created using innovative technologies.

[THORACOSCOPIC LOBECTOMY WITH MEDIASTINAL LYMPH NODE DISSECTION--THE STANDARD IN SURGICAL TREATMENT OF PATIENTS WITH T1-2N0M0 NON-SMALL CELL LUNG CANCER].

In recent years a large number of thoracic clinics in the world recommend the performance of minimally invasive surgical procedures in the early stages of lung cancer arguing that this technique reduces a number of postoperative complications, shortens the period of social rehabilitation of patients and does not significantly affect the long-term results of treatment. This work is devoted to the study of immediate and long-term results of surgical treatment of patients who have had surgery in the volume of thoracoscopic lobectomy at the early stages of non-small cell lung cancer.

[INCIDENCE OF ACUTE URINARY RETENTION IN PATIENTS WITH PROSTATIC ADENOMA AND 8-YEAR LONG TAMSULOSIN THERAPY].

This report introduces results of an 8-year study estimating the risk of acute urinary retention in patients with stage I prostatic adenoma. Patients were randomly assigned into two groups. The first group consisted of 331 men was regularly taking Omnic (tamsulosin) 0.4 mg 1 time daily for 8 years as a means of medical therapy. The second group consisted of 334 patients treated with herbal preparations (Gentos, Tadenan or Speman). In the case of acute urinary retention patients were taken to the urological department to release urine from the urinary bladder by catheterization or by the surgical procedure. The incidence of acute urinary retention in group 1 ranged from 0.3 to 1.2% per year and, for a total of 8 years of follow-up was 6.45%. In the second group, it ranged from 1.8 to 7.3% per year, making a total of 36.2%. Therefore, the risk of acute urinary retention in patients receiving Omnic (tamsulosin) was reduced by 5.6 times in comparison with the group of patients treated with herbal medications. Thus, the need for surgery decreased from 27.8 to 6.3%. According to the results of an 8-year long tamsulosin was found as a safe and highly effective means to reduce the risk of acute urinary retention.

[RESULTS OF IMPLEMENTATION OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN NEPHROLITHIAS IS ENDEMIC REGION].

This paper presents results of implementation (1993) of extracorporeal shock wave lithotripsy (ESWL) in Perm region, in which nephrolithiasis is endemic. Results achieved with ESWL using two Dornier lithotripters in 6054 patients were analyzed in detail. 93% of the patients had complete and 6,2% partial stone destruction and clearance, therefore positive results were achieved in 99,2% patients. In only 0,8% of the patients ESWL did not result in stone destruction. ESWL complications were registered in 0,64% of patients and included: subcapsular kidney hematoma (0,03%), intense hematuria (0,15%), acute pyelonephritis (0,46%). Over the past 22 years since implementation of ESWL in Perm region with the use of 4 Dornier lithotripters the number of open surgeries for nephrolithiasis fell by 11 times (4% of all nephrolithiasis patients), nephrolithiasis mortality and length of treatment decreased by 5,4 and 4,1 times, respectively.

[DIETARY SUPPLEMENT REKECEN IMPROVES SAFETY AND EFFICACY OF CHRONIC PROSTATITIS ANTIBACTERIAL THERAPY].

This randomized comparative study was carried out to estimate efficacy and safety of the natural complex of fermented food fibers and short chain fatty acids (dietary supplement rekicen-RD®) in antibacterial therapy of 64 patients with chronic infectious prostatitis. 32 patients of the treatment group received 8 week standard antibacterial therapy for chronic prostatitis in combination with dietary supplement rekicen-RD® and 32 patients of the control group were treated only with antibacterial therapy. Short-term and long-term results were estimated after 8 weeks and 6 months follow-up, respectively. It was found, that addition of dietary supplement rekicen- RD® to antibacterial therapy resulted in statistically significant improvement of the treatment efficacy. Compared to patients of the control group, patients of the treatment group had more pronounced positive changes of all indicators of treatment efficacy (NIH-CPSI total score, quality of life, echo-structure of prostate, the number of leukocytes in prostatic secretions). Long-term (after 6 months) clinical efficacy of the combination of antibacterial therapy with dietary supplement rekicen-RD® was 96,9%, bacteriological efficacy after 8 weeks - 87,5%, after 6 months - 81%. Notably, there was 4,5-fold reduction in the rate of antibiotics adverse side effects in the treatment group patients without a single gastro-intestinal side effect.