[The use of antioxidants in combination therapy of chronic prostatitis].

Currently, the significance of the chronic prostatitis (CP) is undoubted. Oxidative stress is considered as one of the standard mechanisms of cellular damage that is associated with inflammatory diseases such as CP. When choosing the combination therapy for this group of patients, a correction of oxidative stress is pathogenetically justified. Literature data about the pathogenetic feasibility and prospects of using a biologically active complex containing flavonoids and carotenoids quercetin, lycopene and naringin as part of the combination treatment of patients with CP are presented in the article. Considering the various effects of the biologically active complex Querceprost, containing quercetin, lycopene and naringin, among which antioxidant, anti-inflammatory, antimicrobial and immunomodulatory are of greatest importance, as well as taking into account the synergistic effect of flavonoids and carotenoids, we suggest that Querceprost is promising component of combination treatment of patients with CP.

[The efficiency of various cytokine therapy regimens in the complex treatment of men with chronic abacterial prostatitis].

INTRODUCTION: Chronic prostatitis (CP) is one of the most important and discussed urological diseases. Treatment of bacterial CP with an established pathogen usually is not associated with any difficulties. Chronic abacterial prostatitis (CAP) remains the most problematic issue. Immune defense mechanisms are important in the development of CP, including a decrease in the functional activity of monocytes/ macrophages, neutrophils, as well as imbalance of pro- and anti-inflammatory cytokines. AIM: To evaluate the efficiency of various schemes of using the immunomodulatory drug Superlymph as part of the combination therapy of men with CAP. MATERIALS AND METHODS: A total of 90 patients with category IIIa CAP (NIH, 1995) were included in the study. In the control group, patients received basic therapy of CAP, namely behavioral therapy, 1-adrenoblocker and fluoroquinolone for 28 days. In the main group I basic therapy in combination with Superlymph 25 ME in one suppository q.d. for 20 days was administered. In the main group II basic therapy in combination with Superlymph 10 ME in one suppository b.i.d. for 20 days was given. Evaluation of treatment efficiency was carried out after 14 +/- 2 days (visit 2) and 28+/- 2 days (visit 3) from the start of treatment. RESULTS: The study groups were homogeneous, and baseline characteristics did not differ significantly (p>0.05). However, significant differences were found between the results in the main groups and the control group at visit 2 for all the indicators (p<0.05). The number of daytime urinations was lower in the main group I and II compared to CG by 16.7% and 28.4%, the number of night urination by 28% and 40%, the average IPSS score by 29.1% and 38.3%, the average QoL score by 32.4% and 45.9%, the average NIH-CPSI score by 26.8% and 37.4%, the number of leukocytes in expressed prostatic secretion by 41.2% and 52.1%, prostate volume by 16.8% and 21.8%, bladder volume by 15.8% and 21.7%, and Qmax by 14.3% and 21.2%, respectively. Similar significant differences between the main groups and control group were also seen at visit 3, while the indicators in main groups I and II reached normal values after 28 days of therapy. In this study, for the first time, a comparative analysis of two different treatment regimens with Superlymph was carried out. In the main group I, patients received suppositories at a dose of 25ME q.d., while in the main group II, the drug was administered 10 ME b.i.d. The results indicate a comparable efficiency of both schemes after 4 weeks. However, in the main group II, after 2 weeks, there was a significantly more pronounced positive dynamics of all indicators in comparison with the main group I (p<0.05). Consequently, the use of Superlymph at a dose of 10ME b.i.d. a day allows to reduce the severity of the inflammatory process in a shorter time. CONCLUSION: The use of Superlymph in patients with CAP allows to reduce the severity of clinical manifestations in a shorter time, and has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life. According to our results, the most effective scheme in patients with CAP is basic therapy in combination with Superlymph 10 ME for 1 suppository 2 times a day for 10 days. In our opinion, Superlymph can be effectively used as part of the combination therapy of men with CAP.

[Evaluation of the effect of Alfuprost MR on detrusor thickness and bladder mass in patients with detrusor hypertrophy caused by benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) can lead to the detrusor hypertrophy and deterioration of the bladder function with a decrease in its contractile activity. A number of publications are presented in the literature, the results of which indicate the possibility of reducing bladder hypertrophy with alpha-blockers. AIM: To carry out the retrospective analysis to study the effect of Alfuprost MR on urodynamic parameters, as well as the influence of the therapy on detrusor thickness and bladder mass in patients with detrusor hypertrophy and bladder outlet obstruction caused by BPH. MATERIALS AND METHODS: Outpatient records of 30 patients with lower urinary tract symptoms (LUTS) caused by BPH who received Alfuprost MR as monotherapy for 24 weeks were reviewed. Based on the diaries, the following parameters were assessed: total IPSS score, IPSS voiding (questions No. 1, 3, 5 and 6) and storage subscale scores (questions No. 2, 4 and 7), maximum flow rate (Qmax) according to uroflowmetry, the volume of the prostate and the postvoid residual (assessed by ultrasound), satisfaction with treatment on the quality-of-life score (QoL), as well as the changes in detrusor thickness and bladder mass index. RESULTS: An improvement in LUTS severity, starting from the 4th week of treatment, followed by a positive trend that persists until the 24th week of therapy with Alfuprost MR, was found. The overall average IPSS score improved by 39.0% by the 24th week of therapy. At the same time, voiding symptoms improved by 46.8%, and storage symptoms improved by 30.9% by 24 weeks of therapy. The average Qmax increased significantly (p<0.05) by 22.1% after 24 weeks of therapy. The average detrusor thickness decreased by 40,2%. Bladder mass index decreased significantly by an average of 34,3% (p<0.05). QoL score improved significantly (p<0.05) by 2.2 points after 24 weeks of therapy. CONCLUSION: During the 24-week treatment of patients with BPH, Alfuprost MR demonstrated clinical efficacy not only in reducing voiding symptoms and in improving the QoL, but also a positive effect on detrusor hypertrophy, as evidenced by changes in detrusor thickness and bladder mass index. The absence of any adverse events, including decrease in blood pressure and heart rate, allows us to recommend Alfuprost MR as an effective treatment for LUTS associated with BPH, which reduces detrusor hypertrophy and has a high safety profile and minimal vasodilating effects.

[Evaluation of long-term results of the use of entomological drug in the combination therapy of patients with benign prostatic hyperplasia and chronic prostatitis].

INTRODUCTION: Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are among the most important urological diseases. The right choice of treatment for patients with BPH and CP continues to be contradictory. Recently, a new group of entomological drugs has been increasingly used, one of which is Adenoprosin. AIM: To study the efficiency of Adenoprosin as part of combination therapy, as well as to evaluate the long-term outcomes in patients with BPH and CP. MATERIALS AND METHODS: A total of 60 patients with BPH and CP were included in the study. They were randomized into two groups of 30 each. In the comparison group, traditional therapy with 1-blockers and fluoroquinolones was administered. In the main group, similar therapy was prescribed in combination with Adenoprosin for 6 months. The follow-up period was 12 months. RESULTS: At baseline, the groups were homogeneous. After three and six months, the results in the control group did not significantly improve, but negative dynamics was revealed at visit 4. The results obtained in the main group at visits 3 and 4 were also significantly better (p<0.05) compared to the control group. During 12 months of follow-up, 7 (23.3%) cases of recurrent CP in the comparison group and 1 (3.3%) case in the main group were seen. CONCLUSION: According to our results, the use of Adenoprosin for 6 months allowed more effectively to reduce the lower urinary tract symptoms. The obtained effect persisted for the next 6 months, as evidenced by the dynamics of the studied indicators and the relapse rate of CP.

[Entomological drug adenosine for the treatment of patients with benign prostatic hyperplasia and chronic prostatitis].

INTRODUCTION: Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are common disorders that are typical for age-related health changes in men. The combination of BPH with CP raises many questions when treatment tactics is chosen. Currently, new drugs have been developed and widely used, namely entomological drugs, which are biologically active substances with anti-inflammatory and antioxidant properties. The aim of our study was to study the efficiency of the entomological drug Adenoprosin in the complex therapy of patients with BPH and CP. MATERIALS AND METHODS: A total of 60 patients with BPH and P were included in the study. Patients were randomized into two groups of 30 people. In the control group, alpha-blockers and fluoroquinolones were prescribed. In the main group, patients received the same therapy with alpha-blockers and fluoroquinolones, but additionally took Adenoprosin once a day for three months. The results were evaluated at baseline (Visit 1), after four weeks (Visit 2) and three months (Visit 3) of therapy. The frequency of urination, the number of night urinations, the average score on the IPSS, QOL, NIH-CPSI scales, the maximum urine flow rate (Qmax), prostate volume and residual urine volume, as well as microscopic study and culture of expressed prostatic secretion were evaluated. RESULTS: At baseline, there were no differences between group in all studied values (p>0.05). By the second visit, despite the absence of significant differences (p>0.05), a more pronounced positive changes in the most parameters were showed in the main group. According to evaluation at visit 3, in the control group all values didnt change significantly compared to those at visit 2. In the main group, there was a significant decrease in the number of day and night urinations, an increase in the Qmax and the average score on the NICH-CPSI, IPSS and QOL scales, and a decrease in the prostate volume and residual urine volume. There was significant difference between results in the main and control group (p<0.05). CONCLUSIONS: Considering anti-inflammatory, antioxidant activity and antiproliferative effect, entomological drug Adenoprosin may become a novel drug for the complex therapy of patients with BPH and CP. However, to validate the results and to study the mode of action of this group of drugs in details, there is a need to carry out large-scale placebo-controlled clinical trials.

[Comparative analysis of the effectiveness of early and delayed initiation of combined DRUG therapy for bph].

INTRODUCTION: Currently, -blockers (-AB) and 5-alpha-reductase inhibitors (I-5-AR) are recommended as the drugs of choice for the treatment of patients with benign prostatic hyperplasia (BPH). However, despite the clear advantages of combination therapy, at the initial stages of treatment, I-5-AR is either not prescribed at all, or added to therapy after a few months. The aim of our study is to study the effectiveness of early and various options for delayed combined drug therapy of patients with BPH using -AB and I-5-AR. MATERIALS AND METHODS: The study included 90 patients with BPH, who were divided into three groups of 30 people. In group 1, monotherapy with drugs from the -AB group was performed for 6 months, after which they were transferred to treatment with a combined drug. In group 2, monotherapy was performed for three months, after which they were also transferred to treatment with a combined drug. And in group 3, patients were prescribed combination therapy from day 1. RESULTS: Early combination therapy with dutasteride was more effective than delayed Therapy for 6 months. There were no significant differences in the main parameters studied between patients who simultaneously started combination therapy and switched to it after 3 months, by the end of the 12th month of treatment. However, early therapy is a combined drug made it possible to achieve a more rapid effect in relation to LUTS. CONCLUSION: Thus, the data obtained confirm the clinical recommendations regarding the expediency of early initiation of combined therapy with an -adrenoblocker and a 5-reductase inhibitor in patients with moderate and severe LUTS caused by BPH and the risk of disease progression. Postponing the transition to combination therapy for 6 months or more may lead to a decrease in the effectiveness of treatment of patients in this category.

[The use of bioregulatory peptides in the treatment of men with benign prostatic hyperplasia and chronic prostatitis].

INTRODUCTION: Benign prostatic hyperplasia (BPH), and chronic prostatitis (CP) are considered to be among the most common causes of lower urinary tract symptoms (LUTS) in men. The combination of BPH with CP raises many questions when choosing the right treatment strategy. For a long time, bioregulators isolated from the prostate gland of cattle have been successfully used in the treatment of CP. OBJECTIVE: to evaluate the effectiveness of bioregulatory peptides, in particular vitaprost, in the treatment of men with benign prostatic hyperplasia and chronic prostatitis. MATERIALS AND METHODS: The study included 60 patients with BPH and CP, who were divided into two groups of 30 people. In the comparison group (CG), complex therapy with drugs from the group of alpha-blockers and fluoroquinolones was performed. In the main group (MG), a similar complex therapy was performed in combination with vitaprost tablets. The effectiveness of the treatment was evaluated after two weeks (visit 2) and after 4 weeks (visit 3). RESULTS: In the MG, a more effective reduction in the severity of LUTs and manifestations of the inflammatory process was noted than in the HS. After 2 weeks of therapy in OG, the average score on the IPSS, QOL and NICH-CPSI questionnaires was lower by 2.4 points, 1.2 points and 2.5 points, respectively, the number of white blood cells in the prostate secret was on average 1.5 times less, and Qmax was higher by 1.4 ml/sec. The revealed differences were statistically significant (p<0.05). This trend continued after 4 weeks of therapy. CONCLUSION: Thus, the use of bioregulatory peptides, in particular the drug vitaprost, in patients with BPH and CP helps to reduce the severity of LUTs and pain in a shorter time, has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life of patients in this category.

[An observational randomized study of the efficacy and safety of the drug Longidase, vaginal and rectal suppositories 3000 iu in the treatment of patients with symptoms of the lower urinary tract on the background of benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is among the most significant urological diseases, and improving the effectiveness of treatment of patients with this disease is one of the main tasks in modern urology. The aim of the study is to evaluate the effectiveness of Longidase in the treatment of men with benign prostatic hyperplasia. MATERIALS AND METHODS: The study included 120 patients with lower urinary tract symptoms caused by BPH, who were randomly assigned to 2 groups of 60 people. In the main group (MG), Longidaza 3000 ME therapy was performed in combination with tamsulosin. In the comparison group (CG), tamsulosin monotherapy was performed. The patients were examined during 5 visits for 162+/-3 days. RESULTS: During the treatment period, compliance was 100%, all patients followed the doctors prescriptions, there were no cases of refusal of therapy. In addition, there were no cases of adverse events associated with taking the drug Longidaza. The examination initially revealed symptoms of the lower urinary tract in both groups against the background of prostatic hyperplasia, erectile dysfunction and a decrease in the quality of life. The therapy performed in both groups was effective, as evidenced by a decrease in the average score on the I-PSS scale, an increase in maximum urine flow rate, a decrease in volume of residual urine, which led to an improvement in the quality of life according to the QoL scale. Nevertheless, in the group of patients receiving Longidaza, after 50 days of therapy, there was a more pronounced positive dynamics of both the average score on the I-PSS and QoL scales, and the average maximum urine flow rate value according to the results of uroflowmetry. The differences between the groups according to these indicators were statistically significant (p<0.05). After 50 days of follow-up in GS, the average prostate volume did not change significantly, whereas in MG it decreased, and the differences between the groups were statistically significant (p=0.001). During subsequent visits, there was a tendency to decrease the size of the prostate in the MG, while in the CG there was a moderate increase in the volume of prostate according to ultrasound. CONCLUSION: Thus, according to the results obtained in the course of this observational study, the drug Longidaza 3000 ME can be effectively used in patients with BPH, prevent the progression of the disease, contribute to the persistent relief of LUTS and improve the quality of life of patients in this category.

[Modern possibilities of therapy of a urological patient with concomitant diseases of the cardiovascular system].

INTRODUCTION: Currently, there is a large selection of -blockers on the pharmaceutical market, while they have comparable effectiveness, slightly differing only in safety profile. However, even small differences are of fundamental importance for comorbid patients, especially for those patients who are prone to developing cardiovascular diseases in adulthood. The choice of -blockers, which is able to minimize the risks of cardiovascular complications, is important. MATERIALS AND METHODS: Outpatient cards of 120 patients with BPH and concomitant high blood pressure or stage 1-2 hypertension, who had been taking Alfuprost MR for at least 12 weeks, were analyzed. All patients were divided into two groups of the same number. In group 1, 60 patients with LUTS/BPH and concomitant high blood pressure did not take any antihypertensive drugs, while 60 patients with LUTS/BPH and stage 1-2 hypertension in group 2 received antihypertensive drugs (according to the recommendation of an internist or cardiologist). Based on the analyzed data, the efficacy of the drug Alfuprost MR, its safety profile, including the effect on blood pressure and pulse, and the recorded adverse events after 4 and 12 weeks were assessed. RESULTS: An analysis of the results of a retrospective study showed an improvement in LUTS in both groups, starting from 4 weeks of treatment, followed by positive dynamics by 12 weeks of therapy with Alfuprost MR. The data obtained correspond to those presented in the literature. During 3 months of therapy, it was recorded: a decrease in the average score on the IPSS scale by 30%; an increase in the average urine flow rate by 20.6%; a decrease in the average amount of residual urine to normal values; an improvement in the quality of life of patients, according to the results of filling out the QoL questionnaire, by an average of 1.8 points. Patients in both groups had clinically insignificant fluctuations in systolic and diastolic blood pressure, less than 1 mmHg (in both groups) during 12 weeks of therapy; changes in heart rate during 3 months of therapy with Alfuprost MR were also clinically insignificant and averaged no more than 1 beat per minute In the medical records of patients, no adverse reactions were registered during therapy with Alfuprost MR, which confirms the high safety profile of the drug in clinical practice. CONCLUSION: Thus, Alfuprost MR is an effective means for the treatment of LUTI in BPH, with minimal vasodilating effects, which allows the drug to be prescribed to comorbid patients with concomitant high blood pressure or hypertension, including those taking antihypertensive drugs.

[Current trends in the treatment of chronic recurrent bacterial cystitis].

INTRODUCTION: Every year, more than 7 million women go to the doctor for chronic cystitis. An important factor is the psychoemotional component of this disease. OBJECTIVE: comparative analysis of various options for complex treatment of women with chronic recurrent bacterial cystitis using phototherapy, chronotherapy and correction of psychoemotional disorders with the anxiolytic drug Adaptol. MATERIALS AND METHODS: 90 women with chronic recurrent bacterial cystitis in the acute stage were examined and divided into 3 groups of 30 people. In group 1, patients received basic therapy with Furamag (furazidin kalium). In group 2, patients received standard therapy in combination with phototherapy in the acrophase of the chronorhythm. In group 3, basic therapy was performed in combination with phototherapy in the acrophase of the chronorhythm and Adaptol. The severity of dysuria and pain, leukocyturia, bacteriuria, chronobiological and psychoemotional status were evaluated. RESULTS: Initially, all patients showed signs of desynchronosis and psychoemotional disorders. All groups showed signs of exacerbation of chronic cystitis. The results obtained on the 5th day of therapy in groups 2 and 3 were statistically significantly different (p<0.05) from those in group 1. In group 3, the number of nocturnal urination (0.9+/-0.7), the number of imperative urges per day (0.7+/-0.5), and the intensity of pain (0.7+/-0.6) were the closest to normal. By day 10, clinical and laboratory parameters in all three groups reached normal values, which indicates the effectiveness of the therapy in each of the groups. CONCLUSION: Thus, the use of Furamag and Adaptol in combination with phototherapy at the maximum peaks of psychoemotional and physiological activity of the body effectively stops the clinical and laboratory manifestations of the disease, corrects the mental status and improves the quality of life of women in a shorter period of treatment.

[Modern view on the use of antioxidants in the treatment of male infertility].

Based on the literature data, this review discusses the prevalence and etiology of male infertility, as well as the current view of the reasons for the lack of effectiveness of treatment of idiopathic infertility in men. The effectiveness of antioxidant therapy in various variants of redox balance disorders is evaluated. Possible prerequisites and mechanisms of complications in the administration of antioxidants are described. In addition, the need to introduce laboratory confirmation of oxidative stress and review approaches to antioxidant therapy is justified. The article also discusses the possibility of treating idiopathic pathospermia with the help of a complex drug Androdoz, which, according to the literature, can improve such indicators of sperm as the volume of ejaculate, the number and viability of spermatozoa and the proportion of their actively mobile forms due to the synergy of its components.

[Use of D-mannose in the prevention of recurrent lower urinary tract infection in women].

Lower urinary tract infections (LUTI) currently retain the status of one of the most urgent problems of urology. According to extensive microbiological studies of UTIAP I and II, "DARMIS" the most common pathogens that are detected in the urine of women with LUTI are gram-negative bacteria of the Enterobacteriales family, in particular E. Coli. Antibacterial therapy demonstrates high effectiveness in the treatment of uncomplicated LUTI. However, the problem of recurrent infection remains unresolved. Taking into account known side effects of continuous antimicrobial prevention, as well as data on the high frequency of relapses after its cancellation, it is necessary to identify alternative LUTI prevention strategies. The use of D-mannose can be one of these strategies. D-mannose use for the prevention of relapses of INMP is indicated in the clinical recommendations of the American (AUA) and European (EUA) urological associations. D-mannose is a monosaccharide that is extracted from a larch rod. It is relatively quickly absorbed and reaches the peripheral organs in about 30 minutes, after which it is excreted in the urine. The structure of d-mannose allows it to bind to mannose-sensitive E. Coli fimbriae and prevent their adhesion to the urinary tract mucosa. Several studies demonstrated high safety profile and effectiveness of long-term D-mannose treatment in preventing LUTI. The data presented in the literature allow us to recommend patients with recurrent LUTI long term D-mannose intake helps to reduce the severity of symptoms in acute episodes and prolong relapse-free period. As a source of D-mannose, we can recommend Ecocystin 1 sachet 1 time a day.

[The efficacy of fesoterodine in patients after transurethral resection of the prostate].

AIM: For a long time, benign prostatic hyperplasia (BPH) was considered as only cause of lower urinary tract symptoms (LUTS) in elderly men. More than 30% of patients underwent surgery by the age of 80. Unsatisfactory outcome of surgical treatment of BPH are observed in 9-27% of cases. Various irritative symptoms, which are typical for detrusor overactivity, persist especially often. Currently, anticholinergic drug therapy (m-cholinoblockers) is the main treatment for detrusor overactivity. The aim of our study was to assess the effectiveness of m-cholinoblockers for the treatment of persisted LUTS in men with BPH who had undergone transurethral resection of prostate (TURP). MATERIALS AND METHODS: The study included 60 patients with BPH who underwent TURP. All patients were divided into two groups. In Group 1, anti-inflammatory therapy for 10 days with 1-month follow-up was prescribed. In Group 2, anti-inflammatory therapy was combined with the drug Toviaz for 1 month. Evaluation of the treatment effectiveness was carried out 3-5 days, 14-15 days and 1 month after TURP, respectively and included voiding diary, IPSS score, QOL, uroflowmetry, adverse events and acute urinary retention. RESULTS: At baseline, in the Group 1 and 2, average urination frequency was 12.6 and 12.7 times per day, the number of urgency episodes was 9.2 and 9.0 times and number of nocturnal voiding episodes was 5,2 and 5.3 times, respectively. The average IPSS score was 19.8 and 19.7 points and Qmax was 6.5 and 6.7 ml/sec, respectively. By the 14th-15th day of therapy, in both groups positive changes were found. There was a significant decrease (p<0.05) in the urination frequency and nocturnal voiding episodes according to voiding diaries, an increase in Qmax and average IPSS and QOL score. The adverse events rate in group 2 was 16.7%. By the 30th day of therapy in the group 1 there were no significant changes. However, in group 2, urination frequency, number of urgency episodes, average IPSS and QOL score decreased to an average of 5.7 times a day, 0.4 times, 1.2 times, 9.3 points and 1.6 points, respectively. Average Qmax increased to 15.5 ml/sec. No adverse events were detected. CONCLUSION: According to the results of our study, the use of m-cholinoblockers, in particular Fesoterodine (Toviaz), in combination with standard therapy in patients with detrusor overactivity after TURP is reasonable and allows to effectively and safely alleviate irritative symptoms.

[Efficacy of combined antibacterial-prebiotic therapy in combination with D-mannose in women with uncomplicated lower urinary tract infection].

INTRODUCTION: Acute cystitis is the most common manifestation of uncomplicated urinary tract infection. One of the drugs whose effectiveness in the treatment of patients with INMP has been proven is fosfomycin, which has been on the pharmaceutical market for a long time and is widely used in urological practice. despite the good results of etiotropic therapy, the problem of recurrent UTI remains unresolved, which occurs in about 30% of women within a year after the first episode of cystitis. alternative prophylactic agents, such as probiotics, cranberry preparations, phytopreparations, etc. are increasingly used in prolongation of the inter-relapse period. One such remedy is D-mannose. OBJECTIVE: to evaluate the effectiveness of D-mannose and the combined drug Ecofomural containing fosfomycin and lactulose in the complex treatment of women with uncomplicated lower urinary tract infection. MATERIALS AND METHODS: 60 women with acute uncomplicated cystitis were examined and treated. By random sampling, all women were divided into 2 groups of 30 people. In group 1, antibiotic therapy with Ecofomural once 1 sachet after urination was prescribed. The product contains 3G of fosfomycin and 1.5 g of prebiotic lactulose. In group 2, a similar antibacterial therapy with the enrichment of the diet with a source of D-mannose (Ecocystin) 1 sachet 1 time per day for 6 months. Evaluation of the effectiveness of antibacterial therapy was carried out on the 3rd and 7th day. It included analysis of dysuric symptoms according to diaries of urination, assessment of pain intensity, laboratory tests. Long-term results of therapy were evaluated within 6 months after taking the antibacterial drug. The examination included a comparative analysis of the frequency of relapses of the disease, filling diaries of urination and laboratory tests. RESULTS: When treated, all women showed signs of acute cystitis. On the 3rd day of therapy in both groups there was a statistically significant (p<0.05) positive dynamics of the studied parameters. By the 7th day in both groups marked relief of dysuric phenomena and pain. The number of white blood cells in the urine of all patients was within normal values. During a further 6-month follow-up, relapses of the disease were detected in 7 (23.3%) patients in group 1 and in 1 (3.3%) in group 2. Bacteriological examination in group 1 revealed the same pathogen in 5 (16.7%) cases as in the first treatment. The other women had different pathogens. CONCLUSION: The results of the study demonstrated the high efficacy and safety of complex therapy with Ecofomural containing fosfomycin and lactulose, in combination with long-term enrichment of the diet with D-mannose (Ecocystin) b in order to prolong the inter-relapse period of uncomplicated lower urinary tract infection.

[Efficiency of immunomodulatotors for complex therapy of chronic recurrent cystitis in women].

INTRODUCTION: Currently, chronic recurrent cystitis is one of the most important problems in urology. Considering the role of immune status disorders in the pathogenesis of inflammatory diseases, the use of immunocorrective drugs as part of the complex therapy is of particular relevance. AIM: to study the efficiency of therapy for chronic recurrent bacterial cystitis in combination with immunomodulators (Galavit). MATERIALS AND METHODS: A total of 60 women with acute stage of chronic recurrent bacterial cystitis were examined. The patients were randomized into 2 groups of 30 patients. In the control group, standard antibiotic therapy was administered. In the treatment group, patients received Galavit in combination with standard therapy. All patients were followed-up on the 1st, 5th and 10th day. Voiding diaries, chronobiological status and pain severity using a 5-point scale were evaluated. In addition, complete blood count, urinalysis, urine culture and enzyme immunoassay for determination of serum level of interleukin (IL) 1, IL-6, tumor necrosis factor (TNF-) were analyzed. A number of recurrences after 3 months of therapy was assessed. RESULTS: Complex therapy in combination with Galavit in women with acute stage of chronic bacterial cystitis allows to decrease in desynchronosis by 20%, reduce pain by 2.5 times, frequency of urination by 1.7 times, the number of urgent voids and night urination by 2.4 and 5 times, respectively, by the 5th day of therapy. In the group of patients receiving immunomodulators a significantly more pronounced decrease in the level of IL-1, IL-6, TNF- and CRP was noted. During 3 months of follow-up, there were 2 recurrences in the control group and no recurrences in treatment group (10%). CONCLUSION: The use of Galavit in the treatment of women with chronic recurrent bacterial cystitis has pathogenetic basis. A clear advantage of the drug is more rapid relief of symptoms, normalization of laboratory parameters, recovery of chronorhythms and the achievement of clinical remission.

[Experience of application of hormonal and probiotic therapy in the complex treatment of women in peri- and postmenopausal with chronic recurrent bacterial cystitis in the background of vulvovaginal atrophy].

INTRODUCTION: Lower urinary tract infections (LUTI) are one of the most common diseases among women. The risk of LUTI increases with the onset of peri- and postmenopause. Vulvovaginal atrophy occurs in 30% of women aged 55 years and 75% of women aged 70 years. Currently, local hormone therapy is the main method of its treatment. However, different variants of complex therapy are also used. MATERIALS AND METHODS: The study included 60 women aged with the diagnosis: "Postmenopausal atrophic vaginitis. Chronic recurrent bacterial cystitis in the acute stage". The patients were divided into 2 groups of 30 people. In group 1 was carried out etiotropic antibiotic therapy in combination with local use of single-agent preparation or estriol for 3 months. In group 2, the patients received antibiotics in combination with Triozhinal for 3 months. The effectiveness was monitored on the 1st and 7th day of therapy, as well as 3 months after the start of treatment. RESULTS: At admission in both groups there were signs of vulvovaginal atrophy and exacerbation of chronic cystitis. Complex therapy with Triozhinal, containing lyophilized culture of lactobacilli L. casei rhamnosus Doderleini, contributed to the normalization of PH, restoration of vaginal biocinosis, and, consequently, reduce the severity of complaints of dryness and burning in the vagina, dyspareunia. Thus, despite the reduction of symptoms in the majority of women, the proportion of such patients in group 2 was higher and amounted to 96.7% against 83.3% in group 1. Supportive reception of the drug for 3 months. it allowed to preserve the normocinosis of the vagina until the restoration of its trophic, as well as to reduce the frequency of bacteriuria and leukocyturia by 20% compared with the results of group 1, and to significantly reduce the number of relapses of infection (p<0.05). CONCLUSION: Triozhinal improves the results of treatment of recurrent urinary infection in women with vulvovaginal atrophy in peri- and postmenopausal and can be recommended for use in combination therapy.

[Efficiency of fosfomycin trometamol for treatment of acute uncomplicated cystitis].

INTRODUCTION: Acute cystitis is the most common type of uncomplicated urinary tract infection. A choice of antibiotics for the treatment depends not only on the spectrum of antimicrobial activity against pathogens, but also on the pharmacokinetic properties, due to high urine concentration after single or double use is needed. In addition, high safety profile and acceptable cost are important. Fosfomycin is one of the drugs whose efficiency in treating of patients with lower urinary tract infection is proved. It has been on the pharmaceutical market for a long time and is widely used in urologic practice. There is a risk of a decreasing of efficiency of fosfomycin, considering sustained downward trend in the sensitivity of uropathogens. This causes a need to monitor the resistance of main uropathogens to fosfomycin. In this article our experience of using of fosfomycin for the treatment of women with acute uncomplicated cystitis is presented. AIM: to evaluate an efficiency of fosfomycin trometamol for treatment of women with acute uncomplicated cystitis. MATERIALS AND METHODS: During the period from September to November 2018, we performed an examination and treatment of 57 women with acute uncomplicated cystitis aged from 19 to 40 years. All patients were prescribed 1 sachet of Fosfomycin Esparma (fosfomycin trometamol) after urination. The examinations were carried out on the 1st, 3rd and 7th day, including an evaluation of urination frequency, urgency, nocturia and pain intensity. In addition, urinalysis and urine culture using solid media with determination of the type of pathogens, sensitivity to antibiotics and the level of bacteriuria were also performed. RESULTS: Baseline, all patients had complaints of pain in the bladder, urethral discomfort and frequent urination, but passing only small amount of urine. All women had leucocyturia and bacteriuria. By the 3rd day after receiving fosfomycin, urinary disturbances persisted in 22.8% patients and 17.5% of women still described pain. Mild leucocyturia was determined in 42% cases. Urine culture was negative. By the 7th day after the start of therapy, all clinical and laboratory data were returned to the normal values in all patients. CONCLUSION: Based on the results of our study, we recommend the fosfomycin as the first-line treatment of uncomplicated lower urinary tract infection due to broad spectrum, low resistance of uropathogens, high safety profile and good compliancy.

[The effectiveness of complex phytotherapeutic medications in the management of uncomplicated lower urinary tract infections in women].

INTRODUCTION: Lower urinary tract infections (LUTI) are the most common urological diseases. Fosfomycin is one of the antibiotic agents with proven efficacy that are most frequently used to treat UTIs. Despite the high effectiveness of antibiotic therapy with this drug, in some patients, the LUTIs persist or recur. It is advisable to prevent the development of recurrent infections using herbal preparations. The study aimed to evaluate the effectiveness of integrated treatment of women with acute uncomplicated cystitis using the plant-based medication Phytolysin. MATERIALS AND METHODS: The study comprised 63 women with acute uncomplicated cystitis, who were randomly assigned to two groups. The women in the control group (n = 31) received a single 3-g dose of fosfomycin. In the study group (n = 32), women received a single 3-g dose of fosfomycin and Phytolysin according to the manufacturers instructions three times daily for a month. The examination was performed on admission and on days 3, and 7, and included daily filling out voiding diaries, a 5-point verbal assessment of pain, urinalysis and urine culture. During the next three months, cases of recurrence were registered, and bacteriological analysis of urine was conducted. RESULTS: On admission, all patients complained of pain in the projection of the urinary bladder, frequent urination in small portions, and a sensation of urethral discomfort. All women had leukocyturia and bacteriuria. By the 3-rd day after taking fosfomycin, both groups showed similar improvement in the clinical manifestations of the disease. All urine cultures were negative. By the 7th day after the initiation of therapy, the patients in the study group had normal laboratory parameters and no clinical manifestation of LUTI, while in the control group leukocyturia (p <0.05) persisted. During a 3-month follow-up, recurrence of LUTI was observed in 6 (19.4%) and 3 (9.4%) patients in the control and study group, respectively. Also, bacteriological studies of urine showed the same pathogen as on admission in 5 (16.1%) and 1 (3.2%) patients of the control and study group, respectively. CONCLUSION: Phytolysin can be recommended for use in the integrated management of acute uncomplicated cystitis, as well as a means of preventing recurrences of this disease.

[Chronobiological features of different regimens of testosterone gel therapy in men with androgen deficiency].

INTRODUCTION: Androgens play a key role in the male development. All the physiological processes in the body, including the production of testosterone, have their chronobiological features. Aging is accompanied by a disruption in the regulation of chronobiological processes. With androgen deficiency, these changes occur at any age. In recent years, transdermal forms of testosterone have become very popular in the treatment of this condition. AIM: To evaluate the effectiveness and chronobiological features of various regimens of testosterone gel therapy for external use in men with androgen deficiency. MATERIALS AND METHODS: The study comprised 90 men aged 45 to 60 years with testosterone deficiency. Patients were randomized into three groups of 30 people each. In group I (control) patients received basic therapy, including exercise, diet, and multivitamins. In group II, patients received basic therapy concurrently with testosterone gel for external use (Androgel) at a daily dose of 5 g (1 sachet). Patients in group III were administered basic therapy in combination with 10 g testosterone (2 sachets). The effectiveness of treatment was assessed at 3 (visit 2) and 6 (visit 3) months. Depending on the results of visit 2, a correction of therapy was carried out, if necessary. During each visit, the patients underwent evaluation, including hematocrit, levels of FSH, LH, prolactin, total testosterone, blood SHBG, waist circumference, and body weight. Patients completed the ICEF-5 questionnaire, the Hamilton scale (HDRS, HARS), and the SF-36 questionnaire. We also tested the patients for the chronobiological status and desynchronosis. RESULTS: During the visit I, the homogeneity of the study population was confirmed. At three months, the patients of groups II and III showed a more pronounced increase in testosterone, a decrease in body weight and waist circumference, as well as an improvement in the psycho-emotional status and quality of life according to the questionnaires. Desynchronosis persisted in 25 (83.3%), 9 (30%), and 4 (13.3%) patients in groups I, II, and III, respectively. Given the findings, the treatment was adjusted. The patients in the groups were divided into subgroups A and B. In subgroups A, patients continued to receive initial therapy, and in subgroups B, the treatment was adjusted. At six months, the level of GT increased to normal values in all subgroups except subgroup IA. The most marked reduction in body weight and waist circumference was noted in subgroups IA, IIA, and IIIB. A significant decrease in the average scores on the HDRS and HARS scales and an improvement in the SF-36 scale were observed in the subgroups IA, IIA, IIIB. Desynchronosis persisted in 3, 2, and one patient in subgroups IB, IIB, and IIIA. CONCLUSION: The testosterone gel therapy in patients with androgen deficiency can effectively reverse the manifestations of the disease and normalize the chronorhythm. Transdermal testosterone gel at a daily dose of 5 g in the morning can be recommended to alleviate clinical manifestations of the disease and eliminate desynchronosis in this category of patients. In patients with low baseline testosterone levels, it is advisable to administer the drug at a daily dose of 10 g.

[Combination drug therapy in patients with BPH].

Introuction. One of the risk factors for LUTS is an infravesical obstruction, which is most often caused by benign prostatic hyperplasia (BPH). BPH symptoms are formed due to three components: static (mechanical), dynamic, and impaired functional capacity of the bladder. Medical treatment with 1-blockers decreases the outflow obstruction. 5-alpha reductase inhibitors are used to inhibit the static component of BPH. AIM: To investigate the effectiveness of various modifications of medical therapy of BPH using -blockers and 5-reductase inhibitors and combinations thereof. MATERIALS AND METHODS: The study comprised 90 BPH patients who were divided into three groups, with each group containing 30 people. Patients of group I, II and III received monotherapy with -blockers, a combination of 5-reductase and -blockers, and fixed-dose combination drug Duodart, respectively. Evaluation of the treatment effectiveness included filling out voiding diaries, completing the I-PSS and QL questionnaires, uroflowmetry, transrectal ultrasonography of the prostate and estimation of the incidence of adverse effects. Also, compliance with the treatment was evaluated, and the number of patients who had episodes of acute urinary retention and required surgical treatment during the 12 month treatment course was registered. RESULTS: Compared to monotherapy, combination therapy with -blockers and 5-reductase inhibitors more effectively reduces the LUTS, increases Qmax and prevents the disease progression, which manifests in a lower incidence of AUR and fewer surgical interventions in groups II and III. However, the combination therapy can be associated with some side effects. Patients who received fixed-dose combination drug Duodart had a greater compliance rate than patients on the combination of drugs, which, in our opinion, is associated with fewer cases of AUR and surgical interventions. CONCLUSION: The use of Duodart in patients with BPH effectively alleviates LUTS and reduces the risk of the disease progression, which manifests itself in a reduced number of complications and thereby contributes to improving the quality of life of patients.