[Clinical immunological rationale of interferon therapy in chronic bacterial prostatitis].

The study of changes in the immune status of patients with chronic bacterial prostatitis demonstrated changes in immunological parameters reflecting depression of the immune system (subnormal levels of interferon alpha, gamma, sIgA, functional activity of neutrophils, high concentration of IgA, IgG, IgM). Thus, combined treatment of chronic bacterial prostatitis must include administration of immunomodulators.

[Vitaprost plus in the treatment of chronic bacterial prostatitis].

Our study has demonstrated that compound medicine vitaprost plus in therapy of chronic bacterial prostatitis (CBP) reduces intensity of prostatic inflammation, significantly relieves symptoms of chronic prostatitis and pain syndrome. The absence of unwanted side effects, significant changes in clinical and biochemical blood and urine parameters evidences for good tolerance and safety of the drug. Thus, rectal suppositories vitaprost plus can be recommended for treatment of chronic bacterial prostatitis caused by both gram-positive and gram-negative bacteria in patients of different age and clinical symptoms.

[Administration of oral vitaprost for prevention of exacerbations of chronic abacterial prostatitis].

Active substance of vitaprost is a complex of water-soluble biologically active peptides isolated from bovine prostate. The prostatic extract has an organotropic action in relation to the prostate. As all peptide bioregulators, prostatic extract has antiaggregant and anticoagulant properties, enhances synthesis of antihistamine and antiserotonine antibodies, improves microcirculation in the prostatic gland. This accounts for its ability to reduce edema in prostatic inflammation. This clinical trial demonstrated that vitaprost tablets decreases twice probability of chronic prostatitis exacerbation, of development of secondary exacerbations. A prophylactic intake of vitaprost relieves symptoms of chronic prostatitis, first of all pain (discomfort), improvement of quality of life by NIH-CPSI, including exacerbation and significantly reduces size of the prostate. Vitaprost tablets can be effectively used prophylactively in chronic prostatitis for reducing probability of the disease exacerbations and their severity.

[Vitaprost forte in the therapy of patients with prostatic adenoma].

Active substance of the drug vitaprost is a complex of water-soluble biologically active peptides isolated from bovine prostatic gland. Prostatic extract has an organotropic effect in respect to the prostatic gland. It inhibits proliferative activity of cells and, therefore, development of prostatic adenoma, reduces edema and inflammation activity in prostatic diseases. Our study has shown that rectal suppositories vitaprost forte, as monotherapy of prostatic adenoma, produces a statistically significant moderate decrease of prostate size. The resultant infravesical obstruction also diminished this manifesting with increased maximal and mean volumetric urine flow rate and low volume of residual urine. A decline in obstructive and irritative symptoms due to vitaprost forte was confirmed by IPSS scores showing deterioration of quality of life. Rectal suppositories vitaprost forte can be used as monotherapy of prostatic adenoma in patients with moderate infravesical obstruction irrespective of age and concurrent diseases.

[Use of oral vitaprost in the treatment of chronic abacterial prostatitis].

An open trial performed in 2001 by the Research Institute of Urology has demonstrated good efficacy and safety of rectal suppositoria Vitaprost, the active substance of which is a complex of water-soluble biologically active peptides isolated from bovine prostate, in combined treatment of chronic bacterial and abacterial prostatitis in patients of all ages including those with concomitant adenoma. Current comparative clinical trial has shown that Vitaprost tablets in combination with nonsteroid anti-inflammatory drugs effectively treat prostatic inflammation in patients with chronic abacterial prostatitis, produce more potent and stable effect than monotherapy with ketonal. The absence of side effects and negative alterations in clinical and biochemical blood and urine parameters evidences for good tolerance and safety of Vitaprost tablets. Vitaprost tablets can be used in therapy of chronic abacterial prostatitis for raising efficacy of the standard treatment in patients of different ages and having associated diseases.

[Impase in the treatment of erectile dysfunction].

The authors review epidemiology, classification, etiology and pathogenesis of erectile dysfunction (ED), its diagnosis and treatment with a focus on mechanisms of action and efficacy of the drug impase. Impase is the drug of superlow doses of affinitively purified potentiated antibodies to human endothelial NO-synthase. The drug regulates NO synthesis in the cavernous bodies, enhances an NO relaxing action on their smooth muscles and blood flow in the penis under sexual stimulation. The drug demonstrated its high efficacy and safety in many clinical trials. Impase trial performed in the Research Institute of Urology in 2004 has found that impase is more effective in long-term administration, most of the examinees exhibited a clinical response only after one month of regular intake. The drug can be used both as the first-line monotherapy of ED and combined treatment of this disease. Clinical recommendations for practitioners on administration of impase are provided.

[Use of proscar in preoperative preparation of patients with benign prostatic hyperplasia before transureteral resection]. / Primenenie proskara v kachestve predoperatsionnoi podgotovki bol'nykh s dobrokachesvennoi giperplaziei prostaty pered transuretral'noi rezektsiei.

Effects of proskar-MSD used before transurethral resection (TUR) of the prostate in patients with benign prostatic hyperplasia (BPH) were studied with specification of the drug action on hematuria during and after operation. Patients with histologically verified BPH received proskar for 3 and 6 months in a dose of 5 mg/day. Control patients did not receive preoperative proskar. Of patients who received proskar for 3 months, TUR with estimation of the intraoperative blood loss and changes in microcirculation and structure of prostatic tissue induced by proskar was made in 20 patients (mean age 68 years). A 3-month course of proskar reduced prostatic volume and its hyperplasia by 18-20 cm3, on the average. Mean blood loss was about 111 ml vs control 223 ml. Dopplerography revealed consolidation of adenomatous tissue and decline of volumic blood flow in the prostate after 3-month proskar course. Thus, preoperative proskar administration before TUR of prostatic adenoma results in sclerosing of prostatic tissue, decrease of microcirculation manifesting intraoperatively with diminished hematuria and less number of subsequent complications; promotes a favourable outcome of the operation; improves life quality.

[Operative treatment of benign prostate hyperplasia: modern aspects]. / Sovremennye aspekty operativnogo lecheniia dobrokachectvennoi giperplazii predstatel'noi zhelezy.

A retrospective analysis was made of the treatment results for the last 5 years of 879 patients with benign prostatic hyperplasia (BPH), 214 (24.3%) of whom had undergone transvesical adenomectomy while 665 (75.7%) had undergone transurethral resection (TUR) of the prostate. Adenomectomy had rather high effectiveness but was less safe than endoscopic intervention (higher lethality, more frequent development of myocardial infarction, pulmonary artery thromboembolism, postoperative hemorrhage). Patients operated for BPH are at risk of postoperative urethral stricture and sclerosis of urinary bladder cervix. Prebladder and postoperative stress urine incontinence appear only after open operations in BPH.

[Transurethral radiofrequency thermal destruction as the method of choice in patients with benign prostatic hyperplasia with a high degree of surgical risk and the presence of a cystostoma (or pronounced infravesical obstruction with preserved micturition)]. / Transuretral'naia radiochastotnaia termodestruktsiia kak metod vybora u bol'nykh dobrokachestvennoi giperplaziei prostaty s vysokoi stepen'iu operatsionnogo riska i nalichiem tsistostomy (ili vyrazhennoi infravezikal'noi obstruktsii pri sokhrannom mocheispuskanii).

The authors employed transurethral radiofrequency thermodestruction (TRT) in 27 BPH patients with infravesical obstruction and grave somatic status excluding radical surgery. 17 of them had cystostomic drainage. A single procedure was not long and ran without general anesthesia. In patients able to urinate objective and subjective improvement was recorded, in those with cystostomic drainage suprapubic fistula was eliminated in 10 patients. In some cases TRT produced the results comparable to transurethral resection of the prostate. TRT complications comprise mainly infection and inflammation (11.1%). By efficacy and safety TRT occupies an intermediate position between thermotherapy and prostatic transurethral resection. This method is alternative in BPH patients with cystostoma and severe associated diseases.

[Features of transurethral electric resection of the prostate in patients undergoing thermal treatment]. / Osobennosti transuretral'noi élektrorezektsii prostaty u bol'nykh perenesshikh termal'noe lechenie.

23 patients with benign prostatic hyperplasia (BPH) aged 60-82 years underwent transurethral resection (TUR) of the prostate in different periods after thermal treatment which had appeared uneffective or brought complications. In the performance of the endoscopic techniques we found macroscopic changes of the prostatic parts of the urethra and bladder cervix characteristic for certain thermal impact (energy, power, site of exposure). Intraoperative bleeding of prostatic tissue was also different depending primarily on the time which had passed after the thermal treatment. Minimal bleeding occurred at least 3 months after the thermotherapy. Thus, thermal treatment of the prostate can be used in combined treatment of BPH for reducing intra- and postoperative hemorrhage due to subsequent TUR. Among the methods of thermal therapy, transurethral microwave thermotherapy is preferable as minimally invasive and deeply penetrating into the depth of the prostatic gland with maximal effect. TUR of the prostate should be performed not earlier than 3 months after thermotherapy which is indicated only for patients at high risk of intraoperative hemorrhage because of unaffected circulation. Therefore, it is desirable to include transrectal dopplerography of the prostate to urological examination of BPH patients.