[Clinical guidelines for male infertility: controversial issues and the need to reach interdisciplinary consensus].

A review of controversial issues about the terminology on male infertility and reproductive function, which is currently used, as well as proposals for updating clinical guidelines for the diagnosis and treatment of male infertility and men in infertile couples are presented in the article. An algorithm is described, the elements of which ensure referral of patients based on the possibility and timing of restoration of reproductive function, taking into account the reproductive health of a woman, as well as increasing the likelihood of successful treatment aimed at the birth of a healthy child.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[Russian experience with Vitaprost Forte suppositories in patients with lower urinary tract symptoms and benign prostatic hyperplasia: comparative analysis of studies].

The article reviews the domestic studies showing the efficacy and safety of suppositories containing prostate extract (Samprost substance) Vitaprost Forte in treating men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The data obtained by Russian specialists confirm the effectiveness of Vitaprost Forte suppositories in managing patients with moderate LUTS and infravesical obstruction caused by BPH to reduce dysuria, improve the quality of life and normalize urodynamic parameters.

[Epidemiology of urinary disorders in men in the Russian Federation].

AIM: To compare the results of population studies conducted in the Russian Federation to identify the prevalence, severity and risk factors for urinary disorders in men. MATERIALS AND METHODS: Data of a survey of 1083 men were analyzed for the age, weight, height, comorbidities with their signs and symptoms, history of surgery on pelvic organs, copulative disorders, and IPSS and quality of life scores. The findings were compared with the results of a survey of 482 Russian men under the protocol of the International Society of Continence (ICS) aimed to identify patients with overactive bladder (OAB), in whom pollakiuria, nocturia, urgency, urinary incontinence, stress-incontinence, poor flow and terminal dribbling were registered. RESULTS: According to findings on IPSS scores voiding disorders were diagnosed in 649 (59.9%) of respondents, with mild, moderate and severe lower urinary tract symptoms (LUTS) in 370 (34.2%), 216 (19.9 %) and 63 (5.8%) men, respectively; mean IPSS score was 5,0+/-7,0. Among men with LUTS 34.6% were not satisfied with their quality of life. The severity of LUTS was greater among older respondents (B = 0,441; p<0,001), having a high body mass index (B = 0,119; p<0.001), ischemic heart disease (B = 0,231; p<0,001), hypertension (B = 0,240; p<0,001), diabetes mellitus (B = 0,158; p<0,001), obesity (B = 0,151; p<0,001), history of surgery on pelvic organs (B = 0,259; p<0,001), suffering from erectile dysfunction (B = 0,126; p<0,001). 116 (24.1%) men surveyed under ICS protocol had LUTS consistent with OAB criteria. Symptoms of urine storage, emptying and post-micturition symptoms were found in 299 (62%), 164 (34%) and 106 (22%) patients, respectively and were more common in older men. 236 (48.9%) of respondents experienced discomfort or pain, in 72 (15%) - LUTS resulted in decreased sexual activity, but only 149 (30.9%) of men sought treatment. CONCLUSIONS: LUTS in Russia are common among men of any age. They reduce the quality of life, closely associated with erectile dysfunction, metabolic disorders and diseases. Men with urinary disorders need a comprehensive examination and treatment based on an interdisciplinary approach.

[SILDENAFIL CITRATE DOSE ADJUSTMENT FOR MEN WITH ERECTILE DYSFUNCTION: PERSONALIZED APPROACH].

The high prevalence of erectile dysfunction (ED) in men of all age groups with different psychogenic and organic disorders requires a personalized approach to the choice of treatment. Widely prescribed as first-line treatment for ED, sildenafil can be used in various dosages that are selected depending on comorbidities, tolerability and efficacy of the drug. Currently there is a wealth of accumulated experience of sildenafil dose adjustment depending on the severity of ED, its etiology and duration, as well as matched to the individual characteristics of copulatory activity. Divisible tablets Tornetis® ("Sandoz") give the opportunity to choose an effective and safe dose of sildenafil for of all patients with ED.

[Determinants of risk of the development of erectile dysfunction in the Russian Federation: analysis of epidemiological studies].

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

[Levitra (oral dispersible tablet)--an innovative drug for the treatment of patients with erectile dysfunction].

The arsenal of professionals providing assistance to men with erectile dysfunction includes a new, mouth dissolving dosage form of the vardenafil--levitra ODT. This form is effective, safe, and has a higher bioavailability as compared to vardenafil in the form of coated tablets. POTENT I and POTENT II studies revealed that levitra ODT equally successfully corrects erectile dysfunction in men younger and older than 65 years regardless of concomitant diseases and metabolic disorders: hypertension, diabetes, dyslipidemia. In addition, it was found that this drug helped to successfully carry out sexual intercourse in the first 15 minutes after dosing in 62.5% of patients. This allows to widely recommend levitra ODT for the treatment of erectile dysfunction in young men and older men.

[The prognostic value of KI-67 proliferation index in transitional cell carcinoma of renal pelvis and ureter].

The investigation deals with Ki-67 immunoreactivity assay in upper urinary tract transitional cell carcinoma (TCC) with respect to grade, stage and survival after radical surgery. In a retrospective study (5yrs) of 37 patients with TCC of the renal pelvis and ureter, who had undergone radical nephroureterectomy and bladder resection, pT1-pT4 lesions and G1-G3 tumors were identified. Ki-67 expression was evaluated by immunohistological staining (1:100; MIB-1; Immunotech. Inc., Westbrook, USA). By using fifteen x600 visual fields, Ki-67 labeling index (number of positive cells per 100 tumor cells) was found (mean +SD--29.7 +/- 9.22). There was a correlation between the index and tumor stage (p < 0.001) and grade (p = 0.002). The Ki-67 values in excess of 27 corresponded to high risk of bladder recurrence (p < 0.001) and short duration of recurrence development (p = 0.067) whereas, for the index of under 22, five-year progression-free survival was more frequent (p < 0.001). Having been tested in that study, discriminative modeling yielded the following parameters: sensitivity and specificity for bladder recurrence was 93% and 79% while for 5-year progression-free survival- 89% and 100%.

[Sexual dysfunction in males with concomitant urological diseases].

A clinical data was studied for 117 males without complaints for copulative disorders admitted to urological clinic electively for benign prostatic hyperplasia (BPH)--44 (37.6%), urolithiasis--25 (21.4%), external genital diseases--17 (14.5%), renal cyst and hydronephrosis--16 (13.7%), renal and vesical tumors--15 (12.8%). Mean age of the patients was 56.2 +/- 16.1 years. The patients filled in IPSS and IIEF questionnaires. Mean score set (+/-SD) for IIEF and IPSS was 35 +/- 23 and 12 +/- 10, respectively. The majority of the patients (n = 61) were not sexually active. Erectile dysfunction (ED) was detected in 23 (19.7%) patients: mild and moderate in 19 (16.2%) and 4 (3.4%), respectively). 24 (73%) patients with normal erectile function, 10 (44%) patients with ED and the majority (n = 37) of sexually inactive men were satisfied with their sexual activity. Those males who needed improvement of sexual life quality had higher (p < 0.05) parameters of erectile function and sexual satisfaction. Age of the patients (R2 = 33.1; p < 0.0001) and IPSS index (p < 0.015) were leading indices in determining condition of the copulative function. IIEF correlated with tumors of the kidney or urinary bladder (p < 0.004) and benign prostatic hyperplasia (p < 0.015). Erectile dysfunction in men with urological diseases was closely related with age and severity of lower urinary tract symptoms. Other sexual disorders may be due both to general causes and urological diseases.

[Argentophilic nucleolar organizers and prognosis for patients with surface and locally advanced transitional cell cancer of the urinary bladder].

The aim of the study was to estimate distribution of the nucleoli and argentophilic nucleolar organizers in surface and locally advanced transitional cell tumors of the urinary bladder (TCTUB), to analyse correlation between this distribution, tumor recurrence and survival of the patients. The data on primary examination and 5-year follow-up of 61 patients (47 male and 14 female, mean age 64 +/- 1 year) with surface and locally advanced TCTUB were studied retrospectively. All the patients were radically operated on, 5-year progression-free survival made up 62%, recurrences of the urinary bladder tumors were detected in 61% patients. In addition to the standard morphological examination, tumor tissue was stained with silver nitrate according to the Howell and Black technique and the number of the nucleoli and argentophilic granules in them was counted in magnification 1000. The findings were compared with the invasion depth, grade of cancer differentiation, tumor recurrence and 5-year survival. The count of argentophilic granules increased with reduction of differentiation grade and an increase of cancer invasion depth. Distribution of the nucleoli and granules significantly differed in the subgroups of patients with recurrent and recurrence-free course of the disease, depending on 5-year survival without progression. Probable duration of the recurrence-free period was estimated best by coefficient of variation of argentophilic granules distribution (p = 0.001). Parameters of distribution of the nucleoli and granules allowed specification of the risk of tumor progression for 5 years for all the patients (p = 0.035) and patients with surface tumors (p = 0.007) irrespective of categories T and G. Thus, the number of nucleoli and argentophilic nucleolar organizers increases with lowering of differentiation and deepening of tumor invasion. The analysis of nucleoli and argentophilic granules distribution provides additional information on recurrence and transient cell carcinomas probability.

[Study of nucleolar organizer regions in chromosomes of bladder cancer]. / Izuchenie iadryshkoobrazuiushchikh raionov khromosom v kartsinomakh mochevogo puzyria.

The data on tumor at presentation and 5-year follow-up after surgery for urinary bladder cancer were assessed retrospectively in 62 patients, with particular emphasis on nucleolar distribution revealed by silver staining. A close relationship was found between mean values and even distribution of argentaffine granules and nucleoli in tumor cells, on the one hand, and morphological features of carcinoma and clinical course, on the other. Also, correlations were established between distribution of nucleoli, nucleolar organizer regions and histological pattern (p=0.001), stage (p=0.013), grade (p=0.001), multiplicity (p=0.001), size (p<0.001), localization (p=0.005), frequency (p=0.014), period (p<0.001) and 5-year relapse-free survival (p=0.021). Grade and stage of disease appeared to be pivotal to tumor progression. Favorable course was reported when mean values of number of nucleoli and standard error of argentaffine granule distribution in tumor cells were less than 1.65 and 4.4. respectively. Relapse-free time was the shortest when coefficient of variation of distribution of argentaffine granules and nucleoli in tumor cells exceeded 42%.

[Prognostic implication of morphometric stromal parameters of renal pelvis and ureteral transitional cell carcinomas]. / Prognosticheskoe znachenie morfomekhanicheskikh parametrov stromy prekhodno-kletochnykh kartsinom lokhanki pochki i mochetochnika.

To evaluate prognostic value of morphometric studies of the stroma of transitional cell carcinomas of the renal pelvis and ureter, we studied retrospectively the data of primary examination and follow-up of 75 patients (49 males, 65% and 26 females, 35%; mean age 61.9 +/- 1.2 years) given radical surgical treatment for cancer of the renal pelvis and ureter. Five-year survival in the absence of tumor progression was 23%. Morphological examination diagnosed transitional cell carcinoma with invasion pT1, pT2, pT3 and pT4 in 3(4%), 15(20%), 47(63%) and 10(13%) cases and differentiation degree G1, G2, G3 in 31(41%), 15(20%) and 29(39%) cases, respectively. In addition to the standard morphological examination of the tumor, we made morphometry of stromal and tumor area, analysed composition and count of stromal effector cells (lymphocytes, eosinophilic and neutrophilic leukocytes, macrophages, mast and plasmic cells), the degree of stromal vascularization. Prognostic value of the above parameters was estimated according to significance of their correlation with postoperative survival of the patients. The survival correlated with the depth of cancer invasion (p = 0.005) and differentiation of tumor tissue (p = 0.006), high cell infiltration of tumor stroma is prognostically unfavourable (R2 = 0.03; F = 3.41; p = 0.069) as well as weak presentation of stromal component of the tumor (p = 0.056). The lowest survival was observed in patients with cancer of the renal pelvis and ureter with a great number of mast cells (p = 0.056), macrophages (p = 0.037) and neutrophils (p = 0.029) in the tumor stroma. According to the results of multiple regression analysis (R2 = 0.08; F = 5.42; p = 0.024), five-year postoperative survival most closely correlated with cancer invasion depth (p < 0.001), degree of tumor cells differentiation (p < 0.001) and number of macrophages infiltrating tumor stroma (p < 0.001). Significance of survival prognosis for patients with cancer of renal pelvis and ureter can be raised by estimation of mean number of free stromal cells and expression of stromal component.