[Efficacy of 5-reductase inhibitors in the treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia].

In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.

[Efficiency of phosphodiesterase-5 inhibitors for treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia and concomitant erectile dysfunction].

Lower urinary tract symptoms (LUTS) in combination with benign prostatic hyperplasia and erectile dysfunction are more common than commonly thought. Unfortunately, urologists often dont ask about concomitant erectile dysfunction in patients with irritative or obstructive symptoms, which leads to the progression of underline disease, a deterioration in the quality of sexual life, and, as a result, overall quality of life. The relevant studies of recent years dedicated to feasibility of using tadalafil 5 mg a day are analyzed in the article. In addition, the results of scientific work conducted on the Department of Urology and Andrology of Faculty of Fundamental Medicine of Lomonosov Moscow State University, whose aim was to study the efficiency of phosphodiesterase-5 inhibitors in patients with LUTS of varying severity in combination with other types of drugs, are presented. Tadalafil in a dose 5 mg leads to a decrease in the severity of LUTS, as confirmed by a decrease in the mean I-PSS score by 2.19 points in the presented studies. No significant changes were found in Qmax (>0,05). We also proved in our work that phosphodiesterase-5 inhibitor can supplement any combined therapy for benign prostatic hyperplasia in the case of concomitant erectile dysfunction. Tadalafil in a dose 5 mg once a day can be recommended as monotherapy for patients with moderate LUTS caused by benign prostatic hyperplasia with concurrent erectile dysfunction, as an alternative to conventional treatment schemes.

[Herbal preparations and microelements as alternative therapy in benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction].

The aim of the work is to provide a current view on the efficiency of the components of dietary supplement Antiprost for the treatment of urological diseases. The study results on the influence of the dietary components of supplement Antiprost are presented in the article in according to principles of evidence-based medicine. Antiprost can be used in the routine urological practice in specific situations, e.g., if patient refuses from the conventional treatment in BPH/LUTS/ED for any personal reasons, or in case of individual intolerance of standard drugs. Randomized clinical trials should be performed for further studying of the efficiency of dietary supplement Antiprost.

[A role of fructose in urinary stone formation].

Obesity is one of the actual problems of modern medicine. The comorbid conditions in patients with obesity and metabolic syndrome have no less important value, attracting the attention of scientists and clinicians. Renal stone disease is one these diseases. We are interested in its development, which is directly related to the effect of excess amounts of such a monosaccharide, as fructose. For quite a long time, this carbohydrate was considered to have only positive properties, including its role in carbohydrate metabolism in general, and, in particular, in diabetes mellitus. Over the years, a pathological effect of excess fructose was detected. Since fructose was used to replace glucose, and accordingly, its amount in food, and especially in diabetic foods, was growing. In addition, the industrial production of corn-based fructose has become much less expensive than the production of sucrose, which has also contributed to the increased use of this monosaccharide in the food industry. In this article, the mechanisms leading to the development of pathologies which are associated with the excessive use of fructose, increase in the level of uric acid with subsequent formation of uric acid stones, are reviewed. Thus, the study of the effect of fructose on the pathogenesis of renal stone disease is interesting and extremely relevant, since for many specialists, it is animal protein that is associated with the development of kidney stone disease and the role of fructose is not only unobvious, but is also a revelation.

[Changes in the concentration of urolitiasis markers depending on stone-forming activity in patients with recurrent urolithiasis].

The study aimed to investigate the changes in the concentration of bikunin, osteopontin, and nephrocalcin, depending on the changes in the renal stone-forming activity in patients with recurrent urolithiasis. MATERIALS AND METHODS: The study comprised 152 patients with recurrent calcium oxalate stones at various localizations. Patients of the study group (n=78) were administered complex preventive treatment (water load, Blamaren, thiazide diuretics, oral calcium supplementation) aimed at reducing the activity of urolithiasis. Patients of the control group (n=74) received no treatment. The studied parameters included concentrations of urine bikunin, osteopontin, and nephrocalcin in using ELISA. The follow-up period was six months. RESULTS: By the end of the follow-up, the bikunin concentration in the control group was significantly higher than in the study group (7.0+/-0.81 mg/ml vs. 3.28+/-0.86 mg/ml, respectively, p<0.05) while osteopontin level was significantly lower (2.4+/-0.39 mg/ml vs. 3.4+/-0.36 mg/ml, p<0.05). The nephrocalcin concentrations during the follow-up period did not change significantly (p>0.05). The presence of hypercalciuria did not lead to significant changes in the concentration of stone formation inhibitors. DISCUSSION: The increase in bikunin concentration in control patients is associated with an increase in the expression of this stone formation inhibitor due to the rise in the urolithiasis activity. Reduction in the osteopontin concentration in patients with high urolithiasis activity is a consequence of osteopontin being a constituent of calcium oxalate stones. CONCLUSION: In patients with calcium oxalate urolithiasis, testing for urine concentrations of bikunin and osteopontin as potential markers can be used to estimate the risk of stone recurrence.

[Antioxidative activity and clinical efficiency of dietary supplements Nefradoz for treatment of recurrent calcium oxalate urolithiasis].

AIM: to evaluate antioxidant properties of dietary supplements Nefradoz, as well as its role in the prevention of calcium oxalate stones. MATERIALS AND METHODS: Our study consisted of two parts, clinical and experimental. In the clinical trial a total of 80 patients with recurrent calcium oxalate urolithiasis of various localization were included. All patients were divided into 2 groups. In treatment group (n=45) patients received Nefradoz 1 capsule 2 times a day. In control group (n=35) no treatment was prescribed. In all patients a biomarkers level (bikunin, osteopontin, nephrocalcin) in urine was determined by ELISA. In addition, Litos-test was performed. Follow-up duration was 6 months. In the experimental part of the study, the antioxidant properties of Nefradoz were evaluated using chemiluminescence method. RESULTS: The antioxidant activity of resveratrol, which is contained in 300 mg Nefradoz (1 capsule), was 23.66+/-1.18, which corresponds to the moderate activity. After 6 months of therapy a level of bikunin and osteopontin did not significantly changed, which indicates a minimal risk of stone recurrence. According to the Litos-test, the activity of stone formation in Nefradoz group significantly decreased to minimal values in 42 out 45 patients (p<0.05). In the control group an excretion of biomarkers was minimal, which significantly increased the risk of stone formation. CONCLUSION: Dietary supplement NefraDoz can be used for prevention of calcium oxalate urolithiasis in case of increased stone formation according to the Litos-test. The antispasmodic, uroseptic and diuretic effects allow to maintain the effective level of biomarkers which is required for a recurrence-free course of urolithiasis compared to the control. The antioxidant activity, primarily determined by the resveratrol, can sufficiently compensate for oxidative stress and prevent the development of calcium oxalate stone. Further studies are needed to confirm our results.

[The role of the Randalls plaques in the pathogenesis of recurrent urolitasis].

The aim of the work was to present current concept of the pathogenesis of urolithiasis. Treatment and prevention of this disease a challenging issue. The article presents basic information about Randalls plaques that are described as calcium salt deposits on the surface of the transitional cell epithelium. The cause of Randalls plaques was the subject of many studies and is still not completely clear. To date, we can state that the deposit formation starts in the pelvicalyceal system and is directly linked to recurrent urolithiasis. The discovery of Randall plaques in the 1940s transformed the conception of stone formation, but there are even more questions about the pathogenesis of urolithiasis. In that respect, we consider it important to analyze the studies on Randalls plaques.

[PROSPECTS FOR THE TREATMENT OF IDIOPATHIC AND NEUROGENIC OVERACTIVE BLADDER].

Overactive bladder (OAB) is a common problem in modern population. The main line of medical treatment of this condition is the use of M-cholinoblockers. Solifenacin has shown high selectivity for the bladder in preclinical studies. Data on the efficacy and safety of high-dose (10 mg/day) of solifenacin are insufficient. The study was aimed to the comparative evaluation of the effectiveness and safety of solifenacin at a dose of 5 and 10 mg/day. The study included 28 patients (17 women and 11 men), mean age was 41.3±6.7 years. All patients were divided into two groups. In Group 1 included 12 patients with idiopathic overactive bladder, the Group 2 (n=16) - with neurogenic overactive bladder. Depending on the effect obtained, in some patients the dose was increased to 10 mg/day 1 month after starting treatment. The duration of treatment was 12 weeks. Application of solifenacin at a dose of 5 mg in patients with overactive bladder significantly reduces the severity of symptoms. Increasing the dose was required in 3 (25%) patients with idiopathic OAB and in 10 (62.5%) - with neurogenic OAB. Patients unsatisfied by therapy with solifenacin 5 mg/ day initially had more severe symptoms of the disease - significantly more urgency frequency, incontinence episodes, and nocturia. The use of high doses of solifenacin increased the effectiveness of treatment. Statistical significance was achieved for all parameters evaluated. Against the background of increasing doses, the number ofadverse effects may increase, but within a month of therapy in most cases they are reduced.