[Robot-assisted radical prostatectomy in patients after transurethral resection of the prostate].

Performing a radical treatment of prostate cancer in patients with a history of transurethral resection of the prostate (TURP) is a serious task even for an experienced surgeon, due to the anatomical and topographic changes that occur after endoscopic surgery. The technical possibilities of robotic technologies have great potential for obtaining the best treatment results for this category of patients. In order to review the intra- and postoperative outcomes of robot-assisted radical prostatectomy (RARP) in patients with a history of PCa and TURP, we selected relevant publications in the PubMed and Google Scholar databases for the period from 2008 to 2022. Based on the analysis of publications, there is no definite opinion on the efficacy and safety of RARP in patients after TURP compared with patients without a history of TURP. However, an experienced robotic surgeon with an appropriate level of expertise should perform surgical treatment of patients with a history of TURP. It has been shown that the choice of surgical approach when performing radical prostatectomy does not have a significant impact on treatment outcomes. At the same time, before performing radical treatment of prostate cancer in this category of patients, it is necessary to inform them about the possibly worse oncological and functional results of the operation.

[Outpatient treatment and quality of life of patients with interstitial cystitis and Hunners lesion: cohort cross-sectional study].

AIM: To assess the quality of life of patients with interstitial cystitis (IC) and to study effective options used to control symptoms on outpatient basis. MATERIALS AND METHODS: The results of a descriptive prospective cross-sectional cohort study are presented. The medical charts of patients who were treated in the City Clinical Hospital named after Spasokukotsky from 2021 to 2023 were analyzed. Eighty inpatient medical charts of various patients with a final diagnosis of IC with Hunner's lesion were identified. Only 53 patients were interviewed due to the inclusion/exclusion criteria. Respondents were asked to complete a survey consisting of 15 questions. The survey was carried out online for patients who did not require surgical treatment at the time of the study, and offline for patients admitted for repeated surgical treatment. RESULTS: The average age of respondents was 59.011.1 years. 58% (31) of patients noted the presence of constant pain in the pelvic area during the day, while 85% (45) of patients reported pain outside the bladder area, in the urethra and perineum. The intensity of pain in the pelvic area was 4.9 (2.3-5.6) points. Higher pain scores 6.24 (5.8-9.0) were observed in 47% (25) of patients admitted for repeat surgical treatment. 62% (33) of patients had a titer of bacteria in a urine test above 104, while 51% (27) of patients experienced relief of symptoms after taking antibacterial drugs. For the treatment and symptomatic relief, the following are most often used: pentosan sodium polysulfate (26%, n=14), antibacterial drugs of the nitrofuran group (25%, n=13), amitriptyline (15%, n=8), non-steroidal anti-inflammatory drugs (11%, n=6) patients. 23% (12) of respondents received intravesical therapy. The time from the onset of symptoms to the final diagnosis was 48 (24-96) months. CONCLUSIONS: Although infection is a criterion for excluding the diagnosis of IC, more than 62% of patients have positive urine culture. The results obtained indicate the need to improve existing approaches to the diagnosis of IC, as well as to develop treatment algorithms for painful bladder syndrome to control symptoms.

[Robot-assisted prostatectomy for PT3. Oncological and functional outcomes].

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

[Optimization of prevention of infectious complications during prostate biopsy].

Prostate cancer (PCa) is one of the most common malignant neoplasms in middle-aged and elderly men. Transrectal ultrasound guided prostate biopsy is the standard method for diagnosing prostate cancer but is associated with a high incidence of infectious compli-cations. A review of the literature on optimizing the prevention of infectious complications when performing transrectal prostate biopsy is presented. The main risk factors and the common measures to prevent the development of complications are discussed, including a study of using fosfomycin trometamol as the preferred drug for antibacterial prophylaxis. Fosfomycin meets the requirements for empirical prophylaxis, but further clinical studies are needed.

[Evaluation of long-term results of using the drug Fertiwell: impact on the likelihood of conception and pregnancy outcome].

INTRODUCTION: Current methods of treating male infertility have limited efficiency, since they are aimed to individual stages of the pathogenesis. Preparations based on testicular regulatory polypeptides are the most physiological and universal, owing to a complex effect on the self-regulation of testicular tissue. AIM: To study the delayed efficiency and safety of therapy with Fertiwell in patients with pathospermia and to assess the frequency of conception and pregnancy outcome in their partners based on the collection, analysis and interpretation of medical data. MATERIALS AND METHODS: A telephone survey of patients participating in the phase III clinical trial was carried out. The fact of conception in a couple was assessed over a period of 1 to 9 months after completion of therapy, as well as time from completion of the course to conception, pregnancy outcomes, newborn health outcomes. RESULTS: In the period from 1 to 9 months after completion of therapy, pregnancy occurred in 17 out of 34 couples (50%) in the Fertiwell group and in 13 out of 42 couples (30.95%) in the placebo group. This difference was statistically and clinically significant (p<0.05). All pregnancies resulted in a live birth. The median time from completion of the course to conception was 4 months in Fertiwell group and 6 months in the placebo group. There were no significant differences in anthropometric parameters of newborns between the two groups (p>0.05). CONCLUSION: When using the drug Fertiwell, pregnancy and live birth rate was significantly higher (2.23 times) compared to the control group. There was a trend toward earlier pregnancies in partners of men receiving Fertiwell. Thus, this drug can be recommended for the treatment of men with idiopathic infertility as monotherapy, as well as in combination with assisted reproductive technologies.

[Protective properties of urothelium and possibilities of targeted pathogenetic therapy of chronic pelvic pain: sodium pentosan polysulfate].

The review article is devoted to the possibilities of using targeted therapy for urothelial diseases, namely painful bladder syndrome (BPS). The protective structural components of the bladder mucosa, as well as their chemical features, are described in detail. Pentosanpolysulfate (PPS), being an oral heparinoid, can be used as part of pathogenetic therapy to restore the mucous membrane of the bladder. The efficacy and safety of this drug has been proven by us in a multicenter, randomized, double-blind, placebo-controlled trial. An additional assessment of the effectiveness and safety of the use of PPS in BPS was confirmed as part of our systematic review and meta-analysis. Thus, PPS is a pathogenetically sound tool in the treatment of patients with painful bladder syndrome.

[The influence of alfuzosin monotherapy on the sexual function of patients with benign prostatic hyperplasia in real clinical practice (results of a Russian multicenter study)].

INTRODUCTION: The current armamentarium of drugs for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is diverse and includes both monotherapy and combination therapy. Indirect and limited direct comparisons have demonstrated that all alpha-1-blockers (a1-ABs) have similar efficacy when used at appropriate doses. Differences in tropism to the prostate of modern 1-ABs are largely responsible for the severity of their side effects, mainly negative influence on sexual function and cardiovascular system. AIM: To evaluate the influence of Alfuprost MR 10 mg once daily on sexual function in patients with LUTS due to BPH during 3-months therapy in real clinical practice. The secondary endpoint was an effect on systolic, diastolic blood pressure (BP) and heart rate. MATERIALS AND METHODS: A total of 537 men with LUTS/BPH were included in the study by urologists from 21 outpatient departments of the Russian Federation. The follow-up included 3 visits: visit of inclusion in the program of patients with a previously prescribed drug of Alfuprost MR in a dosage of 10 mg once a day (visit "0"), visit 1 at 30 days (+/-5 days) later, and visit 2 at 90 days (+/-5 days) after inclusion in the study. At each visit, evaluation of complaints and physical examination was performed. In addition, patients completed questionnaires: International prostate symptom score (IPSS) and quality of life (QoL) index; the full version of the International Index of Erectile Function (IIEF) questionnaire; the Likert scale for the patient and for the physician. Also, laboratory and instrumental studies used in routine clinical practice were recorded: total prostate specific antigen (PSA) in serum; ultrasound examination (US) of the bladder; transrectal ultrasound examination (TRUS) of the prostate; uroflowmetry (maximum urine flow rate (Qmax)); measurement of systolic and diastolic BP; measurement of heart rate. RESULTS: after 3 months of therapy with Alfuprost MR in a dosage of 10 mg once a day, significant (p<0.05) improvement of all urodynamic parameters was documented, including a decrease in the average IPSS score by 55% and improvement of quality of life by 2.46 points (on the QoL index); increase of Qmax by 53%; reduction of the average postvoid residual to normal values. In addition to a significant improvement in the quality of urination, changes in sexual function were also positive. Thus, the average total IIEF score increased significantly (p<0,05) from 45.35 to 53.18 points. When considering specific domains of male sexual function, positive dynamics in all domains was noted: overall improvement of orgasm function, sexual desire, sexual satisfaction and overall sexual functioning was 11.98%, 15.14%, 19.7% and 18.46%, respectively. Hemodynamic indices remained stable during the 3-month follow-up; only clinically insignificant decrease in systolic BP by no more than 2 mm Hg during the entire follow-up period was observed. At the same time there was no influence on diastolic BP. Changes in heart rate were also clinically insignificant, averaging no more than 1 beat per minute. CONCLUSIONS: The results of observational study allow to recommend Alfuprost MR as a first-line therapy for BPH, including for sexually active men and patients with various types of sexual dysfunction. Considering minimal and clinically insignificant vasodilatory effects observed during 3 months of therapy, it is possible to prescribe Alfuprost MR in a dosage of 10 mg once daily, including comorbid patients.

[Assessment of the safety and efficacy of medicinal product PPR-001 based on regulatory polypeptides of the testes].

OBJECTIVE: Evaluation of the effectiveness and safety of the drug PPR-001 (lyophilizate) in comparison with placebo in men with impaired spermatogenesis. MATERIALS AND METHODS: This study was a randomized, double-blind, placebo-controlled, prospective, multicenter, parallel-group research. RESULTS: It was found that the drug has clinical efficacy and a positive effect on the concentration of spermatozoa in the ejaculate, the percentage of progressively mobile forms and the number of morphologically normal forms of spermatozoa was increased in the group of PPR-001. The primary end point was defined as a proportion of patients who had a therapeutic response (TO) at Visit 3. TO meant at least 20% increase in the concentration and/or progressive motility of spermatozoa compared to the baseline level. The hypothesis of Superiority of PPR-001 over placebo based on primary end point was confirmed (the limit of Superiority was more than 27%). In total, AEs were identified in 65 patients out of 100 (34 patients in the PPR-001 group and 31 patients in the placebo group). When assessing the number of patients who had AEs, there were no statistically significant differences between the groups. All identified AEs were of mild severity; during the study. No negative dynamics was found according to the results of the assessment of vital functions, biochemical and clinical blood tests, clinical urinalysis, ECG indicators. CONCLUSION: The study demonstrated the superiority of PPR-001 over placebo in terms of increasing concentration and motility of spermatozoa in the ejaculate. A significant increase in the number of morphologically normal forms of spermatozoa in the PPR-001 group was also revealed.

[Sperm retrieval techniques in patients with non-obstructive azoospermia].

Patients with non-obstructive azoospermia (NOA), which accounts for up to 10-15% of all cases of male infertility, until recently could only become parents using donor sperm or through adoption. Modern technical capabilities of sperm extraction in combination with the use of assisted reproductive technologies, make it possible to effectively overcome infertility in this group of patients. A number of highly effective techniques have been proposed for spermatozoa retrieval. However, surgical intervention is associated with certain risks, and therefore, the choice of the optimal treatment method is under discussion. A total of 52 articles were analyzed using the MEDLINE database (PubMed) to form an overview of the current principles of examination and preparation of a patient with NOA for the surgical sperm retrieval. This review is dedicated to the role of diagnostic testicular biopsy. In addition, a comparative information on the efficacy and safety of percutaneous, fine-needle aspiration, open multifocal and microdissection (micro-TESE) testicular biopsies is presented. Of the currently available sperm retrieval techniques in the urologic armamentarium, micro-TESE seems to be both the most effective and the safest. Micro-TESE can be a cumbersome procedure, however, it provides successful treatment in situations previously associated with zero chance of pregnancy.

[Diagnostic nomograms for the treatment of urogenital fistula].

AIM: Studies on non-obstetric urogenital fistula provide limited information on predictive factors. The aim of our study was to specify and to analyze the predictors for long-term anatomical and functional results in women with non-obstetric urogenital fistula. MATERIALS AND METHODS: A cross-section study of surgical repair for non-obstetric urogenital fistula repairs was carried out. From 2012 to 2018, a total of 446 patients with urogenital fistulas were treated in two tertiary centers. Patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. Anatomical outcome was assessed by resolution of symptoms and/or results of clinical examination. Urinary distress inventory (UDI-6) was used for the measurement of functional outcomes. The nomogram is based on a multiple regression equation, the solution of which is performed using a computer. The nomogram is presented as a set of scales, each of which corresponds to a certain variable. The baseline parameter is assigned certain points, depending on its value, then the sum of all parameters is calculated. As a result, it is possible to determine the risk using a couple or three scales. RESULTS: Overall, 169 patients were studied (mean age of 49.2, mean follow-up of 34 months). The most common cause of fistulas included hysterectomy (69.4%), followed by pelvic radiotherapy (18.9%). Only 64% of cases were primary fistula. Closure rate was 90.7% (98/108). Anatomical success depended on the surgical approach. For transvesical procedure, success rate was 89.4% (42/47), compared to 84% (89/106) and 87.5% (14/16), respectively for transvaginal and transabdominal success rate. According to Clavien-Dindo, complications were grade 1 (11.8%) and grade 2 (4.7%). As UDI-6 showed, the most common symptoms were frequency (62%), urgency (50%), incontinence (73%), pain (55%) and voiding symptoms (27%). Fistula size > 3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk of failure or more severe lower urinary tract symptoms. A high number of re-do cases and complex fistulas could be a limitation of this study. Factors for successful non-obstetric urogenital fistula closure were fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries. CONCLUSION: According to our results, only fistula size > 3 cm, previous vaginal procedures and pelvis irradiation were unfavorable predictors for anatomic success of fistula repair. In addition, our results allow to determine the predictors for successful repair and risk of recurrence lower urinary tract symptoms postoperatively.

[Systematic review of current russian-language literature on urogenital fistulas in women].

Urogenital fistulas in women are an urgent problem in modern urology, gynecology and surgery. Several decades earlier, iatrogenic damage was the main reason for their development. The aim of this review was to analyze the etiology, characteristics and results of treatment of fistulas in women in Russia and the CIS countries. A systematic analysis of the articles in the PubMed and eLibrary databases dedicated to etiology, treatment technique and postoperative results of treatment of urogenital fistulas in women was carried out. The results were compared with European data. A total of 16 articles were selected over a 20-year period that met the inclusion criteria. Iatrogenic injury resulted in the fistula formation in 40.54% (373/920) of cases. The majority of fistulas were caused by radiation therapy (58.91%, 542/920). According to the results, 84.02% (773/920) of fistulas were successfully healed. Cure rate of patients with post-radiation fistulas was 75.83% (411/542). Comparison of surgical techniques was difficult, since in most cases the preference of the surgeon was main determinant factor.

[Alpha1-adrenergic blockers therapy and sexual function].

An increase in life expectancy and the number of older and elderly men, an improvement in the quality of medical care and socio-economic factors in most countries contributed to an increase in the number of patients with benign prostatic hyperplasia (BPH). Currently, improvement of the quality of life is the mainstay of strategy for managing patients with BPH, as well as prevention of complications and the need for surgery. In this regard, the pharmacotherapy with 1-adrenergic blockers (1-AB) is widely used as an effective method for improving lower urinary tract symptoms and reducing the risk of BPH progression. Given that the quality of life is becoming increasingly important in evaluating the efficiency of BPH treatment, including therapy in elderly patients, it is necessary to take into account its effect on sexual function, when choosing a particular drug. The use of 1-AB can be accompanied by side effects manifested by various sexual disorders. Alfuzosin does not adversely affect sexual function in men with BPH, may improve erectile and ejaculatory function and should be considered as the drug of choice, especially in sexually active men and patients who already suffer from worsening ejaculatory function while using another 1-AB.

Prognostic Role of Matrix Metalloproteinases 2, 7, 8, 9 and Their Type 1 Tissue Inhibitor in Blood Serum of Patients with Kidney Cancer.

The study compared the levels of MMP-2,7,8,9, and TIMP-1 in blood serum of healthy people (N=97) and patients with primary renal cell carcinoma (N=93) to assess relevance of these markers to prognosis of overall survival of these patients, which were followed-up over 1 to 45 months (median 26 months). To evaluate the survival with the Kaplan-Meier estimator, the median values of examined markers in the total group of patients were taken as the threshold levels. This estimator showed that the high levels of serum MMP-7 and MMP-8 were indicative for unfavorable prognosis in the total group of patients with renal cell cancer. Of them, the most significant marker was the level of MMP-7: at its low level (<6.3 ng/ml), a 3-year survival was 93%, whereas survival dropped down to 51% at a higher value of this marker (p<0.001). For MMP-8, the threshold level was 51 ng/ml, and the corresponding survivals were 78 and 58% (p<0.01). The level of MMP-7 was also prognostically significant for the patients with stage I kidney cancer: during a 3-year follow-up, all the patients with low MMP-7 were alive, while the 3-year survival of the patients with a high level of MMP-7 was only 72% (p=0.02). There were the declining trends for survival at high TIMP-1 and low MMP-2. In contrast, the level of MMP-9 virtually did not correlate with survival of the patients with renal cell cancer.

[Evaluation of the clinical efficacy of urethroplasty after failed hypospadias repair].

BACKGROUND: Evaluation of surgical treatment of hypospadias is one of the most controversial problem in urology, considering a lack of continuity in the management of these patients between pediatric andrologists and general urologists. Patients who undergone to multiple hypospadias repairs remain one of the most difficult categories for reconstructive urethral surgery and urology in general. MATERIALS AND METHODS: The treatment results of 112 adult patients who had complications of previously performed hypospadias repairs were evaluated. The results of repeated procedures were compared in patients, in whom modified balloon urethral catheter (group 1; n=50) or standard Foley catheter (group 2; n=62) was used, respectively. RESULTS: Most patients after surgery assessed the appearance of the penis as "good" (92% in group 1, 77.4% in group 2). In group 1, satisfactory results was seen in 8% of cases and there were no unsatisfactory results, while in group 2, where standard Foley catheter was used, these values were 19.4% and 3.2%, respectively. In group 1, complication rate was lower than in group 2 (10% versus 41.9%; p<0.05). In group 1, there was a significantly higher proportion of patients with a Qmax score of more or equal 18 ml/s (90% versus 74.2%; p<0.05). CONCLUSIONS: Repeated procedures in adult men with late complications of surgical treatment of hypospadias are quite effective, although they are accompanied by a rather high complications rate. The use of a new model of the urethral catheter with dilating cuff and an irrigation canal allows to improve treatment results in this category of patients.

[Results of treatment and risk factors for recurrence of iatrogenic urethral strictures in men].

AIM: Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. MATERIALS AND METHODS: A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. RESULTS: Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. CONCLUSION: Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

[Moscow program of early detection and treatment of prostate cancer].

The aim of this study is to improve the results of detection and treatment of patients with prostate cancer (PCa) in the Moscow. For this purpose, we performed our own clinical diagnostic, epidemiological, autopsy, experimental and comparative studies that emphasize the relevance of the stated subject in the study of the diagnosis and treatment of patients with PCa. Urology Department of A. I. Evdokimov Moscow State University of Medicine and Dentistry was at the forefront of the Men's Health program in Moscow and in early 2003 it was the first to have an office for early diagnosis of prostate diseases, as part of the Program. Over 20,000 patients were screened for PCa. For the first time in Russia, methods for the early detection of PCa were investigated on a cohort of Russian men using PCA3 and the Prostate Health Index. The role and significance of prostate saturation biopsy was examined. The investigation of aspects of the morphological assessment of prostate diseases formed the basis for the development of an electronic atlas of PCa images. A series of studies on various prostate visualization methods, including Histoscanning system and MRI, have been performed. A new minimally invasive method for the treatment of prostate cancer has been introduced - a robot-assisted radical prostatectomy and cryoablation. The concept of surgical treatment of localized forms of PCa has been developed and the factors predicting the success of treatment have been determined. This study is reflected in numerous publications both in Russia and abroad, in monographs and dissertations.

Kidney Injury Molecule-1 (KIM-1) in Blood Plasma of Patients with Clear-Cell Carcinoma.

The concentration of kidney injury molecule-1 (KIM-1) was measured in blood plasma of 99 patients with clear-cell carcinoma and 14 patients with benign renal tumors using a Human Serum TIM-1/KIM-1/HAVCR Quantikine ELISA kit. The control group consisted of 15 healthy male and 14 healthy female subjects. KIM-1 levels in blood plasma of patients with cancer or benign renal tumors were significantly higher than in the control (p<0.00001 and p<0.01, respectively). In patients with benign tumors, this parameter was significantly lower than in patients with cancer (p<0.0001). KIM-1 level significantly increased with disease stage (p<0.0001), and even in stage I cancer, it was higher than in the control group (p<0.0001) or in patients with benign tumors (p<0.01). The best sensitivity/specificity ratio for stage I renal cancer detection (81 and 83% respectively) was achieved at cut-off level 77 pg/ml, the sensitivity of detection of for stages II-IV being 97%. Plasma level of KIM-1 increased with increasing the size and area of the primary tumor (T). This parameter was higher in patients with metastasis in regional lymph nodes irrespective of their number (N1 or N2) in comparison with patients without regional metastasis (N0). It is also higher in patients with distant metastasis (M+). In patients with grade III-IV cancer, KIM-1 level was 7-fold higher than in patients with grade I-II tumor (p<0.0001). Thus, KIM-1 can be regarded as a highly sensitive marker for early detection of clear-cell carcinoma.

[Treatment of patients with lower urinary tract symptoms in Moscow].

INTRODUCTION: In recent years, there has been a persistent tendency to a decrease in surgical treatment of patients with lower urinary symptoms (LUTS). This fact can be explained by variety drugs which have acceptable safety and high efficiency for treatment of urinary disorders. As part of our survey of men in Moscow region, the trends in prescribing the different drugs for the LUTS was studied. In addition, the duration of therapy and patient adherence were analyzed. MATERIALS AND METHODS: A prospective multicenter epidemiological study "Characteristics of lower urinary tract symptoms in men in the Moscow region" was carried out using data obtained from April 1 to May 31, 2017 with anonymous survey of 525 men with mean age of 64.2+/-9.93 years, living in Moscow and went to the urologist with urinary disorders. All respondents answered questions from specially designed questionnaire consisted from 140 items. All medical data were analyzed, including received drugs, the duration of the therapy and subjective assessment of efficiency. RESULTS: A total of 419 patients from 525 (79.8%) received any kind of therapy. The most commonly used drugs were -blockers, which consisted 65% of all prescriptions. Other drugs were administered significantly rarely. It is surprisingly, that 85.6% of respondents in Moscow region received the original -blockers, not generic drugs. Satisfaction rate was 74.3%. Most of patients (58.3%) had received -blockers for 1-3 years and 33.3% administered these drugs for more than 3 years. Combined drug therapy was the second most popular (25.5%). The most commonly used combination included -blockers and inhibitors of 5-reductase. In 90.6% cases the appointment was made by urologist. CONCLUSION: Drug therapy is the most popular treatment in patients with LUTS. Our data suggest that -blockers as monotherapy or in combination with inhibitors of 5-reductase is the most often prescribed therapy. These results are in concordance with the main conclusions of international studies dedicated to this issue.

[The experience of using drug Afalaza for treatment of lower urinary symptoms in treatment-nave patients with benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 50 years. The prevalence of the BPH increases with age, and pathologic features of BPH are found in about 90% of men over 80 years. AIM: The aim of the study was to study the efficacy and safety of Afalaza for the treatment of lower urinary tract symptoms (LUTS) in treatment-nave patients with BPH. MATERIALS AND METHODS: A multicenter study of using Afalaza for the treatment of LUTS in treatment-nave patients with BPH was carried out in 9 urological centers in Moscow. A total of 80 treatment-nave patients with BPH were enrolled. The improvement in the total score of IPSS, IIEF-5 and QoL after 30 weeks of therapy was evaluated as well as changes in prostate volume and maximum urinary flow rate (Qmax). RESULTS: After 30 weeks of therapy, there was a significant decrease in the total IPSS score. A decrease in the total IPSS score by 5.5 points (+37.9%) from 14.5+/-4.0 at the baseline to 9.0+/-4.1 at the visit 9 was seen. The QoL decreased by 1.8 (-38.3%) points from 4.7+/-1.0 at the baseline. The Qmax also changed from 12.7+/-4.6 to 16.4+/-5.7 (+28.3%) after 30 weeks of therapy. At the visit 9, the total IIEF5 score increased by 3.4+/-4.4 (+19.9%) from 17.1+/-4.3 at the baseline. In addition, prostate volume decreased from 42.7+/-11.1 at baseline to 41.0+/-9.8 cc post-treatment (-5.15%). A reduction of post-void residual urine volume from 26.0+/-25.3 at baseline to 17.7+/-24.2 (-31.9%) post-treatment was also shown. CONCLUSION: The results of a multicenter study demonstrate the efficacy of Afalaza for treatment of treatment-nave patients with LUTS/BPH. Afalaza reduces prostate volume and improves an erectile function.

[Suprapubic cartilaginous cyst].

Suprapubic cartilaginous cyst represents a rare disease. Considering its low prevalence, only 9 clinical case have been described in literature. This lesion is often overlooked due to absence of clinical manifestations, incomplete diagnosis or the lack of necessary information about the disease. We observed a 74-year-old woman whose diagnosis of suprapubic cartilaginous cyst was confirmed by biopsy, as well as ultrasound, computer tomography and MRI results.