[Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city].

THE PURPOSE OF THE STUDY: to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm. MATERIALS AND METHODS: The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests. RESULTS: During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies. CONCLUSION: As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.

[Sexual dysfunction in patients with chronic prostatitis and its treatment].

AIM: to study the frequency and type of sexual disorders in patients with chronic prostatitis (CP) and to evaluate the efficiency of Vitaprost and the biologically active complex NeuroDose in treating sexual dysfunctions. MATERIALS AND METHODS: The study was conducted in 2015-2019 and consisted of two stages. STUDY DESIGN: At the first stage, the frequency and type of sexual disorders were evaluated in 422 patients with CP. Standard methods for examining patients with CP included Loran-Segal questionnaire of male copulative function (MCF), International Index of Erectile Function (IIEF-5), ICEF-5, criteria of premature ejaculation, Treatment Satisfaction Visual Analogue Scale of orgasm quality and Hospital Anxiety and Depression Scale (HADS). Patients received standard 6-week complex therapy for CP. After that, at the second stage, 244 patients with sexual dysfunction (premature ejaculation, decreased intensity of orgasm) received Vitaprost and the NeuroDose biocomplex for 2 months. RESULTS: Sexual disorders were detected in 77% of patients with CP. The main disorders were premature ejaculation (60.9%) and decreased intensity of orgasm (43.8%), which often occurred simultaneously. Two-month therapy of sexual dysfunction with Vitaprost and NeuroDose was effective in 94.3% of patients. Good results were observed in 80.3% of cases, while satisfactory results were obtained in 14% of patients. According to MCF, total copulative function increased by 46%, the duration of sexual intercourse increased from 1.1+/-0.4 min to 4.1+/-0.4 min (p<0.001) with an absence of premature ejaculation in 81.6% of patients, the intensity of orgasm increased from 3.8+/-0.4 to 8.0+/-0.5 (p<0.001) points, and the number of patients with neuropsychiatric symptoms associated mainly with sexual dysfunction decreased by 69.3%. CONCLUSION: Premature ejaculation and decreased intensity of orgasm are the most common sexual disorders in CP, and the combination of Vitaprost and dietary supplements NeuroDose is highly effective for their treatment.

[Treatment of acute uncomplicated cystitis in women with antibiotic allergy or intolerance].

AIM: A comparative evaluation of the efficacy and safety of Canephron N and Cystone as monotherapy in women with acute uncomplicated cystitis and antibiotic allergy or intolerance was performed. MATERIALS AND METHODS: A prospective, randomized, controlled study of drug Canephron N as monotherapy for acute uncomplicated cystitis in 51 women with a history of antibiotic allergy or intolerance was carried out in 3 urological centers in Perm from 2016 to 2019. In the main group, patients received Canephron N for 30 days, while in comparison group, Cystone was prescribed. The Acute Cystitis Symptom Score (ACSS), microscopic study of urine sediment, urine culture and other methods were used. Results were evaluated 3, 6, 30 days and 1 year after the start of treatment. RESULTS: In the main group, monotherapy with Canephron N for 30 days resulted in a decrease in the total ACSS score from the baseline 12.9 to 0.3 points, while in Cyston group, changes of ACSS score were less pronounced, from baseline 12.8 to 1.4 points (p<0.01). Clinical cure rate in the main and comparison group was 88.5% and 68%, respectively. In another 3.8% and 1% of patients in the main and comparison group, an improvement was seen. The number of patients with leukocyturia in the Canephron N group decreased to 11.5% compared to 28% in Cyston group (p>0.05). Bacteriuria rate in the main group was 7.7%, which was less than in the comparison group (20%, p>0.05). Number of sick days in the main group was 4.9+/-0.4, compared to 7.4+/-0.6 days in Cyston group. In the Canephron N group, 1-year recurrence rate was only 7.7%, while in the Cyston group the recurrence was seen in 16% of patients. CONCLUSION: According to the results, Canephron N is an effective and safe drug as monotherapy for acute uncomplicated cystitis, and can be considered as drug of choice for the treatment of women with antibiotic allergy or intolerance.

[Comparative assessment of Canephron N and ciprofloxacin as monotherapy of acute uncomplicated cystitis in women].

The study aimed to compare the efficacy and safety of Canephron N and ciprofloxacin as monotherapy in the management of mild forms of acute uncomplicated cystitis in women of working age. MATERIALS AND METHODS: A prospective, randomized study of Canephron N and ciprofloxacin for treating mild forms of acute uncomplicated cystitis (ACSS score less or equal 10) comprising 160 women aged 18-55 years was conducted from 2015 to 2017. Group I consisted of 80 women, who received oral Canephron N 2 tablets 3 times daily for 30 days. Group II included 80 women who took oral ciprofloxacin 0.5 g twice daily for 3 days. The results were assessed using the ACSS scale, urinalysis by microscopy, bacteriological examination of urine, etc. The outcomes were evaluated at 3, 6 and 30 days, and one year after the treatment initiation. RESULTS: In group I, monotherapy with Canephron NH resulted in a marked improvement in symptoms, a decrease in the ACSS scores from 7.9 at baseline to 0.1 at day 30. The indicator of clinical efficacy (recovery) was 93.75%, bacteriological efficiency was 91.3%, relapse of cystitis within one year was observed in 5% of patients; no side effects were registered. In group II, the symptoms and bacteriuria decreased more rapidly in the early periods, but after 30 days the results of clinical and bacteriological efficacy did not differ from the group I (93.75 and 91.3%, respectively). Side effects and cystitis relapses were noted in 18.8% and 12.5% of patients, respectively. CONCLUSION: The findings of the study show that Canephron N is an effective and safe alternative to treating mild forms (ACSS score less or equal 10) of acute uncomplicated cystitis in women, allowing the use of antibiotics to be reduced. In our opinion, patients with more severe forms of acute uncomplicated cystitis should be treated with traditional antibiotic therapy.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men].

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[INCIDENCE OF ACUTE URINARY RETENTION IN PATIENTS WITH PROSTATIC ADENOMA AND 8-YEAR LONG TAMSULOSIN THERAPY].

This report introduces results of an 8-year study estimating the risk of acute urinary retention in patients with stage I prostatic adenoma. Patients were randomly assigned into two groups. The first group consisted of 331 men was regularly taking Omnic (tamsulosin) 0.4 mg 1 time daily for 8 years as a means of medical therapy. The second group consisted of 334 patients treated with herbal preparations (Gentos, Tadenan or Speman). In the case of acute urinary retention patients were taken to the urological department to release urine from the urinary bladder by catheterization or by the surgical procedure. The incidence of acute urinary retention in group 1 ranged from 0.3 to 1.2% per year and, for a total of 8 years of follow-up was 6.45%. In the second group, it ranged from 1.8 to 7.3% per year, making a total of 36.2%. Therefore, the risk of acute urinary retention in patients receiving Omnic (tamsulosin) was reduced by 5.6 times in comparison with the group of patients treated with herbal medications. Thus, the need for surgery decreased from 27.8 to 6.3%. According to the results of an 8-year long tamsulosin was found as a safe and highly effective means to reduce the risk of acute urinary retention.

[DIETARY SUPPLEMENT REKECEN IMPROVES SAFETY AND EFFICACY OF CHRONIC PROSTATITIS ANTIBACTERIAL THERAPY].

This randomized comparative study was carried out to estimate efficacy and safety of the natural complex of fermented food fibers and short chain fatty acids (dietary supplement rekicen-RD®) in antibacterial therapy of 64 patients with chronic infectious prostatitis. 32 patients of the treatment group received 8 week standard antibacterial therapy for chronic prostatitis in combination with dietary supplement rekicen-RD® and 32 patients of the control group were treated only with antibacterial therapy. Short-term and long-term results were estimated after 8 weeks and 6 months follow-up, respectively. It was found, that addition of dietary supplement rekicen- RD® to antibacterial therapy resulted in statistically significant improvement of the treatment efficacy. Compared to patients of the control group, patients of the treatment group had more pronounced positive changes of all indicators of treatment efficacy (NIH-CPSI total score, quality of life, echo-structure of prostate, the number of leukocytes in prostatic secretions). Long-term (after 6 months) clinical efficacy of the combination of antibacterial therapy with dietary supplement rekicen-RD® was 96,9%, bacteriological efficacy after 8 weeks - 87,5%, after 6 months - 81%. Notably, there was 4,5-fold reduction in the rate of antibiotics adverse side effects in the treatment group patients without a single gastro-intestinal side effect.

[Treatment of prostatic adenoma with concomitant chronic bacterial prostatitis].

A randomized trial of efficacy and safety of vitaprost plus and vitaprost forte has been made in 70 patients with prostatic adenoma comorbid with chronic bacterial prostatitis. The patients were randomized into two groups: group 1 patients received vitaprost plus in rectal suppositoria for 1 months, then vitaprost forte for 2 months; group 2 patients (control) received gentos and lomefloxacin per os. Short- and long-term results were evaluated in 3 and 6 months. By all parameters group 1 achieved better treatment results than controls. Immediate positive response was observed in 97.1% patients, long-term positive effects were observed in 85.7%. Total points of prostatic adenoma symptoms reduced by 37%, chronic prostatitis--by 55%, residual urine diminished by 66%, Qmax increased, quality of life improved by 45%, sexual function enhanced. Size of the prostate decreased by 7.4 cm3, leukocyte count in prostatic secretion fell 6-fold, eradication of prostatitis causing agent was achieved in 3 months in 80% patients. Side effects and complications were not registered. Thus, vitaprost plus and vitaprost forte are highly effective and safe for treatment of patients with combination of prostatic adenoma with chronic bacterial prostatitis.

[Blood reinfusion during nephrectomy in patients with kidney neoplasm']. / Reinfuziia krovi vo vremia nefréktomii pri rake pochki.

Reinfusion of autologous blood in 22 patients with cancer of the kidney was used during nephrectomy. Intraoperative blood loss made up 1000-4000 ml (20-80% VCB). 800-3600 ml of blood was collected from the operation wound and reinfused. In spite of massive blood loss, 20 patients recovered. Lethal outcomes (2 patients) were not caused by blood reinfusion. In 19 patients of control group with renal cancer massive blood loss was compensated by preserved donor blood transfusion. It is shown that reinfusion of autologous blood promotes more stable hemodynamics during the operation, reduces the quantity of postoperative complications and lethal outcomes, provides qucker restoration of morphologic structure of the blood and results in less substantial changes in filtration of a single kidney. There were no statistically significant differences in 5-year survival rate of patients in the study (40.9%) and control (42.1%) groups, nor in the frequency of hematogenous metastasizing of cancer. Because blood reinfusion does not increase the risk of hematogenous metastases of cancer, it is not contraindicated in massive blood loss during nephrectomy in patients with renal cancer.

Cardiopulmonary bypass and cell-saver technique in combined oncologic and cardiovascular surgery.

The purpose of this study was to work out an adequate operative technique for patients with malignant tumors who also need open heart surgery or procedures on major blood vessels. We had 8 such patients. In 6 of them, a tumor (3 cases hypernephroid cancer and 3 cases retroperitoneal sarcoma) had grown through the inferior vena cava (IVC) up to the right atrium. Two patients had lung cancer together with severe coronary artery disease. All of these patients were operated on using a heart-lung machine (HLM) and cell saver (CS). In 6 patients the intravascular portion of the tumor was extracted as much as possible through a right atrium approach (in 3 cases a nephrectomy was performed). Two patients had a one-stage coronary artery bypass graft (CABG) and a lobectomy. All of the patients had uneventful postoperative periods and were alive when checked on 1 year after the procedures. During cytological investigation after each operation, tumor cells were found only on the internal surface of the HLM arterial filters with 20 microns holes. We suggest that special cardiovascular devices such as the HLM and CS might be used in borderline situations in oncology without increasing the risk of hematogenous tumor dissemination.

[Phytoperfusion of the bladder after adenomectomy]. / Fitoperfuziia mochevogo puzyria posle adenoméktomii.

For continuous irrigation of the bladder after prostatic adenomectomy herb infusion (Urtica dioica L. 12-15 g/l, Hypericum perforatum L. 8-12 g/l. Marticaria recutita L. 8-10 g/l, folia Plantaginis majoris 7-10 g/l, Herba Millefolii 4-6 g/l, folia Betula 3-5 g/l. Artemisia vulgaris L. 1-2 g/l, folia Fragaria vesca 3-4 g/l, water 11 maximum) was dripped through a thin suprapubic and urethral drainages. Such phytoperfusion of the urinary bladder used in 22 patients reduced postoperative blood loss, bacteriuria, prevented hemorrhagic and purulent inflammation following adenomectomy. Side systemic effects were not reported.

[Treatment of patients with ureteral calculi]. / Lechenie bolnykh s kamniami mochetochnikov.

Various methods of treatment were introduced to improve the results of management of patients with stones in the ureters and early restoration of their working capacity. Emergency ureterolithotomy (197 patients) reduced the incidence of postoperative complications by 2.4 times and the duration of in-patient treatment by 1.8 times. Hermetic sealing of the ureteral suture with glue in ureterolithotomy (43 patients) led to airtightness of the suture in 93.0% of cases. Needle reflexotherapy relieved an attack of renal colics in 94% of patients. After general multicomponent vibration (71 patients) and sonic stimulation (216 patients) the stones were discharged in 80.3 and 93.1% of patients, respectively. The application of organizational measures (creation of a city center of emergency urological service) and introduction of new methods for treatment of ureteral stones reduced the terms of rehabilitation of patients by 1.8 times, the economical effect in this case came to 392,3 rubles per each patient.

[Blood reinfusion in acute blood loss during urologic surgery]. / Reinfuziia krovi pri ostroi krovopotere vo vremia urologicheskikh operatsii.

In massive blood loss (1,000-4,900 ml) during operations on the kidneys and prostate in 42 patients, 900 to 3,600 ml of blood was reinfused. Thirty-seven (88.1%) patients recovered. Fatal outcomes in 5 cases were caused by complications of the principal and concomitant diseases and were unrelated to blood reinfusion. Study of the morphological, biochemical, and coagulation properties of the patients' blood showed gradual restoration of hemostatic values and no harmful effect of the reinfusion on the organism. The authors claim that blood reinfusion can be undertaken in operations on the kidneys and prostate when there are vital indications. Kidney tumors are a relative contraindication for reinfusion. Blood reinfusion is not indicated in purulent diseases of the kidneys.