[Hormonal and metabolic disorders as systemic factor for the formation of urinary calculi].

In patients suffering from urolithiasis, metabolic diagnostics often reveals abnormalities contributing to the formation of stones: hypocitraturia, hyper- and hypocalcemia, hypercalciuria, hypomagnesemia/hypomagnesuria, hyperoxalaturia, etc. Before surgery, complex biochemical examination of blood and 24-hourcollection urine in 82 patients with urolithiasis was performed. The analysis of the main laboratory parameters of carbohydrate, lipid, calcium and phosphorus and purine metabolism found the prevalence of violations of calcium and phosphorus metabolism in these patients. Dyslipidemia was diagnosed in 31 (37.8%) patients. There was a significant positive correlation between serum total cholesterol and serum total calcium (rs = 0.3315, P = 0.0103). Low serum calcium levels were associated with hyperoxalaturia (rs = -0.4270, P = 0.0295). There was a significant effect of natriuria on urinary excretion of oxalate (rs = 0.6107, P = 0.0001), Mg (rs = 0.4156, P = 0.0096) and K (rs = 0.5234, P = 0.00005). The study shows the role of magnesium in the prevention of recurrence and manifestation of urolithiasis. The combination of two or more types of hormonal and metabolic disorders increases the incidence of recurrent stones. Timely correction of hormonal-metabolic status allows to reduce the risk of stone formation, and hospitalization attributable to the complications associated.

[The results of the 10-year study of efficacy and safety of Serenoa repens extract in patients at risk of progression of benign prostatic hyperplasia].

The article presents the results of an open, noncomparative, observational study of the efficacy and safety of continued use of the Serenoa repens (prostamol uno) plant extract at a dose of 320 mg 1 time a day for 10 years in 38 patients with early manifestations of BPH and the risk of its progression. The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.

[Treatment of chronic prostatitis in prophylaxis of prostatic adenoma].

The results of a retrospective study of efficacy of prostamol uno in a standard single dose of 320 mg/day in prevention of chronic prostatitis recurrences and prostatic adenoma used for 5 years as an adjuvant to standard therapy of chronic prostatitis exacerbations were compared with those of standard course antibacterial and anti-inflammatory treatment alone. The analysis demonstrated that prostamol uno (Serenoa repens extract) in a dose 320 mg/day improves both subjective symptoms (data of IPSS, QoL scale) and objective ones (the absence of the disease progression and adverse effects, enhancement of the erectile function). Prostamol uno is effective for prevention of both recurrences of chronic prostatitis exacerbations and development of prostatic adenoma.

[Herbal preparation Canephron N in the treatment of patients with urolithiasis].

Under current conditions, high-technology herbal preparations take an important place in the complex treatment of patients with urolithiasis. Canephron N (Bionorica, Germany) is one of these herbal drugs widely used in urology. The article presents the results of comprehensive evaluation of the effectiveness of the canephron N in patients with urolithiasis, who undergone extracorporeal shockwave lithotripsy, in the postoperative period and in the period of early (up to 3 months) metaphylaxis. It is shown that the use of the drug in complex treatment of patients with urolithiasis contributes to more rapid discharge of fragments of stones and effective improvement of renal function after removal of stones. The use of canephron N has great potential in the complex metaphylaxis of urolithiasis.

[A comparative clinical randomized trial of cernilton efficacy and safety in patients with chronic abacterial prostatitis].

The trial of efficacy and safety of two doses of the drug cernilton in patients with chronic abacterial prostatitis made in the Research Institute of Urology and I.M. Sechenov Medical Academy in 2008 gave evidence for subjective (NIH-CPSI, Sex-4, IPSS and other scales, QOL) and objective (leucocyte count in prostatic secretion) pronounced anti-inflammatory effects of the drug which persist for at least 6 months. Comparison of the two doses of cernilton showed significant differences in subjective response of the patients (NIH-CPSI and Symptom Frequency Scale). Cernilton is recommended as a medication of choice for treatment of patients with chronic abacterial prostatitis.

[Results of three-year clinical study of prostamol uno efficacy and safety in patients with initial symptoms of prostatic adenoma and risk of its progression].

Prostamol Uno (PU) efficacy and safety were studied in a multicenter, open-population, randomized and comparative trial. PU was given in a single daily dose 320 mg for 36 months to 50 patients with initial symptoms of prostatic adenoma (PA) in comparison with 50 matched controls. The trial evaluated PU action on the symptoms progression and quality of life with application of questionnaires IPSS and QoL (BS). It was found that PU treatment relieved PA symptoms by IPSS, while these symptoms progressed in the controls. QoL improved in the study group and deteriorated in the control one. Administration of PU significantly increased urinary flow rate though in the controls urinary flow rate decreased, size of the prostate diminished and increased, respectively. Changes in the PSA were not seen and were insignificant, respectively. The results of the study say that prostamol Uno in a dose 320 mg/day can prevent PA progression without side effects.

[Efficacy and safety of prostamol-UNO in the treatment of patients with initial symptoms of prostatic adenoma and risk of progression: 2 years of investigations].

The article presents 2-year pilot results of a multicenter, randomized, controlled trial of prostamol-UNO effects on symptoms progression, quality of life, tolerance and safety in patients with early prostatic adenoma. The drug was used in a single dose 320 mg/day for 36 months. Prostamol-UNO efficacy in arrest of the symptoms progression and quality of life was assessed with the use of IPSS and QoL (BS) questionnaires. Measurements were also made of changes in Qmax, urine volume, residual urine, size of the prostate.

[Cernilton in the treatment of prostatic adenoma and chronic prostatitis].

The efficacy of the drug cernilton was studied in patients with prostatic adenoma (PA) and chronic bacterial prostatitis (CBP). One group and two subgroups of patients were studied: 31 men with PA received cernilton for 3 months (group 1); 32 patients with CBP received antibacterial treatment (for 8 months) and cernilton for 3 months (group IIa); 30 CBP patients received standard antibiotic treatment for 2 months maximally (group IIb). All the patients were examined before the treatment and 3 months later. According to IPSS, patients of group 1 showed a significant (p < 0.001) regress of low urinary tract symptoms and improvement of quality of life. PSA in the serum lowered by 21.2%. Qmax significantly increased (p < 0.001), Vprost and Vres diminished. According to the scale NIH-CPSI, relief of pain, dysuria was greater, quality of life improved more in patients of group IIa than in group IIb (p < 0.05). The same trend was in the values Qmax, Vres and Vprost. Thus, it is evident that cernilton is effective in monotherapy of PA and combined treatment of CBP.

[Results of a multicenter trial of serenoa repens extract (permixon) in patients with chronic abacterial prostatitis].

Chronic prostatitis (CP) morbidity now makes up 8 to 35% in males aged 20-40 years (N.A. Lopatkin et al., 1998; O.L. Tiktinsky, 1999). In general population CP incidence rate is 5 to 8% (J.C. Nickel, 1999). Phytotherapy is now widely practiced in CP. A multicenter trial conducted by the authors demonstrates high efficacy ofpermixon in the treatment of chronic prostatitis/chronic pelvic pain syndrome. The results of 6-month follow-up are presented.

[Transurethral electroresection of prostatic adenoma under transrectal ultrasonic control].

The aim of the study was to improve the results of transurethral prostatic resection (TUPR) by introduction of intraoperative transrectal ultrasonic investigation (TRUSI) and to determine topographic-anatomic features of the prostate, intraorgan relations of adenomatous nodes and surgical prostatic capsule on-line in TUPR. A total of 64 patients with prostatic adenoma (PA) of the second degree aged 52-79 participated in the study. All of them have undergone TUPR. The patients were divided into two study groups (15 patients with volume of the prostate 36.5-78.6 cm3 and 17 patients with prostate size 80-4-141.2 cm3) in which TRUSI was performed and two control groups (n = 14, size 34.9 to 79.2 cm3 and n = 18, size 81.7-130.8 cm3, respectively) who have not undergone intraoperative TRUSI. PA clinical symptoms were similar in all the groups. Intraoperative TRUSI was conducted in 3 stages (in the beginning, middle and end of surgery) in two planes--transverse and sagittal. Postoperative complications required repeated endoscopic interventions in 2 and 4 patients of groups 2, 3 and 4, respectively. Control TRUSI on day 7 after TUPR registered mean volume of the prostate to be 19.3 +/- 1.4 cm3 in group 1, 39.8 +/- 2.1 cm3 in group 2, 28.1 +/- 1.6 cm3 in group 3, 47.7 +/- 3.2 cm3 in group 4. Maximal flow rate 1 month after TUPR was, on the average, 21.4 +/- 1.4 ml/s, 18.8 +/- 1.1 ml/s, 18.3 +/- 1.6 ml/s and 15.5 +/- 1.2 ml/s in groups 1, 2, 3 and 4, respectively. Thus, intraoperative TRUSI provides information which helps the surgeon to orient in the course of surgery and minimize the threat of perforation of the prostatic capsule; minimizes intraoperative complications and enhances efficacy of radical transurethral electroresection of prostatic hyperplasia improving long-term outcomes of the operation.

[Efficiency and safety of prostamol-Uno in patients with chronic abacterial prostatitis].

In this open label prospective study in patients with category III prostatitis we assessed efficacy and safety of Sabal serrulata plant extract (prostamol Uno 320 mg) (group I, n=30) as compared to watchful waiting (group II, n=24). Efficacy was evaluated by means of NIH-CPSI, IPSS-QoL questionnaires, patients' general subjective assessment of treatment outcome, uroflowmetry and transrectal Doppler mapping (colour doppler and spectral doppler) of the prostate. Patients receiving prostamol Uno in comparison with watchful waiting group had significant improvement of mean NIH-CPSI (from 17.8 to 11.4 vs 17.1 to 16.5) and IPSS (from 13.0 to 6.3 vs 13.2 to 11.6) scores, Qmax values (from 12.9 ml/s to 17.8 ml/s vs 13.3 ml/s to 14.4 ml/s) and Doppler parameters of vascular resistance in the prostate. According to the patients' subjective assessment, moderate and significant improvement was reported by 76.7% patients in prostamol Uno group vs 23.3% in the watchful waiting group. There were no severe side effects. In prostamol Uno group one patient (3.3%) had moderate dyspepsia that resolved without termination of the drug administration. Prostamol Uno showed good efficacy and safety profile in patients with category III prostatitis.

[A phytogenic drug kanefron H in patients with chronic cystitis and urolithiasis].

To evaluate efficacy of kanefron H (KH) in combined therapy of chronic cystitis and urolithiasis (after extracorporeal shock-wave lithotripsy-ESWL), we examined 48 women suffering from chronic cystitis. The patients were divided into two groups by the presence of pyuria: 20 patients of group 1 had pyuria, 28 patients of group 2 had no pyuria. Each group was subdivided into two groups in relation to KH. Subgroup 1a received phosphomycin as monotherapy, subgroup 1b--phosphomycin with KH (2 pellets 3 times a day for 30 days). Subgroup 2a was initially treated with anti-inflammatory drugs, local medication physiotherapy, circulation improving drugs for 10 days. Then the patients were followed up for a months without any treatment. Subgroup 2b received the same initial course but it was followed for 30 days with KH. 79 patients with urolithiasis (uroliths and ureteroliths) have undergone ESWL. 45 entered KH group (2 pellets 3 times a day), 34--the control group (spasmolytic and anti-inflammatory therapy). KH in combined treatment of chronic cystitis raises efficacy of the initial therapy (antibacterial or combined, made in the absence of pyuria), promotes achievement of longer disease remission, elimination of concrement fragments from the urinary tract. Long-term administration of KH induce no side effects. Thus, KH can be recommended in chronic cystitis and urolithiasis in patients exposed to ESWL as an effective and safe drug.

[Causes of erectile dysfunction after transurethral resection of hyperplastic prostate and its prophylaxis].

The study was made of 60 sexually active patients with prostatic hyperplasia after monopolar transurethral operations (mean age 61.3 years). 30 patients entered a control group, 30 ones--the study group. The latter received 10 mg vardenafil each other day for 7 weeks after the intervention. The patients filled in questionnaire, underwent dopplerography and electromyography of the penis. Questionnaire said that erection was worse after operation in 6 (20%) patients (p < 0.01) of the control group and none of the study group. The latter also showed better circulation. All the men with postoperative erectile dysfunction (ED) had electromyographic signs of impaired autonomic innervation of the penis. Thus, ED after transurethral operations for prostatic hyperplasia is primarily neurogenic and is seen in 20% operated patients. Early vardenafil therapy is effective in prevention of postoperative ED.

[Five-year experience in treating patients with prostatic hyperplasia patients with permixone (Serenoa repens "Pierre Fabre Medicament)]. / Piatiletnii opyt lecheniia permiksonom (Seronoa repens "Pierre Fabre Medicament") bol'nykh s giperplaziei predstatel'noi zhelezy.

Specialists of the urologic clinic of the I.M. Sechenov Moscow Medical Academy studied effectiveness of lipidosterol extract Serenoa repens (permixon) in 26 patients with prostatic hyperplasia (total prostate-specific antigen was under 4 ng/ml). The trial has been performed from November 1995 up to now. The drug was taken before meal with a small quantity of water in a total daily dose 320 mg twice a day. Initial IPSS values ranged from 8 to 18 scores (mean 11.65 +/- 0.59). Life quality index was 1 to 4 scores (mean 2.46 +/- 0.15). Initial size of the prostate varied from 26 to 63 cm3 (mean 36.23 +/- 1.57 cm3). Maximal urinary flow rate (Qmax) made up 8.7 to 14.6 ml/s (mean 11.83 +/- 0.31 ml/s). Residual urine was initially 0-60 ml (mean 10.58 +/- 2.91 ml). Permixon significantly reduced the disease symptoms and improved quality of life. 5 years of treatment decreased mean IPSS by 8.8 +/- 0.18 (75.5%). QOL--by 1.31 +/- 0.08 (53.3%), size of the prostate--by 10.81 +/- 0.55 cm3 (29.8%). Neither the symptoms nor quality of life became worse for these five years. The size of the prostate reduced in 16, unchanged in 9 and increased only in 1 patient. Qmax was initially under 15 ml/s and rose after the treatment by 4.13 +/- 0.51 ml/s (35%), on the average. Qmax rose above 15 ml/s in 16 patients. Residual urine increased during the treatment in one patient only. Permixon intolerance was not observed. Thus, continuous 5-year therapy with lipidosterol extract Serenoa repens (permixon) proved highly effective and safe in 26 patients with initial or moderate symptoms of prostatic hyperplasia.

[Transurethral electrosurgery in the treatment of benign prostatic hyperplasia]. / Transuretral'naia élektrokhirurgiia v lechenii dobrokachestvennoi giperplazii predstatel'noi zhelezy.

The article is devoted to topical problem of modern urology, one of the lines of surgical treatment of benign prostatic hyperplasia (BPH)--transurethral electrosurgery. Physical principles which are the basis of transurethral electrosurgical interventions and influence of transurethral electrosurgery on prostatic tissue are described. Methods of necessary preoperative examination of patients with BPH are presented. The most often used transurethral electrosurgical technique for destruction of hyperplastic prostatic tissue is described. The results of 5-year use of combination of transurethral electroresection and electrovaporisation in the treatment of BPH and its complications are presented. Ways of prophylaxis of possible complications are proposed.

[Mineral water Volzhanka from Undorovski spring in combined therapy of patients with nephrolithiasis and chronic pyelonephritis]. / Undorovskaia mineral'naia voda "Volzhanka" v kompleksnoi terapii bol'nykh nefrolitiazom i khronicheskim pielonefritom.

Water loading is an essential component in therapy of nephrolithiasis, especially in the presence of small ureteral concrements or fragments after extracorporeal shock-wave lithotripsy. Saluretics, furosemide in particular, cause side effects. One of these is dyselectrolytemia due to potassium loss. Mineral waters have advantages in the treatment of nephrolithiasis and pyelonephritis as their drinking does not lead to electrolyte loss. Low mineral waters are highly diuretic, e.g. after drinking 1 liter of Volzhanka day-time diuresis increases by 300-400 ml. This relieves ureteral and calyceal-pelvic tonicity stimulating elimination of the concrements or their fragments after lithotripsy. Intake of Volzhanka proved effective in combined therapy of nephrolithiasis, calculous pyelonephritis, urate nephrolithiasis.

[Results of surgical treatment of cancer of the kidney with high surgical risk under hyperbaric oxygenation]. / Rezul'taty operativnogo lecheniia bol'nykh rakom pochki s povyshennym operatsionnym riskom v usloviiakh giperbaricheskoi oksigenatsii.

Refusal of operative intervention because of high operative risk not infrequently deprives the patients of the only chance to prolong survival. Surgical treatment under hyperbaric oxygenation (HBO) creates adequate conditions for such operations as oxygen saturation of the blood and tissues prevented hypoxia developing due to the severe operative trauma and blood loss. Intraoperative and early postoperative hemodynamic and gas exchange parameters become stable. HBO extends indications for operative treatment of renal carcinoma contributing to improvement of treatment results.