[HIFU therapy of localized prostate cancer using image-guided robotic HIFU Focal One].

INTRODUCTION: Prostate cancer (PCa) is the second most commonly diagnosed malignant tumor in men after lung cancer and is the fifth leading cause of death worldwide. In November 2019, the spectrum of alternative treatment for PCa was added by a novel minimally invasive method, namely high-intensity focused ultrasound (HIFU) using the latest Focal One machine (with the possibility of combining intraoperative ultrasound and preoperative MRI data). MATERIALS AND METHODS: During the period from November 2019 to November 2021, HIFU using Focal One device (manufactured by EDAP, France) was performed in 75 patients with PCa. Total ablation was done in 45 cases, while 30 patients undergone to focal prostate ablation. The average age of the patients was 62.7 (51-80) years, the total PSA level was 9.3 (3.2-15.5) ng/ml and the prostate volume was 32.0 (11-35) cc. The maximum urinary rate was 13.3 (6.3-36) ml/s, IPSS score was 7 (3-25) points, IIEF-5 score was 18 (4-25). Clinical stage c1N0M0 was diagnosed in 60 patients, 1bN0M0 in 4 patients, 2N0M0 in 11 patients. In 21 cases, transurethral resection of the prostate was performed within 4-6 weeks prior to total ablation. Before surgery, all patients underwent magnetic resonance imaging (MRI) of the pelvis with intravenous contrast and PIRADS V2 assessment. MRI data were used intraoperatively for precision planning of the procedure. RESULTS: In all patients, the procedure was performed under endotracheal anesthesia in accordance with the technical recommendations of the manufacturer. Prior to surgery, a silicone urethral catheter of 16 or 18 Ch was placed. The average duration of the intervention was 101 (56-147) minutes. The postoperative period was uneventful in all cases.Patients received antibiotic therapy via parenteral route for 4 days, followed by oral administration for another 10 days, as well as alpha-blockers (at least 1 month after procedure). After removal of urethral catheter on the 4th day, all patients started to void. In 9 cases there was acute urinary retention in the evening and in 4 patients in the next morning, requiring temporary bladder catheterization. A year after the procedure, 53 patients were fully examined: the average total PSA level in patients who underwent total ablation (n=53) was 0.96+/-0.11 ng/ml, the IPSS score was 6.9+/-0,6 points (no difference compared to baseline). Follow-up biopsy revealed PCa in 6 patients; in other cases, prostate fibrosis was determined. CONCLUSIONS: HIFU in patients with localized PCa using image-guided robotic HIFU (Focal One) is promising and feasible. This method has shown good oncological results with a short follow-up period. It is advisable to carry out further prospective analysis.

[TREATMENT OPTIMIZATION IN PATIENTS WITH ERECTILE DYSFUNCTION].

Erectile dysfunction (ED) is one of the most urgent problems of modern urology, significantly affecting quality of life of male population worldwide. According to European Association of Urology ED is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Premature ejaculation (PE) is also a significant medical and social issue as it seriously affects the quality of life, especially in the presence of more or less severe ED. The aim of this study was to determine the clinical efficacy and safety of combination therapy of phosphodiesterase type 5 inhibitors and dietary supplements NeyroDoz in patients with ED and PE. The study results demonstrate the effectiveness and good compatibility of phosphodiesterase type 5 inhibitors and dietary supplements NeyroDoz as a combination therapy in patients with ED and PE. Dietary supplement, having a good tolerance, reduced psychosomatic symptom and significantly increased duration of intercourse, thus significantly improving the quality of patients' sexual life. The feasibility to prolong the effect of the therapy by the individual adjustment of NeyroDoz dosing mode after a 60-day treatment course offers new opportunities for personalized medicine, and the dietary supplement may be recommended as a complementary preparation to provide an adequate sexual functioning.

[Hyperbaric oxygenation in combined treatment of interstitial cystitis].

A total of 116 female patients with painful bladder syndrome/interstitial cystitis aged 32-78 years (mean age 56 +/- 2.4 years) entered the trial. They were divided into two groups according to treatment. Group 1 (n = 54) received 10-day combined conservative treatment consisting of antimicrobial drugs (if urinary infection was diagnosed), angioprotectors, mast cell activity stabilizers and bladder instillation with combined solution. Group 2 included 62 patients whose treatment included complex anti-inflammatory therapy in combination with HBO sessions (7-10 sessions in barochamber OKA-MT, 2.0 +/- 0.2 atm). Subjective (the disease course, pain intensity, 24-h and nocturnal pollakiuria, effective urine volume) and objective (microcirculation in the bladder wall) results were assessed. Dopplerograms revealed venous stagnation. Patients of group 2 had a persistent improvement of microcirculation in bladder mucosa as shown by better blood flow in the veins and arterioles. In group 1 the above improvement was less pronounced. Thus, HBO in combined treatment of interstitial cystitis improves treatment results and promotes long-term remission of the disease.