[Onto-phylogenetic prerequisites for development of chronic cystitis in women].

INTRODUCTION: Urinary tract infections (UTIs) are among the most common bacterial infections. At the request "cystitis", there are 12,067 publications in the RSCI system (e.library) as of 10/08/2023 and 16,332 articles were screened in the Pubmed. This is evidence that the problem of cystitis is far from being resolved. MATERIAL AND METHODS: A total of 425 patients with bacterial vaginosis and 77 women with chronic recurrent cystitis were included in the study. In all patients, the vaginal biocenosis was assessed through molecular genetic testing. The examination included filling out the Russian version of the Acute Cystitis Symptom Score (ACSS), urinalysis, and urine culture. In addition, local microcirculation was measured using laser Doppler flowmetry (LDF). After examination, patients were prescribed basic therapy and randomly assigned to one of three groups. In a control group (n=17), only basic therapy, consisting of fosfomycin 3.0 once at night + furagin 100 mg after meals 3 times a day for 5 days was prescribed. In the main group 1, 29 women received basic therapy plus Superlymph suppositories 10 units 2 times a day vaginally for 10 days. In the main group 2, 31 patients received basic therapy plus suppositories Superlymph 10 units (rectally in the morning) and Acylact Duo (vaginally in the evening) for 10 days. RESULTS: Among 425 patients with bacterial vaginosis, 78 (18.3%) complained of various urinary disorders, but only 21 women (4.9% of those with vaginal dysbiosis and 26.9% with dysuria) had a diagnosis of cystitis. In all cases, it was an exacerbation of a chronic disease. Among 77 patients with chronic cystitis, normal vaginal flora was initially present in 32 patients (41.6%), and bacterial vaginosis was found in 45 (58.4%) cases. After therapy, positive results were noted in patients of all groups. Complete eradication of the pathogen occurred in 15 women (88.2%) who received only basic therapy; in the main groups 1 and 2, uropathogens were not detected in 27 (93.1%) and 28 (90.3%) cases, respectively. In the control group, the proportion of patients with normal vaginal flora remained virtually unchanged (41.2% [n=7] vs. 47.1% [n=8]). In the main group 1, the proportion of patients with normal vaginal flora almost doubled: from 41.4% (n=12) to 79.3% (n=23). In main group 2, restoration of vaginal flora was noted in 87.1% of cases. CONCLUSION: According to our data, only 4.9% of patients with bacterial vaginosis were diagnosed with chronic cystitis, however, 58.4% of patients with chronic cystitis had vaginal dysbiosis. The use of a complex of antimicrobial peptides and cytokines has significantly increased the bidirectional effect of therapy. Suppositories Superlymph in a combination with vaginal use of Acylact Duo allow to obtain the best results.

[Chronic cystitis: how to prolong the relapse-free period?]

INTRODUCTION: Chronic cystitis predominates in the structure of urinary tract infections (UTIs). International guidelines are mainly focused on the treatment of acute uncomplicated cystitis; the approaches for managing patients with chronic cystitis has not been sufficiently developed. MATERIAL AND METHODS: A total of 91 patients were included in prospective multicenter randomized comparative controlled study. They were divided into three groups. In the group 1, 32 women received only standard antibiotic therapy for 5 days. In the group 2, 28 patients (received standard therapy plus rectal suppositories Superlymph 25 IU 1 time per day for 10 days). In the main group, 31 women received standard therapy in combination with the use of rectal suppositories Superlymph at a dose of 10 IU 1 time per day for 20 days. Standard antibiotic therapy included fosfomycin trometamol 3.0 g once and furazidin 100 mg three times for 5 days. To assess the long-term results, patients were invited for a follow-up 6 months after the end of therapy. AIM: To determine the long-term results of combined etiologic and pathogenetic therapy, including Superlymph rectal suppositories at a dose of 10 U and 25 U, in patients with chronic cystitis. RESULTS: Six months later, 82/91 (90.1%) women were examined to assess the long-term results. At 6 months, in group 1 a relapse of the cystitis developed in 17 women (60.7%) after an average of 67.3+/-9.4 days. In group 2, recurrence was observed in 12 patients (44.4%), and the relapse-free period was longer, averaging of 84.3+/-9.2 days. The best results were demonstrated in the main group, in which the relapse-free period lasted an average of 123.5+/-8.7 days, and a relapse developed in only 8 cases (29.6%). In 19 patients (70.4%) there were no symptoms after six months. Differences between groups were highly significant (p<0.001). In all groups, none of the patients had more than one recurrence of the cystitis during the follow-up. CONCLUSION: Combined antibiotic therapy results in the absence of recurrence within six months in 39.3% of patients with chronic cystitis. Complex etiologic and pathogenetic therapy, including Superlymph rectal suppositories, allows to significantly reduce the number of recurrences and prolong the relapse-free period. Among the patients who received a course of local cytokine therapy at a dose of 25 units for 10 days, 55.6% did not have a recurrence of chronic cystitis within 6 months. In the group of patients who, along with etiologic therapy, received Superlymph rectal suppositories at a dose of 10 IU for 20 days, a relapse was absent in 70.4% of patients.

[The use of complex herbal supplements for the prevention and treatment of urinary tract infections. The analysis of active components].

Urinary tract infections, especially recurrent cases, are caused by uropathogens, which, after repeated courses of antibiotic therapy, can develop antibiotic resistance, which requires a search for an alternative treatment strategy. In this regard, the restoration of nonspecific protective factors that normally prevent the adhesion and colonization of pathogens is of interest for clinicians. To date, scientific data has been accumulated about the anti-uropathogenic and antiadhesive activity of many plant extracts. However, studies on the specific action of herbal components are limited. Data on the chemical composition, mechanisms of action, in vivo and in vitro efficacy of medicinal plants growing on the European continent and used for the prevention or treatment of acute and chronic (recurrent) urinary tract infections are presented in the review.

[Influence of phenazopyridine on the well-being of patients during and after cystoscopy].

INTRODUCTION: Cystoscopy is one of the most common procedures in urology. There is no single approach to pain relief. In the literature, there are conflicting data on the efficiency of intra-urethral gels. The use of non-steroidal anti-inflammatory drugs, intravenous sedation, and nitric oxide analgesia has been described. Phenazopyridine has been known for a long time. Acting on the bladder mucosa, it has a local analgesic effect. AN evaluation of phenazopyridine intake prior to cystoscopy in order to decrease pain during procedure and facilitate subsequent urination was performed. MATERIALS AND METHODS: A total of 97 patients were included in the study. Indications for cystoscopy were as following: hematuria, lower urinary tract symptoms/pain, a need to remove ureteral stent. The patients were randomized into two groups. In the main group (n=50), phenazopyridine 200 mg was administered 20 minutes before cystoscopy and then at a dose of 200 mg every 8 hours (in total three doses) in combination with lidocaine gel. In the control group (n=47), only lidocaine gel was used. Heart rate was measured before and after the procedure. All patients were asked to complete a visual analogue scale (VAS) 3, 8 and 24 hours after cystoscopy with the assessment of the first urination. RESULTS: After cystoscopy, the difference between groups in VAS score was 27.7% in favor of the main group (p<0.001). After 3 hours, the average score in the main group was two times less than in the Control (p=0.012), while 3 and 8 hours after cystoscopy, the proportion of "zero" results was 10% and 0%, 28% and 4%, respectively, p<0.005. The heart rate after the procedure in the main group was 75.1 beats/min, compared to 77.9 beats/min in the control group (p=0.016). CONCLUSION: The intake of phenazopyridine allows to reduce pain intensity during and after cystoscopy and alleviate pain during first urination.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[Improvement of performance of semen culture in infertile men undergone to diagnostic evaluation].

INTRODUCTION: Barren marriage is an important medical and social problem. Up to 20-60% of cases of male infertility are associated with inflammatory diseases of the reproductive system. Chronic prostatitis constitutes up to 50% cases. In this regard, a search of methods aimed at improvement of detection rate of pathogens in inflammatory prostatic diseases of the prostate is still relevant. AIM: To study the influence of bovhyaluronidaze azoximer (Longidaza) on the diagnostic sensitivity of semen culture in infertile men. MATERIALS AND METHODS: a total of 87 infertile men were included in the study. The main group consisted of 41 patients who received Longidaza 3000 IU, one suppository every two days, for a total of 5 suppositories, prior to semen culture. In the control group, 46 patients had semen culture without any interventions. When evaluating the result of semen culture, clinically significant bacterial count was more or equal 103 CFU/ml. RESULTS: In the main group, bacterial growth was seen in 19 (46.3%) patients, which is 2.7 times higher than in the control group (n=8; 17.4%; 2=4.47, p=0.0346). A total of 36 patients in the control group with negative semen culture at baseline undergone to repeat analysis, according to the protocol in the main group. As a result, in 12 more patients in the control group (33% men with initially negative semen analysis) a bacterial growth was shown. The detection rate of bacteria in the ejaculate in the control group after repeat analysis was similar to those in the main group (43.5 46.3%, respectively, =0.87). CONCLUSION: The preliminary use of bovhyaluronidaze azoximer rectal suppositories (Longidaza) in infertile men, when they undergone diagnostic evaluation, contributes to increase in diagnostic sensitivity of semen culture and allows to improve the quality of diagnosis of the inflammatory diseases of reproductive system.

[The impact of ureteral stent surface on encrustation and biofilm formation].

INTRODUCTION: Encrustation and biofilm formation is a clinical problem occurring with indwelling urinary drainage devices routinely used in urological practice. AIM: To investigate the impact of ureteral stent surface on encrustation and biofilm formation. MATERIALS AND METHODS: Polyurethane stents of two manufacturers were examined using the scanning electron microscopy and scanning probe microscopy before use and three weeks after their initial ureteral placement in patients with no evidence of a urinary tract infection and urolithiasis. RESULTS: In one case, there were irregularities in the form of pyramids with a height of 0.15+/-0.02 m with a tendency to occur at regular intervals, forming ordered rows, with a density of 2.67 per 10 m2. The cross-sectional area of the irregularities in the probe displacement direction was 1.015 m, after use - 1.271 m (25.2% increase). In another case, pyramids with a height of 0.39+/-0.03 m (p<0.0001) were detected without the pattern of repetition in the form of a network, the density was 3.31+/-10 m2. The cross-sectional area of the irregularities was 1.158 and 2.29 m2, respectively (an increase of 97.8%). In the first case, after three weeks of stent placement, the pyramids increased twofold, were amenable to counting, the biofilms had the appearance of scattered "loose" formations. In the second case, there were polygonal conglomerates of salts dozens of times larger than the primary elements; biofilms had the appearance of well-formed massive layers. CONCLUSION: The nature of the ureteral stent surface exerts a direct independent effect on the degree of encrustation and the formation of biofilms.

[Lesion of pelvic organs in secondary varicose veins of the small pelvis].

The authors studied peculiarities of pelvic organs lesions in patients presenting with secondary small pelvic varicose veins (SPVV) induced by endured thrombosis of iliac veins. The study included a total of 70 patients after endured thrombosis of iliac veins verified by radiodiagnostic methods. The average duration of thrombosis amounted to 3.8 years. The patients were subdivided into two groups. The Study Group comprised 48 patients presenting with small pelvic varicose veins revealed by duplex scanning; the Control Group was composed of 22 patients with no varicose pelvic veins. It was determined that characteristic features of patients with secondary SPVV having developed after iliac veins thrombosis included chronic pelvic pain, dilatation of cavernous veins of the rectum, inguinal vein varicosity and varicose veins of the groin and anterior abdominal wall. Formation of secondary SPVV after endured iliac vein thrombosis leads to disorders of pelvic organs, similar to those in primary varicosity, but more often being functional. Endured iliac veins thrombosis in formation of secondary SPVV leads to urination impairments with prevalence of moderately pronounced symptomatology. Small pelvic organs dysfunction in women with secondary SPVV due to endured iliac veins thrombosis manifests itself in dyspareunia, leukorrhea, and dysmenorrhea.