[Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury].

AIM: to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI). MATERIALS AND METHODS: a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate. RESULTS: In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group. CONCLUSION: Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.

[Docosahexaenoic acid in the treatment of idiopathic male infertility].

AIM: docosahexaenoic acid is one of the most common fatty acids in the cell membranes of sperm. This substance is a structural component of cell membranes, and is responsible for such properties as plasticity and fluidity which are necessary for the implementation of the process of capacitation and acrosome reaction. In addition, docosahexaenoic acid has antioxidant properties. Aim of our study was to assess the effect of dietary supplement docosahexaenoic acid (Brudi PLUS) on such markers of male fertility as the sperm DNA integrity, standard indicators of semen analysis and cryotolerance in infertile men. MATERIALS AND METHODS: a randomized, multicenter, double-blind, placebo-controlled study was conducted. A total of 109 infertile men were recruited to participate in the study. All patients underwent different analyzes, including semen analysis, sperm DNA fragmentation, MAR-test, test of cryotolerance and electron microscopy analysis of spermatozoa. In active treatment group patients were prescribed to drug containing 350 mg of docosahexaenoic acid 3 times a day for 90 days. In the control group, patients were administered to a placebo with a similar scheme. All analyzes were repeatedly performed after 3-months of therapy. RESULTS: An increase in the progressive mobility and sperm viability was determined after the test of cryotolerance in the active treatment group. According to electron microscopy analysis of spermatozoa, positive changes were observed in the number of heads of the normal form with the normal structure of chromatin and acrosome, as well as a decrease in the number of spermatozoa with insufficiently condensed chromatin. CONCLUSIONS: the therapy with drug Brudi PLUS in patients with male infertility allows to increase in cryotolerance of sperms as well as decrease in number of sperm ultrastructure defects.

[Investigation of mechanisms of action of growth factors of autologous platelet-rich plasma used to treat erectile dysfunction].

AIM: To determine the quantitative and qualitative composition of growth factors (PDGF-AA, PDGF-BB, VEGF, VEGF-D, FGF-acid, FGF-basic) and platelets in various modifications of APRP. MATERIALS AND METHODS: Blood of 12 male volunteers (control group) and 12 patients with ED was used to prepare APRP and the subsequently determine the concentration of growth factors. The growth factor concentrations (FGF acid, FGF basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D) was determined using a flow cytometry-based xMAP Luminex (Gen-Probe) system. RESULTS: Concentration of platelets in APRP obtained by two stage centrifugation, reached 1480 (1120-1644) in the control group and 1232 (956-1502) in patients with ED. The concentration of growth factors in the samples prepared without preliminary freezing was: PDGF-AA 842 (22-3700), PDGF-BB 2837 (1460-4100), FGF-basic 7.9 (0.28-127), FGF-acid 3, 4 (0.14-11), VEGF 19 (4.6-46), VEGF-D 21 (14-38). After thawing, the concentration of all growth factors in the samples increased. DISCUSSION: The study findings suggest that the mechanism of erectile function recovery following the use of APRP is through the active substances detected in APRP, i.e. FGF-basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D and FGF-acid. Also, the study showed that the content of growth factors in APRP after of freezing/thawing is higher than in APRP that has not been frozen. This is due to the cell membrane destruction at extremely low temperatures during freezing.

[New approaches for recovery of erectile function in patients after radical prostatectomy].

Prostate cancer (PCa) is one of the most common maligmancies and causes of death among men. Radical prostatectomy (RP) is optimal and recommended treatment modality for localized prostate cancer. More than half of all men undergoing surgery experience problems with erectile function and existing treatments do not provide a positive effect. Thus, there is a need for new approaches to the restoration of erectile function in patients after RP. One of these is the use of cell technologies, namely the stromal-vascular fraction and autologous platelet-rich plasma. This review examines the results of preclinical and clinical studies investigating the efficacy and safety of these treatment options in erectile dysfunction.

[Cell technologies' application in practical andrology].

The article is devoted to new methods for treating men's erectile dysfunction using platelet-rich auto plasma and adipose tissue stromal vascular fraction. Recently, there has been increased interest in these methods due to their high level of efficiency and safety. Platelet-rich auto plasma and adipose tissue stromal vascular fraction have been successfully applied in different medical fields - traumatology, orthopedics, plastic surgery, etc. At the same time, efficacy and safety of these technologies has not yet been clinically studied from the perspective of evidence-based medicine.

[ABTU-01 andromed device in the treatment of erectile dysfunction].

The compression-decompression method was used in the treatment of vasculogenic erectile dysfunction in 42 patients. The barotherapeutic urological unit (ABTU-01) Andromed was used. The alternation of compression and decompression of cavernous bodies stimulates synthesis and maximal realization of biological effects of nitric oxide the abnormal synthesis and release of which due to endothelial dysfunction are among the leading causes of erectile dysfunction. The efficacy of the method was 90-93%, duration of the effect--from 7 to 12 months depending on the kind of vascular disorders.

[Treatment of prostatic cancer with high intensity focused ultrasound (HIFU) using Ablatherm device].

High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point and thus destroying it, causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the surrounding tissue. A total of 122 patients with biopsy-proven prostatic cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic for 3.5 years using the Ablatherm device. Seventy one of them entered this study. They were followed up for six months to three years at a regular interval. Follow-up PSA measurements and control sextant biopsies were made. The median PSA nadir 1.5-3.0 months after treatment ranged from 0.10 ng/ml (in low-risk localized prostate cancer group) to 2.50 ng/ml (in patients with disseminated process). Negative control biopsies were registered in 74-77.7% patients with local prostatic cancer and in 60-68% patients with disseminated process. Of all the patients, 90% had undergone transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and significantly reduced treatment-related morbidity. Urinary stress incontinence grade 2 was observed in 1.6% and grade 3--in 0.8% of all the patients. No other severe complications occurred. The erectile function was preserved in 71.2% patients. Our results demonstrate efficacy and safety of HIFU. HIFU does not exclude other treatment options and can be repeated. HIFU seems to be a valid alternative treatment for patients with contraindications for radical surgery.

CD24 and CD70 as differential markers of human hepatocellular carcinoma cells in culture.

We developed a new method for evaluation of the purity of cell population in primary cultures of hepatocellular carcinoma. Expression of potential surface molecular markers on primary cultures of renal tumors was assayed by the method of flow cytofluorometry. CD24 and CD70 were identified as differential markers, which allowed us to distinguish cancer cells from tumor stromal cells in vitro. A negative marker CD90 was expressed on fibroblasts of the tumor stroma, but not on cancer cells. Combined use of these three markers allows evaluation of the severity of tumor culture contamination with stromal cells.

[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.