[Treatment of patients with lower urinary tract symptoms in Moscow].

INTRODUCTION: In recent years, there has been a persistent tendency to a decrease in surgical treatment of patients with lower urinary symptoms (LUTS). This fact can be explained by variety drugs which have acceptable safety and high efficiency for treatment of urinary disorders. As part of our survey of men in Moscow region, the trends in prescribing the different drugs for the LUTS was studied. In addition, the duration of therapy and patient adherence were analyzed. MATERIALS AND METHODS: A prospective multicenter epidemiological study "Characteristics of lower urinary tract symptoms in men in the Moscow region" was carried out using data obtained from April 1 to May 31, 2017 with anonymous survey of 525 men with mean age of 64.2+/-9.93 years, living in Moscow and went to the urologist with urinary disorders. All respondents answered questions from specially designed questionnaire consisted from 140 items. All medical data were analyzed, including received drugs, the duration of the therapy and subjective assessment of efficiency. RESULTS: A total of 419 patients from 525 (79.8%) received any kind of therapy. The most commonly used drugs were -blockers, which consisted 65% of all prescriptions. Other drugs were administered significantly rarely. It is surprisingly, that 85.6% of respondents in Moscow region received the original -blockers, not generic drugs. Satisfaction rate was 74.3%. Most of patients (58.3%) had received -blockers for 1-3 years and 33.3% administered these drugs for more than 3 years. Combined drug therapy was the second most popular (25.5%). The most commonly used combination included -blockers and inhibitors of 5-reductase. In 90.6% cases the appointment was made by urologist. CONCLUSION: Drug therapy is the most popular treatment in patients with LUTS. Our data suggest that -blockers as monotherapy or in combination with inhibitors of 5-reductase is the most often prescribed therapy. These results are in concordance with the main conclusions of international studies dedicated to this issue.

[The experience of using drug Afalaza for treatment of lower urinary symptoms in treatment-nave patients with benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 50 years. The prevalence of the BPH increases with age, and pathologic features of BPH are found in about 90% of men over 80 years. AIM: The aim of the study was to study the efficacy and safety of Afalaza for the treatment of lower urinary tract symptoms (LUTS) in treatment-nave patients with BPH. MATERIALS AND METHODS: A multicenter study of using Afalaza for the treatment of LUTS in treatment-nave patients with BPH was carried out in 9 urological centers in Moscow. A total of 80 treatment-nave patients with BPH were enrolled. The improvement in the total score of IPSS, IIEF-5 and QoL after 30 weeks of therapy was evaluated as well as changes in prostate volume and maximum urinary flow rate (Qmax). RESULTS: After 30 weeks of therapy, there was a significant decrease in the total IPSS score. A decrease in the total IPSS score by 5.5 points (+37.9%) from 14.5+/-4.0 at the baseline to 9.0+/-4.1 at the visit 9 was seen. The QoL decreased by 1.8 (-38.3%) points from 4.7+/-1.0 at the baseline. The Qmax also changed from 12.7+/-4.6 to 16.4+/-5.7 (+28.3%) after 30 weeks of therapy. At the visit 9, the total IIEF5 score increased by 3.4+/-4.4 (+19.9%) from 17.1+/-4.3 at the baseline. In addition, prostate volume decreased from 42.7+/-11.1 at baseline to 41.0+/-9.8 cc post-treatment (-5.15%). A reduction of post-void residual urine volume from 26.0+/-25.3 at baseline to 17.7+/-24.2 (-31.9%) post-treatment was also shown. CONCLUSION: The results of a multicenter study demonstrate the efficacy of Afalaza for treatment of treatment-nave patients with LUTS/BPH. Afalaza reduces prostate volume and improves an erectile function.

[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.

[One-stage cryoablation of two renal tumors]. / Odnomomentnaia krioablatsiia dvukh opukholei u patsienta s pochechno-kletochnym rakom.

The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.

[Specific features of lower urinary tract symptoms in men living in the moscow region. Results of the epidemiological study].

INTRODUCTION: Voiding disorders in men are manifested by various symptoms associated with impairment of the urinary flow along the urinary tract and worsening of the urinary bladder storage function. There is a considerable lack of data on the prevalence of LUTS, their severity, and correlation with data from objective studies in men in the Russian Federation in general and in the Moscow region in particular. MATERIALS AND METHODS: A prospective multicenter epidemiological study "Specific Features of Lower Urinary Tract Symptoms in Men Living in the Moscow Region" was conducted based on data acquired from April 1 to May 31, 2017 by an anonymous survey of 525 men (mean age 64.2+/-9.93 years old), residing in Moscow and presenting with complaints of urination disorders. The respondents answered questions of a specially developed 140-item questionnaire. All demographic and medical information was taken into account, including concomitant diseases and ongoing therapy. The patients filled out the IIEF, I-PSS, QoL, and AMS (Aging Male Screening) questionnaires. RESULTS: Analysis the I-PSS scores showed that symptoms of the emptying phase predominated over the symptoms of the filling phase in all age groups. The most frequent complaints were "frequent urination" and "weak urine stream". Forty and 30% of respondents had moderate and severe LUTS, respectively. The remaining 30% of men had mild LUTS. Prostate volume was significantly greater than that reported in similar studies conducted in Asia, Europe and North America (mean 55.27 cm3). The level of total prostate-specific antigen (PSA) was known in 98.8% of patients over the age of 50 and averaged 3.87+/-4.41 ng/ml. The mean age at the first testing for total PSA in Moscow is 56.7+/-9.0 years. CONCLUSION: This study is the first epidemiological study of this scale and focus. Its findings can be used to compose a "portrait" of a standard patient and identify patterns that limit the extrapolation of international epidemiological studies to the population of Russian patients. It seems necessary to develop an updated LUTS management strategy, taking into account the identified national characteristics.

[Analysis of factors affecting the compliance with medical therapy for benign prostatic hyperplasia].

AIM: To investigate factors affecting the compliance of patients with the combination therapy for benign prostatic hyperplasia. MATERIALS AND METHODS: Four hundred BPH outpatients treated with combination therapy were surveyed. RESULTS: The absolute majority of patients (76.16%) expected a quick positive result. 10.47% viewed their disease as too advanced, did not believe in the effectiveness of medical therapy and believed the surgery to be the only treatment option. 24.42% of patients changed the medication dosage on their own, and 11% were ready to discontinue the treatment without consulting their doctors. 76.16% of patients considered the recommended treatment to be effective, 77.33% fully trusted the doctor. In the opinion of 8.7% of patients, the doctor did not sufficiently inform them about the prescribed drug. 22.67% of patients had doubts about a physicians competence, and 5.23% believed the doctor complicated their medical treatment and changed prescriptions too often. CONCLUSIONS: The patients had a high level of trust in doctors and showed psychological adherence to therapy. However, about a quarter of patients changed the treatment regimen on their own. Many patients had exaggerated expectations of the treatment. 8% of patients reported insufficient awareness regarding the nature and appropriateness of drug therapy, and one in five patients had difficulties in perceiving, remembering and following the treatment regimen. CONCLUSION: streamlining therapeutic regimens, prescribing non-titratable or combined drugs will help improve patients therapy compliance.

[EVALUATION OF DIAGNOSTIC SIGNIFICANCE OF PELVIC MRI IN PROSTATE CANCER PATIENTS].

Accurate staging of prostate cancer is a prerequisite to forecast disease progression and-to guide surgery planning. In current clinical practice, contrast-enhanced MRI is one of the imaging tools for improving the evaluation of prostate cancer patients. To assess the diagnostic value of MRI a retrospective study in a real clinical practice setting was conducted. Preoperative MRI imageswere compared to postoperative pathological findings after radical prostatectomy. Accuracy of 85,3% was found in detection of seminal vesicle involvement and 65% in extracapsular extension. Specificities achieved 93,9% and 98,5%, respectively.

[Simulation-based robot-assisted surgical training].

Since the first use of robotic surgical system in 2000, the robot-assisted technology has gained wide popularity throughout the world. Robot-assisted surgical training is a complex issue that requires significant efforts from students and teacher. During the last two decades, simulation-based training had received active development due to wide-spread occurrence and popularization of laparoscopic and robot-assisted surgical techniques. We performed a systematic review to identify the currently available simulators for robot-assisted surgery. We searched the Medline and Pubmed, English sources of literature data, using the following key words and phrases: "robotics", "robotic surgery", "computer assisted surgery", "simulation", "computer simulation", "virtual reality", "surgical training", and "surgical education". There were identified 565 publications, which meet the key words and phrases; 19 publications were selected for the final analysis. It was established that simulation-based training is the most promising teaching tool that can be used in the training of the next generation robotic surgeons. Today the use of simulators to train surgeons is validated. Price of devices is an obvious barrier for inclusion in the program for training of robotic surgeons, but the lack of this tool will result in a sharp increase in the duration of specialists training.

[Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

[Benign mimics of prostatic adenocarcinoma].

Prostate cancer occupies 2nd place on the prevalence and 6th place on mortality among all cancers in men. That is not to deny the social importance of prostate cancer, but attention is drawn to significant advantage of newly detected cases above the cancer-specific mortality. "Gold standard" for diagnosis includes morphological study of tissue fragments after transrectal multifocal prostate biopsy. The importance of the differential diagnosis is particularly relevant when analyzing fragments of prostate tissue obtained from biopsies as a false positive result may cause unnecessary and excessive treatment. This article presents the most common benign processes that can simulate various grade adenocarcinoma. Awareness about the presence of such cancer mimics and careful examination of micropreparations in most cases allows to come to the correct conclusion.

[The evaluation of efficacy and safety of treatment with dalfaz SR in patients with prostatic adenoma].

An open non-comparative multicenter study-observation according the program involving 190 patients (mean age--62.3 +/- 9.7 years) with benign prostatic hyperplasia (BPH) and severe urination disorders was performed. All of the patients received alfuzosin (dalfaz SR) 10 mg daily for 12 months. The primary criterion for evaluation of treatment effectiveness was the change of the total IPSS score. As secondary criteria, change of QoL score, total number of urination per day and subjective patient's satisfaction with the treatment results were registered. Safety was assessed by recording the adverse events. The treatment led to the progressive decrease in the total IPSS score--from 16.4 +/- 4.8 at baseline to 7.7 +/- 2.6 at the final visit (P < 0.001). The average QoL score has decreased by 67% - from 3.9 +/- 1.1 to 1.3 +/- 0.7 at the end of the study (P < 0.001). In general, 94.2% of respondents positively assessed the results of treatment. The frequency of urination at night has decreased by 56%. Adverse effects (dizziness and slight fatigue) were recorded only in 1 (0.5%) patient. The present study has demonstrated a high efficacy and a favorable safety profile of dalfaz SR at a dose of 10 mg in the treatment of patients with BPH. Of particular note is the high proportion of patients who continued to receive the drug for 12 months, showing a good tolerability ofdalfaz SR and high treatment compliance.

[Awareness of the patients about detection of prostatic cancer].

We introduced an original simple anonymous questionnaire for urological patients in Moscow and Omsk outpatient clinics and hospitals. A total of 580 patients aged between 40 and 70 years (mean age 61.48 years) responded from February to June 2008. The questions concerned PSA test. In Omsk more men were tested for PSA: 77% against 67 in Moscow. Men with higher education made PSA test more often (88 and 60%, respectively). Only 31% responders know why PSA test is made. Of men over 70 years of age in Moscow, 43% responders made PSA test for the first time at the age from 60 to 69 years, the rest patients made it at the age 70 years and older. In Omsk, 88% responders made PSA test at the age of 70 and older. In men aged 40-49 years a mean IPSS point was 4, QOL--3. The highest IPSS (20 points) and QOL (4 points) were registered in men over 70. Among the responders over 70 years old, 38% were sexually active. The results of our questionnaire survey demonstrate that age of the patients who undergo PSA test in Moscow and Omsk is over 70. Quality of life is not adequately understandable for elderly questionnaire responders and should be simplified. Regular check-ups are effective for early detection of prostatic cancer and other diseases.

[Administration of two uroselective alpha-adrenoblockers in pharmacological treatment of acute urinary retention in patients with prostatic adenoma].

Acute urinary retention in males is often caused by infravesical obstruction due to enlargement of the prostatic gland. Recently it was found that alpha-adrenoblockers promote recovery of physiological voiding in patients with benign prostatic hyperplasia. In our study urinary bladder draining with urethral catheter in 136 patients with acute urinary retention was immediately followed by simultaneous administration of two alpha1-adrenoblockers--alfuzosine (10 mg once a day) (dalfaz CP) and tamsulosine (0.4 mg once a day) (omnik okas). The control group of 96 patients received monotherapy with alfuzosine. Physiological voiding recovered in 42.7% patients on alfuzosine monotherapy and in 64% patients on alfuzosine+tamsulosine.