[Monitoring of nocturnal penile tumescence in healthy volunteers by the Androscan MIT registrar to establish reliable normal physiological values in a multicenter study].

AIM: To evaluate the normal numerical and graphic values of nocturnal penile tumescence (NPT) test using Androscan MIT in healthy males in order to use the collected data as reference standard. MATERIALS AND METHODS: NPT monitoring was carried out in 38 healthy male volunteers by fixing a sensor designed for 20 measurements on their penis. During the NPT test the following parameters were recorded: 1) total sleep time; 2) minimal penis diameter (PD) in the flaccid state recorded by the apparatus; 3) maximum PD during effective penile tumescence; 4) absolute PD increase during effective erections; 5) increase in PD in %; 6) the overall time of the rigid-erection phase; 7) the number of penile rigidity episodes; 8) the average duration of each effective erection; 9) the percentage of rigid erections during the whole monitoring period. RESULTS: Based on the data collected by Androscan MIT, we have specified the numerical values which characterize normal physiological NPT indices in healthy male volunteers. The number of tests performed and similar inclusion criteria contribute to the objectiveness of the presented data. Normal sleep time was from 7.3 to 9.5 hours. Monitoring during sleeping reflected the upper and lower limits of the minimal PD value recorded by Androscan MIT, which was from 23.5 mm to 30.2 mm. The maximum PD increase during the most effective erection varied from 35.3 mm to 44.3 mm. Total PD increase was from 10.6 mm to 15.4 mm (from 35.6% to 59.2%). In all cases a significant difference in PD increase between flaccid state and effective erection during sleeping was seen. The number of penile rigidity episodes varied from 3 to 7 a night. The overall time of effective erections was from 62.3 to 206.7 minutes, while the minimum duration of a single erection episode was 16.4 minutes and the maximum duration reached 35.8 minutes. The ratio of effective NPT to the total sleep time (the percentage of penile rigidity episodes) varied from 11.9% to 41.3%. CONCLUSION: Our results allowed to define reference qualitative and quantitative values of NPT in healthy male volunteers recorded by Androscan MIT which can be considered as normal and physiological and used for differential diagnostics of erectile dysfunction.

[The effects of combination therapy with 5-reductase inhibitor and -blocker on the prognosis of BPH].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a polyethological disease of elderly and old men. The symptomatic pharmacological treatment of BPH involves the use of drugs that reduce either the dynamic component of obstruction or the size of the prostate (a mechanical component of obstruction). 5-reductase inhibitors (5-ARI) and -blockers are considered first-line therapy in the management of prostate adenoma. AIM: To investigate the efficacy of combination therapy with Fokusin and Penester in BPH patients. MATERIALS AND METHODS: The study is based on the analysis of medical records of 67 BPH patients aged over 50 years. All patients included in the study were randomized to 3 groups and had comparable age, sex, clinical manifestations and severity of the disease. Group 1 comprised 21 patients (mean age 63.8+/-9.7 years), who received a 5-reductase inhibitor (5-ARI) Pentester (Sanofi, France) 5 mg once daily. Group 2 included 22 patients (mean age 65.2+/-7.8 years), who received an -blocker Fokusin (Sanofi, France) 0.4 mg once a day. Group 3 comprised 24 patients (mean age 64.2+/-8.6 years) who received combination therapy with 5-reductase inhibitor (5-ARI) (Penester 5 mg once daily) and blocker (Fokusin 0.4 mg once daily). RESULTS: The study findings showed that in comparison with monotherapy, the concurrent administration of Fokusin and Penester was more effective in reducing the clinical manifestations of BPH, slowing the growth of adenomatous tissue thus reducing the size of the enlarged prostate. CONCLUSION: Combination therapy with Fokusin and Penester can be recommended to improve the treatment results of BPH patients.

[Comprehensive rehabilitation of a patient after penile amputation by the methods of augmentation reconstruction of corpora cavernosa, urethra and glans penis].

The article presents a unique clinical case of social, psychological and sexual rehabilitation of a patient who had undergone amputation of the penis due to penile cancer, without recurrence. The patient was submitted to comprehensive reconstruction of the lost parts of the sexual organ (corpora cavernosa, urethra, glans penis) using both conventional techniques and the ones performed for the first time in reconstructive plastic surgery.

[Modern approaches to the treatment of patients with overactive bladder and urge urinary incontinence].

Overactive bladder (OAB) is found in 20% of patients with various disorders of urination, and the imperative urinary incontinence diagnosed in one third of these patients. The study was aimed to improvement the treatment outcomes in OAB women with imperative incontinence and obstructive urination disorders by using a combination of alpha1-adrenoblockers and PDE-5 inhibitors, and to evaluation of relationship between clinical and urodynamic manifestations of the disease. The state of the microcirculation of the bladder mucosa before and after treatment was also evaluated. We have examined and treated 40 women aged 17 to 69 years with disease duration ranged from 1 to 20 years. Patients received combination of al-adrenoblocker alfuzosin (dalfaz) 5 mg at night and reversible selective PDE5 inhibitor tadalafil (Cialis) 5 mg daily in the morning for a month. After treatment, according to the uroflowmetry and cystometry data, the time of urination was reduced, urinary volume and maximum urinary flow rate, as well as cystometric capacity have increased; involuntary detrusor contractions in the bladder filling phase (spontaneous or provoked) became less, or absent. According to the results of ultrasound examination, residual urine volume has decreased. Laser Doppler flowmetry showed an increase of neurogenic tone in precapillary, bypass coefficient and microcirculation effectiveness index, increase in microcirculation index and the coefficient of variation, indicating an improvement of microcirculation in the bladder mucosa. As a result of treatment, the clinical effect was seen in 29 (73%) patients, urinary incontinence was noted only in 6 (15%) patients.

[Age changes of the connective tissue structures of human penis].

This investigation was aimed at the study of age changes of penis connective tissue structures. Tissue fragments of penis were obtained from 20 cadavers of men at the age of 20-38 years in group I, and from 20 cadavers of men at the age of 41-59 years in group II. The criteria for the exclusion of material from the research were arterial hypertension, diabetes mellitus, atherosclerosis of internal iliac arteries, Peyronie's disease, and anomalies of genital organ development. It was shown that in the cavernous body of penis, aging was associated with the increased amount and thickening of collagen and argyrophilic fibers, decreased content and thinning of elastic fibers, and the reduced amount of smooth muscle cells (SMC). The average area of fibroblast and SMC nucleolus was not different in both groups studied. The average area of endotheliocyte nucleolus was equal to 1.9+/-0.9 microm2 in group II, being lower than that one in group I, in which this index was equal to 2.1+/-0.9 microm2. No differences in the content of type III and IV collagen were found between the study groups. Age-associated decrease in the average area of endothelial cell nucleolus in the cavernous bodies may reflect the reduction of the activity of these cells and may indicate the development of endothelial dysfunction, which is one of the most important steps in the morphogenesis of age-related male erectile dysfunction.

[Efficacy of combined physiotherapeutic methods in complex treatment of patients with chronic infectious urethroprostatitis].

The study is aimed at investigation of efficacy and safety of a combined effect of laser therapy and vibromagnetotherapy in complex treatment of patients with chronic urethroprostatitis in the presence of sexually transmitted infection (STI). A total of 35 males aged 20 to 51 years entered the study. They were divided into 3 groups. Group 1 received standard basic therapy, group 2 received basic and laser therapy, group 3 - basic treatment and laser plus vibromagnetotherapy. Effectiveness of the treatment was assessed by the evidence obtained from clinical, bacteriological, device and functional examinations. The results of the treatments were evaluated after 2 weeks of the follow-up. It is shown that patients of groups 2 and 3 achieved more pronounced improvement of clinical and laboratory indices, parameters of basal blood flow. Thus, physiotherapy, added to antibacterial treatment, is safe and effective in the treatment of chronic urethroprostatitis and STI.

[Characteristic of gram-positive microorganisms isolated during chronic bacterial prostatitis].

AIM: To study microbial spectrum of urethra and prostate secretions (PS) in patients with chronic bacterial prostatitis (CBP) as well biological characteristics and pathogenicity factors of isolated staphylococci. MATERIALS AND METHODS: Seventy-five patients with CBP were examined. Fourty-six samples of PS, 28 samples of urethra secretions, and 153 strains of microorganisms were studied. Bacteriologic tests were performed using unified methods according to Ministry of Health order no. 535 (1985). Susceptibility to antibiotics was assessed according to methodic guidelines 4.2.1890-04 (2004). RESULTS: It was revealed that Gram-positive microorganisms, mostly Staphylococcus spp. and Enterococcus spp., were most frequently isolated from PS and urethra. Isolated microorganisms had secreting pathogenicity factors and were resistance to multiple antibiotics that could promote their persistence in prostate tissues and urethra. CONCLUSION: Gram-positive microflora possessing the range of pathogenicity factors, probably, maintain chronic inflammation in genitourinary system.

[The practice of instrumentation of automated working place of physician in territorial andrology center].

The article presents the design of automated working place of physician andrologist. This working place assists in resolving problems physician and nurse deals with in the everyday practice. This approach enhances the quality of case monitoring in patients with andrologic pathology, significantly expands the possibilities of prevention, treatment and rehabilitation of andrologic patients and develops the prerequisites in further development of dispanserization monitoring.

[The modular principle in the organization of territorial andrological service].

To establish the andrological service at the territory of the Russian Federation it is proposed to use the modular principle with the organization of the net of primary and consolidated modules in the regions of the Altai Krai and in the Coordinating Federal Center. For the realization of the project a step-by-step principle is needed. At the first stage--the creation of the net of men's consultations having personnel arrangements, material and technical provision, a set of premises, auxiliary services, and delivering a certain amount of care under the interregional urological departments. At the second stage it is planned to amalgamate men's consultations into a single telemedical net, to construct buildings of the Consultative Andrological Center (CAC) and the buildings of a sanatorium. At the third stage it is planned to complete equipping the CAC and the sanatorium in the town of Belokurikha.

Use of impaza in the treatment of erectile dysfunction in patients with essential hypertension and CHD.

Impaza treatment of erectile dysfunction in patients with essential hypertension and CHD receiving cardiotropic therapy improved erectile function and increased reserve circulation. Addition of impaza to the treatment protocol in cardiological patients considerably increased perfusion and reduced the content of desquamated epitheliocytes. No side effects of impaza were noted.

[Efficacy of vibrothermomagnetic impact on the perineum from the device Avim-1 in the treatment of chronic abacterial prostatitis patients with chronic pelvic pain syndrome].

Combined treatment of patients with chronic abacterial prostatitis and chronic pelvic pain syndrome including vibrothermomagnetic impacts on the perineum from the device AVIM-1 proved effective in relation to all aspects of the disease pathogenesis. The comfort and simple conduction of the procedures make the device use perspective not only in the treatment but also for prophylaxis of exacerbations.

[Characteristics of a spermogram and metabolic parameters of active oxygen forms in the ejaculate of patients with chronic abacterial prostatitis].

Chronic inflammatory diseases of the prostate are accompanied by the accumulation of active oxygen forms and the activation of biopolymer peroxidation. The increased concentration of thiobarbituric acid reactive substances and the decreased activity of antioxidant enzymes in the ejaculate of patients with chronic abacterial prostatitis are attended by spermatozoon defects. It is suggested that correction of the metabolism of active oxygen forms in patients with chronic abacterial prostatitis has a positive effect.

[Administration of afala preparation in urological practice].

Our studies of afala in patients with prostatic adenoma demonstrate that afala reduces irritative disorders of urination. Effect of this drug is seen in 98.3% patients during 4 weeks of its use. In longer intake the effect becomes stronger. The dose of 6 tablets a day significantly improves life quality. Three times a day dose is more effective in elimination of nicturia, enhances urine flow rate. Thus, choice of afala dose depends on the symptoms. Afala is indicated for prophylaxis in patients with initial stage of prostatic adenoma and as an alternative to expectation policy.

[Normal connective tissue in penis and its changes in patients with erectile dysfunction and Peyronie's disease].

The aim of this study was to examine the connective tissue of penis in normal individuals and in patients with erectile dysfunction (ED) and Peyronie's disease (PD) using computer methods of image analysis. Penis tissues were obtained from 20 males aged 20-40 years who died in accidents, penis biopsies were taken from 23 patients with ED and 9 patients with PD (average age: 51 +/- 11.5 years). In both groups of patients, the volumetric fraction of collagen fibers in the tunica albuginea and corpora cavernosa was increased, while that one of elastic fibers was decreased. At the same time, the changes of elastic fibers were noted: the fibers become thinner and formed "rods". The reduction of the amplitude and the wavelength in the collagen fibers of the tunica albuginea in patients with ED and the presence of fibrous plaques in corpora cavernosa in in patients with PD were registered. The methods of computer image analysis may improve the morphologic diagnosis of ED and PD.

[Defects in spermatogenesis and their correction in patients with chronic abacterial prostatitis].

A total of 28 males aged 20-46 years with chronic abacterial prostatitis (CAP) were divided into two groups. Group 1 patients received standard therapy (prostatotropic, vitamin, antioxidant); group 2 received the same standard treatment plus peloid therapy including silver-containing clay "Bekhtemirskaya". Eleven males with documented fertility (sperm donors) comprised a control group. The participants of the trial were examined for ejaculate indices, activity of the antioxidant system, ion composition of ejaculate, prostatic microcirculation before the treatment, on treatment day 14 and 90. The examination revealed the following disorders in CAP patients: low activity of anti-oxidant enzymes, abnormal static microcirculation, low content of normal spermatozoa in ejaculate. Complex rehabilitation of the patients of both groups improved prostatic microcirculation, raised activity of the antioxidant system resulting in better mobility and viability of spermatozoa. In group 2 the results were better showing the efficacy of local peloid therapy.

[Treatment of erectile dysfunction in patients with essential hypertension and ischemic heart disease].

AIM: To evaluate the effect of impasa on activity of N0-dependent processes in cardiological patients with erectile dysfunction (ED). MATERIAL AND METHODS: 58 patients with IHD and angina of effort and 48 patients with hypertension participated in the study of efficacy of conventional treatment combined with impasa on the course of the basic disease, peripheral blood count of desquamated endotheliocytes, microcirculation and erectile function. RESULTS: IHD patients given impasa showed increased exercise tolerance, less number of anginal attacks, improved coronary microcirculation, improved metabolism of vascular endothelium. Manifestations of erectile dysfunction regressed. Hypotensive therapy also reduced the above manifestations in hypertensive patients. CONCLUSION: The addition of impasa to conventional cardiotropic and hypotensive therapy promotes ED regression.

[Treatment of erectile dysfunction in patients with ischemic heart disease and angina of effort].

A total of 58 patients with ischemic heart disease and angina of effort (FC II) (mean age 55.6 years) participating in the study were diagnosed to have erective dysfunction (ED) of a mild (35%), moderate (57%) and severe degree (8%). All the patients were randomized into two groups. Group 1 (n=21, mean age 56.4 years) received standard cardiotropic therapy (nitrates, beta-blockers, ACE inhibitors on demand, diuretics, antioxidants) and placebo. Group 2 (n=37, mean age 54.3 years) received the same standard cardiotropic therapy plus impase (1 tablet each other day for 3 months). The results of the trial show that impase addition to cardiotropic therapy raised exercise tolerance, diminished the number of anginal attacks in mild and moderate exercise, enhanced coronary microcirculatory blood flow, increased reserve circulation index by 34%, improved metabolism of vascular endothelium in the whole body. Impase acts pathogenetically in endothelial insufficiency. Prevention of endothelial dysfunction by impase allows both to stop progression of cardiovascular disease and to prevent erectile dysfunction.

[Naiz (nimesulid) in combined treatment of patients with chronic non-bacterial prostatitis with chronic pelvic pain syndrome]. / Opyt ispol'zovaniia naiza (nimesulid) v kompleksnom lechenii bol'nykh khronicheskim abaketrial'nym prostatitom s syndromom khronicheskoi tazovoi boli.

Naiz (nimesulid) was given to 46 patients (age 24-52 years) with chronic abacterial prostatitis suffering from chronic pelvic pain syndrome (CPPS) which appeared from 20 to 3 years before the treatment. Microscopy of prostatic secretion showed normal count of leukocytes. Transrectal ultrasound investigation with dopplerography has found normal echostructure of the prostate but blood flow parameters were subnormal. Naiz was given in a dose 100 mg (1 tablet) twice a day for 15-20 days. The treatment relieved pain in 68-87% patients (mean 77.5%). The control ultrasound investigation detected much better circulation. Quality of life improved significantly. Side effects were mild. The effect persisted for 3 months of the follow-up. Thus, the addition of such nonsteroid antiinflammatory drug as naiz (nimesulid) to treatment of patients with chronic abacterial prostatitis is justified. The drug improves quality of life, induces side effects rarely and can be used for a long time with a persistent efficacy.

[Role of spermatic plasma enzyme in pathogenesis of relative male sterility]. / Znachenie issledovaniia énzimov spermal'noi plazmy v patogeneze otnositel'nogo muzhskogo besplodiia.

A complex of biochemical tests and standard techniques were used in males with relative sterility (RS) for ejaculate study allowing to detect pathology by qualitative and quantitative characteristics of the activity of spermatic plasma enzymes: alkaline phosphatase, acid phosphatase, gamma-glutamyl transferase, dipeptyl aminotransferase IV. A comprehensive evaluation of spermatic plasma enzymes of membrane-bound and intrastructural location made in 602 patients helped to establish severity and pathogenetic mechanisms of spermatozoon membrane damage in male RS. Hyperenzymospermia in patients with RS was of membrane origin and could be due to destabilization of the membrane and spermatozoon intrastructural elements. Staging of and an original approach to pathogenesis of impaired fertilizing ability of spermatozoa in males with RS are proposed.

[Changes in the enzyme level of the sperm of men with infertility]. / Izmenenie urovnia énzimov spermy u muzhchin s besplodiem.

Spermatic enzymes (fructose, alkaline phosphatase, gammaglutamyl transferase, alpha-glucosidase, dipeptydil aminopeptidase IV) were measured in 200 patients with secretory-toxic infertility. It is shown that in some variants of infertility changes in the levels of spermatic enzymes are compensatory. These changes may also reflect qualitative characteristics of spermatozoa.