[Possibilities of monotherapy with Prostatex in patients with chronic abacterial prostatitis].

AIM: To study the efficiency of the treatment of patients with chronic abacterial prostatitis using the drug Prostatex. MATERIALS AND METHODS: A total of 72 patients aged 22 to 43 years with chronic abacterial prostatitis were included in the study. All patients received Prostatex in the form of suppositories 10 mg QD within 20 days. The duration of the follow-up was 1 month. RESULTS: By the third visit from the start of treatment, there were almost no symptoms of the disease, according to the NIH-CPSI and IPSS questionnaires. In 67 (93.1%) patients, the prostate became an elastic, while in 69 (95.8%) men it was painless at palpation. In addition, a decrease in the prostate size, volume of residual urine and an improvement in urine flow rate were seen. CONCLUSION: Our results showed that monotherapy with Prostatex in patients with chronic abacterial prostatitis was effective and had pathogenetic rationale. This drug has a positive effect on the main symptoms of the disease, significantly reduces pain, urination disturbances, helps to reduce the prostate size and the volume of residual urine, improves prostate microcirculation and can be recommended for this category of patients.

[Afalaza in the management of patients with chronic pelvic pain syndrome].

INTRODUCTION: Currently, chronic pelvic pain syndrome (CPPS) is one of the most prevalent urological diseases, but due to the multifactorial nature of the disease and the lack of consensus on its pathogenesis, the issue of adequate therapy remains open. Since the vascular factor plays the major role in the pathogenesis of CPPS, we hypothesized that this category of patients has microcirculatory disturbances of the prostate. AIM: Detection of microcirculatory disturbances of the prostate, their correction, and evaluation of the effect on the course of CPPS. MATERIALS AND METHODS: The study comprised 60 healthy, sexually active men with clinical manifestations of CPPS lasting from 6 months to 5 years. After a comprehensive examination, all patients received Afalaza 2 tablets twice daily for 16 weeks. At the end of week 16, patients were re-examined. RESULTS: In patients with CPPS, therapy with Afalaza resulted in a significant improvement in microcirculation in the prostate thus leading to the reduction of the severity of disease manifestations.

[The effectiveness of Uroprofit in women with chronic cystitis].

AIM: To evaluate the effectiveness of the biologically active dietary supplement Uroprofit in the comprehensive management of exacerbations of chronic recurrent cystitis in women. MATERIALS AND METHODS: We examined 40 women with chronic cystitis aged 20-68 years. All patients were allocated to receive either monotherapy with fosfomycin (Monural) (control group, n=20) or combination therapy with fosfomycin and biologically active dietary supplement Uroprofit (study group, n=20). The results were evaluated at 1 and 2 months after treatment initiation. All patients before and after treatment underwent diagnostic work-up including standard laboratory tests, uroflowmetry, cystometry, cystoscopy, and laser Doppler flowmetry to assess microcirculation. RESULTS: The patients of the study group showed faster improvement in clinical manifestations of the disease, laboratory indicators, the dynamics of the endoscopic pattern and had positive changes in the bladder mucosa microcirculation. DISCUSSION: Uroprofit produces an antimicrobial and anti-inflammatory effect, helps normalize urodynamics of the lower urinary tract, improves microcirculation in the bladder wall and reduces the risk of repeated relapses of chronic cystitis. CONCLUSION: Uroprofit could be recommended as a component of the comprehensive management of exacerbations of chronic recurrent cystitis in women and as the means of preventing relapses in disease-free periods.

[X-ray-guided endovascular surgery in patients with benign prostatic hyperplasia and prostate cancer].

AIM: To evaluate the efficacy and safety of superselective embolization and chemoembolization of the prostatic artery as an independent method of treating prostate cancer and BPH. MATERIALS AND METHODS: From 2004 to 2015, 116 patients with BPH (mean age 73.2+/-5.2 years) underwent prostatic artery embolization. Mean prostate volume ranged from 55 to 296 cc3. From 2011 to 2015, 37 patients with prostate cancer (mean age 72.3+/-2.06 years) were treated with X-ray-guided endovascular chemoembolization. All patients had confirmed PCa, of whom 7 had stage T2a and 30 stage T2c disease. PSA ranged from 0.8 to17 ng/ml (mean 13.1+/-3.9). Prostate volume ranged from 61 to 93 cc3 (mean 69.4+/-9.3). The follow-up ranged from 8 to 42 months. RESULTS: Prostatic artery embolization in BPH patients resulted in a significant reduction in IPSS symptom score and increase in Qmax. The volume of prostate and nodular mass decreased on average by 53% and 47%, respectively, maximum by 82%. Chemoembolization was effective in 31 (83.7%) patients. An objective response was achieved in reducing the PSA level and prostate volume measured by TRUS, and improved urination. The median PSA at 6 months was - 3.4 +/- 0.02 ng/ml. In all patients, chemoembolization resulted in a marked reduction in the prostate volume. The greatest decrease in the prostate volume was observed at 6 months after treatment. Chemoembolization led to a marked improvement in the quality of urination confirmed by uroflowmetry and IPSS symptom scores. At 12 months, 16 patients with prostate cancer underwent the follow-up biopsy. In 12 cases pathology showed fibrosis and epithelial degeneration without signs of atypia and in 2 cases curative pathomorphosis was observed. Chemoembolization was well tolerated and did not cause any significant complications. CONCLUSION: Embolization techniques for BPH and chemoembolization for localized PCa showed good effectiveness and safety in patients who had medical contraindications to traditional treatments.

[Potentials for the use of complex drugs in the treatment of patients with chronic abacterial prostatitis].

Efficiency and safety of complex preparation prostadoz was evaluated in 25 patients with chronic abacterial prostatitis. It is proved that the use of prostadoz has a positive effect on the main subjective and objective signs of the disease: improves urination, reduces the severity of pain, moderately reduces the prostate volume, improves sexual-ejaculatory performance and improves quality of life.

[Application of udenafil for the correction of endothelial disorders in patients with stress-induced erectile dysfunction].

The study was aimed to the evaluation of vascular endothelium status in patients with stress-induced arterial hypertension, coupled with erectile dysfunction (ED). 51 patients underwent examination. Laurent--Segal Male Copulative Function Questionnaire (MCF), and International Index of Erectile Function (IIEF) were used for the detection of ED and assessment of its severity. Microcirculation in penile vessels was evaluated by laser Doppler flowmetry. Markers of endothelial function--endothelin 1 and asymmetric dimethylarginine-were measured. For the correction of violations identified, the drug udenafil (zydena) was used at a dose of 50 mg daily for 1 month. Against the background of therapy with udenafil, restoration of function of endothelial cells was detected. This suggested the functional nature of the violations in the genital sphere, and was regarded as a manifestation of stress-induced ED. Elimination of endothelial dysfunction led to significant reduction in ED symptoms.

[The use of drug vitaprost forte in patients with benign prostate hyperplasia].

The efficacy and safety of vitaprost forte rectal suppositories 100 mg in 30 patients with benign prostate hyperplasia (BPH) were evaluated. It is proven, that the use of this drug positively affects both the subjective and the objective symptoms of BPH. Vitaprost forte significantly reduces the clinical signs of the disease and improves quality of life, that is, reduces the severity of bladder outlet obstruction (according to the data of uroflowmetry, it increases maximum urinary flow rate), decreases the amount of residual urine. In addition, moderate reduction in mean prostate volume was revealed in BPH patients receiving vitaprost forte.

[The role of human papilloma virus in development of chronic urethritis and vulvodynia in females: perspectives of immunomodulating therapy].

The article is devoted to combined affection of the lower urinary tracts and genitalia in women with human papilloma virus (HPV) infection which manifests with persistent recurrent urethritis, pelvic pain syndrome. The colposcopic and urethrocystoscopic features, disturbed microcirculation of urethral and vaginal mucosa in virus infection promoting recurrences and persistence of HPV are discussed. Immunomodulators (inosin pranobex-groprinosin) are recommended for more effective treatment.

[Combined lumbosacral and vaginal physiotherapy in the treatment of overactive bladder in postmenopausal women].

Efficacy of combined application of physical factors including lumbosacral magnetotherapy and vaginal vibromagnetic impact is shown in 48 postmenopausal women (mean age 62.5 +/- 1.6 years) with overactive bladder (OAB). Choice of this combination is explained by a multifactorial OAB pathogenesis and degenerative spinal diseases often encountered in postmenopausal women (70.8% in this study). The exposures of the spine and the bladder (vaginal) were made one after the other with duration of the first stage 10-15 min, of the second--5-7 min, the course consisted of 10-12 procedures. The results of the treatment were assessed by urination rhythm, volume, number of incontinence episodes. Quality of life was evaluated according to special questionnaires. Trophic function of the spinal cord and innervation of the bladder were studied by n. tibialis conduction measured by electroneuromyography (ENMG). The following results were obtained: reduction of urinations for 24 hours by 36.9%, urgent episodes--by 44%, urgent incontinence--by 59.7%. Voiding volume significantly increased (by 26%). A total score of anxiety related to OAB fell by 51.3%. M-response amplitude in ENMG rose 1.5-fold, while velocity of the impulse conduction along the n. tibialis enhanced 1.2-fold. The technique was accomplished with AMUS-01-Intramag device and attachment to it Rectomassager made in Russia.

[Administration of vitaprost plus for prevention of infectious-inflammatory complications of transurethral prostatic resection in patients with prostatic adenoma].

The study of efficacy and safety of the drug vitaprost plus (rectal suppositories) in its use for prevention of infectious-inflammatory complications after transurethral resection (TUR) of the prostate for adenoma included 55 male surgical patients with prostatic adenoma (PA). The patients were randomized into two groups matched by age, symptoms and clinical data. The control group consisted of 20 patients (group 1), the study group--of 35 patients (group 2). TUR of the prostate was made in both groups, but patients of group 2 were given additional prophylactic treatment--vitaprost plus, one suppository before going to bed 2 days before surgery and for 8 days after TUR, the course lasted for 10 days. Postoperative blood and urine samples showed inflammatory changes more often in group 1, free of infection bacterial tests were more often in group 2. Renal microcirculation in group 1 after TUR evidenced for functional depression on perfusion intensity and renal ischemia and congestion. These changes persisted on postoperative day 8, being a potential cause of renal inflammation and ascending pyelonephritis. Group 2 patients exhibited insignificant postoperative microcirculatory disorders in the kidneys and were not registered on postoperative day 8. Infectious-inflammatory complications in group 1 patients were registered much more frequently than in group 2 patients. Thus, vitaprost plus can be recommended for prophylaxis of infectious-inflammatory complications of TUR in PA patients.

[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.

[Characteristics of bladder microcirculation in women with overactive bladder].

We studied microcirculation and a blood nitric oxide level in 30 females aged 23-63 years with overactive bladder (OAB) before and after administration of oxibutinin. We found that OAB patients have microcirculation disorders accompanied with elevation of nitric oxide in the blood. Oxibutin improved bladder microcirculation, normalized blood nitric oxide with resultant positive changes in clinical symptoms with less frequent voiding and alleviation of imperative disorders.

[Efficacy of low-intensity laser radiation and antibacterial therapy in the treatment of chronic prostatitis in the presence of sexually transmitted infections].

We studied 94 patients with chronic prostatitis (CP) in combination with urogenital chlamydiasis. The patients were divided into three groups. Group 1 consisted of 32 patients with bacterial prostatitis and sexually transmitted infection (STI). They were treated with fromilid in a dose 500 mg twice a day. Group 2 (n = 27) received also low-intensity laser radiation (LILR) on the prostatic gland. Group 3 patients (n = 35) with abacterial prostatitis were given fromilid (500 mg twice a day). We studied prostatic hemodynamics with color doppler mapping. A specific feature of prostatic vascularisation in CP and STI versus healthy subjects is heterogeneous decline of vessels density in ischemic zones with parallel decrease in these vessels diameter. A peripheral prostatic zone in CP patients with STI was characterized by lower vascularisation than central one. This deteriorates the course of the disease. The results of the study show that adjuvant LILR in CP patients with STI raises efficacy of therapy by 11%. Investigation of prostate vascularisation and hemodynamics of its vessels in CP patients with STI using transrectal ultrasonography and dopplerography provide detailed information about prostatic structure allowing for lesion zones. This facilitates choice of an optimal complex treatment with application of LELR in peripheral inflammation of the prostate.

[Effects of transcranial magnetotherapy on electroencephalographic parameters in females with overactive urinary bladder].

Urodynamic parameters and bioelectric brain activity were studied in 30 females aged 24-66 years with overactive bladder (OAB) before and after transcranial magnetotherapy. It was found that OAB patients have disorders of bioelectric brain activity by two types of EEG patterns (I.A. Svyatogor classification)--thalamic and stem, Patients with thalamic type EEG benefit more from magnetotherapy higher efficacy of which manifests with regress of clinical symptoms and urodynamic improvement.

[Transrectal magnetotherapy of the prostate from Intramag device in prophylaxis of postoperative complications of transurethral resection of prostatic adenoma].

The authors analyse preoperative preparation of 91 patients with benign prostatic hyperplasia (BPH). Two groups of patients received conventional preparation (group 1) and magnetotherapy (group 2) before TUR of the prostate. The examination covered immune system, bacteriological indices of urine and prostatic tissue. Infection of the urinary tract is a main risk factor of complications after TUR. Conventional preoperative preparation fails to correct immunity, to change bacterial urine flora, to improve hemodynamics in the prostate. Transrectal magnetotherapy with running magnetic field eliminates deficiency of T- and B-cell immunity, raises functional activity of B-lymphocytes and phagocytic ability of neutrophils, reduces endogenic intoxication, tissue edema, bacterial contamination, number of thrombohemorrhagic complications. This leads to a decrease in the number of postoperative complications.

[Effects of various kinds of conservative treatment on urodynamics and microcirculation in females with hyperactive urinary bladder].

Urodynamic and microcirculatory parameters were studied in 70 females aged from 21 to 70 years with hyperactive urinary bladder (HAUB) and 15 females free of diseases of the lower urinary tract. HAUB patients appeared to develop microcirculatory disorders in the wall of the bladder manifest as slow circulation resulting in detrusor hyperactivity responsible for HAUB symptoms. HAUB development is accompanied with urodynamic disorders - enhancement of detrusor contractility and that of urethral sphincter with growing amplitude of their electric activity leading to potentiation of bladder evacuatory ability. Different conservative treatments were evaluated for their influence on urodynamics and microcirculation in females with HAUB.

[Treatment of persistent dysuria in women]. / Lechenie stoikoi dizurii u zhenshchin.

Sixty female patients with chronic cystitis and persistent dysuria (PD) were divided into two groups according to their treatment. Group 1 (n = 38) patients have received combined conservative treatment; group 2 (n = 22) received the above treatment plus have undergone transurethral resection (TUR) of the urinary bladder mucosa. For control, urodynamic tests were made (uroflowmetry, sphincterometry, electromyography of the urinary bladder muscles); microcirculation was studied at laser doppler flowmetry. It was found that PD females with chronic cystitis develop microcirculatory disorders registered at laser doppler flowmetry. They consist in congestion of blood in the microvessels, vascular spasm, red cell aggregation with sludge-syndrome and combine with urodynamic disorders manifesting as weak detrusor contractivity and evacuation function. The above urodynamic and microcirculatory disorders are treated conservatively (antibacterial therapy, transcutaneous laser irradiation of the suprapubic region using intravesical methods). To eradicate PD in long-term inflammation in the urinary bladder and development of squamous cell metaplasia of the urothelium, TUR of the affected area and intramural nerves with partial denervation of the urinary bladder is indicated.

[Treatment of stable dysuria in women]. / Lechenie stoikoi dizurii u zhenshchin.

The authors analyse treatment results for 88 women suffering from stable dysuria (SD). 44 of them with diagnosis "proliferative cystitis" underwent TUR of the bladder mucosa. The rest were treated conventionally. Biopsy of the bladder was made in all the patients. It is shown that mechanisms of SD development lies in that developing metaplasia of the squamous epithelium prevents close contacts between the surface cells leading to urine penetration into the submucous layer. This provokes frequent and painful micturition. The area of the bladder triangle contains vaginal epithelium (embryological) which changes according to the menstrual phases. Dysuria is more pronounced in the premenstrual period, i.e. in the period of marked desquamation of the squamous epithelial. Desquamation of the surface layer of metaplastic squamous epithelium cells and its thinning ease urine diffusion via intercellular space to the nerves and muscles of the bladder detrusor, thus deteriorating clinical symptoms. Thus, pain in full bladder results from functional failure of metaplastic multilayer squamous epithelium. To eradicate SD in such a situation, TUR of the bladder is recommended.

[Prospects for preoperative low-intensity laser therapy in preventing postoperative thrombohemorrhagic complications in adenomectomy]. / Vozmozhnosti predoperatsionnoi nizkointensivnoi lazernoi terapii v profilaktike posleoperatsionnykh tromogemorragicheskikh oslozhnenii pri adenoméktomii.

The authors analyse the results of preoperative preoperation of 143 patients with benign prostatic hyperplasia (BPH). Conventional preoperative preparation (antibiotics, uroantiseptics and phytotherapy) was used in combination with intravascular laser irradiation of blood (group 1, 30 patients), local laser therapy (transurethral and transrectal) (group 2, 27 patients), variation of laser methods (group 3, 28 patients) and alone (61 patients, group 4). Such preoperative preparation was aimed at prophylaxis of thrombohemorrhagic complications after adenomectomy. The efficiency of the treatment was assessed by hemostasis parameters. It was found that conventional antiinflammatory therapy had a weak effect on hemostasis, the greatest positive effects being achieved with combined laser preoperative preparation. Hyperfibrinogenemia, thrombinemia and activation of XII + a-dependent finrinolysis were stopped in patients of group 3. Because of less number of postoperative hemorrhages, hemotransfusions and transfusions of blood preparations were used less frequently, red cell parameters improved, exacerbations of chronic pyelonephritis occurred less often.