[The possibility of correcting oxidative stress in patients with inflammatory type of chronic abacterial prostatitis (chronic pelvic pain syndrome category IIIa)].

INTRODUCTION: The term "chronic prostatitis" includes many different symptomatic patterns, many aspects of which still remain a mystery. The role of oxidative stress in the pathophysiology of many diseases, including prostatitis, is undisputable. AIM: To evaluate the capabilities of a mineral-vitamin antioxidant complex for the treatment of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIAL AND METHODS: A total of 47 patients with inflammatory type of chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) were included in the study. The examination, along with standard tests, included evaluation of the antioxidant status. Patients were randomized into the main group (n=26), and the control group (n=21). All men received standard therapy. However, in the main group, Selzinc-plus was additionally prescribed, 2 tablets per day for 2 months. The results were assessed after 2 months of therapy. RESULTS: Standard therapy had a significant effect in patients of both groups, which lasted for two months. However, additional antioxidant therapy practically doubled this effect on the symptom scale, although it had no influence on the number of leukocytes in the expressed prostate secretions. At baseline, all patients in both groups had a decrease in antioxidant protection. Two months of taking Selzinc-plus led to normalization of the overall antioxidant status. In the control group, there was also a positive trend in antioxidant status, but significant differences were obtained only in the activity of erythrocyte superoxide dismutase. CONCLUSION: CP/CPPS is accompanied by oxidative stress. Taking Selzinc-plus for two months allows to restore the activity of the antioxidant system.

[Impact of the SARS-CV-2 virus on the urinary bladder].

INTRODUCTION: There are publications about the impact of a new coronavirus infection (COVID) on the lower urinary tract, including the development of overactive bladder (OAB) or COVID-associated cystitis. The cause of dysuria in patients with COVID is not fully understood. MATERIAL AND METHODS: A total of 14 consecutive patients after COVID with complaints of frequent urination with urgency were included in the study. The main inclusion criterion was the development or worsening of OAB symptoms after resolution of COVID, confirmed by the eradication of SARS-CoV-2 by a polymerase chain reaction. The severity of OAB was assessed using the International Scale of Symptoms (Overactive Bladder Symptom Score, OABSS). RESULTS: Three (21.4%) out of fourteen patients had OAB symptoms prior to COVID, while in 11 (78.6%) patients OAB symptoms developed in post-COVID period. In 4 patients (28.6% of the entire cohort and 36.4% of patients in de novo group) urge urinary incontinence and urgency developed. The average score on the OABSS scale in patients with baseline OAB was 6.7+/-0.8, which corresponded to the moderate severity. In this group, one patient developed urge urinary incontinence and urgency, which were not present prior to COVID. In a retrospective evaluation of symptoms before the COVID, their average score on the OABSS scale was 5.2 +/- 0.7, i.e., past COVID led to an increase in OAB symptoms by 1.5 points. In patients with OAB de novo, the symptoms were less pronounced, with a score of 5.1+/-0.6 points, that is between mild and moderate OAB. At the same time, urinalysis in 9 patients did not have signs of inflammation: in 5 cases, 5-7 white blood cells per field of view was seen only once. A follow-up urine test was normal, suggesting contamination. None of the cases revealed bacteriuria over 102 CFU/ml. All patients were prescribed trospium chloride at a dose of 30 mg per day. The choice of the drug was due to the absence of a negative effect on the central nervous system, which is very important both during COVID and in post-COVID period, since the neurotoxicity of SARS-CoV-2 has been proven. CONCLUSION: A past history of COVID led to an increase in OAB symptoms by 1.5 points in patients who had OAB prior to infection. In 11 patients, after the treatment of COVID, the moderate symptoms of OAB developed de novo. Our small study showed the importance of focusing the attention of internists and infectious disease doctors on urination disorders in patients with COVID and timely referral to a urologist. For the treatment of post-COVID OAB, trospium chloride is the drug of choice, as it does not aggravate the potential neurotoxicity of SARS-CoV-2.

[Tuberculosis of the male genital organs].

INTRODUCTION: Tuberculosis of the genitourinary system is still of importance. The observed decrease in the incidence of urogenital tuberculosis is largely due to the inaccuracies of registering this disease. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study of the structure of urogenital tuberculosis in the Siberian and Far Eastern federal districts was carried out. We analyzed statistical reports from 2003 to 2015, which included data for a total of 456 patients, as well as extended questionnaires compiled specifically for this study. In addition, outpatient records of 95 patients with urogenital tuberculosis who were registered at the Novosibirsk Regional Tuberculosis Dispensary by 01/01/2022 were evaluated. RESULTS: An analysis of the structure of urogenital tuberculosis from 2003 to 2015 showed that urinary system was affected in the most of cases (n=314, 68.8%). Tuberculosis of male and female genital organs took the second place (n=101, 22.2%) patients. Generalized urogenital tuberculosis was diagnosed in 41 (9%) patients. From 2003 to 2008, the proportion of renal tuberculosis increased by 12.6%, but then a significant decrease in its proportion was found (82.2% in 2008 vs. 48.6% in 2015 [2 =12.71; =0.0004]). On the contrary, in 2003 the proportion of genital tuberculosis was 18% (n=18) compared to 29.1% (n=3) in 2015 (2 =3.46; p=0.06). In 2015, generalized forms of urogenital tuberculosis were diagnosed in 23 (22.3%) patients, which is approximately 2.5 times more than in 2003 (n=9; 9%) and 2008 (n=7; 6.6%) (2> 6.46; p<0.01). The proportion of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013. In 2003, tuberculosis of the scrotum was diagnosed in 100% of men with genital tuberculosis, while in 2013 and 2015 its proportion was 25%. In total, scrotal tuberculosis during whole follow-up was diagnosed in 26 patients, which accounted for 41.9% of all male genital tuberculosis. The combination of tuberculosis of the scrotum and prostate also varied significantly from 17.3 to 35.7%. Generalized urogenital tuberculosis was diagnosed with a minimum proportion (1.4%) in 2008, then there was an upward trend with a maximum rate in 2015 (22.3%, 2 =29.38; <0.0001). Among 95 patients with tuberculosis of the urinary and male reproductive system, who were followed by the phthisiourologist of Novosibirsk Regional Tuberculosis Dispensary, 34 (35.8%) had a diagnosis of kidney tuberculosis, 42 (44.2%) had isolated tuberculosis of the male genital organs, and the remaining 19 (20.0%) men had generalized urogenital tuberculosis. In total, HIV infection was detected in 23 (24.2%) patients with urogenital tuberculosis, and among patients with kidney tuberculosis, it was diagnosed in 7 (20.6%) cases compared to 9 (21.4%) cases in those with male sexual tuberculosis. In patients with generalized urogenital tuberculosis, HIV infection was detected almost 2 times more often, namely in 7 (36.8%) cases. CONCLUSION: Patients with urogenital tuberculosis are under follow-up of urologists for a long time with erroneous diagnoses, and only when the disease becomes irreversible and requires surgical intervention, the pathomorphological study of the surgical material will allow to make a proper diagnosis.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

INTRODUCTION: Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. CLINICAL CASE: A clinical observation of patient Ch., born in 1976, who was admitted to TB Research Institute of Ministry of Health of Russia on 17.02.2020. A diagnosis was cavernous renal tuberculosis. Tuberculosis of the ureter. MBT (-). Right ureteral stricture (obliteration), complicated by ipsilateral hydronephrosis. Right nephrostomy tube (2018). Clinical cure of disseminated pulmonary tuberculosis. He underwent planned laparoscopic bowel substitution of the right ureter on 10.03.2020. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. CONCLUSION: In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

[The features of the recurrence of urogenital tuberculosis].

INTRODUCTION: Tuberculosis is an infectious disease, which can result in self-cure, chronic process or relapse course. AIM: To analyze the incidence of recurrence of urogenital tuberculosis and to identify the features of patients with recurrent disease. MATERIALS AND METHODS: Specially developed questionnaires on the structure of the incidence of extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were analyzed. We also studied 140 outpatient medical records of patients with tuberculosis of the urinary tract and male reproductive system, who was followed at the Novosibirsk Regional TB Outpatient Department. The medical records of patients with recurrent disease were analyzed in detail. RESULTS: In 2019, 563 patients with isolated extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were identified, and 14.4% of them had urogenital tuberculosis. In 99 (17.6%) patients, the present state was a relapse, while urogenital tuberculosis occupied 8.1%, and all patients were HIV-negative. In the Novosibirsk Region, 127 out of 140 patients were diagnosed with urogenital tuberculosis for the first time, and in 13 (9.3%) had recurrent disease. Among patients with relapse, male predominated (61.5%). The primary focus of tuberculosis was located in the genitourinary system in 53.9% of patients, which supports the theory of reactivation of dormant foci. In addition, 38.5% of patients with primary episode of tuberculosis were smear-positive. The average relapse time after successful cure of tuberculosis was 9.1 years. Among patients with recurrent urogenital tuberculosis, mycobacteriuria was recorded in 23.1% of cases, and in one case drug resistance of the pathogen to streptomycin and isoniazid was seen. In general, the kidneys were the most susceptible to relapses and were involved in 69.2% of cases. CONCLUSIONS: Nearly 8.1-9.3% of patients with genitourinary tuberculosis had previously tuberculosis and were successfully cured. When urogenital tuberculosis recurs, the kidneys are affected in 69.2% of cases. The overwhelming majority (61.5%) of patients with recurrent genitourinary tuberculosis are men, therefore gender can be considered a predictor of recurrence. HIV infection was found in isolated cases in patients with both newly diagnosed and recurrent urogenital tuberculosis.

[Method for evaluating the efficiency of treatment of urogenital tuberculosis].

INTRODUCTION: Methods for evaluating the efficiency of treatment which were developed for pulmonary tuberculosis (absence of bacterial transmission and closure of cavities) are not suitable for urogenital tuberculosis. AIM: To evaluate the use of scoring system for assessing the efficiency of treatment of urogenital tuberculosis. MATERIALS AND METHODS: A pilot simple open-label prospective noncomparative cohort study was carried out, which included 15 patients with urogenital tuberculosis. All patients completed the urogenital tuberculosis score upon admission and after 1 month, along with standard clinical, laboratory and X-ray examinations. We developed this score to objectify evaluate the efficiency of antituberculosis therapy and it includes clinical and laboratory manifestations of urogenital tuberculosis. RESULTS: Eleven (73.3%) patients responded well to standard therapy, and 4 (26.7%) required therapy correction. Considering that the correction of therapy was carried out in a timely manner, the final result of the treatment was satisfactory. The efficiency of the proposed score has been demonstrated by clinical results. CONCLUSION: Using the urogenital tuberculosis score for assessing the results of treatment of urogenital tuberculosis allows timely correction of therapy according to objective criteria.

[New opportunities of using gialuronidase in chronic prostatitis].

INTRODUCTION: The use of hyaluronidase contributes to improvement in microcirculation, destruction of biofilms and reducing of congestion in patients with chronic prostatitis. Based on this mechanism, the use Longidaza for the diagnosis of latent bacterial prostatitis was suggested. AIM: To evaluate diagnostic and treatment capabilities of the long-acting enzyme preparation Longidaza (rectal suppositories with an activity of 3000 IU), prescribed to patients with chronic prostatitis in routine clinical practice. MATERIALS AND METHODS: A total of 39 men with chronic prostatitis of categories II and IIIa were included in open, prospective, non-interventional, comparative, single-center study. A microbiological study of expressed prostate secretion (EPS) was performed three times, at baseline, after using two suppositories Longidaza 3000 IU and after 7 weeks of therapy. From the 1st to the 10th suppository, Longidaza was used every 48 hours, then, from the 11th to the 20th suppository, it was prescribed every 72 hours. The isolation of the pathogen was an indication for the antibiotic therapy. The treatment outcome was evaluated by using NIH-CPSI scale and laboratory and microbiological analysis of EPS. RESULTS: Diagnostic stage. Initially, pathogens were isolated in 27 (69.2%) patients. The number of leukocytes in EPS averaged 25.9+/-2.3. The use of two suppositories Longidaza increased the number of patients with isolated pathogens to 33 (82%). In 7 out 12 patients with an initial diagnosis of abacterial prostatitis, the use of two suppositories of Longidaza contributed to isolation of the pathogen in EPS (58.3%). The number of leukocytes in the EPS after enzymatic provocation increased by 50.2%. Treatment stage. The number of patients with isolated pathogens decreased from 33 to 7 (17.9%). The pain intensity decreased on average to 2.2+/-0.4 points, and in 27 (69.2%) men dysuria resolved. The quality of life significantly improved up to 1.3+/-0.2 points. The total score on NIH-CPSI scale decreased on average from 17.3+/-1.9 to 3.9+/-0.3 (p<0.05). An increased number of white blood cells in EPS was seen only in 5 (12.8%) men. CONCLUSION: In many cases, bacterial prostatitis remains undiagnosed. Rectal suppositories Longidaza can be recommended for the diagnosis of the latent bacterial chronic prostatitis, since this drug contributes to detection of pathogen and inflammation.

[Adjunctive technologies in treatment of patients with urogenital tuberculosis].

INTRODUCTION: Currently, the limits of therapeutic efficiency in urogenital tuberculosis have been achieved. The etiological therapy should be supplement by pathogenetic drugs. AIM: to determine the efficiency of deoxyribonucleate sodium in the complex treatment of patients with urogenital tuberculosis. MATERIAL AND METHODS: Single-center open-label randomized comparative prospective study was carried out. A total of 62 patients with active urogenital tuberculosis were included. All patients received therapy in accordance with National clinical guidelines for urogenital tuberculosis. In the main group, patients additionally received pathogenetic therapy in form of deoxyribonucleate sodium via intramuscular injection of 75 mg every 48 hours. Whole one-month course consisted of 15 injections. Pathogenetic therapy was started immediately after the choosing of anti- tuberculosis drugs and confirmation of good tolerability. The efficiency of treatment was evaluated after one and three months. The assessed criteria included the intensity of pain and severity of dysuria, signs of inflammation, bacterial isolation and changes in the quality of life. CONCLUSION: The addition of deoxyribonucleate sodium in the form of intramuscular injections of 75 mg every 48 hours for 1 months resulted in a significant increase in the efficiency of treatment. Quality of life in patients receiving deoxyribonucleate sodium improved twice (from 11.1 to 21.5 points), while in the control group this value was twice as low (from 10.8 to 15.9 points).

[Patients with newly diagnosed benign prostatic hyperplasia].

The study aimed to characterize patients with newly diagnosed benign prostatic hyperplasia (BPH) and identify patterns that lead to late diagnosis of the disease. STUDY DESIGN: Simple open retrospective non-comparative study. MATERIAL AND METHODS: To determine the frequency of requests for medical care for BPH, the study analyzed medical records of 3544 patients who sought outpatient urological care at the municipal polyclinic # 26 in Novosibirsk in 2013. Outpatient medical cards of 165 patients with newly diagnosed BPH were analyzed. RESULTS: Among 3544 patients seen by the urologist of the polyclinic, 960 (27.1%) had BPH. Analysis of medical records of 165 men with newly diagnosed BPH showed that the disease was associated with age. The shortest duration of the disease (0.8+/-0.5 years) was noted in patients under 50 years old, the longest (4.7+/-2.1 years) in men over 70 years old. The smallest prostate volume was 32 ml, the largest 150 ml. The mean size of the gland naturally increased with age. The mean PSA level also naturally increased with age: from 1.1+/-0.8 ng/ml in individuals up to 50 years to 3.0+/-0.7 ng/ml in patients older than 70 years. The maximum IPSS was in the 61-70 year age group (16.7+/-5.9 points); the minimum IPSS was in the age group up to 50 years (9.5+/-3.6 points). The duration of the symptoms directly correlated with the prostate volume. At the prostate volume of 60 ml and more, symptom scores showed a 1.5 fold increase. In married patients, the mean IPSS was 13.8+/-5.4, while in single men it was 16.3+/-5.5 (p=0.008). CONCLUSION: Patients with BPH account for 27.1% of all patients seeking urological care at the polyclinic. In young men, symptom severity is lower than that in senior men. However, the elderly are more concerned about their symptoms, they have worse quality of life, and they seek medical attention earlier. Married patients are more likely to see a urologist with significantly less severe symptoms than single men.

[Is there screening for urinary tuberculosis?]

INTRODUCTION: Most of the patients with genitourinary tuberculosis are detected too late. One of the reasons for this is the lack of a simple, cheap, reliable screening. The purpose of this study was to investigate the possibility of using a recombinant tuberculosis allergen (diaskintest) as a screening test to detect patients with genitourinary tuberculosis. MATERIAL AND METHODS: This is a simple prospective, open-label cohort study comprising 197 patients admitted to the Novosibirsk Research Institute of Tuberculosis for differential diagnosis in 2014-2016. Of then, 72 patients were found to have urogenital tuberculosis, while 125 patients had chronic nonspecific infections. RESULTS: The sensitivity of the Kochs subcutaneous tuberculin test and the diaskintest was 80.4% and 63.8%, respectively. The specificity of the Kochs test was 91.5%, which makes it still possible to consider it essential in the differential diagnosis of urogenital tuberculosis and nonspecific urogenital infections. A high percentage of positive diaskintest results in patients with chronic infectious and inflammatory diseases of the genitourinary system caused a low specificity of the test - 37.5%. CONCLUSION: Diaskintest can be used in screening for genitourinary tuberculosis, but its positive result indicative for diagnosis. It may be used only as a reason for in-depth phthisiourological examination using additional provocative tests, in particular, Kochs test, which showed high diagnostic performance.

[Extracorporeal shock wave therapy in chronic prostatitis].

INTRODUCTION: Chronic prostatitis is a prevalent urologic disease, but treatment outcomes are not always satisfactory. As a rule, chronic prostatitis results in chronic pelvic pain syndrome, significantly reducing the patient's quality of life. MATERIAL AND METHODS: Open pilot prospective non-comparative study was conducted to test the effectiveness of extracorporeal shock wave therapy (ESWT) using Aries (Dornier) machine in patients with chronic prostatitis (CP) of IIIb category. A total of 27 patients underwent ESWL as monotherapy, 2 times a week for a course of 6 sessions. Exposure settings: 5-6 energy level (by sensation), the frequency of 5 Hz, 2000 pulses per session; each patient received a total energy up to 12000 mJ. per procedure. RESULTS: Treatment results were evaluated using NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) upon completing the 3 week course of 6 treatments and at 1 month after ESWT. Immediately after the ESWT course positive trend was not significant: pain index decreased from 9.1 to 7.9, urinary symptom score remained almost unchanged (4.2 at baseline, 4.1 after treatment), quality of life index also showed a slight improvement, dropping from 7.2 points to 6.0. Total NIH-CPSI score decreased from 20.5 to 18.0. One month post-treatment pain significantly decreased to 3.2 points, the urinary symptom score fell to 2.7 points, the average quality of life score was 3.9 points. CONCLUSION: ESWT, performed on Aries (Dornier) machine, is highly effective as monotherapy in patients with category IIIb chronic prostatitis.

[Acute cystitis do we always need antibiotics?]

We attempted to skip the antibiotic therapy in 17 patients with acute uncomplicated cystitis in the early time of presentation (up to 12 hours from the disease onset). All patients received ketoprofen (Flamax forte) 100 mg once daily for 5 days and the combined herbal preparation KanefronH 2 tablets t.i.d. for 1 month. In 82.4% of patients acute uncomplicated cystitis was cured without antibiotics; 17.6% of cases required additional administration of antibacterial drugs.

[Diagnosis and treatment of cystitis: more questions than answers?]

INTRODUCTION: Despite the prevalence of acute cystitis, there are still many unsolved problems of diagnosis and treatment of this disease. MATERIAL AND METHODS: To determine the nosological structure of dysuria, 126 female patients who sought medical attention for frequent painful urination were examined. To determine the incidence of outpatient visits to an urologist for patients with cystitis, medical records of 6753 patients of municipal outpatient clinic were analyzed. The results of treating cystitis in 85 patients also were evaluated. RESULTS: Among 126 patients with dysuria, 31 (24.6%), 42 (33.3%) and 47 (37.3%) patients had acute uncomplicated cystitis, recurrent (chronic) cystitis without the complicating factors and recurrent (chronic) cystitis with complicating factors, respectively. Three (2.4%), 2 (1.6%) and 1 (0.8%) patients had trichomoniasis, urogenital herpes and tuberculosis, respectively. As a result of 6753 visits to the urologist, inflammatory diseases of the genitourinary system were detected in 3194 (47.3%) patients, of which 64.7%, 19.6%, 5.3% and 2.7% had chronic pyelonephritis, chronic cystitis, chronic prostatitis and acute cystitis, respectively. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively. CONCLUSIONS: Most of clinical guidelines and scientific publications aimed at acute uncomplicated cystitis, while the proportion of the disease does not exceed 26% among the patients presenting with dysuria, and comprise only 2.7% among outpatient urologist visits for infectious and inflammatory diseases of the urogenital tract. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively.

[The epidemiological situation of urogenital tuberculosis in Siberia and the Far East].

INTRODUCTION: Tuberculosis remains one of the most important problems of our time. Late diagnosis of urogenital tuberculosis (UGT) results from a lack of a clinician awareness, paucity of pathognomonic symptoms and suboptimal therapy for urinary tract infections while UGT often manifests under their disguise. AIM: To determine the incidence of urogenital tuberculosis and its structure in an epidemiologically unfavorable region. MATERIAL AND METHODS: The study compared the temporal changes in the structure of UGT morbidity from 1999 to 2015 in the Siberian and Far Eastern Federal Districts and analyzed outpatient medical records of 456 UGT patients. RESULTS: The highest (46%) proportion of UGT in the structure of extrapulmonary disease was found in 2003, the lowest (22.9%) in 2014. According to outpatient medical records, the proportions of patients with stage 1, stage 2 and cavernous forms of nephrotuberculosis ranged from 21.2 to 37%, 26 to 53.5% and 21.6 to 37%, respectively. The incidence of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013, averaging to 33.9%. CONCLUSIONS: Currently, it is impossible to estimate the true prevalence of UGT, we can only speak about the detection rate. Every fourth UGT patient was under the medical supervision with a wrong diagnosis for 5 or more years. The proportion of UGT in the structure of morbidity from all forms of extrapulmonary TB reached a minimum (22.9%) in 2014 but went up again. Introducing new technologies has led to an improvement of bacteriological verification of UGT and increased prostate tuberculosis detection rate to 35.7%.