[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Urination disorders. Do we know all about them?].

The article presents the results of the pilot questionnaire survey of doctors of various specialties, living in some cities in the Southern Federal District, in the diagnosis and treatment of various urination disorders. The survey involved 101 urologists, 33 obstetricians, 37 internists, 35 surgeons, 9 neurologists and 1 infectiologist. Inadequate training of doctors of various specialties regarding the diagnosis and treatment of various disorders of urination of inflammatory and non-inflammatory nature should be noted. Misunderstanding of differential diagnosis of various forms of urinary incontinence and tactics of management of each of them come under notice. Most urologists (95.46%), obstetricians (92.3%), physicians (100%), neurologists (66.6%), and surgeons (88.58%) did not have a thorough knowledge about the symptoms of overactive bladder (OB). Only 63.37 % of the entire group of respondents, and 81% of urologists using conservative therapies, has prescribed M-anticholinergics for the treatment of OB. In the treatment of urgent forms of urinary incontinence, only 64.5% of urologists use M-anticholinergics. Excessive use of M-anticholinergics for the treatment of stress urinary incontinence still persists--38% of urologists. alpha-blockers are the main group of drugs (96.6%) used in medical treatment of LUTS in benign prostatic hyperplasia. However, there is reduced (14.8%) understanding of the need to designate combination therapy with M-cholinergic antagonists when indicated. The issues of therapy of patients with lower urinary tract infections, namely the choice of antibiotics without considering antibiotic sensitivity and antibiotic resistance and knowledge of Russian and national guidelines and recommendations of the European Association of Urology are of particular concern. Curiously enough, there is underestimation of this issue by urologists (23%) compared to obstetricians (45%) and physicians (40.7%). These findings can determine the need for education programs for professionals in different areas of medicine, because patients with urination disorders occur in practice of doctors of various related specialties.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Improvement of quality of life of patients with internal stents by changing the shape of the stents].

Transurethral stenting of the ureter was made in 130 patients (51 males and 79 females, aged 19-81, mean age 51.3 years) after contact ureterolithotripsy (n=86), endoureterotomy (n=13) and endopyelotomy (n=31). All the patients received internal polyuretanic stents (size N 6 F) made by one company. The patients were randomized into two groups by the shape of the stent. Group 1 (n=65) received a modified mono-pigtail stent made of the standard polyuretanic double-pigtail stent by cutting off 2-4 cm of the distal end and distal (vesical) curl. In group 2 (n=65) stenting was made with standard double-pigtail stent. Questionnaire survey was made 2 weeks after stenting, 1 month before stent removal and 1.5 months after stent removal. In the postoperative period 12 patients of group 2 (18.5%) developed acute pyelonephritis resultant from vesicorenal reflux. In other cases pyelonephritis was managed by draining bladder with urethral catheter. In group 1 vesicoureteral reflux was absent, but in 3 cases (4.6%) there was an attack of acute pyelonephritis because of obstruction of the intramural (not intubated by the stent) part of the ureter with fragments of the crushed concrement. This attack required urgent ureterolithoextraction and removal of the stent in 2 cases, transcutaneous nephrostomy in 1 case. Mean postoperative stay in the hospital was 3.1 +/- 0.6 in group 1 and 6.7 +/- 1.2 (p = 0.001) days in group 2. The comparison of the stent-related symptoms 2 weeks after stenting and before stent removal showed that severity of the symptoms was significantly greater in group 2 vs group 1 (21.3 and 9.6, respectively). Thus, the proposed mono-pigtail stent reduces severity of stent-related symptoms 2.5 times and improves quality of life. Further prospective studies are planned for final assessment of efficacy of the modified stents and their influence on quality of life.

[Panavir in combined treatment of chronic cystitis with hyperplastic changes in urinary bladder mucosa].

Human papilloma virus was detected by polymerase chain reaction in patients suffering from chronic cystitis with hyperplastic changes in urinary bladder mucosa. In most of the examinees (90%) it was HPV of highly oncogenic type 16. Panavir added to combined treatment of such patients produced a significant positive result in long-term period. Improvement was observed both in subjective assessment and the absence of dysuria episodes.

[Intravesical electrostimulation and magnetophoresis in overactive bladder in females: efficacy of Amus-01-Intramag device with Intrastim attachment].

High-frequency intravesical electroneurostimulation was made simultaneously with magnetophoresis of the mixture based on oxibutinin. Compared to effects of oral intake of oxibutinin, such method was two times more effective in relation to overactive bladder symptoms relief in shorter duration of the treatment and reduced side effects. Laser Doppler flowmetry discovered that the above combined treatment corrects microcirculation in bladder mucosa.

[Endoscopic sling in the treatment of urine incontinence in males].

Using an original algorithm of examination, we have selected 26 of 74 patients suffering from urine incontinence after prostatic surgery for sling operation. Endoscopic sling was performed in group 1 (n = 17) patients, standard retropubic bulbourethral sling--in group 2 (n = 9) patients. Injuries of large vessels, prostatic gland or urinary bladder were not observed in group 1 while intraoperative injury of the paraprostatic venous plexus (1 case) and perforation of the bladder wall with a needle-perforator (1 case) took place in group 2. One year after surgery in group 1 there were 9 (53%) good outcomes, 4 (23.5%) satisfactory and 4 (23.5%) unsatisfactory results; in group 2--5 (56%), 1 (11%) and 3 (33%) patients, respectively. Our method of videocontrol over movement of the needles in the retropubic space proved to be a reliable technique of reducing the number of intraoperative complications and blood loss. However, the procedure can be used only in patients subjected to transurethral resection of the prostate and not subjected to open surgical interventions on the lesser pelvic organs.

[Comparative efficacy of immunomodulation treatment schemes in patients with herpetic prostatitis].

The immune status was studied in 150 patients with herpetic prostatitis before and after therapy. All the patients were divided into three groups: group 1 (n=50) received standard therapy, group 2 (n=50) received standard therapy plus immunocorrection, group 3 (n=50)--standard therapy, immunocorrection and inductor of interferon. Combined treatment in group 3 produced changes in parameters of cellular and humoral immunity associated with regress of herpetic prostatitis manifestations and reduction in the number of relapses.

[Nongonococcal urethritis treatment in men with avelox (moxifloxacin)].

The role of urogenical infection in males in present-day urology is demonstrated with a focus on fluoroquinolones efficacy in combined treatment of urogenital infection. The mechanism of action, pharmacokinetics, the spectrum of antimicrobial activity of a novel fluoroquinolone drug avelox are detailed. Avelox use in combined therapy of mono- and mixed infections caused by ureaplasmas, chlamidias, mycoplasms is illustrated by original experience of the authors. Avelox is well tolerated and safe.

[Cystourethroanastomosis in extended obliterations and strictures of the posterior urethra in men].

The authors review short- and long-term clinical results of surgical treatment of extended urethral strictures and obliterations. A new vesicourethral anastomosis was created by novel technique with longitudinal suturing of the neck of the urinary bladder. A scheme of the operation is presented. Causes necessitating this plastic intervention are analysed. Variants of possible urine incontinence after operation depending on etiological cause of the stricture or obliteration of the posterior urethra in males are considered.

[Extracorporeal shock-wave therapy in Peyronie's disease]. / Udarno-volnovaia terapiia pri bolezni Peironi.

The aim of the study was to validate clinical methodology on application of shock-wave impact on plaques in Peyronie's disease (PD). We studied short- and long-term results of extracorporeal shock-wave therapy (ESWT) in 54 patients 3, 6 and 12 months after the exposure. We performed ESWT sessions on different lithotriptors using different mechanisms of shock wave mechanism (hydromechanical and piezoelectric). Choice of the ESWT technique was based on the thickness and density of the plaque. The proposed ESWT method provides an effective treatment of the disease basing on the initial angle of penis deformation in erection.

[Endoscopic nephropexy]. / Endoskopicheskaia nefropeksiia.

In line with new prospects, introduction of laparoscopic technique in nephropexy gave rise to some problems. One of them--postoperative rotation of the kidney (RK). Upper-pole endovideosurgical nephropexy (EVSN) with prolen net performed in the diagnostic center "Zdoroviye" in 90 patients has demonstrated that late after surgery 9 (10%) patients had pains provoked by RK and abnormal renal circulation confirmed by Dopplerography. In 1998 specialists of the diagnostic center "Zdoroviye" developed a novel method of EVSN providing elimination of the ptosis and RK. A total of 88 patients have been operated since. 67 patients with nephroptosis and RK have undergone nephropexy with a splitted flap of the prolen net, 21 patients without RK--standard nephropexy. Long-term postoperative follow-up showed that only 3 of 88 patients failed to retain normal velocity of the major renal blood flow, though they improved this velocity noticeably. Thus, a differentiated approach to EVSN based on dopplerographic examination of the major renal blood flow brings about improved treatment results in nephroptosis.

[State of the gastric mucosa in patients with benign prostatic hyperplasia in the early postoperative period at initial stages of chronic renal failure]. / Sostoianie slizistoi obolochki zheludka u bol'nykh s dobrokachestvennoi giperplaziei v rannem posleoperatsionnom periode pri nachal'nykh stadiiakh khronicheskoi pochechnoi nedostatochnosti.

Biochemical, endoscopic and morphological tests were made to study changes in gastric mucosa and activity of antioxidant defense enzymes of the blood in patients with benign prostatic hyperplasia and initial chronic renal failure early after transvesical adenomectomy. Acute erosive-ulcerative lesions of gastric mucosa and acute gastric hemorrhages arose most frequently in patients with latent stage of chronic renal failure operated on without preoperative preparation. Preoperative medication lowers probability of the complications.

[Comparative analysis of long term results of modified transcutaneous urethro-cysto-cervico-pexy with vaginal flap in the treatment of stress urinary incontinence in women]. / Sravnitel'nyi analiz otdalennykh rezul'tatov modifitsirovannoi chreskozhnoi uretrotsistotservikopeksii vlagalishchnym doskutom v lechenii stressovogo nederzhaniia mochi u zhenshchin.

The authors present a comparative analysis of long-term results of transcutaneous urethrocystocervicopexy (TU) with a vaginal graft according to O. B. Loran-D. Yu. Pushkar and its modification. The former method provided good 2-year results in correction of urinary stress incontinence (USI) in 84.8% of cases, satisfactory and unsatisfactory results were achieved in 6.5 and 8.7%, respectively. In modified TU the results were good, satisfactory and unsatisfactory in 89.7, 6.9 and 3.4%, respectively. This modified method of surgical USI treatment in women allows to create individual degree of tension of pubovaginal ligatures in each female, provides optimal anatomic correlations of the urinary bladder and urethra in TU, prevents obstruction and induced by it disorder in urine evacuation from the bladder in the postoperative period, reduces duration of catheterization of the bladder up to 1-2 days and hospital stay to 4.5 days, results in normal physiological urination.

[Mental disorders in patients with benign prostatic hyperplasia]. / Psikhicheskie rasstroistva pri dobrokachestvennoi hiperplazii predstatel'noi zhelezy.

310 patients with benign prostatic hyperplasia have been studied. Their mental state being analyzed by clinical and psychometric methods using Spilberger and Hamilton scales. Neurotic disorders have been reported in all the patients: 53.8% having neurasthenic syndrome, 30% anxiety- or astheno-subdepressive syndrome, 16.2% neurotic hypochondriac symptomatology. After treatment with minor neuroleptics, antidepressants and tranquilizers, patients' psychic state improved, even when the objective urologic data remained unchanged. Treatment of mental disorders makes it possible to prepare a patient for the operation and to improve quality of life of patients with benign prostatic hyperplasia before the operation.

[Transurethral rotoresection - a new method of benign prostatic hyperplasia treatment]. / Transuretral'naia rotorezektsiia v lechenii dobrokachestvennoi giperplazii predstatel'noi zhelezy.

Karl Storz company (Germany) offers a novel endoscopic technology in the treatment of benign prostatic hyperplasia (BPH) i.e. rotoresection which combined mechanic and electrosurgical methods of removal of the hyperplastic tissue. The operation is performed with application of a special rotoresectoscope connected with a rotor electrode which, in its turn, is connected with mechanical rotor generator making it to rotate and with powerful electrogenerator (radiotome). The hyperplastic tissue is removed both mechanically (by high-frequency rotation of the rotor tip) and due to electrovaporization with simultaneous coagulation of the underlying tissue layers. Transurethral rotoresection was performed in 40 patients with BPH. Intraoperative and postoperative complications were not observed. Examination at discharge and 1 month after surgery showed a 4-fold decrease in the prostatic symptoms by IPSS scale, residual urine decreased 3-fold, maximal urine flow rate rose 2.5-fold. Transurethral rotoresection combines effective removal of BPH tissue with minimal intraoperative bleeding. It is a good alternative to conventional TUR. For more detailed evaluation further studied are needed.