[Duties, rights and activity monitoring of the head of a medical organization worldwide].

The quality of medical care in a medical organization is largely determined by the effectiveness of its Head. The article looks at current regulatory acts, main factors of healthcare organization process in developed countries (France, Switzerland, Australia and South Korea) and methods for assessing the quality of health services. This work analyzes the world practice of appointment, functioning and activity effectiveness of the heads of healthcare system.

[Regulatory Support for Monitoring the Effectiveness of Medical Managers].

Authors considered the issue of regulatory support for dynamic control methodology concerning the performance efficiency of a head (head physician) of the medical organization of Moscow healthcare system. The regulatory framework for assessing the performance of managers in the public healthcare management system is described. The indicators for assessing the execution effectiveness of the state program "Development of Healthcare in the Russian Federation" and Moscow program "Development of Healthcare in Moscow (Capital Health)" are given. Authors analyzed recommendations of the federal executive authorities on the development of performance indicators of social organizations, as well as experience of their implementation by the constituent entities of the Russian Federation. Proposals to improve the system for assessing performance efficiency of head managers of medical organizations were developed.

[Quality of life in patients with lower urinary tract symptoms after TURP for benign prostatic hyperplasia].

INTRODUCTION: To date, the gold standard for the surgical management of BPH is transurethral resection of the prostate (TURP). Most patients who undergo TURP for BPH experience immediate effects and complete relief of lower urinary tract symptoms and do not need further urological care. However, some patients after this operation have some level of persistent residual lower urinary tract symptoms, which may require additional therapy. AIM: To investigate voiding function and the need for medical therapy in patients who underwent TURP for LUTS due to BPH. MATERIALS AND METHODS: This study was performed as an anonymous survey among male patients presenting to a urology clinic. During the visit, the patients were offered to fill out I-PSS and SF-36 questionnaires. Also, they were asked about their socio-economic status, history of BPH, their perception of surgery and the postoperative period up to the day of the interview, presence or absence of symptoms of voiding dysfunction and any drug therapy at the time of the interview or after surgery. The patients also rated the severity of the symptoms using the IPSS questionnaire. The study comprised patients after 12 months to 3 years following successful TURP for LUTS due to BPH. A total of 1100 questionnaires were forwarded to researchers for interviewing patients who underwent TURP for prostatic hyperplasia. RESULTS: After collecting and reviewing all the questionnaires, 921 questionnaires were found eligible. The findings of the survey showed that a significant proportion of patients who underwent TURP require a long-term postoperative medical therapy. At the same time, in the Russian Federation, there are no standard approaches to medical management of this category of patients.

[Bacterial prostatitis and prostatic fibrosis: modern view on the treatment and prophylaxis].

Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidase. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men].

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[PROSPECTS FOR THE TREATMENT OF IDIOPATHIC AND NEUROGENIC OVERACTIVE BLADDER].

Overactive bladder (OAB) is a common problem in modern population. The main line of medical treatment of this condition is the use of M-cholinoblockers. Solifenacin has shown high selectivity for the bladder in preclinical studies. Data on the efficacy and safety of high-dose (10 mg/day) of solifenacin are insufficient. The study was aimed to the comparative evaluation of the effectiveness and safety of solifenacin at a dose of 5 and 10 mg/day. The study included 28 patients (17 women and 11 men), mean age was 41.3±6.7 years. All patients were divided into two groups. In Group 1 included 12 patients with idiopathic overactive bladder, the Group 2 (n=16) - with neurogenic overactive bladder. Depending on the effect obtained, in some patients the dose was increased to 10 mg/day 1 month after starting treatment. The duration of treatment was 12 weeks. Application of solifenacin at a dose of 5 mg in patients with overactive bladder significantly reduces the severity of symptoms. Increasing the dose was required in 3 (25%) patients with idiopathic OAB and in 10 (62.5%) - with neurogenic OAB. Patients unsatisfied by therapy with solifenacin 5 mg/ day initially had more severe symptoms of the disease - significantly more urgency frequency, incontinence episodes, and nocturia. The use of high doses of solifenacin increased the effectiveness of treatment. Statistical significance was achieved for all parameters evaluated. Against the background of increasing doses, the number ofadverse effects may increase, but within a month of therapy in most cases they are reduced.

Efficiency assessment of shock wave therapy in patients with pelvic pain employing harmonic analysis of penile bioimpedance.

In searching for novel objective methods to diagnosticate pelvic pain and assess efficiency of analgesic therapy, 37 male patients were examined prior to and after the course of extracorporeal shock wave therapy (5-10 sessions) with the waves directed to projections of prostate and/or crura and shaft of the penis. The repetition rate of mechanical pulses was 3-5 Hz. The range of energy pulse density was 0.09-0.45 mJ/mm(2). The overall number of pulses in a session was 1500-3000 in any treated zone with total energy smaller than 60 J. The applicator was relocated every other series of 300-500 pulses. Effect of the shock wave therapy was assessed according to subjective symptomatic scales: International Prostate Symptom Score, International Index of Erectile Function, Quality of Life, and nociceptive Visual Analog Scale. The objective assessment of shock wave therapy was performed with harmonic analysis of penile bioimpedance variability, which quantitatively evaluated the low-frequency rhythmic and asynchronous activities at rest as well as the total pulsatile activity of the penis. The magnitude of spectrum components of bioimpedance variations was assessed with a novel parameter, the effective impedance. The spectral parameters were measured in 16 patients prior to and after the treatment course. The corresponding control values were measured in the group of healthy patients. Prior to the shock wave therapy course, all spectrum parameters of penile bioimpedance significantly differed from the control (p<0.05). After this course, low-frequency rhythmic and the total pulsatile activity decreased to normal, while asynchronous activity remained significantly different from the normal. The novel objective physiological criteria of pelvic pain diagnostics and efficiency of its treatment reflecting the regional features of circulation and neural activity corresponded to the clinical symptom scaling prior to and after the shock wave course, and on the whole, these criteria corroborated improvement of the patient state after this therapy.

[The use of tolterodine in patients with recurrent chronic cystitis].

The article presents the results of evaluation of effect of M-cholinoblocer tolterodine on the symptoms of lower urinary tract diseases (LUTD) and quality of life of patients with recurrent chronic cystitis. The study included 47 patients with chronic recurrent cystitis at acute stage with non-obstructive type of urination and LUTS. Group 1 included 23 women aged 45 to 56 years, who received tolterodine on the background of antibacterial therapy, taking into account the sensitivity of the isolated strain. Control group included 24 patients who received standard antibacterial therapy, also taking into account the sensitivity of the pathogen, and spasmolytics. The groups were almost homogeneous and did not differ on the basic characteristics. Analysis of the results of the study showed that tolterodine as a symptomatic therapy can reduce the time of rehabilitation. Therapy with tolterodine has shown clinical efficacy for 85.7% of women, has improved the quality of life by 24.8% compared with the control group, and provided relief of urgent and irritative symptoms in the short time.

[Phytotherapy in combined treatment of chronic infection of the upper urinary tract in patients exposed to extracorporeal shock-wave lithotripsy].

Multicomponent biologically active additive Uroprofit made by Russian company Ecomir is used for phytotherapy of urolithiasis and urogenital infectious and inflammatory processes. Of 60 patients with urolithiasis and chronic pyelonephritis exposed to extracorporeal shock-wave lithotripsy (ECSWL), 30 patients received additional anti-inflammatory therapy with Uroprofit. As shown by reduction of leukocyturia and crystalluria, increased 24-h diuresis in patients with urolithiasis after exposure to ECSWL, a positive effect was achieved on urethral inflammation. Thus, Uroprofit phytotherapy has antiinflammatory, diuretic, lithokinetic effects which makes it appropriate for treatment and prophylaxis of infectious-inflammatory process in the urethra.

[Combined treatment of patients with prostatic adenoma and overactive bladder].

Of late, we observe a trend to a progressive rise of overactive bladder (OB) morbidity with age. M-cholinolytic drugs are most effective in management of OB but old patients with prostatic adenoma (PA) and comorbid pathology have a risk of acute urinary retention and serious side effects. We have the experience in combined treatment of 30 old patients with PA and OB with M-cholinolytic and alpha-adrenoblocker. The results of the treatment show its efficacy and absence of complications in the control of residual urine for 3 months. Combination of M-cholinolytic with alpha-adreboblocker significantly reduced daily diuresis, improved an accumulation function of the bladder and life quality.

[Clinical implications of E. coli pathogenic factors in patients with urinary infection].

The authors show perspectives of using primers detecting nucleotide gene sequences in isolated E. coli strains; pathogenic factors of E. coli, fimbrial adhesive (type I and type P); alpha-hemolysin (hly); cytotoxic necrotising factor I (cnf-1); iron-regulated proteins for predicting the course of the inflammatory process in urological patients with bacterial infection.