[Spermoprotective properties of Prostatex in patients with chronic abacterial prostatitis].

AIM: To study the effect of Prostatex therapy on spermatogenesis in patients with infertility that developed due to chronic abacterial prostatitis. MATERIALS AND METHODS: A total of 60 men with infertility in marriage and chronic abacterial prostatitis were included in the study. All patients received therapy with Prostatex rectal suppositories 10 mg 1 time per day. The duration of treatment was 30 days. After taking the drug, patients were observed for 50 days. The study was carried out for 80 days and included 3 visits at 1, 30 and 80 days. The study showed that the use of Prostatex rectal suppositories 10 mg had a positive effect on the main indicators of spermatogenesis, as well as on the subjective and objective symptoms of chronic abacterial prostatitis. Based on these results, we recommend Prostatex rectal suppositories to patients with chronic abacterial prostatitis, accompanied by impaired spermatogenesis, according to the scheme: 1 suppository 10 mg 1 time per day for 30 days.

[Management of lower urinary tract symptoms in patients with benign prostatic hyperplasia during COVID-19. results of an all-russian observational study ATLANT].

BACKGROUND: COVID-19 aggravates lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). The optimal treatment regimen for patients with this disease during the COVID-19 pandemic is still under question. OBJECTIVES: The aim of the All-Russian observational study of Afalaza in the Treatment of LUTS in pAtieNTs with BPH during COVID-19 (ATLANT) was to obtain additional data on the efficacy and safety of Afalaza in this patient group. METHOD: s. The study enrolled 73 men aged 46-65 years with LUTS and diagnosed BPH who suffered from COVID-19. All patients received Afalaza for 16 weeks. The dynamics of BHP indicators, erectile function, and quality of life were assessed after 4, 12, and 16 weeks of treatment. RESULTS: Patients with LUTS/BHP who suffered from COVID-19 had a decrease in the total IPSS score from 21.6+/-8.6 to 6.4+/-2.4 (-70.4%) points after 16 weeks of treatment. There was a direct correlation between COVID-19 duration (and beginning of therapy) and the severity of symptoms after Afalaza treatment. According to the subjective assessment of patients, there was a significant increase in the quality of life and erectile function after 16 weeks of treatment. 9 mild AEs were registered in 12.3% of patients and were unrelated to the study drug. CONCLUSIONS: Results show that Afalaza may be a perspective drug for the treatment of LUTS/BPH in patients with COVID-19 and be used for this urological disease in the current COVID-19 pandemic.

[Practice of urological departments during the COVID-19 pandemic].

INTRODUCTION: The pandemic of novel coronavirus infection has had a strong impact on the whole medical system, including urological departments. MATERIAL AND METHODS: We assessed the impact of restrictions due to the pandemic on the work of urological departments of private (Medical Center "Avicenna", Novosibirsk) and community (KGBUZ "City Clinical Hospital No. 11, Barnaul") hospitals; GBUZ of the Novosibirsk region "City Clinical Emergency Hospital" (GBUZ CCEH) No. 2, Novosibirsk) clinics, as well as the urogenital department of the TB Research Institute of Ministry of Health of Russia during the period from 2019 to 2020. The changes in the spectrum of surgical procedures, as well as the structure of patients' visits to a urologist were evaluated. RESULTS: In March 2020, the urogenital department of the TB Research Institute of Ministry of Health of Russia was redesigned into an observational one. Community departments worked with small restrictions or without any limitations. In KGBUZ "City Clinical Hospital No. 11, Barnaul", an increase in the number patients with bladder cancer, ureteral stones, concomitant kidney and ureteral stones by 3-27% was noted (p<0.05), as well as those with acute epididymo-orchitis, including testicular abscess. At the same time, a significant decrease in the number of patients with varicocele, pyelonephritis, chronic cystitis, chronic prostatitis, and phimosis was found. A surgical department of GBUZ CCEH from October to December 2020 was restructured to an infectious hospital; this led to a decrease in the volume of urological care and the number of procedures. The Avicenna Medical Center also established anti-epidemic measures, which made it possible not only not to reduce, but in a number of procedures to increase the volume of surgical care. CONCLUSION: Owing to anti-epidemic measures, including the patient flow distribution, an introduction of mandatory testing, an early detection of patients and carriers among employees, mask regime, the opening of an observational department, single rooms, the lack of contact between patients, short length of stay, it was possible to prevent an outbreak of coronavirus infection among patients and personnel. Both in the municipal and private urological clinics, well-organized work precluded the negative impact of the pandemic.

[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.

[Spontaneous rupture of kidney tumor. Successful surgical treatment].

A clinical case of spontaneous rupture of the kidney lesion that occurred after physical exercise is presented in the article. During the examination (ultrasound, multi-slice computed tomography of the kidneys), the diagnosis was unclear, and therefore, the patient underwent surgical treatment. Given the risks of complications and impossibility to exclude the malignancy, a decision was made to perform nephrectomy. The diagnosis was clear cell adenocarcinoma. We consider the prompt nephrectomy in this clinical situation as a success.

[Combined therapy of patients with recurrent cystitis using a complex of natural antimicrobial peptides and cytokines: first results].

INTRODUCTION: Urinary tract infections (UTIs) remain an important problem in urology due to their high prevalence and tendency to relapse. The improvement of the treatment outcomes in chronic cystitis is still relevant. MATERIAL AND METHODS: A total of 91 patients were included in prospective, multicenter, randomized, comparative, controlled study. They were randomized into three groups: in the comparison group 1 (n=32) basic therapy was administered for 5 days. In the comparison group 2 (n=28) basic therapy was combined with rectal suppositories Superlymph 25 IU once a day for 10 days. In the main group (n=31) basic therapy in combination with rectal suppositories Superlymph 10 IU once a day for 20 days were prescribed. The basic therapy included a combination of two antimicrobial drugs: fosfomycin trometamol 3.0 g at night once on the first day of therapy, and furazidin 100 mg three times a day after meals for 5 days. Pathogenetic treatment was not prescribed in comparison group 1, but administered for 10 days and 20 days in comparison group 2 and main group, respectively. RESULTS: After the completion of etiotropic therapy, a significant effect in all groups was shown. At the same time, at the 2nd visit, there was a significantly better results in patients who received Superlymph rectal suppositories, both at a dose of 10 U and at a dose of 25 U, without any differences between two schemes. The frequency and severity of cystitis symptoms at the end of etiopathogenetic therapy in the main group was less pronounced than in the comparison groups (p=0.0001), and a significant difference was found between comparison groups 1 and 2 (p=0.0001). The use of Superlymph significantly improved the parameters of microcirculation in the urethra, however, there was no difference between comparison group 2 and main group. CONCLUSION: Etiopathogenetic therapy, including Superlymph rectal suppositories at a dose of 10 IU and 25 IU in patients with chronic cystitis, can significantly improve the results of combination therapy. Analysis of the symptoms score of acute cystitis showed the superiority of longer-term use of Superlymph rectal suppositories at a reduced dosage (10 units). Peptide-cytokine therapy led to a significant improvement in local microcirculation in comparison group 2 and the main group.

[The use of neural algorithms when choosing a method of surgical treatment of urolithiasis].

AIM: to assess the possibility of using neural network algorithms in choosing a method for surgical treatment of urolithiasis. MATERIALS AND METHODS: treatment results of 625 patients with kidney stones were analyzed in the study. Information about each patient was presented in the form of a multidimensional vector characterized by following preoperative investigations: questionnaires, clinical examination, instrumental and laboratory studies. A register was created where information on more than 50 parameters for each patient was added. Each example has an output parameter representing a predefined treatment strategy (extracorporeal shock-wave lithotripsy [ESWL] - 1, percutaneous nephrolithotomy [PCNL] - 2, pyelolithotomy or nephrolithotomy - 3). The initial database served as the basis for training the neural network estimation technique. RESULTS: A prospective trial was conducted to assess the clinical efficiency of the recommendations of neural network. A cohort of 150 patients admitted to the urology department was divided into two groups of 75 people. In the group 1, patients received treatment according to the standard recommendations. In group 2, treatment strategy was chosen based on the results of neural network analysis. In the group 1, ESWL was performed in 40 (53.3%) patients. The average number of sessions was 1.8. At the discharge, residual fragments were diagnosed in 12 (30%) cases. In 4 patients, acute pyelonephritis developed, which required performing ureteral catheterization and subsequent treatment. In group 1, the efficiency of ESWL was 75%. In the group 2, where the neural network assessment technique was used, the average number of sessions was 1.4. At the discharge, 7 (15.6%) patients had residual fragments: 4 in the kidney, in 3 in the lower ureter ("steinstrasse"). In 4 cases, a conversion for PCNL was performed. ESWL efficiency was 91.1%. Stone-free rate for ESWL in the second group was significantly higher due to the greater number of stone fragmentation. In addition, number of shock waves was lower (the average number of sessions was 0.4 less). Improvement of treatment tactics through the use of neural network algorithms led to a decrease in hospitalization times, as well as to an improvement in the quality of treatment. The low efficiency of ESWL, as the first-line method, led to a change in treatment tactics in 25% of patients in group 1 and only in 8.9% of patients in group 2. Using these algorithms, it was possible to reduce hospitalization time, need for changing treatment strategy, number of auxiliary procedures, readmission rates, the incidence of inflammatory complications, and the number of residual fragments after ESWL. CONCLUSIONS: The possibility of using the neural network prediction technique at the preoperative stage in patients with kidney stones has been shown. This technique allows practicing urologist to make a decision on the choice of the optimal treatment method on an individual basis, thereby minimizing the risk of early postoperative complications.

[Treatment and prevention of chronic cystitis in women].

AIM: to evaluate the efficiency of the dietary supplement NefroBest in women with chronic cystitis. MATERIALS AND METHODS: On the basis of the Department of Urology and Nephrology of the Altai State Medical University and the urological department of the NUZ CH "RJD Medicine", Barnaul, from September 2019 to August 2020 a total of 40 women with chronic cystitis were treaeted. Depending on the type of treatment, all women were divided into the main and control groups, each of 20 people. In the main group, patients received standard therapy and dietary supplements NefroBest. In the control group, patients were prescribed only to standard therapy. RESULTS: The results were evaluated one and two months after the start of therapy. In the main group a more rapid resolution of symptoms and laboratory abnormalities were seen, as well as an improvement of the endoscopic picture and urodynamic parameters. CONCLUSION: The complex of biologically active substances in the dietary supplement NefroBest has an antimicrobial, anti-inflammatory and antispasmodic effect, and reduces the risk of recurrence of chronic cystitis. Thus, the dietary supplement NefroBest can be recommended as a component of the complex therapy of recurrences of chronic cystitis, as well as a prophylactic treatment during relapse-free period.

[Possibilities of using sildenafil in patients with cardiovascular comorbidities who underwent transurethral resection of the prostate].

AIM: To study the efficacy and safety of using sildenafil in patients with erectile dysfunction (ED) and concomitant cardiovascular diseases (CVD) who underwent transurethral resection of the prostate (TURP). MATERIAL AND METHODS: A total of 59 patients (age from 50 to 75 years) with a diagnosis of benign prostatic hyperplasia (BPH), requiring surgical treatment due to inefficiency of drug therapy, I-PSS score more than 20 points), who were sexually active, but had erectile dysfunction (IIEF score < 21), coronary heart disease (NYHA class I) and stage 1-2 hypertension with stable blood pressure. All patients underwent bipolar TURP. From the first day after the TURP, therapy was prescribed as following: tamsulosin 0.4 mg once a day for 90 days, ciprofloxacin 500 mg twice a day for 10 days. In addition, the patients received treatment for comorbidities. In the main group (n=30), men additionally received sildenafil (EFFEX Sildenafil Evalar) 50 mg daily for 60 days, starting from the 30th day postoperatively. We have chosen this drug from an economic standpoint. RESULTS: At baseline, all patients in both groups had hemodynamic and microcirculatory disorders in the prostate, which got worse in the early postoperative period. During the long-term follow-up, hemodynamic and microcirculatory impairments decreased. This effect was more pronounced in patients who received sildenafil. In addition, patients had an improvement in sexual function. During follow-up, there was no adverse effects of sildenafil on hemodynamic parameters (blood pressure, heart rate). CONCLUSION: Our results allow to recommend sildenafil in order to restore sexual function postoperatively in patients with BPH, including those with concomitant cardiovascular disorders.

[The efficiency of combination therapy of non-gonococcal urethritis in men].

AIM: To carry out a comparative assessment of the efficiency of combination therapy for non-gonococcal urethritis (NGU) in men. MATERIALS AND METHODS: a total of 124 patients with NGU and laboratory-confirmed urogenital infection were included in the study. The diagnostic methods included microscopy of urethral smear, real-time polymerase chain reaction (PCR) for the detection of uropathogens and laser Doppler flowmetry for evaluating the urethral microcirculation. All patients were randomized into three groups matched for age, clinical manifestations, and disease duration. Patients of the group 1 received targeted antibiotic therapy. In the group 2, local peloid therapy was added, while patients in group 3 additionally received vibromagnetotherapy. The control group consisted of 22 patients aged 18 to 55 years. The study included 2 visits, at the baseline and 4 weeks after the end of treatment. RESULTS: After the treatment, the frequency of microbiological cure was 89%. In the group 3, more pronounced improvement in main symptoms of NGU was observed. The analysis of microcirculation after treatment in the groups 2 and 3 showed a significant increase in perfusion and modulation of urethral blood flow and a decrease in venous congestion after combined therapy. CONCLUSION: The combined treatment, including antibiotic, peloid therapy, and vibromagnetotherapy, promotes more pronounced clinical improvement, restoration of urethral microcirculation and relief of inflammatory process in patients with NGU and can be recommended for routine clinical practice.

[Current approaches to the diagnosis of acute cystitis and to evaluation of treatment efficiency].

INTRODUCTION: Lower urinary tract infections are common infectious diseases. Although there are international valid questionnaires for evaluating a number of urological diseases (prostatitis, BPH, erectile dysfunction), a unified questionnaire for cystitis was absent until recently. Our aim was to evaluate the efficiency and ease of use of the Acute Cystitis Symptom Score (ACSS) in the daily urological practice. MATERIALS AND METHODS: A total of 47 women aged 24 to 46 years with typical complaints for acute cystitis were included into multicenter open, non-comparative prospective population-based study. All of them completed the ACSS questionnaire during the first consultation and after 7-10 days at the follow-up visit. The diagnosis of acute cystitis was valid with a total score of 6 or more points. Clinical and laboratory studies were used to diagnose the cystitis. RESULTS: Self-completion of the questionnaire by the patient and its analysis by the physician took about four minutes. The average baseline score for the "typical" domain was 9.8+/-1.3, while a score for the differential diagnostic domain was 1.2+/-0.4. The mean baseline quality of life was 6.4+/-0.8 points. The total score averaged 17.4+/-1.9. All 47 patients had leukocyturia, and 12 (25.5%) had hematuria. A microbiological study was done in 36 (76.7%) patients and revealed an increased concentration of uropathogens in all cases. Thus, acute cystitis diagnosed on the ACSS scale was confirmed, and 41 (87.2%) patients had acute uncomplicated cystitis, and in 6 cases (12.8%) various complications developed. CONCLUSION: The specificity of the ACSS questionnaire was 100%. The questionnaire can be considered as a necessary tool for studies on LUTS in order to standardize obtained data and ensure their comparability.

[Clinical, morphological and microcirculatory criteria of local recurrence of the prostate cancer after HIFU therapy].

AIM: to study the clinical, morphological and microcirculatory criteria for treatment efficiency and prognosis of local recurrence after HIFU. MATERIALS AND METHODS: On the basis of the urological department of Clinical Hospital "Russian Railways - Medicine" in Barnaul (the clinical base of the Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO "Altai State Medical University") for the period 2011-2018, a comprehensive examination and treatment of 240 patients with prostate cancer (PCa) by means of HIFU using "Ablatherm" was performed following transurethral resection of the prostate (TURP). The indication for HIFU was morphologically-proven PCa (stage T2a-cN0M0) in patients with contraindications due to comorbidities or those who refused from radical prostatectomy. RESULTS: A decrease in PSA to 0.5 ng/ml or less was observed in 74% of patients. A stable PSA level for 3 years was observed in 76% of patients. PSA levels differed depending on the PCa risk group. In the low-risk PCa, negative biopsy was seen in 89.6% of cases, in comparison with 72.2% and 69.4% in intermediate and high-risk PCa, respectively. There was a significant decrease in the volume of the prostate in all patients with low-risk PCa. The largest decrease in prostate volume was observed 12 months after HIFU. Regarding recurrence-free survival after HIFU therapy, during follow-up of 3 years or more, 77% of patients didnt have any signs of recurrence. A 3-year overall survival after HIFU was 83%. In addition, an increase in postoperative PSA levels, change in parameters of Doppler study and laser Doppler flowmetry at the area of the prostate during the period of 6-36 months after HIFU was associated with a significant increase in the risk of recurrence of PCa at biopsy. CONCLUSION: HIFU therapy is an effective treatment method for inducing prostate necrosis with minimal collateral damage to the surrounding tissue. The best results were achieved in patients with low-risk PCa. There were minimal adverse events after HIFU. In addition, in case of relapse after HIFU therapy, there is an opportunity for an early assessment of the efficiency and prognosis.

[Retroperitoneoscopic approach for treatment of acute obstructive calculous pyelonephritis. Alternative or a method of choice?]

AIM: to compare the results of treatment of patients with acute obstructive calculous pyelonephritis, who underwent to retroperitoneoscopic procedure, with patients, who underwent to drainage of the collecting system by means of ureteral stent or nephrostomy tube as the first stage. MATERIALS AND METHODS: A total of 121 patients were treated from 2011 to 2019. Of these, 78 patients were included in the main group. The stones were located in the ureteropelvic junction (n = 20) and the upper and middle ureter (n = 58). The average size of the stone was 12.9 +/- 4.8 mm. Preliminary upper urinary tract drainage was not carried out and the stone was removed completely. The group 2 consisted of 26 people. The stones were located in the upper (n = 18) and the middle ureter (n = 8); the average size was 9 +/- 2.8 mm. Renal drainage was done using ureteral stent and when pyelonephritis resolved, ureterolithotripsy was performed. The group 3 was represented by 17 patients. All stones were located in the ureteropelvic junction. The average size was 20.3 +/- 10.7 mm. Renal drainage was done using percutaneous nephrostomy; when there were no inflammatory changes, percutaneous nephrolithotripsy was performed. RESULTS: In the main group, normalization of body temperature and resolution of inflammatory changes in the blood and urine occurred earlier. The stone was removed completely and there were no residual fragments. Period of rehabilitation was are also significantly shorter than in groups 2 and 3. The retroperitoneoscopic method was more effective and safer for the treatment of patients with acute obstructive pyelonephritis caused by large stones located in the upper or middle ureter and ureteropelvic junction.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[The features of the pathologic changes in chronic oxalate stone disease after 16 week of experimental phase].

AIM: to study the pathologic features of chronic oxalate stone disease. MATERIALS AND METHODS: a model of the experimental oxalate stone disease was done in rats that drank the 1% ethylene glycol solution for 16 weeks. The pathologic analysis of the rats kidneys was done. RESULTS: After 16 weeks of oxalate stone disease modeling in all parts of kidneys the large crystals deposits were found, which plugged renal tubules. Moreover, purulent calculous pyelonephritis developed complicated by fibrosis.

[The preparation of patients with urinary stone disease to extracorporeal shock-wave lithotripsy].

The treatment of urinary stone disease is one of the most urgent and complex issue in modern urology. Citrate is one of the most important natural urinary inhibitors of stone formation. In this regard, the drugs containing citrate sodium and potassium are being actively used. AIM: to assess the efficiency and safety of Uryklar, dietary supplements. MATERIAL AND METHODS: A total of 57 patients with proximal ureteric stones were included in the study (intervention group (n=30) and control group (n=27)). After stenting all patients received antispasmoic, anti-inflammatory and antimicrobial therapy. In the intervention group Uryklar was additionally administered (405 mg), 1 capsule TID for 1 month. All patients were undergone to extracorporeal shock-wave lithotripsy with subsequent removing of the stent. In all cases multiplanar CT was done before and 28 days after initiation of drug therapy for determination of stone size, contour and density. 10 days after stent removal the symptoms and stone-free rate were assessed using US, plain X-ray and intravenous urography, blood count, urinalysis, biochemical blood analysis. RESULTS: In patients receiving Uryklar, there was a significant reduction of stone size during the observation, up to complete dissolution.

[The role of presepsin in the estimation of disease severity and assesment the treatment efficiency in patients purulent pyelonephritis].

AIM: to determine the importance of a presepsin plasma level for early identification of urosepsis, assessment the severity and efficiency of therapy. MATERIAL AND METHODS: From 2017 to 2018 . a prospective controlled randomized cohort study with 32 patients (6 men, 26 women) aged from 20 to 60 years was conducted. Patients with diagnosed or suspected purulent pyelonephritis were randomized into two groups depending on the treatment strategy. In Group 1, patients received drug therapy, while in Group 2 surgical treatment was performed due to ineffectiveness of drug therapy. In both groups a level of presepsin was assessed and compared with the clinical manifestation of acute pyelonephritis and the choice of adequate treatment. RESULTS: The mean presepsin level in Group 1 at the admission was 338.4 pg/ml (normal value - 97 pg/ml), while in Group 2 it was 501.125 pg/ml. The presepsin level significantly decreased in both groups on Days 6-7 (<0.005), to 120.4 pg/ml and 66.875 pg/ml, respectively. Consequently, according to clinical and laboratory data, acute purulent pyelonephritis in patients who received combined therapy was successfully managed without surgical treatment, which was confirmed by the positive changes in body temperature, pain severity, blood analysis (leucocytes, ESR) and urine (protein, leukocytes) due to timely detection of presepsin level. DISCUSSION: Our analysis showed that recovery occurred in both groups, but there are differences in the duration of the disease depending on treatment strategy. Using the presepsin level, we found: In Group 1 the level was 338.4 pg/ml (1.5 times less than in Group 2, <0.005), which indicates the possibility of systemic infection. In this group the surgical treatment was avoided without any fatal consequences. In Group 2, in patients who were undergone to surgical treatment the mean baseline presepsin level was 501.125 pg/ml, which indicates the moderate risk of systemic infection (severe sepsis) and increased risk of adverse outcomes, therefore, surgical treatment was recommended. Thus, the determination of presepsin level can influence on the choice of treatment strategy. CONCLUSION: The analysis of presepsin level is necessary for the choice of treatment strategy, since the clinical and laboratory data does not always reflect the changes in the kidneys.

[Acute uncomplicated cysititis: do we follow the guidelines?]

INTRODUCTION: Lower urinary tract infection are a common urologic disease, but a therapy is not always optimal. AIM: to evaluate the compliance of prescriptions made by urologists in treatment of patients with lower urinary tract infection, in particular with acute uncomplicated cystitis. MATERIALS AND METHODS: A specially designed questionnaire was filled out by 161 urologists from Novosibirsk, Barnaul and Krasnoyarsk, as well as participants of VII Congress of urologists of Siberia. RESULTS: The survey showed that 34.8%, 27.9%, 22.4% and 14.9% of urologists had 6-10, 11-20, 1-5 and more than 20 patients with acute uncomplicated cystitis a month, respectively. According to results, 91.9% of urologists are familiar to National guidelines on treatment of lower urinary tract infections and 91.2% of doctors consider them to be reasonable. Among those surveyed, 29.2% of urologists believe that National Guidelines differ from European Guidelines; 95.7% of participants adhere to recommendations, but only 47.4% respect it almost always, 16.9% do it in half of cases and the remaining 35.7% comply with them in less than 40% cases. Moreover, 86.4% of urologists started a treatment of acute cystitis with antimicrobial therapy and preferred fosfomycin in 41.0%, nitrofurans in 20.9%, fluoroquinolones in 21.6% and cephalosporins in 16.5% cases, respectively. Almost all respondents (93.8%) are convinced that antibiotic therapy should be accompanied by phytotherapy, and 71.5% of urologists administer Canephron. CONCLUSION: In the urologic community there are controversies in the treatment of patients with acute uncomplicated cystitis. The choice of therapy is not always optimal.

[Complex treatment of chronic cystitis in women].

PURPOSE: Evaluation of the efficacy and safety of Phytolysin in complex treatment of female patients with chronic cystitis. MATERIALS AND METHODS: 40 women with chronic cystitis were examined from January 2016 to March 2016. Depending on the treatment, all patients were divided into two groups of 20 people. Main group of patients was treated with Fosfomycin (Monural) and Phytolysin. Control group of patients received monotherapy with fosfomycin. RESULTS: The results were assessed at 1 and 2 months after initiation of therapy. Rapid normalization of the status and laboratory parameters, improvement of dynamics of the endoscopic view was observed in main group of patients. CONCLUSION: The complex of biologically active substances contained in Phytolysin has antimicrobial, anti-inflammatory, antispasmodic, and immunomodulatory effects, promotes the normalization of urodynamics of lower urinary tract, reduces the risk of relapse of chronic recurrent cystitis. Thus, Phytolysin can be recommended as a component of complex therapy of exacerbations of chronic cystitis, as well as a drug for prevention of the disease in disease-free periods.

[ROLE OF CYTOMEDINES IN THE TREATMENT OF PATIENTS WITH CHRONIC PROSTATITIS ASSOCIATED WITH IMPAIRED SPERMATOGENESIS].

The efficiency and safety of tablet drug Vitaprost in the treatment of 35 patients with chronic abacterial prostatitis associated with impaired spermatogenesis were evaluated. The treatment course comprises the use of drug 1 tablet 2 times a day for 60 days. It was shown that Vitaprost had a positive effect on the basic parameters of spermatogenesis, helping to increase the number of sperm cells (28.8%), their mobility (17%), and viability (14.2%). The number of abnormal sperm cells at the same time decreased by 26.2%.