[Combined treatment of patients with erectile dysfunction and urination disorders].

The article presents the results of the study aimed to the evaluation the efficacy of combination therapy with alpha1-blocker (tamsulosin) and phosphodiesterase type 5 inhibitor (sildenafil) in patients with urination disorders and erectile dysfunction (ED). A pilot observational study involving 60 men aged from 50 and 80 years divided into 3 groups of 20 people was performed. Group 1 of patients received sildenafil 25 mg daily (dynamico), Group 2--tamsulosin 0.4 mg daily (Omnic-Ocas), and Group 3--tamsulosin 0.4 mg (Omnic-Ocas) and sildenafil 25 mg (dynamico) daily. The visits were carried out at the stage of screening, further--every 10 days (a total number--4 visits). Combination therapy of urination disorders and ED contributed to the significant improvement in uroflowmetry, the stopping of complaints according to the IPSS and IIEF-15 questionnaires, and improving the quality of life (according to the QoL questionnaire). Combination therapy significantly decreased obstructive and irritative symptoms, increased the maximum urine flow rate within the period of observation, as well as significantly decreased the residual urine volume, more pronounced when compared with monotherapy. Significant positive effect on erectile component and all components of the overall satisfaction in the sexual sphere were registered, that as a consequence led to the positive impact on the quality of life in patients treated with PDE5 inhibitor. Given the high prevalence of urinary disorders and erectile dysfunction, combined therapy with alpha1-blockers and PDE5 inhibitors in this case should be a promising area for drug therapy.

[Long-term results of prostatic photoselective vaporization in the treatment of prostatic adenoma].

Assessment of long-term efficacy and complications of prostatic photoselective vaporization (Green Light PV (tm) device, Laserscope, 80W; laser cystoscope, Olympus) was performed in 40 patients with prostatic adenoma (PA) treated in 2005-2006. Mean follow-up was 30.6 +/- 16.6 (5.2-60.6) months, time of operation--52.4 min, intraoperative blood loss--52 ml maximum, duration of bladder draining with catheter--1.15 days. For 12 postoperative months IPSS and QoL declined, then for up to 60 months these parameters went up. An 11-month postoperative follow-up recorded a 68.6% maximal decrease in prostatic volume (the size of the prostate decreased to 22.6 cm3), but after 4 years this volume increased by 24.6% to 38.8 cm3. Qmax increased more actively during postoperative year 1 and reached maximal value to postoperative month 36. Residual urinary volume fell to initial 95.7 ml to minimal 24.8 ml on follow-up month 12. Mean quantity of energy reached 206 +/- 94 (2.4-619.0 kJ. Eleven patients had to take oral anticoagulants without any serious intra- or postoperative complications. Recurrent adenoma rose in 4 patients, urethral stricture--in 6.8% patients, cervical bladder sclerosis was found in 3.6% cases. Prostatic cancer development was not registered. Thus, prostatic photoselective vaporization is a safe and efficave procedure in PA treatment.

[Transurethral photoselective laser vaporization in the treatment of prostatic adenoma].

Progress in laser technologies allowed development of a highly effective method of laser adenomectomy--photoselective vaporization of the prostate (PSVP). The method employs highly potent potassium-titanyl-phosphate (KTP) laser. PSVP with KTP laser (80 W) [GreenLight PV (tm), Laserscope] was made in 40 patients. Duration of surgery averaged 52.4 min, mean time of urethral catheter stay was 14 hours. Complications were insignificant (short-time dysurea--12%, hematurea--8%). Control examination of all the patients 1, 3, 6 and 12 months after PSVP has shown that IPSS diminished by 78% and was 5 points, QoL improved by 50% (2.6 points), Qmax increased by 112% (mean 18.3 ml/s, residual urine reduced by 74% (mean 22.1 ml). Thus, PSVP is low-invasive, is accompanied neither with absorption of the lavage fluid nor with blood loss, reduces hospital stay of the patients, can be performed outpatiently or in day hospital. Therefore, PSVP is an alternative to conventional TUR. Further trial of long-term results of PSVP is needed.