[Metabolic features of the inflammatory syndrome of chronic pelvic pain (category IIIA of chronic non-bacterial prostatitis) in young men, depending on the somatotype].

PURPOSE: dentification of bioimpedance and clinical features in young men with chronic pelvic pain inflammatory syndrome (CP/CPPS NIH IIIa) depending on the somatotype. METHOD: s. 150 men of the first period of adulthood from 22 to 35 years old with CP/CPPS NIH IIIa were examined from 2018 to 2022 years. The average age was 31 [28; 34] year. Somatotypes were computed according to Carter and Heath. Body composition was assessed anthropometry and bioimpedance analysis. RESULTS: Ectomorphs had the least clinical, laboratory and instrumental manifestations of CP/CPPS NIH IIIa, the levels of total and free testosterone were the highest. The active cell mass predominated in the component composition of the body. Manifestations in mesomorphs had a moderate degree of severity. Endomorphs had the most severe manifestations of CP/CPPS NIH IIIa, the largest amount of fat mass was noted in the body composition than in men of other somatotypes, the hormonal status was characterized by the lowest levels of free and total testosterone, and the highest level of estradiol. DISCUSSION: Based on the literature data and our own results, it can be assumed that the identified changes in the body component composition and hormonal status of men contribute to the maintenance of chronic inflammation in the prostate, organ ischemia, impaired intracranial metabolism, recurrent course of CP/CPPS NIH IIIa, which significantly reduces the patients quality of life and increases the risk of prostate inflammation with age. CONCLUSION: Determining the somatotype and conducting a component analysis of body composition allows patients to be divided into groups according to the severity of manifestations of CP/CPPS NIH IIIa. The revealed patterns allow us to classify male endomorphs into the group with the most severe manifestations of CP/CPPS NIH IIIa.

[An observational randomized study of the efficacy and safety of the drug Longidase, vaginal and rectal suppositories 3000 iu in the treatment of patients with symptoms of the lower urinary tract on the background of benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is among the most significant urological diseases, and improving the effectiveness of treatment of patients with this disease is one of the main tasks in modern urology. The aim of the study is to evaluate the effectiveness of Longidase in the treatment of men with benign prostatic hyperplasia. MATERIALS AND METHODS: The study included 120 patients with lower urinary tract symptoms caused by BPH, who were randomly assigned to 2 groups of 60 people. In the main group (MG), Longidaza 3000 ME therapy was performed in combination with tamsulosin. In the comparison group (CG), tamsulosin monotherapy was performed. The patients were examined during 5 visits for 162+/-3 days. RESULTS: During the treatment period, compliance was 100%, all patients followed the doctors prescriptions, there were no cases of refusal of therapy. In addition, there were no cases of adverse events associated with taking the drug Longidaza. The examination initially revealed symptoms of the lower urinary tract in both groups against the background of prostatic hyperplasia, erectile dysfunction and a decrease in the quality of life. The therapy performed in both groups was effective, as evidenced by a decrease in the average score on the I-PSS scale, an increase in maximum urine flow rate, a decrease in volume of residual urine, which led to an improvement in the quality of life according to the QoL scale. Nevertheless, in the group of patients receiving Longidaza, after 50 days of therapy, there was a more pronounced positive dynamics of both the average score on the I-PSS and QoL scales, and the average maximum urine flow rate value according to the results of uroflowmetry. The differences between the groups according to these indicators were statistically significant (p<0.05). After 50 days of follow-up in GS, the average prostate volume did not change significantly, whereas in MG it decreased, and the differences between the groups were statistically significant (p=0.001). During subsequent visits, there was a tendency to decrease the size of the prostate in the MG, while in the CG there was a moderate increase in the volume of prostate according to ultrasound. CONCLUSION: Thus, according to the results obtained in the course of this observational study, the drug Longidaza 3000 ME can be effectively used in patients with BPH, prevent the progression of the disease, contribute to the persistent relief of LUTS and improve the quality of life of patients in this category.

[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 of the chronic prostatitis: current state of the problem].

A review of the literature on the urgent problem of urology, which is therapy of chronic prostatitis (CP) is presented. Despite numerous studies dedicated to the prevention and treatment of CP, it has not yet been possible to reduce the CP incidence. Therapeutic approaches aimed at improving the quality of life are not always effective due to the lack of a clear understanding of the etiology and pathogenesis of the disease. Leading Russian urologists recommend introducing into the complex therapy of CP a domestic drug from the cytomedin, namely Vitaprost, which causes a significant decrease in the severity of trophic disorders, inflammatory and congestive processes, improves microcirculation in the prostate, stimulates cellular and humoral immunity, all of which increase the effectiveness of CP therapy.

[The use of bioregulatory peptides in the treatment of men with benign prostatic hyperplasia and chronic prostatitis].

INTRODUCTION: Benign prostatic hyperplasia (BPH), and chronic prostatitis (CP) are considered to be among the most common causes of lower urinary tract symptoms (LUTS) in men. The combination of BPH with CP raises many questions when choosing the right treatment strategy. For a long time, bioregulators isolated from the prostate gland of cattle have been successfully used in the treatment of CP. OBJECTIVE: to evaluate the effectiveness of bioregulatory peptides, in particular vitaprost, in the treatment of men with benign prostatic hyperplasia and chronic prostatitis. MATERIALS AND METHODS: The study included 60 patients with BPH and CP, who were divided into two groups of 30 people. In the comparison group (CG), complex therapy with drugs from the group of alpha-blockers and fluoroquinolones was performed. In the main group (MG), a similar complex therapy was performed in combination with vitaprost tablets. The effectiveness of the treatment was evaluated after two weeks (visit 2) and after 4 weeks (visit 3). RESULTS: In the MG, a more effective reduction in the severity of LUTs and manifestations of the inflammatory process was noted than in the HS. After 2 weeks of therapy in OG, the average score on the IPSS, QOL and NICH-CPSI questionnaires was lower by 2.4 points, 1.2 points and 2.5 points, respectively, the number of white blood cells in the prostate secret was on average 1.5 times less, and Qmax was higher by 1.4 ml/sec. The revealed differences were statistically significant (p<0.05). This trend continued after 4 weeks of therapy. CONCLUSION: Thus, the use of bioregulatory peptides, in particular the drug vitaprost, in patients with BPH and CP helps to reduce the severity of LUTs and pain in a shorter time, has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life of patients in this category.

[Specific features of the immune status and blebbing of the plasmatic membrane of lymphocytes patients with urolithiasis complicated by the pyelonephritis].

INTRODUCTION: According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role. AIM: To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis. MATERIALS AND METHODS: A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes plasmatic membrane was evaluated by phase contrast microscopy. RESULTS: It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.

[The features of course of chronic abacterial prostatitis with inflammatory compoment in men of the first period of mature age depending on the somatotype. Part 2: laboratory and imaging characteristics].

AIM: to study the course of chronic abacterial prostatitis with the inflammatory component (CAPIC) depending on the somatotype in men of the first period of mature age taking complex treatment with a use of local and systemic ozone therapy. MATERIALS AND METHODS: A total of 306 men of asthenic, normostenic and pyknic somatotypes with CAPIC were followed-up. Along with standard therapy, all patients received systemic and local ozone therapy. Clinical, laboratory and imaging characteristics were recorded before and after treatment. In addition, hemodynamic parameters in the prostate, prostatic part of the urethra and skin projection of the prostate were evaluated. RESULTS: In patients with pyknic somatotype (from 34.12+/-0.51 cm3 to 29.08+/-0.64 cm3) the most significant reduction in prostate size during the treatment with CAPIC was observed, while the improvement of microcirculation parameters were seen in patients with asthenic somatotype. Changes in the microcirculation in the mucous membrane of the prostatic part of the urethra and skin projection of the prostate during the treatment of CAPIC are somatotype-dependent. The highest values of tissue perfusion were found in patients of the normostenic somatotype, while pyknic patients had the smallest values. Along with somatotyping, this allows to use in clinical practice the abovementioned methods for early diagnosis and subsequent monitoring of the effectiveness of CAPIC therapy.

[Current concept of diagnosis of benign prostatic hyperplasia].

This literature review outlines the most common methods of diagnosis of benign prostatic hyperplasia. Promising diagnostic modalities include uroflowmetry, assessment of International Prostate Symptom Score (IPSS), transrectal ultrasound and prostate elastography. The authors address social implications and epidemiological features of the disease in Russia and developed countries.

[The features of course of chronic abacterial prostatitis with inflammatory compoment in men of the first period of mature age depending on the somatotype. Part 1: the clinical characteristics].

AIM: to study the course of chronic abacterial prostatitis with the inflammatory component (CAPIC) depending on the somatotype in men of the first period of mature age taking complex treatment with a use of local and systemic ozone therapy. MATERIALS AND METHODS: A total of 306 men of asthenic, normostenic and pyknic somatotypes with CAPIC were followed-up. Along with standard therapy, all patients received systemic and local ozone therapy. Patients complaints were recorded before and after treatment. Questionnaires for total assessment of the symptoms of CAPIC and male sexual function were used for monitoring of clinical manifestations. RESULTS: Sexual disturbances before and after treatment were less pronounced in patients with normostenic somatotype in comparison to patients with asthenic and pyknic somatotypes. Pain syndrome was less common in normostenic patients (0.83+/-0.09 points). The most severe dysuric symptoms (<0.03) was noted in patients with pyknic somatotype, such as weak urine stream, interrupted stream and incomplete bladder emptying (1.33+/-0.14 points), increased frequency of urination (0.91+/-0.11 points), dribbling (1.22+/-0.14 points). In addition, they had a maximum influence of the symptoms of CAPIC on the professional activity (1.50+/-0.08 points; <0.02). After treatment, a clinical index (CI) of CAPIC in the severity of clinical manifestations in patients of the normostenic somatotype was insignificant (9.29+/-0.55 points), while in patients with asthenic and pyknic somatotype it was moderate, almost insignificant (11.71+/-0.62 and 13.62+/-0.61 points, respectively). Overall, CAPIC was the most severe in patients with a pyknic somatotype, which was objectively confirmed by the of CI of CAPIC. However, standard therapy with a using of regional and local ozone therapy in these patients were more efficient in comparison with patients with other somatotypes and was accompanied by an almost twice decrease in CI of CAPIC (from 24.32+/-0.73 to 13.62+/-0.61 points).

[General clinical and laboratory and instrumental characteristics of the chronic nonbapterial prostatite with the inflammatory component in men of the first period of mature age].

AIM: To investigate the course of CNPIC in young men treated with general and local ozone therapy. MATERIALS AND METHODS: 306 patients underwent standard treatment concurrently with local and systemic ozone therapy. Clinical-laboratory and instrumental parameters were evaluated before and after treatment. In addition, the blood flow of the prostate, prostatic urethra and skin at the projection point of the prostate was studied. RESULTS: Standard treatment of CNPIC with the concurrent use of general and local ozone therapy resulted in a reduction of pain intensity and severity of dysuria, improvement of the sexual function and quality of life of men. There was an increase in blood flow in the arteries and veins of the prostate, a decrease in the prostate size and volume. The study findings showed an almost twofold decrease of the mean values of the CNPIC clinical index during treatment. In the prostate secretion, the leukocyte count decreased from 29.29+/-0.67 to 4.75+/-0.15. A statistically significant (p<0.001) decrease in all sizes of the prostate was observed: height (upper) from 40.99+/-0.22 to 39.13+/-0.21 mm, width (transverse dimension) from 41.94+/-0.21 to 39.94+/-0.22 mm, and thickness (anteroposterior size) from 30.52+/-0.20 to 29.15+/-0.18 mm. Prostate volume also decreased from 27.78+/-0.42 to 24.10+/-0.36 cm (p<0.001).

[Contemporary concept of the diagnosis of prostate cancer].

This review summarizes current evidence of the etiology and diagnosis of prostate cancer. As before, a comprehensive urological examination remains the main method of diagnosing the disease. However, the invasive nature of the multicore prostate biopsy, its high cost and the need for specially trained personnel prompts to seek more state-of-the-art and non-invasive methods for diagnosing prostate cancer. The further research in this direction seems promising.