[Comparative analysis of antibiotic therapy and cytokine therapy (the drug Superlymph) for male infertility associated with male accessory gland infection].

AIM: To compare the effects of cytokine and antibacterial therapy on semen parameters and additional functional tests in patients with infertility due to male accessory gland infections (MAGI) who are preparing for assisted reproductive technologies (ART). MATERIALS AND METHODS: A randomized, prospective, controlled clinical trial without blinding was carried out. A total of 60 men from infertile couples with MAGI who were preparing to ART was included in the study. In the main group (n=30) patients received Superlymph, 1 suppository of 25 units, 2 times a day for 20 days. In the control group (n=30), the antibacterial drug Doxycycline 100 mg 2 times a day for 28 days was given. After the end of therapy on day 33+/-3, a repeated sperm analysis, MAR test, a test for reactive oxygen species in the ejaculate and sperm DNA fragmentation, and bacteriological examination of sperm was performed. In addition, a survey for adverse events was carried out. The significance of differences in initial and final parameters and differences between groups was assessed using the Students t-test, Wilcoxon test and Mann-Whitney U-test depending on the data distribution. The Shapiro-Wilk test was done to investigate the normality of data distribution. Fisher's exact test was used to compare categorical variables. RESULTS: The final analysis included data from 53 patients (n=28 in the main group and n=25 in the control group). In both groups, a significant decrease in the level of free oxygen radicals in the ejaculate was noted (p=0.031), which was more pronounced in the main group. There were no differences in other semen parameters. Eradication of the microorganism according to bacteriological examination occurred in 57.1% of patients in the main group and in 88% of those in the control group (p=0.016). In patients receiving monotherapy with Superlymph, there was a significant decrease in the sperm DNA fragmentation index and the concentration of leukocytes in the ejaculate. In patients receiving antibacterial therapy, there was a significant increase in ejaculate volume, a decrease in the proportion of IgG-associated sperm and leukocyte concentration. CONCLUSION: Many issues of diagnosis and treatment of MAGI have not been thoroughly studied and are poorly standardized. Considering the problems of increasing antibiotic resistance, alternative treatment options are needed. Cytokine therapy (the drug Superlymph) is an effective alternative method of monotherapy for male infertility due to MAGI and is optimal for quickly preparing a couple for ART protocol, given its positive effect on oxidative stress and the index of sperm DNA fragmentation. The prospect of combination therapy with antibiotics and Superlymph seems promising.

[Prognostic ability of seminal plasma lipidomic analysis in predicting the success of microTESE in men with azoospermia].

INTRODUCTION: The aim of this work is to assess the possibility of metabolomic (specifically lipidomic) analysis of seminal plasma to identify patients with preserved focal spermatogenesis in the testes who may have a reasonable chance of sperm retrieval during the microTESE procedure. MATERIALS AND METHODS: lipid composition of semen plasma samples from 64 men with azoospermia and 24 fertile control men was analyzed. Lipids were isolated from semen by a modified Folch extraction method. Lipid extracts were analyzed by reverse phase liquid chromatography coupled to mass spectrometry. Lipidomic data were compared with the results of the microTESE procedure. RESULTS: Comparison of two groups revealed a statistically significant difference in concentration for 23 lipids detected in positive ion mode and 37 lipids detected in negative ion mode. Those lipids mainly belong to hexosylceramides, sphingomyelins and phosphatidylcholines, phosphatidylethanolamines and their ethers. In multivariate analysis content of SM d16: 1/18:0 lipid (beta coefficient: -7.23; 95% confidence interval [95% CI]: -11.93 to - 2.53; odds ratio: 7.23e-04; CI for odds ratio: 6.59e-06 to 7.93e-02; Walds test: -3.02; p=0.003), content of TG 14: 1_16 : 0_18: 3 lipid (beta 2.95; 95% CI 0.98 to 4.93; odds ratio: 1.92e + 01; CI for odds ratio: 2.66e + 00 to 1.39e + 02 ; Walds test: 2.93; p=0.003) and testicular volume (beta: 0.14; 95% CI: 0.04 to 2.45; odds ratio: 1.15e + 00; CI odds ratio: from 1.04e + 00 to 1.27e + 00; Walds test: 2.65; p=0.008) were significantly associated with positive MicroTESE outcome. The sensitivity of this regression model was 61%, the specificity was 83%, and the AUC was 0.75. CONCLUSIONS: seminal plasma serves as a rich source of biological markers for identifying patients with preserved focal spermatogenesis in the testes. Seminal plasma lipidomic profile of the of patients in the control group with normal spermatogenesis clearly differs from the profile of patients with azoospermia, also there was a significant difference in content of a difference in lipids between patients with positive and negative microTESE outcomes. These are preliminary results and further research is needed to confirm the validity of the resulting lipid panel.

[Evaluation of the efficacy of dapoxetine in primary and secondary forms of premature ejaculation].

OBJECTIVE: to compare the efficacy of dapoxetine in treatment of primary and secondary premature ejaculation. MATERIALS AND METHODS: The study included 60 patients with premature ejaculation (PE). Depending on the form of premature ejaculation they were divided into two groups: 27 patients with primary PE (group 1) and 33 patients with secondary PE (group 2). Patients were recommended to take dapoxetine 30 mg 1 hour before intercourse. A follow-up visit was scheduled on day 30 after receiving the drug. The intravaginal ejaculation latency time (IELT) and the Premature ejaculation diagnostic tool (PEDT) score were evaluated before dapoxetine was given and after 30 days from the start of the study. The significance of differences between baseline and follow-up values were compared using Wilcoxons test. In both groups, the proportion of patients with an incomplete response (IELT less than 2 minutes, PEDT more than 10) to symptomatic therapy with dapoxetine was evaluated. The proportion of patients with incomplete response to therapy was compared using the chi-square test. RESULTS: The median IELT among all patients before starting therapy was 63 seconds (interquartile interval [IQR]: 28.75-94). After one month of therapy median IELT increased to 119 seconds (IQR: 58.75-321.75). Median PEDT score was 16 (IQR: 13-19) at baseline and 7 (IQR: 4-12) at follow-up. In group 1, the median IELT increased from 57 to 83 seconds (p = 0.02088), and in group 2, the median IELT increased from 70 to 173 seconds (p<0.00001). The mean PEDT score decreased to 7 in both groups (p<0.00001). Incomplete response to therapy was observed in 66.7% of patients in group 1 and in 39.4% of patients in group 2. The difference between two groups was statistically significant (p=0.035456). CONCLUSION: Symptomatic therapy with dapoxetine has a positive effect on the intravaginal ejaculation latency time and patient satisfaction in both primary and secondary premature ejaculation. However, the incidence of incomplete response to therapy is higher in patients with primary premature ejaculation, which may be due to characteristic differences in the pathogenesis of primary and secondary premature ejaculation.

[The efficiency of combined regimens for the treatment of urinary tract infections in women using the herbal drug Canephron N].

INTRODUCTION: Currently, empiric antibiotic therapy is considered the standard for acute cystitis. However, additional treatment may be required to alleviate the patient's condition and shorten the time to subjective recovery. AIM: To evaluate the efficiency of the combined administration of fosfomycin trometamol and herbal drug Canephron N in comparison with a single oral dose of fosfomycin trometamol in women with uncomplicated bacterial cystitis. MATERIALS AND METHODS: A randomized, comparative, open-label study was carried put between January 2018 and June 2019. The study included 112 women with symptoms of acute uncomplicated cystitis, who were randomized between two groups in a 1:1 ratio. In the main group, patients received a single oral dose of fosfomycin in combination with Canephron N (2 tablets t.i.d. for 2 weeks), while in the control group patients received only a single dose of fosfomycin (3 g). Symptoms were assessed using the Russian version of the Acute Cystitis Symptom Score (ACSS), completed daily for a week. Also, all patients underwent urine analysis on the 1st, 3rd, 5th and 7th days of therapy. The mean time to complete recovery based on the ACSS questionnaire and the time to resolution of pyuria were compared using the Mann-Whitney U test. Comparison of the proportion of patients with complete cure, according to the questionnaire, or with the elimination of pyuria was carried out using the chi-square test. RESULTS: The final analysis included 46 patients who received fosfomycin in combination with Canephron and 47 patients who received fosfomycin as monotherapy. In the group of combination therapy, patient-reported complete recovery (assessed by the ACSS questionnaire) was seen on average after 1 day, while in patients treated with monotherapy, the median time to subjective recovery was 3 days (p=0.00012). A significant difference between the groups in the proportion of patients with complete resolution of symptoms of acute cystitis was observed on days 1, 2, and 3 (p<0.05). The therapy was well tolerated in both groups. The most frequent adverse events were dyspepsia (8.7% in the combination group compared to 6.4% in the control group) and headache (in 4.3% and 6.4% of patients, respectively). CONCLUSION: the combined use of fosfomycin trometamol and the herbal drug Canephron N allows to reduce the duration of symptoms in patients with acute cystitis, thereby accelerating return to their usual lifestyle patterns.

[The correlation of PSA-nadir PS recurrence after total HIFU-ablation in patients with localized prostate cancer].

OBJECTIVE: To study the survival rate of patients without biochemical recurrence according to the Stuttgart and Phoenix criteria in terms of their correlation with four different PSA nadir values as predictors of clinical recurrence in patients with localized prostate cancer who underwent total HIFU prostate ablation. MATERIAL AND METHODS: The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 - T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: less or equal 0.2 ng / ml (1 group), 0.21-0.5 ng / ml (group 2), 0.51-1 ng / ml (group 3) and> 1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups. RESULTS: The median (range) of the observation period for the patients was 5.3 (3-7) years, the mean time to reaching PSA nadir was 14.5+/-2.6 weeks. PSA nadirs less or equal 0.2, 0.21-0.5, 0.51-1.0 and > 1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p<0.001), according to the Phoenix definition - 94, 74, 66 and 47% (p<0.001) respectively. According to the results of the control biopsy, 601 (91.3%) patients in the 1st and 2nd groups had a negative oncological status (approximately 85%). CONCLUSION: This study confirms that PSA nadir after HIFU ablation predicts biochemical recurrence-free survival and is a reliable marker that is easy to integrate into routine clinical practice.

[Evaluation of the clinical efficacy of urethroplasty after failed hypospadias repair].

BACKGROUND: Evaluation of surgical treatment of hypospadias is one of the most controversial problem in urology, considering a lack of continuity in the management of these patients between pediatric andrologists and general urologists. Patients who undergone to multiple hypospadias repairs remain one of the most difficult categories for reconstructive urethral surgery and urology in general. MATERIALS AND METHODS: The treatment results of 112 adult patients who had complications of previously performed hypospadias repairs were evaluated. The results of repeated procedures were compared in patients, in whom modified balloon urethral catheter (group 1; n=50) or standard Foley catheter (group 2; n=62) was used, respectively. RESULTS: Most patients after surgery assessed the appearance of the penis as "good" (92% in group 1, 77.4% in group 2). In group 1, satisfactory results was seen in 8% of cases and there were no unsatisfactory results, while in group 2, where standard Foley catheter was used, these values were 19.4% and 3.2%, respectively. In group 1, complication rate was lower than in group 2 (10% versus 41.9%; p<0.05). In group 1, there was a significantly higher proportion of patients with a Qmax score of more or equal 18 ml/s (90% versus 74.2%; p<0.05). CONCLUSIONS: Repeated procedures in adult men with late complications of surgical treatment of hypospadias are quite effective, although they are accompanied by a rather high complications rate. The use of a new model of the urethral catheter with dilating cuff and an irrigation canal allows to improve treatment results in this category of patients.

[Erectile function after corporoplasty in patients with peyronies disease].

PURPOSE: To evaluate erectile function in patients with Peyronies disease (PD) who underwent corporoplasty. MATERIALS AND METHODS: A total of 374 patients who underwent corporoplasty by a single surgeon during 1996-2016 were analyzed. In all cases IIEF questionnaire was evaluated pre- and postoperatively. Intracavernous injection test and penile doppler ultrasonography were performed if required. Median follow-up was 9.5 years. Analysis of risk factors for erectile dysfunction (ED) before and after corporoplasty was performed. RESULTS: Prevalence of risk factors for ED in our sample has greatly increased during follow-up. At the last follow-up visit 285 patients were sexually active. Evaluation of patient satisfaction with the quality of erections has shown that 139 patients were fully satisfied (48.8%), 84 patients were somewhat satisfied (29.5%) and 62 patients were not satisfied with their erectile function (21.7%). According to IIEF questionnaire, 105 patients (36.8%) had no ED (> 26 points); 74 patients (26%) had mild ED; 67 patients (23.5%) had mild-to-moderate ED; 21 patients (7.4%) had moderate ED; and 18 patients (6.3%) had severe ED. However, a causal relationship between ED and treatment of Peyronie's disease was found not in all cases. Seven patients had infrequent sexual intercourse (1-2 per month) and 50 patients had no sexual activity. DISCUSSION: At long term after corporoplasty some patients experience ED, though causality between ED and PD treatment couldnt be confirmed in all such cases. It should be noted that we have found an increase in prevalence of independent risk factors for ED during follow-up period. These patients could possibly benefit in terms of quality of life if they underwent penile prosthesis placement during primary surgical treatment for PD. However, some patients had no sexual activity due to causes unrelated to ED. CONCLUSION: Not all patients with PD are satisfied with their sexual functioning after corporoplasty. However, ED after surgical management of PD is not always a consequence of surgery itself.

[The role of drug therapy in the management of varicocele].

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

[Salvage external beam radiation therapy for prostate cancer recurrence after high-intensity focused ultrasound ablation].

The article outlines oncological and functional outcomes of salvage external beam radiation therapy after HIFU-ablation in 49 patients. The study determined overall and relapse-free survival, compared the rates of adverse events stratified by CTCAE, erectile function and continence scores assessed by questionnaire survey. Univariate and multivariate analysis of risk factors for failure of salvage radiation therapy after prostate HIFU-ablation were conducted. In univariate analysis the level of prostate-specific antigen (PSA) prior to radiotherapy, the risk group, PSA nadir after radiotherapy, PSA nadir greater than 0.2 ng/mL and the time to nadir after salvage therapy were predictors of failure. There were no serious gastrointestinal side effects. The most frequent urinary adverse event was urgency. The difference in the rates of urinary incontinence before and 1 year after radiotherapy was not statistically significant. The study confirmed the appropriateness of radiotherapy after HIFU-ablation. Radiation therapy can be considered as a treatment option for prostate cancer recurrence after HIFU-ablation.

[Application of rowatinex in the perioperative period in the extracorporeal shock wave lithotripsy].

Despite the high efficacy and safety of ESWL used to disintegrate stones in pyelocaliceal system and upper ureter, the issue of further reduction of the risk of complications of this procedure remains unresolved. The inclusion ofphytopreparations with anti-inflammatory and lithokinetic properties in the scheme of perioperative treatment is one of the ways for prevent complications of ESWL. The effect of the drug Rowatinex on the process of discharge of calculi fragments after ESWL is evaluated. The frequency and intensity of qualitative changes of urine after appointment this drug were assessed. It is concluded that Rowatinex has positive impact on the final result of ESWL in the case of its inclusion in the complex medical treatment, which manifests in terms of reducing the time of discharge of fragments, mitigation of subjective symptoms, as well as reducing the frequency of subclinical bacteriuria and severe complications.

[Combination therapy of prostatitis-associated copulative dysfunction].

Chronic prostatitis is characterized by clinical polymorphism, that may include pain, dysuria, asthenovegetative syndrome, and others. Symptoms associated with impaired copulatory cycle in chronic prostatitis have a significant impact on the quality of life of patient. Sexual dysfunction and sexuality cessation can exacerbate the inflammation of the prostate gland and worsen the underlying disease. The study included 60 patients diagnosed with chronic bacterial prostatitis, complicated by sexual disorders. Patients were divided into two comparable groups of 30 persons. Control group ofpatients received standard antibacterial therapy; study group ofpatients in addition received phytodrug prostanorm. At the end of treatment, higher IIEF-5 scores, increasing number of lecithin granules in the prostate secretion, as well as reducing the severity of irritative symptoms were registered in the study group.