No 1 (2003)

The discussion covers different aspects of application of programs of early prostatic cancer diagnosis. Arguments for and against the screening are presented. The existing methods of early prostatic cancer diagnosis are reviewed. How to improve the technique of taking prostatic biopsy is shown.

Urinary tract occlusion in urolithiasis is a serious complication which provokes an attack of acute obstructive pyelonephritis. The infected urine aggravates this infectious-inflammatory process and endangers bacterial shock. Etiopathogenesis of this shock is outlined and modern approaches to its management are described.

Urodynamics of the upper urinary tract (UUT) was examined in 327 children aged 1.5 months to 15 years with congenital vesicoureteral reflux (VUR) dysplasia treated surgically. 230 patients were followed up for 1 to 20 years. Staging of chronic disorders of UUT urodynamics is thought to be the key criterion of objective assessment of VUR effective surgical treatment . The better long-term treatment outcomes are the earlier the disease was diagnosed and corrected. Early defects of urodynamics in the absence of marked dilatation of the ureter are better corrected by Lich-Gregoir operation which is physiological, low traumatic, technically available and most effective (97% of favourable long-term outcomes). Ureterocystoneostomy by Politano-Leadbetter (in modification of the authors) is indicated in urodynamic disorders stage III and marked ureteral dilatation as providing improvement of urodynamics or stabilization in 93.7% patients.

Lipids were studied in 150 patients with nephrolithiasis, calculous pyelonephritis; enzymes, LPO products, phospholipase in HI patients; vitamins A and E in 136 patients, vitamins B2, B6 and PP in 146 patients in the course of the disease, at admission and after treatment. In acute purulent and aggravated chronic calculous pyelonephritis lysophospholipids levels rose manifolds. Activation of LPO products, phospholipase, organ-specific enzymes is closely associated with low provision of vitamins A, E, B2, B6, PP. Deficiency of these vitamins ranged from 76.8 to 94.6% in acute purulent calculous pyelonephritis in all the patients.

The aim of the study was to improve diagnosis and treatment of women suffering from clinical manifestations of urogenital atrophy in menopause: stress and urgent urine incontinence, disturbances of urination, recurrent infections of the lower urinary tracts. A total of 237 menopausal women were treated for urogenital atrophy for four years. The age of the patients ranged from 51 to 78 years (mean age 64.5 years). After treatment with ovestin they were followed up for 1 to 2.1 years. It was found that stress incontinence is more common in young women, older females suffer more frequently from urgent and imperative incontinence. Ovestin, as a local replacement therapy, relieved symptoms within the first several days of treatment, the complaints disappeared completely after 25 days of ovestin intake. Side effects (nausea, head ache, breast discomfort) occurred rarely, were mild and disappeared within the first two weeks of the treatment. The conclusion is made that urogenital atrophy is a common disease of postmenopausal women arising as a result of lacking estrogenization of the vagina and adjacent tissues. Urogenital atrophy manifests as stress and urgent urinary incontinence, disurea and' recurrent infection of the lower urinary tracts. Ovestin therapy should be given for at least 1.5 months. In positive effect the duration of the treatment is not limited.

The aim of this study was to determine relationships between the level of DHEA-sulfate (DHEA-S), an erectile function and libido in men with chronic prostatitis. 53 patients (mean age 44.6±12.0; range 21-68 years) with chronic prostatitis were studied. Libido and erection were estimated and patients were divided into n»o groups according to their sexual dysfunction: 21 patients with severe sexual dysfunction (SSD) and 32 patients with mild sexual dysfunction (MSD). Testosterone, prolactin and DHEA-S were detected by ELISA. SSD patients had a lower testosterone level than patients with MSD (11.8±4.6 vs 14.8±5.9 nmol/1, respectively, p = 0.04) and DHEA-S (1.7+0.8 vs 2.5+1.2 microg/ml, respectively, p = 0.01). There was a negative correlation between the age of the patents and an erectile function (r = -0.70; p < 0.001), age and libido ir = -0.57; p < 0.001). The negative correlation was revealed between DHEA-S and age (r = -0.59; p < 0.001). A positive correlation »as between DHEA-S and an erectile function (r = 0.45. p = O.OOi i. There was no correlation between DHEA-S and serum testosterone te%ei t.r = 0.10; p = 0.5). Multiple regression analysis showed an independent positive correlation between DHEA-S and erectile function in patients with chronic prostatitis (p = 0.28; p = 0.02: R; = 0.401 The findings show that erectile dysfunction independently from aee s associated with a lower level of serum DHEA-S in patients with chronic prostatitis.

Antibiotic wilprafen (josamycin) was given in a dose 500 mg per os two times a day for 15 days to 30 male patients with a long history of chronic Chlamydia trachomatis infection (CTI) treated ineffectively. The control examination has not detected Chlamydia in 29 (96.5%) patients. The results demonstrate high efficacy of the drug wilprafen in the treatment of patients with urogenital CTI.