No 3 (2003)

The choice of the method to treat erectile dysfunction is often not easy. The evidence-based approach to the critical appraisal of the medical literature could help us to find the best way. All the available information was critically assessed in order to find the answer to the question: Ds sildenafil effective in the treatment of erectile dysfunction in patients with diabetes mellitus? All sourses of information have been analysed including medical text books and the sourses from the university of Cochrane library. The result of the analysis was the following: sildenafil is effective with а В degree of significance in the treatment of erectile dysfunction in patients with diabetes mellitus. This allows us to recommend sildenafil for treatment of erectile dysfunction in men with diabetes mellitus. The above algorithm of the critical assessment of the primary medical literature can be used for preparing standards of urological diseases treatment.

Aim. To analyse data of the preoperative examination of patients and histomorphological examination of prostatectomy samples to determine parameters allowing staging prostatic cancer (PC). Material and methods. 27 patients with staged clinically diagnosed PC have undergone radical prostatectomy with histomorphological examination of the intraoperative samples of the prostate. Results. The preoperative evaluation of PC has revealed no cases with Glisson's scale (GS) score under 5. Only 8.7% of the tumors were well differentiated, of them 28.3% had the score 7 and higher. 85% of the cases were moderately dfifferentiated adenocarcinomas with the score 5 to 7. 33.3% patients had cancer diagnosed by prostatic biopsy (Tic). Nearly 48% had the tumor T2b, T2c. Histomorphologically, 50.7% of tumors were advanced. A high PSA level, a high score by Glisson and a clinical stage of the tumor at least T2b indicated high probability of extracapsular spread and of metastases to the lymph nodes each. The Glisson's score was higher at analysis of prostatectomy samples than prostatic biopsy in 10 (37%) cases while it was lower only in 2 (7.4%) cases. In 5 (18.5%) patients the difference made up 2 and more scores by Glisson. Conclusion. Thin needle biopsy examinations underestimate PC stage. To stage and predict the disease course precisely it is necessary to make a multifactor analysis.

Sixty female patients with chronic cystitis and persistent dysilria (PD) were divided into two groups according to their treatment. Group 1 (n - 38) patients have received combined conservative treatment; group 2 (n = 22) received the above treatment plus have undergone transurethral resection (TUR) of the urinary bladder mucosa. For control, urodynamic tests were made (uroflowmetry, sphincterometry, electromyography of the urinary bladder muscles); microcirculation was studied at laser doppler flowmetry. It was found that PD females with chronic cystitis develop microcirculatory disorders registered at laser doppler flowmetry. They consist in congestion of blood in the microvessels, vascular spasm, red cell aggregation with sludgesyndrome and combine with urodynamic disorders manifesting as weak detrusor contractivity and evacuation function. The above urodynamic and microcirculatory disorders are treated conservatively (antibacterial therapy, transcutaneous laser irradiation of the suprapubic region using intravesical methods). To eradicate PD in long-term inflammation in the urinary bladder and development of squamous cell metaplasia of the urothelium, TUR of the affected area and intramural nerves with partial denervation of the urinary bladder is indicated.

Fluoroquinolones (ciprofloxacine, ofloxacin, pefloxacin, lomefloxacin, etc.) have a long and cussessful history of application in the treatment of urinary infection. They are the first-line drugs in the above nosological entity. Fluoroquinolones of a new generation including moxifloxacin demonstrate a wider spectrum of antimicrobial activity, updated pharmacokinetic properties, low resistance that is are promising in the treatment of urinary infection. We tried moxifloxacin in the treatment of both complicated and uncomplicated infections of the urinary tracts. The response reached 95.7%, bacteriological effectiveness 85.7%. The drug is well tolerated, side effects were not observed. Thus, moxifloxacin can be used in the treatment of urinary and urogenital infections.

Clinical efficacy and safety of the drug impase in erectile dysfunction (ED) were studied in 30 patients with ED of various genesis (mean age 52.0914.75 years). IIED questionnairing was employed, combined andrological examination and standard laboratory investigations. Impase was taken 1 tablet a day each other day for 12 weeks irrespective of the intercourse. The number of attempted intercourses was at least 4 times a month. The treatment efficacy was assessed by changes of IIED parameters, subjective and objective effects. ED was psychogenic in 5 (16.7%) patients, organic in 25 (83.3%) patients. Blood hormones were normal for age in all the patients. According to IIED, "erectile function" mean score after 12 week treatment rose from 18.89±5.25 to 22.50±4.86. In 11 (36.7%), 4 (13.3%), 5 (16.7%) patients the response was rated as excellent, good and satisfactory, respectively. No response was stated in 10 (33.3%) patients. Side effects were absent. Tolerance and safety were excellent. Thus, efficacy of impase therapy varied from 60 to 66.7% depending on ED etiology and pathogenesis. Cost-efficacy, absence of side effects, possible parallel therapy of concurrent diseases, course administration are advantages of the treatment.

Detection of M. tuberculosis DNA by polymerase chain reaction (PCR) and standard technique was compared in 76 new cases of urogenital tuberculosis. In the urinary test PCR confirmed tuberculous etiology of the disease and corresponded to M.tuberculosis detection in 27 (60%) of 45 patients with urinary tuberculosis. M. tuberculosis DNA detection rose significantly in patients with mycobacteriuria (71%) and in examination of aspirates from isolated renal cavern, blocked kidney, epididymis, prostate and seminal vesicles. Treatment for 1 month and longer transforms the positive result into the negative one. Of 16 patients with tuberculosis of male sexual organs M. tuberculosis DNA were detected by PCR in prostatic secretion in 43.7%, in ejaculate in 93%. This did not correlate with detection of M. tuberculosis. Thus, PCR is recommended for instant diagnosis and screening before further examination and cannot be the only method in identification of urogenital tuberculosis.

A total of 39 patients with prostatic hyperplasia (PH) admitted to the urological clinic of I. M. Sechenov Moscow Medical Academy from 1999 have been inserted a biodegradable catheter stent (BCS). Such stents degrade spontaneously to microfragments and come away with urine 4-12 months after catheterization. BCS were used in PH patients with marked urination disorders due to urethral compression by hyperplastic prostate in whom adenomectomy was contraindicated. BCS was used for elimination of a suprapubic fistula in the urinary bladder of 19 PH patients with contraindications to adenomectomy. 5-7 days before catheterization the urinary bladder was drained 2 times a day to reduce pyoinflammatory process. The cystostomic fistula closed within 24 h in all the patients. Adequate urination recovered. Urethral inflammation persisted for 4-6 weeks. It was treated with antibiotics with effectiveness 89.5% (in 17 of 19 patients). Pyoinflammation persisted in two patients who developed uroliths destruoted later at endoscopic pneumatic cystolithotripsy. Control examination 6 months after the stent insertion found that the stent had destructed with evacuation of the fragments. In two patients two large fragments were locked in the urethra provoking acute ischuria. The fragments were removed by the forceps and urination became normal. None of the patients needed recystostomy. 32 stented patients 6 and 12 months after stenting had adequate urination (mean Qmax - 12.3 and 10.8 ml/s, respectively). Mean residual urine - 32 and 37 ml. BCS improves treatment outcomes and quality of life of PH patients with contraindications to adenomectomy.

Urethral anomalies are leading among anomalies of the urogenital system, especially in boys. This is explained by genetic factors, factors of damage to the internal sexual organs and complex embryogenesis. Rare urethral anomalies in children are described: doubling (n = 1), diverticulum (n = 1), ectopy of the external outlet (n = 5), mucosal prolapse (n = 6), accessory urethra (n = 3), megaurethra n = 1), high position of the urethrovesical segment (n = 1), urethral ectopy of the ostium ureteris of the accessory kidney (n = 1). The above urethral anomalies show the necessity of examination of children with minimal manifestations of urethral symptoms.