No 6 (2010)

According to the literature, overactive bladder (OB) occurs in 52-80% men with infravesical obstruction (IVO) due to prostatic adenoma, 38% patients retain the disorder after surgical correction of the obstruction. Urodynamic investigation of the lower urinary tract (LUT) function was conducted in 206 patients with prostatic adenoma admitted to the urological clinic of I.M. Sechenov Moscow Medical Academy. All of them had LUT obstruction. Detrusor overactivity was detected in 58,25% cases. This bladder dysfunction played a leading role in development of IVO complications (vesicoureteral reflux, ureterohydronephrosis) entailing marked disorder of the upper urinary tract disorder - chronic renal failure. Thus, early detection of the cause of urodynamic disorders in IVO patients has a great practical value for functional results of surgery.

The article compares effectiveness of different methods of hemostasis after transvesical adenomectomy for prostatic adenoma practiced in the world and presents original experience in surgical treatment of 224 patients with prostatic adenoma. The latter experience allowed recommendation of the extraurethral method of adenomatous tissue removal as least traumatic, causing minimal blood loss and minimal number of early and late postoperative complications.

We studied microcirculation and a blood nitric oxide level in 30 females aged 23-63 years with overactive bladder (OAB) before and after administration of oxibutinin. We found that OAB patients have microcirculation disorders accompanied with elevation of nitric oxide in the blood. Oxibutin improved bladder microcirculation, normalized blood nitric oxide with resultant positive changes in clinical symptoms with less frequent voiding and alleviation of imperative disorders.

Examination of 65 postmenopausal women with urinary incontinence demonstrated that most of the patients had mixed urinary incontinence. Pathogenesis of urinary incontinence in postmenopausal women is strongly associated with estrogen deficiency. This dictates necessity of preoperative hormone replacement therapy. Surgical treatment of postmenopausal women aims at elevation of obturator pressure, prolongation of the urethra with narrowing of its orifice which can be managed with combination of urethrocystoplasty, levatoroplasty and sling operation.

Long-term clinical experience with conservative treatment of Peyronie's disease has demonstrated that clinical efficacy of this therapy comprises maily anesthesia while erectile problems are not solved. Introduction of the drugs into the fibrous plaque is not adequate and hard to perform. Some drugs affect only some components of pathogenesis. For stabilization of the process it is recommended to use transdermal electrophoresis or phonophoresis. The search for new effective drugs and methods continues.

We made a microbiological study of the urine and prostatic secretion (Meares-Stamey test) of 35 patients with chronic bacterial prostatitis (CBP) aged 35-75 years. We conducted a bacterial assay, determined species, sensitivity to synthetic antibacterial fluoroquinolone drugs. A total of 163 bacterial strains were isolated, of them 13 were staphylococcal. Gram-negative bacteria were identified in the test biomaterial only in 16.6% cases. The analysis of staphylococcal sensitivity showed the highest antistaphylococcal effectiveness of levofloxacin and lomefloxacin. Our study confirms an essential role of staphylococcal bacteria in CBP etiology.

The efficacy of indigal plus containing indol-3-carbinol, epigallocatexin-3-gallat and Serenoa repens extract in combination with sparfloxacin was studied in a trial with participation of 30 patients with chronic infectious prostatitis associated with intracellular agents. Group 1 (n = 15) received indigal plus (2 capsules twice a day for 3 months) and sparfloxacin (200 mg twice a day for 1 month). Group 2 including 15 matched controls received sparfloxacin alone according to the same schedule. The examination included questionnaire survey (IPSS, QoL, NIH-CPSI), blood count, urinalysis, PSA test, microscopy, bacteriological study of prostatic secretion, uroflowmetry, transrectal ultrasound investigation of the prostate with residual urine assay, laser doppleroflowmetry. The examinations were performed on the treatment day 30, 60 and 90. After the antibacterial treatment chlamidia, ureaplasma and E.coli were detected in 13.3, 6.7 and 26.7% patients of the control group, in 6.7, 6.7 and 6.7% patients of the study group, respectively. Thus, the addition of a pathogenetic drug indigal plus to sparfloxacin treatment promoted normalization of apoptosis of the infected cells, led to more effective bacterial eradication, enhanced regression of the symptoms. It is recommended to include indigal plus in a basic scheme of treatment of patients with chronic infectious prostatitis.