No 5 (2012)

The results of evaluation of the efficacy of α1-adrenoblockers in treatment of ureteral calculi are presented. Comparative, prospective, placebo-uncontrolled nonrandomized single-center study was performed, which included 118 patients with solitary diagnosed calculi in various parts of ureter. After the pain relief, all the patients underwent conservative therapy aimed at spontaneous discharge of concretions. The maximum duration of conservative treatment was 28 days. Ultrasound monitoring was performed every week in all patients. The control group of patients received only Drotaverinum 40 mg three times a day, and analgesics. The main group received α1-adrenoblocker tamsulosin at a standard dose of 0.4 mg once a day along with Drotaverinum and analgesics. The overall probability of a discharge of concrements localized in the distal ureter was significantly (P=0.02) higher in the patients treated with α1-adrenoblockers. Treatment regimen in main group of patients allowed better control of pain during all periods of observation, even if the discharge of concretions was not registered. The overall probability of migration of concrements from the proximal to the distal ureter in main group of patients was 52% versus 32% in controls (P=0.17). The frequency of adverse effects was comparable in both groups. Vertigo, postural hypotension, and weakness were significantly more frequent in the main group of patients. Univariate and multivariate analyses of the proportional hazards model have demonstrated that the administration of a1-adrenoblocker increased the likelihood of a discharge of concrement from the distal ureter. It is shown that the nature of the applied therapy has directly influence on the risk of an earlier discharge of concretions. Inclusion of α1-adrenoblockers in the treatment scheme increased the probability of discharge of concrements at 4.11 times.

The study was aimed to examination of prevalence of obstructive complications of the upper urinary tract in patients with pelvic prolapse and evaluation of the effectiveness of their correction using modern reconstructive surgery. Bilateral ureterohydronephrosis was detected in 14 (12%) of 117 patients. In patients with stage IV pelvic prolapse, proportion of patients with hydronephrosis was much higher - 22.6%. Transvaginal reconstructive surgery with the installation of synthetic mesh prosthesis according to the Tension free Vaginal Mesh method ensured the restoration of normal anatomy of the pelvic floor and allowed to eliminate obstructive disorders of the upper urinary tract and their complications.

The article presents the results of urological examination (spermograms and data of ultrasound examination) of 22 patients with chronic brucellosis and diseases of the scrotum (6 patients with orchitis, 16 with orchiepididymitis) before and after conventional therapy (10 patients) and combined treatment with the inclusion of cycloferon (2 courses of 5 intramuscular injection [0.25 g] with an interval of 10 days) - 12 patients. It is shown that the administration of cycloferon leads to more effective relief of intoxication symptoms and inflammation in the testes and appendages (reduction of scrotal wall thickness, size of testes and/or adjuncts, and the incidence and severity of hydrocele), and has a positive effect on spermatogenesis (reduction of semen viscosity, the number of white blood cells in semen, sperm agglutination associated with the formation of sperm antibodies in most patients after treatment), as well as reduces the number of exacerbations of chronic orchitis/orchiepididymitis by 2.4 times.

Background: Silodosin is a new selective therapy with a high pharmacologic selectivity for the a 1A-adrenoreceptor. Objective: Our aim was to test silodosin’s superiority to placebo and noninferiority to tamsulosin and discuss the findings in the context of a comprehensive literature review of the new compound silodosin. Design, setting, and participants: We conducted a multicenter doubleblind, placebo-and active-controlled parallel group study. A total of 1228 men ≥50 yr of age with an International Prostate Symptom Score (IPSS) ≤13 and a urine maximum flow rate (Q max)>4 and <15 ml/s were selected at 72 sites in 11 European countries. The patients were entered into a 2-wk wash-out and a 4-wk placebo run-in period. A total of 955 patients were randomized (2:2:1) to silodosin 8 mg (n=38l), tamsulosin 0.4 mg (n=384), or placebo (n=l90) once daily for 12 wk. Measurements: We calculated the change from baseline in IPSS total score (primary), storage and voiding subscores, quality of life (QoL) due to urinary symptoms, and Q max. Responders were defined on the basis of IPSS and by Q maxa decrease of ≥25% and an increase of ≥30% from baseline, respectively. Results and limitations: The change from baseline in the IPSS total score with silodosin and tamsulosin was significantly superior to that with placebo ( p< 0.001): difference active placebo of -2.3 (95% confidence interval [CI], -3.2, -1.4) with silodosin and -2.0 (95% CI, -2.9, -1.1) with tamsulosin. Responder rates according to total IPSS were significantly higher ( p<0.00l) with silodosin (66.8%) and tamsulosin (65.4%) than with placebo (50.8%). Active treatments were also superior to placebo in the IPSS storage and voiding subscore analyses, as well as in QoL due to urinary symptoms. Of note, only silodosin significantly reduced nocturia versus placebo (the change from baseline was -0.9, -0.8, and -0.7 for silodosin, tamsulosin, and placebo, respectively; p=0.0l3 for silodosin vs placebo). An increase in Q max was observed in all groups. The adjusted mean change from baseline to end point was 3.77 ml/s for silodosin, 3.53 ml/s for tamsulosin, and 2.93 ml/s for placebo, but the change for silodosin and tamsulosin was not statistically significant versus placebo because of a particularly high placebo response (silodosin vs placebo: p=0.089; tamsulosin vs placebo: p=0.22l). At end point, the percentage of responders by Q max was 46.6%, 46.5%, and 40.5% in the silodosin, tamsulosin, and placebo treatment groups, respectively. This difference was not statistically significant (p=0.l55 silodosin vs placebo and p=0.l4l tamsulosin vs placebo). Active treatments were well tolerated, and discontinuation rates due to adverse events were low in all groups (2.1%, 1.0%, and 1.6% with silodosin, tamsulosin, and placebo, respectively). The most frequent adverse event with silodosin was a reduced or absent ejaculation during orgasm (14%), a reversible effect as a consequence of the potent and selective a lA-adrenoreceptor antagonism of the drug. The incidence was higher than that observed with tamsulosin (2%); however, only 1.3% of silodosin-treated patients discontinued treatment due to this adverse event. Conclusions: Silodosin is an effective and well-tolerated treatment for the relief of both voiding and storage symptoms in patients with lower urinary tract symptoms suggestive of bladder outlet obstruction thought to be associated with benign prostatic hyperplasia. Its overall efficacy is not inferior to tamsulosin. Only silodosin showed a significant effect on nocturia over placebo.

The results of study on evaluation of efficacy of combined treatment of patients with acute prostatitis are presented. The study included 34 patients with acute prostatitis aged 19 to 51 years. 13 patients in Group 1 received only basic therapy: fluoroquinolones (ciprofloxacin, 500 mg 2 times daily for 14 days), non-steroidal anti-inflammatory drugs (suppositories voltaren 50 mg at bedtime for 7 days). Along with basic treatments, 21 patients in the Group 2 received phytopreparation prostagutt forte (at a dose 280 mg 2 times a day), which has antiestrogenic, antiproliferative, antiinflammatory, immunomodulatory properties. It was shown that patients receiving prostagutt forte experienced pronounced and significant decrease of white blood count in the prostatic secretion, the decrease of prostate volume according to the data of transrectal ultrasound examination, more rapid relief of the inflammatory process, which was manifested by reduction of hyperthermia and reduction of severity of bladder outlet obstruction associated with swelling of the prostate.

The problem of chronic prostatitis (CP) and erectile dysfunction (ED) involves not only their high prevalence, but also the insufficient effectiveness of their treatments. In this regard, there is need for administration the pathogenetic drugs with antihypoxic, antioxidant and neuroprotective effects and improving blood flow to the genitals. The study included 60 men with CP associated with ED, aged 22 to 60 years. Patients were randomized into 2 groups of 30 people. Patients of comparison group received baseline therapy (α1-adrenoblockers, non-specific anti-inflammatory drugs, digital prostate massage and vacuum phallostimulation). Antibiotics were applied on the basis of their potential effectiveness in chronic abacterial prostatitis. In addition to the above treatment, patients of main group received step-down therapy with cytoflavin (in infusion, then oral administration). Positive dynamics was noted in both groups of patients; however, according to the indicators of the severity of pain and dysuria, as well as quality of life, positive dynamics in the main group of patients was more significant. Similarly, the dynamics of objective criteria for inflammation in the prostate gland was more pronounced when using cytoflavin. After treatment, the rigid phase of erection during vacuum fallotest occurred within 2-3 min from the beginning of the procedure in 16 (53.3%) patients of main group and only in 9 (30%) patients of comparison group. During follow-up examination at 6 months after treatment, stable remission was found in 75% of patients of main group. Thus, the inclusion of cytoflavin in the scheme of complex treatment of patients with abacterial CP associated with ED is pathogenetically justified, makes it more efficient and provides good DFS.

The serum α1-antitrypsin (AAT) levels were determined using enzyme-linked immunosorbent assay (ELISA) and turbidimetry in patients with prostate cancer, patients with benign prostatic hyperplasia and healthy volunteers. Both methods revealed a significant increase of serum AAT levels in patients with prostate cancer compared with patients with BPH and healthy men. ELISA, as used in study, was more sensitive to changes in the concentration of AAT, but the sensitivity of the turbidimetry allows to use this method in the early diagnosis of prostate cancer.

The article presents the results of examination and surgical treatment of 25 patients with congenital disorders of gonadal differentiation. Survey plan included an assessment of the external genitalia, karyotyping and molecular analysis of Y-chromosome, determination of serum gonadotropins and testosterone levels, visualization of the gonads using ultrasound and laparoscopy methods, and intraoperative morphological examination of the material. Based on the results of a comprehensive survey, mixed testicular dysgenesis was identified in 25% of patients, complete testicular dysgenesis - in 16%, partial gonadal dysgenesis -in 44%, ovotesticular violation of sexualization - in 16% of patients. Clinical, macroscopic and morphological characteristics of each of these options are defined. The choice of sexual identity and tactics of surgical treatment are explained.

The article presents the results of an advanced method for retropubic removal of adenomatous prostate tissue. Retropubic extraurethral adenomectomy (REUA) was performed in 29 patients with benign prostatic hyperplasia. Distinctive features of REUA from Lidsky-Millin surgery consist in the fact that the new method of prostatectomy preserve dorsal and urethral vascular plexus and the integrity of the prostatic urethra. Adenomatous tissues fragments are removed through a parallel longitudinally incisions made on the front surface of the fibrous capsule to adenoma. Surgical intervention is accompanied by minimal blood loss and minimal postoperative complications. Hemodynamics of the prostate and external genitalia is not disturbed.