No 6 (2012)

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

The article presents the results of the survey, etiopathogenetic and surgery treatment of 73 patients with nephrotuberculosis complicated by tuberculous ureteritis. Patients were divided into 4 groups. 1 - 3 Groups of patients underwent urine diversion by percutaneous puncture nephrostomy, open nephrostomy and internal stent placement. Patients in Group 4 not underwent surgery with urine diversion. It was found that the long-term etiopathogenetic therapy against the background of retention changes resulted in progression of changes and loss of renal function in 63% of cases. Early urine diversion, depending on its method allows preserving the functional ability of the kidneys in 70.8 to 94.4% of cases. The combination of early renal drainage with antituberculous polychemotherapy is significantly superior to conservative treatment, leads to a rapid reduction of chronic renal failure (CRF) and allows to subsequently perform the greatest number of reconstructive operations: in 62.6% of cases after the external drainage and in 73.3% - after internal drainage (p<0.05). At the same time, good results of plastics were achieved only in patients undergoing a two -stage surgical treatment, and poor results (relapse of stricture, progression of hydroureteronephrosis or CRF) were significantly more often observed (60%) in patients without urine diversion (p<0.05).

The article discusses the critical issues of clinical manifestations and treatment of fungal infections in patients after kidney transplantation. In fungal infection, which is usually detected in the composition of microbial associations, lungs are more often affected. In this case, mortality reaches 60%. Affecting the renal transplant by Candida spp. or Aspergillus spp. can lead to the loss of function of transplanted kidneys. At the current stage, lipid formulations of amphotericin B are drugs of choice for antimycotic therapy in posttransplant period. Nephrotoxic effect of amphotericin B is reversible and does not represent a serious threat to the function of the transplantate. Administration of lipid formulations of amphotericin B is the most justified, since it does not affect the concentration of immunosuppressive drugs in the blood serum of patients after transplantation.

The present article is devoted to the search for the physical factors affecting the intrapelvic pressure in patients with kidney catheters. Based on mathematical prediction and experiment, value of air bubbles, hampering urine outflow and contributing to the development of purulent postoperative complications in urology, was demonstrated. A certain number of air bubbles in catheters leads to the formation of air-urinary impaction, causing a sharp increase of intrapelvic pressure. Correlation analysis showed a direct relationship between the amount of air bubbles in the drainages and resistance force to urinary flow. The study showed that the presence of air bubbles in the catheter and drainage tubes is unacceptable. Compliance with certain rules and standards of work allows to prevent their formation, which in turn reduces the risk of urinary infection and the development of septic complications. This approach will help to predict the possible postoperative complications, accelerate the introduction of modern technologies, and improve the quality of urological care.

Survey of 250 men with category III chronic pelvic pain syndrome/ chronic prostatitis (CPPS/CP-III) showed that the urological disease often proceeds against the background of obesity (29.6%), androgen deficiency (38.4%), increased tone of sympathetic nervous system (62.9%) and the activation of the plasma lipid peroxidation system (oxidative stress) (100%), with significant correlations between these factors. Working hypothesis was formulated; according this hypothesis, the components of metabolic syndrome in men and associated systemic reactions of sympathetic hyperactivity, oxidative stress, and androgen deficiency play an important role in the pathogenesis of CPPS/CP-III. This allows to consider CPPS/CP-III as an interdisciplinary complex issue of men's health and to review the existing traditional approaches to its diagnosis, treatment and prevention.

The study included 320 men with suspected prostate cancer (PC). The mean age was 59 years. The detection rate of prostate cancer depending on PSA level was evaluated. According to the results of histological examination, prostate cancer was detected in 32.8% (105 patients) of cases. The prostate cancer most frequently was diagnosed in patients with PSA levels above 20 ng/ml. Thus, the probability of detection of prostate cancer is directly dependent on the level of PSA. All groups showed signs of prostatic intraepithelial neoplasia (PIN), both low and high degrees, but the direct relationship of identification of PIN depending on PSA level was not established.

From November 2010 to December 2011, 56 patients with coral nephrolithiasis underwent percutaneous nephrolithotomy. To assess the renal function before surgery and before discharge (6 to 7 days after surgery), glomerular filtration rate (GFR) by Cockcroft-Gault equation was defined. Preoperative renal functional reserve was evaluated by method using a single oral loading of protein drugs. 46.4% of patients have decreased GFR before surgery, and before discharge the proportion of such patients was 39.3%. In 80% of patients with reduced GFR, postoperative filtering function of the kidneys in response to a protein load was increased, but did not reach the pre-operative no-load values, and in 7.5% of cases corresponded to a load indicators. Filtering function of the kidneys before discharge below baseline and load levels was observed only in 8.9% of cases. The data obtained in most cases allowed to predict GFR decline in the postoperative period in patients with coral nephrolithiasis. 87.5% of patients before surgery were characterized by the absence of renal functional reserve, but in 28.6% of patients in the postoperative period there was an increase in GFR, indicating the positive impact of endoscopic percutaneous nephrolithotomy on the functional state of the kidneys in the immediate postoperative period.

Comparison of results of standard complex of survey with changes of urine levels of biological inflammatory marker (MCP-1), marker of fibrogenesis (TGF-β1), marker of angiogenesis (VEGF), markers of nephron damage (collagen IV, α-GST, π-GST) in 140 children with vesicoureteral reflux before and 6 months after treatment was performed. It was found that nephrosclerotic process occurs even at low degrees of vesicoureteral reflux. Even in the absence of structural and functional disorders of the kidneys according to traditional methods of evaluation, there were significant changes in the levels of biological markers of inflammation, fibrosis, and angiogenesis, as well as damage of main elements of the nephron. The method for calculating the «index of early renal damage» is proposed; method allows to monitor the state of the renal parenchyma of children with this disease.

Эректильная дисфункция — многофакторное заболевание, негативно влияющее на мужскую самооценку, качество сексуального удовлетворения, межличностные отношения и качество жизни. Для ее коррекции создана инновационная форма препарата левитра ОДТ (варденафил) — орально диспергируемые таблетки или таблетки, растворимые в полости рта, позволяющая мужчинам более гибко управлять своей сексуальной активностью, обладающая максимальной комфортностью приема и обеспечивающая хороший эффект. Данные многочисленных исследований выявили предпочтение мужчин новой лекарственной форме левитры.