No 6 (2014)

The acute uncomplicated cystitis in women is one of the most frequently diagnosed bacterial infection. A clinically symptomatic urinary tract infection must be differentiated from the asymptomatic bacteriuria, which is not considered an infection but rather a colonization which should not be treated. For the antimicrobial therapy according to the European guidelines the old oral antibiotics (fosfomycin trometamol, nitrofurantoin, pivmecillinam) should be prescribed, against which E. coli is still susceptible in over 90%. With new therapeutic concepts not mainly the elimination of bacteria but rather the treatment of the inflammatory (over)reaction of the host is highlighted. To establish the significance of these therapeutic options as compared to the standard antibiotic therapy, the results of the ongoing and planned phase 3 studies need to be awaited. Thus reliable clinical measuring parameters for diagnostics and outcome are needed. The acute cystitis symptom score (ACSS) was developed and validated in Russian and Uzbec languages. Because of its high reliability, validity and predictive value it can be used not only in daily practice but also for clinical studies for the diagnosis of an acute uncomplicated cystitis in women.

An open, prospective, comparative, randomized, placebo-controlled study on the evaluation of the efficacy and safety of combined drug prolit super in patients with chronic abacterial prostatitis without signs of inflammation (NIH 3B category), complicated by sexual dysfunction, was performed. The study included 57 men aged 28 to 50 years. Patients in group 1 (n=29) have received daily 4 capsules of prolit super for 2 months, patients in group 2 (n=28) - placebo for the same period. Excellent results were noted in 58.6% ofpatients in Group 1 and in 17.9% - in group 2; good results - in 20.7 and 21.4%, satisfactory results - in 20.7 and 17.9%, respectively. Weak effect and its absence were registered only in patients in group 2 - 28.6 and 14.3% of cases, respectively. Significant adverse events or complications against the background of therapy were not observed. The results of the study allows to recommend the appointment of prolit super in routine clinical practice for patients with chronic abacterial prostatitis without signs of inflammation, complicated by sexual dysfunction.

Efficiency and safety of complex preparation prostadoz was evaluated in 25 patients with chronic abacterial prostatitis. It is proved that the use of prostadoz has a positive effect on the main subjective and objective signs of the disease: improves urination, reduces the severity of pain, moderately reduces the prostate volume, improves sexual-ejaculatory performance and improves quality of life.

Urethral strictures are urgent urological problem. Anastomotic and substitution urethroplasty are the most effective treatments. For substitution urethroplasty, buccal mucosa is most often used. There are the following difficulties associated with the substitution urethroplasty: complications in the donor area, the lack of tissue for substitution, an additional incision, and increased timing of surgery due to the need to obtain a flap or graft. Tissue engineering can be useful in solving the above problems. Tissue engineering involves the use a matrix without cells and matrix with one or more types of cells (tissue-engineering designs). In our study we have evaluated the ability to create a matrix for the substitution urethroplasty in animal experiments. The decellularized cadaveric arterial wall was used as a matrix. Decellularization was performed using enzymatic method. At the first stage, we transplanted matrix fragments in interscapular region in rats. An extremely weak bioactivity dof decellularized matrix of cadaveric arterial wall (DMCAW) due to the low immunogenicity of the material was revealed. Thus resorption of DMCAW was quite slow (60-90 days). At the second stage, in an experiment on rabbits, substitution urethroplasty using tubular DMCAW was successfully performed. Intraoperative urethral defect up to 1.8 cm was created, which was replaced by a tubular DMCAW. The use of this type of matrix has showed good structural and functional results: urethral strictures did not arise, the rejection of the matrix was not observed. A slow degradation of the matrix and progressive epithelialization of connective tissue capsule were revealed. Decellularized matrix based on cadaveric arterial wall can be considered as a material for substitution urethroplasty.

Prostate cancer occupies 2nd place on the prevalence and 6th place on mortality among all cancers in men. That is not to deny the social importance of prostate cancer, but attention is drawn to significant advantage of newly detected cases above the cancer-specific mortality. «Gold standard» for diagnosis includes morphological study of tissue fragments after transrectal multifocal prostate biopsy. The importance of the differential diagnosis is particularly relevant when analyzing fragments of prostate tissue obtained from biopsies as a false positive result may cause unnecessary and excessive treatment. This article presents the most common benign processes that can simulate various grade adenocarcinoma. Awareness about the presence of such cancer mimics and careful examination of micropreparations in most cases allows to come to the correct conclusion.

Postoperative complications of extracorporeal shock wave lithotripsy (ESWL) develops due to inadequate assessment of the clinical course of urolithiasis, incorrectly defined indications for treatment, lack of adequate preoperative preparation and ESWL technology. Based on the analysis of the results of treatment of 4500 patients with urolithiasis in the Clinic of Urology of the First MSMU n.a. I.M. Sechenov, taking into account the Clavien-Dindo classification of postoperative complications, we proposed a classification of complications of extracorporeal shock wave lithotripsy, which allows to estimate the degree of complications and determine the sequence of the provision of special medical care.

Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient’s desire and physician’s experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.

The study was aimed to the optimization of conservative therapy of micropenis in hypogonadal men using combination of traction therapy and androgen replacment therapy (ART) with injections of prolonged testosterone undecanoate (Nebido) and to evaluatiom of the safety of ART in terms of the risk of prostate cancer against the background of combined treatment of micropenis by both methods within 12 months. The study included 16 men aged 22-62 years with micropenis and hypogonadism. 10 men were diagnosed with primary hypogonadism, 6 men were diagnosed with secondary hypogonadism without reserve gonadal function; therefore, all 16 patients were treated with testosterone undecanoate 1000 mg intramuscularly according to the scheme: the second injection 6 weeks after the first injection, then each injection once a 12 weeks, the course of 12 months. During the first 3 months of ART, hypogonadism in all men was eliminated, but only at 6 month of ART, the length of the penis in the flaccid state at maximum extension increased from 5.8±1.2 to 8.3±1.2 cm (p<0.05), and the length of the erect penis - from 6.8±1.1 to 11.8±0.9 (p<0,05). At the next stage, from the 6th to the 12th month of ART, traction therapy was simultaneously carried out. At the end of the treatment, the length of the penis in the flaccid state at maximum extension increased by 58% of the original length, and in a state of erection - by 114% (p<0.05). During the 12 months of treatment, prostate volume in all men increased from 3.4±1.2 to 16.3±1.2 (p<0.05), which corresponds to the size of the prostate in healthy men. Total blood PSA level increased from 0.72±0.03 to 1.4±0.05 ng/ml (p<0.05), but it was in the acceptable range of reference values for healthy men during whole period of ART in all patients. Start therapy with prolonged testosterone undecanoate for 6 months significantly increases the efficiency of traction therapy in men with hypogonadism and micropenis, but for maintenance of the effect, ART should be continued during all period of treat-ment.

The risk of infectious and inflammatory complications after PNL is based on presence of microorganisms in the form of biofilms inside the stone. Destruction of stones during surgery or lithotripsy may be a trigger for the growth of microorganisms that are integrated into the biofilms, and the migration of bacteria and their toxins in the blood flow under pressure of irrigation fluid can cause septic complications. The danger of infectious and inflammatory complications after percutaneous interventions for kidney stones requires a search for specific antibiotics for antimicrobial prophylaxis and efficient modes of their administration. The results of a comparative study of pharmacokinetic parameters of ciprofloxacin, and the effectiveness of two modes of administration (bolus dosing and prolonged intravenous administration) at a dose of 1000 mg are presented.

Based on literature data and the results of own authors’ research, the review article considers the efficacy and safety of sildenafil, including its long-term use. Application of this drug leads to an improvement of erectile function in patients of all ages, regardless of etiology, severity and duration of erectile dysfunction (ED). Drug has long-term efficacy. Sildenafil affects both arterial and venous blood flow to the penis, which makes it indicated in vasculogenic erectile dysfunction first. Treatment with sildenafil is accompanied by improvement of the cavernous electrical activity, which justifies its use in neurogenic form of the disease. According to results of IIEF questionnaire, sildenafil provides quick and lasting therapeutic effect. Efficacy and safety of sildenafil is rated as good. As for short-term and long-term use, sildenafil does not cause dependence and addiction.

Modern science opens up new potentials for the effective treatment of complex diseases using minimally invasive techniques. One of the obvious achievements of recent years is cryoablation - technology of local freezing of tissues, allowing to create a precision zone of tumor cell death in renal cancer and prostate cancer. The literature review presents historical information, highlighting the main stages in the development of cryosurgery since the XIX century. The analysis of domestic and foreign literature has shown that in urological practice cryoablation has been widely used. Based on the literature data, indications, contraindications and complications of cryoablation in renal cancer and prostate cancer, as well as long-term results of treatment are discussed. Cryoablation has been used actively abroad; in the Russia, method is developing, but without a doubt, will be actively introduced in medical practice.