No 1 (2019)

Aim. To study the changes of the main parameters of the oxidative status in prostate after standard antimicrobial monotherapy and to justify a use of additional antioxidant therapy in various experimental models of chronic bacterial prostatitis (CBP). Material and methods. A total of 60 outbred adult male healthy rats weighing 180-200 grams were used in the experiment. In a control group, 20 intact rats were included. Two experimental groups of 20 animals each were formed and in each group two subgroups (n=10) were distinguished. Two series of experiments were performed in the episodic and relapse models of CBP (based on the Nickel J.C. (1990) and Goto T. (1991)), respectively, with an evaluation of the efficiency of antimicrobial monotherapy (levofloxacin 12.5 mg/kg/day per os for 20 days) in each of the subgroups. In prostate homogenates the levels of CFUs, active forms of oxygen (ROS), diene conjugates and malonic dialdehyde, as well as an activity of superoxide dismutase (SOD) and succinate dehydrogenase (SDH)) were evaluated. Results. The microbiological efficiency of standard antimicrobial monotherapy in the episodic model of CBP was higher than in the recurrent model (90.0% vs 80.0, respectively, p<0.05). The degree of free radical aggression and a severity of lipid peroxidation in recurrent CBP were significantly higher, and the activity of SOD and SDH was significantly lower than in the episodic model of CBP (p<0.05). In both models, residual oxidative stress persisted in the prostate tissue after antimicrobial therapy, indicating an incompleteness (in the case of episodic model of CBP) or decompensation (in case of recurrent CBP) of the antioxidant defense system. Conclusion. A persisting of residual oxidative stress after a course of etiotropic antimicrobial monotherapy in the prostate has justified a necessity of the additional administration of antioxidants (antihypoxants) for a combined pharmacotherapy of CBP.

Introduction. In recent years, a large number of studies has been published that proved a very significant role of diabetes mellitus type 2 for development of urolithiasis. The aim of our work was to conduct a comparative study of biochemical parameters of blood and urine as well as chemical composition of urinary stones in urolithiasis patients in the general population and in patients with diabetes mellitus type 2. Materials and methods. The work was divided into 2 stages. During the first stage an analysis of chemical composition of urinary stones in the general population (n=5669) and in patients with diabetes mellitus type 2 was carried out (n=350). During the second stage an analysis of biochemical parameters of blood and urine in urolithiasis patients in the general population (n=101) and in patients with diabetes mellitus type 2 was conducted (n=350). Results. In the general population calcium oxalate stones was predominated (56.8%), while phosphate (24.9%) and urate (17.4%) stones were less frequent. In a subgroup of patients with diabetes mellitus type 2 uric acid stones were predominated (74.3%), significantly exceeding calcium oxalate (15.1%) and calcium phosphate (10.6%) stones. In the general population of patients with urolithiasis, hypercalciuria, hyperuricosuria, hyperuricemia and hypomagnesiuria was detected in 60.4%, 42.6%, 26.7% and 43.5% of cases, respectively. In patients with concomitant diabetes mellitus type 2, hypercalciuria, hyperuricosuria, hyperuricemia was observed in 9.4%, 26.7% and 42.5%, respectively. In 60.3% of patients with diabetes mellitus type 2 marked acidity of the morning urine was detected (pH<6.0). Conclusion. Correction of metabolic disorders in patients with urinary stone disease and diabetes mellitus type 2 should be aimed at increasing of urine pH and reducing the level of uric acid in the blood and urine.

Introduction. Benign prostatic hyperplasia (BPH) is the most common proliferative disease of the prostate gland in the elderly. Materials and methods. The results ofan open, randomized comparative study of the effectiveness of Serenoa repens in the combination with Urtica dioiccus (Prostagut-forte) are presented in the article. All patients were divided into two groups, depending on the therapy. In group I (n=51) Serenoa repens in combination with Urtica dioiccus 160/120 mg twice daily for 3 months was given, while in Group II (n=51) patients were prescribed to Serenoa repens 320 mg once a day, for 3 months. Results. According to the results, herbal preparations, like Serenoa repens, are effective for the medical treatment of BPH, which is confirmed by a decrease in LUTS severity, an increase in Qmax, a decrease in postvoid residual urine volume and an intensity of the inflammatory process in the prostatic tissue. However, in patients with BPH associated with chronic inflammation, it is preferable to use Serenoa repens in combination with Urtica dioiccus.

Aim. For a long time, benign prostatic hyperplasia (BPH) was considered as only cause of lower urinary tract symptoms (LUTS) in elderly men. More than 30% of patients underwent surgery by the age of 80. Unsatisfactory outcome of surgical treatment of BPH are observed in 9-27% of cases. Various irritative symptoms, which are typical for detrusor overactivity, persist especially often. Currently, anticholinergic drug therapy (m-cholinoblockers) is the main treatment for detrusor overactivity. The aim of our study was to assess the effectiveness of m-cholinoblockers for the treatment of persisted LUTS in men with BPH who had undergone transurethral resection of prostate (TURP). Materials and methods. The study included 60 patients with BPH who underwent TURP. All patients were divided into two groups. In Group 1, anti-inflammatory therapy for 10 days with 1-month follow-up was prescribed. In Group 2, anti-inflammatory therapy was combined with the drug Toviaz® for 1 month. Evaluation of the treatment effectiveness was carried out 3-5 days, 14-15 days and 1 month after TURP, respectively and included voiding diary, IPSS score, QOL, uroflowmetry, adverse events and acute urinary retention. Results. At baseline, in the Group 1 and 2, average urination frequency was 12.6 and 12.7 times per day, the number of urgency episodes was 9.2 and 9.0 times and number of nocturnal voiding episodes was 5,2 and 5.3 times, respectively. The average IPSS score was 19.8 and 19.7 points and Qmax was 6.5 and 6.7 ml/sec, respectively. By the 14th-15th day of therapy, in both groups positive changes were found. There was a significant decrease (p<0.05) in the urination frequency and nocturnal voiding episodes according to voiding diaries, an increase in Qmax and average IPSS and QOL score. The adverse events rate in group 2 was 16.7%. By the 30th day of therapy in the group 1 there were no significant changes. However, in group 2, urination frequency, number of urgency episodes, average IPSS and QOL score decreased to an average of 5.7 times a day, 0.4 times, 1.2 times, 9.3 points and 1.6 points, respectively. Average Qmax increased to 15.5 ml/sec. No adverse events were detected. Conclusion. According to the results of our study, the use of m-cholinoblockers, in particular Fesoterodine (Toviaz®), in combination with standard therapy in patients with detrusor overactivity after TURP is reasonable and allows to effectively and safely alleviate irritative symptoms.

Introduction. The choice of method of surgical treatment for endophytic kidney tumors depends on the precise definition of the location and size, the extent of invasion into adjacent tissues and the type of vascularization. Intraoperative ultrasound (IOUS) in combination with 3D-CT allow to receive this information. The aim of this study was to compare the laparoscopic-assisted extracorporeal partial nephrectomy and laparoscopic partial nephrectomy with IOUS and visualization in Full HD, 3D Full HD and 4K modes. Materials and methods. A total of 77 patients aged 43-75 years with endophytic renal tumors were included in the study. They were undergone either extracorporeal partial nephrectomy or laparoscopic partial nephrectomy with IOUS. We compared the rate of positive surgical margins, early postoperative bleeding, de novo renal failure or aggravation of preexisting renal failure and stricture of vesico-ureteric anastomosis. Results. The rate of early postoperative bleeding, chronic kidney failure and pathologically-proven positive surgical margin in patients who underwent extracorporeal partial nephrectomy followed by kidney autotransplantation was 23.1%, 13.4% and 13.4%, respectively. After laparoscopic partial nephrectomy these values were 12%, 16.7% and 8.3%, respectively. The best outcomes were achieved in patients who underwent laparoscopic partial nephrectomy with IOUS and with a use of visualization in Full HD, 3D Full HD and 4K modes.

Aim. To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI. Material and methods. The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate. Results. There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason > 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason > 4 + 3) compared to SB (p=0.025). Conclusion. MRF-TB allows to detect more significant PCa (Gleason > 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.

Aim: to assess the role of human granulocytic anaplasmosis (HGA) caused by Anaplasma phagocytophilum in the induction of cytogenetic damage of spermatozoa and karyopathological abnormalities of urothelial cells depending on the polymorphism of the gene of enzyme, DNA ligase IV. Material and methods. A total of 129 male patients with HGA and 84 otherwise healthy donors were examined. The samples of both semen and urothelial cells were obtained from each individuals for microscopic analysis. The diagnosis was confirmed by cytological (microscopic) method, enzyme immunoassay and polymerase chain reaction (PCR). An analysis of the frequencies of damaged spermatozoa and urothelial cells in all participants was carried out. In addition, a molecular cytogenetic study of spermatozoa by fluorescent in situ hybridization (FISH) was carried out using an AneuVysion multicolour for chromosomes 18 and 21 («Abbott», USA) to determine the frequency of aneuploidy in spermatozoa. The level of DNA fragmentation was studied by SCD (Sperm Chromatin Dispertion Test) using a commercial Halosperm kit («Halotech DNA», Spain). Results. The cytological analysis revealed the significant increase in the proportion of spermatozoa with cytogenetic abnormalities and urothelial cells with karyopathological damage in the HGA patients. The most significant damage to nuclear structures of cells was determined in the patients with Ile/Ile genotype. The significant effects of HGA in DNA damage and cytogenetic abnormalities in patients were verified by the increased frequency of spermatozoa with DNA fragmentation, monosomy and disomy in 21 and 18 chromosomes, as well as the appearance oi urothelial cells with karyopathological abnormalities. In addition, the increased frequencies of pathospermia with pathological abnormalities of head, neck and tail of spermatozoa in HGA patients were found. Conclusion. According to our results, the cytological analysis in the patients with HGA demonstrated the significant increase in the frequencies of spermatozoa with head, neck and tail defects and DNA fragmentation, monosomy and trisomy of the 18th and 21st chromosomes, as well as the increase in the frequencies of urothelial cells with karyopathological abnormalities. The genetic polymorphism of the effects of HGA was revealed, and the most significant cytogenetical damage was found in the patients carrying the Ile/Ile genotype of the LIG4 Thr9Ile gene.

Aim. To analyze the clinical spectrum of urogenital tuberculosis (TB) in children from 1993-1997 to 2013-2017, who were treated at the FSCU «Kiritsy». Materials and methods. Clinical forms of urogenital tuberculosis were diagnosed in 195 children (stage 1) and 158 children (stage 2). Conventional methods of TB diagnosis, including clinical, laboratory, imaging studies, tuberculin skin test and urine culture for BCG were used. In all cases, standard treatment for TB in combination with physiotherapy were performed. Results. When comparing the clinical spectrum of urogenital tuberculosis in children in 1993-1997 yy. (stage 1) and 2013 and 2017 yy. (stage 2), who were treated at the children's tuberculosis clinic "Kiritsy", the authors concluded that during the last 5 years the number of children with urogenital tuberculosis had decreased by 1.5 times (195 children in 1 stage, 158 in 2 stage) and proportion of children with a destructive form of urogenital tuberculosis decreased by 4 times (15 children in stage 1, 4 in stage 2). The contemporary diagnostic methods (urine culture, Diaskintest, ultrasound, instrumental methods) contributed to improved diagnosis of urogenital tuberculosis. Novel powerful antituberculous antibiotics allowed to significantly improve treatment outcomes. Results. 1) The incidence of urogenital tuberculosis in children over the past 5 years has decreased by 1.5 times compared with 90th years of the the last century. 2) At the current stage, the use of urine culture, Diaskintest, ultrasound, x-ray and instrumental methods contributes to the diagnosis of urogenital tuberculosis in children. 3) Multidisciplinary team consisted of pediatricians, pediatric urologists, phthisiopediatric as well as sanitary and educational work in the foci of infection allow to identify the urogenital tuberculosis in children.

All theories of stone formation are based on the common condition, which is the supersaturation ofstone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

Tadalafil is a drug from the phosphodiesterase-5 inhibitors (PDE-5) group, which is used to treat erectile dysfunction (ED), lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and ED with LUTS in patients with BPH. The efficacy and safety of tadalafil were reviewed. The focus was on cardiovascular safety of tadalafil due to frequent cardiovascular comorbidities in patients with ED. We concluded that tadalafil is well tolerated and safe in patients with cardiovascular comorbidities and, in addition, has a beneficial effect on the cardiovascular system.

In this publication a summary of the published manuscript “Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study” developed by a working group under the guidance of the Standardization Steering Committee of International Continence Society (ICS)1 is presented. The members of the working group were: Werner Schaefer, Gunnar Lose, Howard B. Goldman, Michael Guralnick, Sharon Eustice, Tamara Dickinson, Hashim Hashim and Peter F.W.M Rosier.