卷 11, 编号 1 (2021)

绪论。男子自身免疫性不育症约占不育男子的5–15%。目前使用的保守治疗方法对男子自身免疫性不育症无效，需要开发新的方法，以及建立预测其有效性的算法。

目的：评价红外光谱（IR）低强度激光治疗（LLLT）对男子自身免疫性不育症射精混合抗球蛋白反应试验评分及生育特性的影响，并开发预测该治疗效果的方法。

患者与方法。对47例男子自身免疫性不育症进行了检查：31例（第一组）患者接受了10次红外光谱低强度激光疗程，16例（第二组，比较组）接受了安慰剂激光治疗（10次疗程）。在治疗前后，评估混合抗球蛋白反应试验的价值，以及精子图的主要参数和精子DNA碎片。分辨法用于创建低强度激光治疗（LLLT）有效性的算法。

结果。在第一组组患者中，观察到混合抗球蛋白反应试验指数有统计学意义的下降，平均而言，低强度激光治疗结束后即刻下降19%，治疗结束2个月后下降33%，初始值为60%或更小。低强度激光治疗提高了射精的生殖能力，19%的已婚夫妇在自然生殖周期中怀孕。开发了一种数学模型，用于预测低强度激光治疗在男子自身免疫性不育症的红外光谱中的有效性。

结论。对于低强度激光治疗，红外光谱中的低强度激光治疗可使初始水平的混合抗球蛋白反应试验值下降不到60%，并改善了射精的生育特性。在进行低强度激光治疗之前，建议使用一种算法来预测其有效性。

研究现实性。结核性脊柱炎可并发神经源性排尿障碍。目前已有少量研究发表对这类患者下尿路功能障碍的研究。

目的：探讨脊柱手术前后结核性脊柱炎患者下尿路尿动力学的变化。

材料与方法。对脊柱手术前后伴有排尿障碍症状的结核性脊柱炎患者（n=19）进行了检查。

结果。术前11例（57.9%）发现逼尿肌活动过度，合并逼尿肌-括约肌协同失调为2例（10.5%）， 8例（42.1%）患者诊断逼尿肌功能减退/收缩力减弱。在术后期间，5例（26.3%）患者观察到积极的动态，其中1例出现尿动力学障碍。1例患者发生逼尿肌新生过度活动伴尿失禁。在另一例中，随着敏感性和灵活性障碍的进展以及收缩性膀胱的发展，神经系统状况恶化。

结论。结核性脊柱炎患者有多种下尿路功能障碍。术后早期，26.3%的患者尿动力学得到改善，在某些情况下，可能会加重现有的疾病，并发展为另一种类型的de novo下尿路神经源性功能障碍。

PURPOSE OF THE STUDY: to evaluate the effectiveness of personalized complex treatment of patients with benign prostatic hyperplasia (BPH) in combination with chronic prostatitis using a combined physiotherapeutic effect, taking into account the individual chronobiological characteristics of patients.

MATERIALS AND METHODS: We examined 60 patients with benign prostatic hyperplasia and chronic prostatitis who were sent to the TUR of the prostate. Patients were divided into two groups (n = 30). The comparison group (CG) was treated with alpha-blockers and fluoroquinolones for 28 days. In the main group (MG) – personalized complex therapy. The effectiveness of treatment was evaluated at the time of treatment (visit 1), two weeks later (visit 2) and 4 weeks later (visit 3). The severity of lower urinary tract symptoms, prostate volume and residual urine volume, hemodynamic parameters in the gland were evaluated, and a bacterioscopic and bacteriological examination of prostate secretion was performed.

RESULTS: At the end of 4 weeks of therapy, statistically significant differences (p < 0.05) were found in the MG for all the studied parameters. In the bacteriological study of prostate secretions at visit 1 Escherichia coli prevailed in the crops. At visit 2 to the CG bacteria were detected in 11 (36.7%) crops, and in 10 (33.3%) patients in the MG. At visit 3, no microbial growth was detected in both groups based on the results of a bacteriological examination of prostate secretions. Initially, both groups had low hemodynamic parameters in the prostate. After the treatment, a more pronounced dynamics of improvement of blood flow in the gland by visit 2 was noted in the MG than in the GP. By visit 3, statistically significant differences were found in all the studied indicators (p < 0.05).

CONCLUSION: Thus, according to the results, a personalized comprehensive treatment of patients with benign prostatic hyperplasia and chronic prostatitis reduced the severity of lower urinary tract symptoms and manifestations of the inflammatory process in the prostate, improved hemodynamic parameters and increase of efficiency of antibacterial therapy, as evidenced by the results of bacteriological studies.

PURPOSE OF THE STUDY: to evaluate the effectiveness of personalized complex treatment of patients with benign prostatic hyperplasia (BPH) in combination with chronic prostatitis using a combined physiotherapeutic effect, taking into account the individual chronobiological characteristics of patients.

MATERIALS AND METHODS: We examined 60 patients with benign prostatic hyperplasia and chronic prostatitis who were sent to the TUR of the prostate. Patients were divided into two groups (n = 30). The comparison group (CG) was treated with alpha-blockers and fluoroquinolones for 28 days. In the main group (MG) – personalized complex therapy. The effectiveness of treatment was evaluated at the time of treatment (visit 1), two weeks later (visit 2) and 4 weeks later (visit 3). The severity of lower urinary tract symptoms, prostate volume and residual urine volume, hemodynamic parameters in the gland were evaluated, and a bacterioscopic and bacteriological examination of prostate secretion was performed.

RESULTS: At the end of 4 weeks of therapy, statistically significant differences (p < 0.05) were found in the MG for all the studied parameters. In the bacteriological study of prostate secretions at visit 1 Escherichia coli prevailed in the crops. At visit 2 to the CG bacteria were detected in 11 (36.7%) crops, and in 10 (33.3%) patients in the MG. At visit 3, no microbial growth was detected in both groups based on the results of a bacteriological examination of prostate secretions. Initially, both groups had low hemodynamic parameters in the prostate. After the treatment, a more pronounced dynamics of improvement of blood flow in the gland by visit 2 was noted in the MG than in the GP. By visit 3, statistically significant differences were found in all the studied indicators (p < 0.05).

CONCLUSION: Thus, according to the results, a personalized comprehensive treatment of patients with benign prostatic hyperplasia and chronic prostatitis reduced the severity of lower urinary tract symptoms and manifestations of the inflammatory process in the prostate, improved hemodynamic parameters and increase of efficiency of antibacterial therapy, as evidenced by the results of bacteriological studies.

Comparative morphofunctional and histological visualization of bladder wall lesions in 15 patients with chronic bacterial cystitis and in 15 patients with chronic radiation cystitis using positron emission tomography - computed tomography (PET/CT) was performed. The studies have revealed significant differences in the parameters of blood flow and tissue metabolism in patients with these forms of bladder lesions. In patients with chronic bacterial cystitis, an increase in the frequency of urination was accompanied by a decrease in the capacity of the bladder under conditions of a decrease in the velocity of arterial and venous blood flow in its wall as compared with the control. At the same time, at the cellular-molecular level in the bladder wall, no significant metabolic abnormalities, assessed by the SUVmax indicator, were revealed. Chronic radiation cystitis was characterized by a significant increase in the rate of systolic and diastolic blood flow in the bladder wall, its thickening and hypermetabolism of ¹⁸F-FDG.

本文就生物反馈法在根治性前列腺切除术后尿失禁治疗中的应用作一综述。本文介绍了男性尿潴留的机制及手术中尿潴留损害的相关资料，并强调了骨盆底肌肉练习对这类患者治疗效果的发病基础。我们分析了目前国内外关于生物反馈法在前列腺术后尿失禁患者中的应用的主要临床研究。提示生物反馈可提高尿失禁保守治疗的有效性，然而，由于缺乏统一的生物反馈控制下的骨盆底肌肉练习方案，这种治疗方法的更广泛应用受到了限制。

The calyx diverticulum is a cavity lined with urothelium that communicates through a narrow canal with the renal calyx-pelvis system. Most calyx diverticula are 0.5 to 2.0 cm in diameter and require surgical treatment exclusively for clinical manifestations of associated diseases. The most common complications of this nosology include urolithiasis and recurrent urinary tract infections. This article presents a rare case of a large diverticulum of the middle group of the calyces of the left kidney. The dimensions of the cavity filled with urine were 10 cm, which resulted in recurrent pyelonephritis, paranephritis and urosepsis.