Vol 11, No 1 (2021)

INTRODUCTION: Autoimmune infertility is diagnosed in 5–15% of men. Currently applied methods of medical therapy of autoimmune male infertility are not very effective, which requires the development of new ones and creation of predictive algorithms for their efficacy.

The aim of our study was to evaluate the influence of low-level laser therapy (LLLT) in infrared spectrum on MAR-test rate and sperm fertile properties in men with autoimmune infertility, develop ways to predict the efficacy of this therapy.

PATIENTS AND METHODS: 47 men with autoimmune infertility were examined. 31 of them (1^st group) underwent course of LLLT in infrared spectrum (10 procedures), and 16 patients (2^nd group, comparison) had placebo-laser therapy sessions (10 procedures). MAR-test value, main semen parameters and sperm DNA fragmentation were assessed before and after the treatment. For creation of LLLT efficacy algorithm we used discriminate analysis.

RESULTS: In patients of the 1st group we indicated statistically significant decrease of MAR-test by an average of 19% immediately after the course of procedures, and by 33% – within two months after the end of the treatment, at its initial level 60% or lower. LLLT contributed to improvement of the semen fertile properties, pregnancy developed in the natural reproductive cycle in 19% of couples. We developed math model for prediction the efficacy of LLLT in infrared spectrum of autoimmune male infertility.

CONCLUSION: LLLT in infrared spectrum of male autoimmune infertility leads to MAR-test value decrease at its initial level less than 60%; improves sperm fertile properties. It is appropriate to use before LLLT predictive algorithm of its efficacy developed by us.

ABSTRACT: Tuberculosis inflammation of vertebral column (spondylitis) can lead to neurogenic lower urinary tract dysfunction. There is lack of available publications for neurogenic lower urinary tract dysfunction in spinal tuberculosis.

OBJECTIVE: To evaluate urodynamic disturbances in spinal tuberculosis before and after surgery for spondylitis.

MATERIALS AND METHODS: We observed 19 patients with spinal tuberculosis, who had symptoms of micturition’s impairment. 14 patients (73,6%) were male and 5 (26,4%) were female, average age was 43,7 ± 7,9 years (27–66). Control evaluation was performed after surgery on day 21–28.

RESULTS: Before surgery we found detrusor overactivity in 11 (57,9%) patients and 2 of those with detrusor overactivity had detrusor-sphincter dyssynergia. Detrusor hypo-/acontractility was diagnosed in 8 (42,1%). After surgery 5 patients (26,3%) exhibited improvement, in one case urodynamic disturbances were resolved. One patient developed detrusor overactivity and incontinence de novo and one patient had worsening neurological status, loss of sensitivity and acontractile bladder.

CONCLUSION: Variable lower urinary tract dysfunction can be diagnosed in spinal tuberculosis. Only 26,3% of patients have improvement after surgery. New conditions or worsening of previous neurogenic lower urinary tract dysfunctions can be observed.

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.

The review article is devoted to the application of the biofeedback in the treatment of patients with urinary incontinence after radical prostatectomy. The data on the mechanism of urinary continence in men and its damage during surgery are presented, the pathogenetic basis of the therapeutic effect of pelvic muscle training in this patients is highlighted. The analysis of the main russian and foreign clinical studies on the use of the biofeedback in patients with urinary incontinence after prostatectomy has been carried out. It is indicated that biofeedback increases the effectiveness of conservative treatment of urinary incontinence, however the even wider use of this method of treatment is limited by the lack of standard protocols for training pelvic muscles under the control of biofeedback.

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.