Rectal cream “Hem” (as suppositories) in treatment of chronic abacterial prostatitis

Chronic prostatitis is one of the most common disorders in men of reproductive age. In 5-10 % of cases, prostatitis is caused by bacterial infection. In 80-90 % of patients, bacterial agent cannot be detected, and chronic abacterial prostatitis is diagnosed per the National Institute of Health classification (NIH, 1995).Even with combination therapy using drugs of different groups, chronic prostatitis is a recurrent disorder and can lead to development of symptoms in the lower urinary tract and chronic pelvic pain syndrome decreasing patients' quality of life.Phytotherapy and beekeeping products with anti-inflammatory, pain-relieving, immunostimulating effects has a certain place in the treatment of chronic prostatitis.The study objective is to evaluate the effectiveness and safety of rectal cream “Hem” (as suppositories) manufactured by Russian company ADONIS CNPG and TM LCC in patients with chronic abacterial prostatitis.

Mathematical postprocessing analysis of contrast-enhanced computed tomography data of the kidneys in evaluation of split renal function in patients with kidney stone disease

Introduction. An original research work was performed to assess split kidney function by glomerular filtration rate (GFR) with mathematical analysis of the kidneys computed tomography (CT) data in patients with kidney stone disease (KSD). Objective was to evaluate the GFR and the parenchyma structure of each kidney and identify the possible patterns of contrast medium intrarenal transport with mathematical analysis of the kidneys CT data in patients with KSD.Materials and methods. Data of 27 patients of both genders with KSD were retrospectively analyzed. To evaluate GFR separately for each kidney we analyzed the data of contrast-enhanced CT (GFR reference values are 0.55 % of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size ≤1,5-2,0 cm, no obstruction of the urine flow registered; 3) no kidney or upper urinary tract surgical history; 4) age - ≤45 years; 5) no severe chronic diseases. All of these allowed to minimize influence of any other disorders on split renal function except for SKD and conduct per se research.Results. The mathematic analysis of the contrast-enhanced CT data revealed GFR changes in 26 (96.3 %) out of 27 patients. Hyperfiltration was found in 12 (44.4 %) patients: right kidney GFR - 0.6-0.77 %, mean value - 0.65 %; left kidney GFR - 0.59-0.79 %, mean value - 0.67 %. Hypofiltration was found in 13 (48.1 %) patients: right kidney GFR - 0.2-0.54 %, mean value - 0.37 %; left kidney GFR - 0.2-0.53 %, mean value - 0.4 %. The GFR values significantly differed between the groups both for the right (p = 0.000014) and left (p = 0.000045) kidneys. We found no significant age-related difference between the groups (p = 0.895). As well as that no significant differences in Resistance Index both in magistral (right kidney: p = 0.221; left kidney: p = 0.850) and segmental (right kidney: p = 0.306; left kidney: p = 0.957) arteries between the groups with hyperfiltration and hypofiltration were observed. One patient demonstrated no changes in GFR, and the other one had hyperfiltration (0,62 %) in one kidney and hypofiltration (0,48 %) in another.Conclusion. Most of the patients (92.6 %) with SKD demonstrate GFR changes (either hyperfiltration or hypofiltration) that may indicate the disturbed intrarenal blood and urine flow through the kidney.

Risk factors for erectile dysfunction: known and unexpected facts (review)

The prevalence of erectile dysfunction (ED) among men over 50 years is 31-51 %. By 2025, the prevalence of ED is expected to increase to 322 million men worldwide. In Russia, according to academician D.Yu. Pushkar', ED suffers up to 89.9 %.In this regard, it seems very important to establish the causes of this condition. The purpose of this review is to assess the current state of the literature on the issue of risk factors leading to or associated with the development of ED.The presented works show that well-known factors play a role in the occurrence of ED: unfavorable environmental conditions, harmful lifestyle factors, chronic intoxication, obesity, genetic predisposition, deficiency of sex hormones and vitamins, diseases of the cardiovascular system, prostate and urethra, as well as drugs for their treatment. Also, new indicators in laboratory and instrumental studies that change with ED are considered.Among the well-known data, there are also some very original works devoted to this topic. The relationship between ED and reproductive disorders, psoriasis, periodontitis, human immunodeficiency virus infection and some drugs use is now being investigated, which is presented in this review.

Male factor of infertility in spinal cord injury

Currently, traumatic spinal cord injury disease is a common problem in men of sexual and reproductive active age. The result may be disturbance of erectile and ejaculatory functions, which often leads to inability of natural conception. Vibrostimulation, electrical stimulation or surgical sperm extraction, intrauterine insemination procedures and assisted reproductive technologies are the standard procedures in the treatment of fertility disorders in men with spinal cord injury and dysejaculation. The effectiveness of the techniques directly depends on the quality of sperm and the female reproductive health. Currently, the potential mechanisms of the disorders of spermatogenesis in patients with spinal cord injury are not clearly learned. The literature review of sexual dysfunction and pathogenetic aspects of pathospermia in men with spinal cord injury is provided.

Therapy challenges in patients with Mycoplasma genitalium infection of the urogenital tract: clinical observations

Mycoplasma genitalium is a clinically significant intracellular bacterium from the family of genital mycoplasmas; it absolutely dominates in persistent/recurrent nongonococcal urethritis, causes chronic inflammatory diseases of the urogenital organs which dictates the necessity of treating this infection. The study presents observations of 2 patients with chronic recurrent urethritis caused by multiple drug resistant strains of M. genitalium. None of the administered schemes of antibacterial treatment covered in the international protocols on treatment of M. genitalium infection allowed to achieve clinical or microbiological cure in these patients. Practicing doctors require development and improvement of nucleic acid amplification methods with antimicrobial testing for M. genitalium resistance and new antimicrobial drugs with improved chemical and pharmacological characteristics for treatment of patients with intracellular urogenital infections.

Mullerian ducts derivatives in abdominal cryptorchism in children

Disorder of sex determination is a condition associated with clinical and biochemical discrepancy between genetic, gonadal, and phenotypic sex of a child requiring detailed examination for final selection of sex. Indications for sex determination can arise both in infancy and during puberty. Several conditions pertaining to abnormal sex differentiation are manifested as normal male genitalia with Mullerian ducts derivatives.The study objective is to present clinical observations of children with persistent Mullerian duct syndrome.The study presents 2 clinical cases of children with disorders of sex determination. Both children were initially hospitalized at the surgical facility with cryptorchism diagnosis, Mullerian duct derivatives were found intraoperatively. During examination of the children (karyotyping, histological and immunohistochemical examination) in one case persistent Mullerian duct syndrome was diagnosed, in the other - chromosomal abnormality of sex formation (45,X/46,XY), mixed dysgenesis of the gonads.If Mullerian duct derivatives are found during diagnostic laparoscopy, resection biopsy of the ambiguous gonad and intraoperative single-step urethrocystoscopy for visualization of the seminal colliculus and catherization of the uterus for its identification from the abdominal side should be performed. Further examination includes karyotyping, hormonal examination, consultations with an endocrinologist and a geneticist, and genetic examination if necessary.

Application of improved percutaneous cystolithotripsy in patients with benign prostatic hyperplasia

Introduction. The article presents an improved method of percutaneous cystolithotripsy. The results of its application are described and a comparison is made with the traditional method of transurethral cystolithotripsy with lithoextraction. The study objective is development of a comprehensive method of treating patients with bladder stones arising against the background of bladder outlet obstruction caused by benign prostatic hyperplasia (BPH), assessment of its effectiveness and safety.Materials and methods. The treatment was carried out in 56 patients with bladder stones arising on the background of BPH at the age from 42 to 89 years. According to the proposed method, 20 patients with BPH (main group) were operated on. Transurethral cystolithotripsy (control group) was performed in 36 patients. The results of the performed operations were compared with each other.Results. According to the comparison results, it is noted that the proposed method of percutaneous cystolithotripsy is performed faster and more efficiently, due to the fixation of the calculus in the basket. Due to the presence of a laparoscopic bag that completely isolates the stone from the bladder wall, there were no intraoperative complications. Drug therapy made it possible to quickly level the symptoms of cystitis. The patients were discharged 4-6 days after surgery with a cystostomy, which was removed after treatment for BPH.Conclusion. The proposed complex treatment of patients with bladder stones on the background of BPH is a safe method and has clear advantages over traditional transurethral, contact cystolithotripsy with lithoextraction.

Antegrade retroperitoneoscopic revascularization of the penis. Successful surgical treatment case of arteriogenic erectile dysfunction

This work presents a clinical case of a successful surgical treatment of arteriogenic erectile dysfunction by antegrade retroperitoneoscopic penile revascularization. This method has been developed, tested, patented and clinically implemented in the center of urology and andrology of State Scientific Center - A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia. The method was developed on the basis of a thorough analysis of the complications and disadvantages of previous revascularization methods.

Low-risk prostate cancer: evaluation of quality of life after surgical treatment and during active observation

The study objective is to improve results of treatment of patients with low-risk prostate cancer (PC).Materials and methods. In the study, comparative analysis of data from 84 patients with low-risk PC was performed: 40 patients were included in the active observation group (group 1) and 44 patients underwent radical prostatectomy (group 2). For evaluation of functional responses the following questionnaires were used: Short Form 36 Health Quality Survey (SF-36), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26). For control of oncological results, tests for prostate-specific antigen, digital rectal examination, magnetic resonance imaging of the pelvic organs with intravenous contrast, and confirmation biopsy of the prostate were preformed.Results. Mean score for the SF-36 questionnaire in the group 1 (active observation) at the beginning of the study was 63.2 ± 11.5 for mental health (MH) and 57.1 ± 9.8 for physical health (PH), while in the group 2 MH score was 63.1± 6.8, PH score was 56.2 ± 8.6. However, 18 months later in the group 1 mean MH score increased to 68.2 ± 10.1, mean PH score to 62.4 ± 7.8; in the group 2 PH score increased insignificantly to 64.2 ± 7.4 and PH score decreased to 54.8 ± 5.4 (p <0.05). IIEF-5 score in the group 1 decreased from 18.8 ± 4.2 to 18.3 ± 4.0, in the group 2 from 19.1 ± 4.3 to 16.9 ± 4.8 (p <0.05). Mean IPSS score insignificantly increased in the group 1 from 9.1 ± 2.1 to 9.3 ± 2.7, while in the group 2 it decreased from 9.2 ± 2.3 to 8.4 ± 1.5 (p <0.05). For the EPIC-26 questionnaire, mean score for all criteria initially was 56.1 ± 5.1 in the group 1 and 54 ± 4.4 in the group 2 (after prostatectomy), and currently it increased to 65 ± 4.6 in the group 1 and decreased to 49 ± 5.4 in the group 2.Two (5 %) patients from the group 1 underwent surgical treatment due to PC progression. One (2.5 %) patient chose surgical treatment due to cancer-related anxiety. Biochemical recurrence with an increase in prostate-specific antigen of 0.29 ± 0.09 ng/ml was observed in 3 (6,8 %) patients in the group 2.Conclusion. Strategy of active observation is the preferred method of care for patients with low-risk PC allowing to preserve high quality of life while surgical treatment should be performed only if necessary.

Aneuploidy in sperm of fertile men and patients with impaired fertility

The review presents generalized current data on sperm aneuploidy in healthy (fertile) men and infertile male patients with a normal karyotype and with chromosomal abnormalities. The mechanisms of aneuploidy in germ cells, factors affecting of its level, the relationship with defects of spermatogenesis, meiosis, decreased sperm parameters, as well as the effect of sperm aneuploidy on male fertility, embryo development and gestation are discussed.