[Evaluation of the efficiency and safety of the dispersed form of sildenafil (50 mg) in males with erectile dysfunction]

INTRODUCTION

The erectile dysfunction is defined as an inability to achieve or maintain an erection sufficient for sexual intercourse lasting more than 3 months. According to literature, about 90 million men worldwide suffer from erectile dysfunction of different severity.

AIM

To evaluate the efficacy and safety of the dispersed form of sildenafil ("Ridzhamp" 50 mg), compared with the standard tablets of sildenafil (50 mg).

MATERIALS AND METHODS

The study included 60 men aged 27 to 67 years (average age 40.2 years) with moderate erectile dysfunction (11-15 points according to IIEF-5). In group I (n=30), patients took a dispersible form of the drug sildenafil, 50 mg ("Ridzhamp") 60 minutes before sexual intercourse; in group II (n=30), a standard form of the drug sildenafil was prescribed at a dosage of 50 mg, 60 minutes before sexual intercourse.

RESULTS

Positive dynamics according to IIEF-5 score was found in all the study groups. In group I, IIEF-5 score increase by 53.85%, while in group II by 50% (p<0.05). The average onset of erection in group I was 45+/-2.2 min, while in group II it was 51+/-1.9 min. In the main group (group I) one patient (3.33%) complained of persistent headache after taking the drug, and therefore refused the therapy. In the comparison group (group II) one patient (3.33%) reported dyspeptic disorders while taking the drug, 1 patient (3.33%) reported dizziness. All patients in the main group noted the convenience of taking the "Ridzhamp".

CONCLUSIONS

Our results indicate the comparable efficiency of the dispersed form of sildenafil (group I) and the standard tablet form of the drug (group II). All patients in the main group (group I) noted a faster onset of erections, as well as the convenience of "Ridzhamp" and the ability to take the drug without water intake.

[Prevention of the development of catheter-associated urinary system infections in the early postoperative period]

BACKGROUND

Bladder catheterization is a common medical manipulation that is associated with the risk of complications, including catheter-associated urinary tract infection (CAUTI), which accounts for 80% of all nosocomial infections of the urological profile.

AIM

To evaluate the combined use of the biologically active additive Uronext and ceftriaxone in the prevention of the development of CAUTI in the early postoperative period in 120 patients aged 20-80 years with a Foley indwelling catheter.

MATERIALS AND METHODS

The patients were divided into 2 groups: in group I (n=60), D-mannose with cranberry extract and vitamin D3 as part of Uronext dietary supplement was administered orally in the form of sachets 48 hours before surgery and after surgery until urethral catheter was placed, as well as intravenous ceftriaxone 1000 mg 2 hours before surgery and in the postoperative period within 7 days. In group II (n=60), ceftriaxone monotherapy was prescribed in a similar way.

RESULTS

According to the results of bacteriological examination of the removed urinary catheter on 3-7 days in Uronext group, bacterial growth was absent in 40 patients (66.67%, p<0.05), versus 23 cases (38.33%) in the control group.

CONCLUSIONS

The data obtained confirm the efficiency of the use of the biologically active additive Uronext in combination with an antibacterial drug, which allows to recommend this scheme in patients with an indwelling urinary catheter for the prevention of the development of CAUTI.

[Ureteral obstruction and segmental ureteral stents]

Currently, various types of stents are widely used in urological practice. One of the indications is the presence of upper urinary tract strictures. The factors leading to the development of strictures can be endogenous and exogenous, iatrogenic and non-iatrogenic, benign and malignant. After open, laparoscopic and X-ray-endoscopic procedures a double-J stent is usually placed or, less often, nephrostomy tube. It should be noted that both methods have certain side effects and may affect the patient's quality of life. To reduce the stent-related symptoms and increase their tolerability, various modifications of ureteral stents have been developed. In this article, we analyze the publications devoted to the most commonly used segmental stents without renal and bladder coils, such as Memokath, Uventa, Allium, Memotherm and nitinol stents manufactured by MIT LLC.

[Challenges in the clinical diagnosis and treatment of encrusted cystitis]

Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.

Comparative assessment of the results of detection of СagА-positive strains of Helicobacter pylori by molecular-genetic and immunochromatographic methods in different biological materials

A comparative analysis of the detection of CagA-positive strains of H. pylori by immunochromatographic and molecular genetic methods was carried out. We used H. pylori strains isolated from individuals with diseases of the gastrointestinal tract. The immunochromatographic method was implemented using a developed experimental model of an immunochromatographic test system for detecting the H. pylori CagA protein in various biological materials. Determination of the pathogenicity gene cagA of H. pylori was carried out using the «Helikopol SA» test system («Litekh», Russia). The assessment of the comparability of the results of detecting CagA-positive strains of H. pylori was carried out using statistical methods: Monte-Carlo, calculation of the chi-square test (χ2) and Kendall's τ-b and Somer's d coefficients. Statistical analysis was performed using the software packages «Microsoft Office Excel», «Statistica 10.0», «WinBUGS 1.4.0.» The study showed the absence of a statistically significant difference and the presence of a direct strong correlation between the results of detecting CagA-positive strains by molecular genetic and immunochromatographic methods, which indicates that these methods provide similar results in identifying highly pathogenic strains of H. pylori.

[Complications after PCNL: diagnosis and management]

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

[Laparoscopic partial nephrectomy using a technology of augmented reality: new vector of the development of operative urology?]

AIM

to evaluate the efficiency and usefulness of augmented reality (AR) technology using HoloLens glasses for laparoscopic partial nephrectomy (LPN).

MATERIALS AND METHODS

From July to December 2019, a total of 5 patients with localized kidney cancer (cT1aN0M0) underwent AR-assisted LRP. The mean RENAL score was 6 points (5-8). Preoperatively, all patients underwent contrast-enhanced multispiral computed tomography (MSCT). The three-dimensional reconstructions of the kidney, tumor, part of the abdominal aorta with the renal artery and its branches, part of the inferior vena cava with the renal vein were segmented with color coding and connected into a single virtual 3D model, which was loaded into the program in order to display image in AR glasses. The duration of surgery and thermal ischemia, type and frequency of intraoperative complications, as well as the time spent on preparing the 3D model and the Microsoft HoloLens device were evaluated. To assess the feasibility of using AR technology intraoperatively, a Likert scale was filled out by the surgeon.

RESULTS

It took 10 (9-11) hours to prepare the model, including time to optimize the model and to set up its display and interactions. The setup of HoloLens required an average of 7.8 (5- 12) min. The total duration of the operation and the period of warm ischemia was 108 (90-120) and 20 (15-25) min, respectively, while intraoperative blood loss was 160 (110-250) ml. In all cases, a negative surgical margin was found. The surgeon who performed all the operations assessed the use of AR technology with the HoloLens device as highly beneficial in all clinical cases.

CONCLUSION

The use of AR technology with a HoloLens holographic device during LPN can lead to improved treatment outcomes.

[Efficiency and safety of phenazopyridine for treatment of uncomplicated urinary tract infection: results of multi-center, randomized, placebo-controlled, clinical study]

AIM

to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain.

MATERIALS AND METHODS

A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events.

RESULTS

All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups.

CONCLUSION

The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.

[Design and materials for ureteral stents: past, present and future]

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

[Dynamics of crystallogenic properties of the oral fluid and periodontal status when using toothpaste with fluoride]

The aim of the study was to assess the efficacy of parodontax complex anti-inflammatory toothpaste with fluorine for treatment of moderate catarrhal gingivitis.

MATERIAL AND METHODS

Within 6 weeks a group of students was observed, which was divided into 2 subgroups depending on the activity of the carious process and with characteristic changes in crystalloscopy of the oral fluid. Clinical trials of parodontax anti-inflammatory toothpaste with fluorine were conducted. The properties declared by the manufacturer were evaluated using clinical, biochemical, laboratory studies, and criteria-based assessment of crystalloscopic features of the oral fluid.

RESULTS

The study revealed a statistically significant correlation of the cleaning ability of the hygiene product and crystalloscopic properties of saliva and changes in the clinical picture of chronic catarrhal gingivitis. With the inclusion of a comprehensive anti-inflammatory toothpaste containing fluorine and natural herbal extracts, a shift in the acid-base balance of the oral fluid to the alkaline side was recorded.

CONCLUSION

The improvement in the oral hygiene indices and the resolution of inflammatory processes in periodontal tissues prove the efficacy of comprehensive treatment of chronic gingivitis including parodontax toothpaste.

[Imidafenacin for treatment of overactive bladder and urgent urinary incontinence: the results of open-label multicenter randomized controlled clinical trial]

INTRODUCTION

The analysis of the results of a multicenter, open, randomized comparative phase III clinical trial on the use of imidafenacin for treating patients with OAB was carried out. A clinical study was conducted according to GCP standards in 12 urological centers of the Russian Federation with the support of company AO "R-Pharm".

MATERIALS AND METHODS

A total of 296 patients (men and women) aged from 18 to 65 years with OAB and urgent urinary incontinence were included in the study. All patients were randomized into two groups. In Group 1 (n=148) patients received -cholinoblocker imidafenacin 1 tablet (0,1 mg) twice a day. Group 2 patients (n=148) were prescribed a comparison drug tolterodine 1 tablet (2 mg) twice a day, as well. The duration of treatment was 12 weeks.

RESULTS

The analysis of results showed a significant decrease in the OAB symptoms in both groups. In Group 1 a decrease of episodes of urge urinary incontinence was more pronounce compared to Group 2, as well as amount of day-time and night-time of episodes of urge urinary incontinence by the 2nd, 4th, 8th and 12th weeks of treatment in comparison with baseline scores. There were no differences between two groups in the severity of reducing average urinary frequency per day. Reducing the severity of urinary disturbances in patients of both groups was accompanied by an improvement in the quality of life. There was a significant and similar decrease in the average total score of both OAB Awareness Tool and EQ-5D questionnaires. Tolerability of treatment was satisfactory in both groups and there were no differences in the adverse events in Group 1 and 2.

CONCLUSION

Imidafenacin showed high clinical efficacy for treating patients with OAB, which is not inferior, and in some values, is superior in comparison to tolterodine. Both drugs had a similar safety and tolerability profile.

[The role of laparoscopic salvage lymphadenectomy in patients after initial extended lymphadenectomy for prostate cancer]

This work presents results of the analysis of safety and efficacy of laparoscopic superextended lymphadenectomy, which was performed in patients with clinical progression (the presence of lesions in the lymph nodes of the pelvis and beyond) after undergoing prostatectomy. A feature of the work is that these patients initially extended lymphadenectomy was performed. Clinical detection of foci was carried out by 11C-PET/ CT. Laparoscopic salvage lymphadenectomy appears to be the safe method of performing surgery. When monitoring patients there was evaluated the effectiveness of the operation - the percentage of patients with marked regression and stabilization of markers (PSA), duration of remission. The analysis of the data attempted to determine the predictors of non-response patients after salvage lymphadenectomy.

[Results of surgical treatment for stress urinary incontinence in prostate cancer patients after radical prostatectomy using modified version of transobturator synthetic sling]

Approximately 6-9% of prostate cancer patients suffering from incontinent of urine after radical prostatectomy are in need of surgical correction of this condition after failure of conservative treatment for 12 months. The study involved 65 patients who were divided into 2 groups of follow-up. Group №1 (n = 31) - patients with mild urinary incontinence, group №2 (n = 34) - patients with medium (moderate) urinary incontinence. Follow-up median of the group №1 was 36 months, an average of 39.5 (12-84) months. Follow-up median of the group №2 was 36 months, an average of 41.65 (12-84) months. The overall efficiency of surgery in both groups was 84% and 82.4%.

[The comprehensive approach to ensure the quality of forensic medical examination of a cadaver]

The objective of the present work was to estimate the effectiveness of the comprehensive monitoring system designed to enhance the quality of forensic medical expertise for determining the cause of death in the hanging cases. It was shown that the practical application of the algorithmization and automated quality control system improves the effectiveness of forensic medical examination of the cadavers in the hanging cases. The system performs the control, directing, and teaching functions. Moreover, it allows to estimate the completeness of the examination of the cadaver.

[LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER]

Radical cystectomy is the standard method for treatment of muscle-invasive and locally advanced bladder cancer. Several less invasive approaches have been suggested recently, including totally laparoscopic radical cystectomy and robotic cystectomy. However despite significant improvements in surgical techniques the overall occurrence of perioperative complications is still high. Analysis of the literature data and comparison of these data with the results of our study was performed with respect to perioperative complications after radical cystectomy and oncological outcomes. In most of the studies, operating time during laparoscopic cystectomy was longer than that of open approach. Despite that, there was no influence of type of surgery on intraoperative complications. Major complication rates were similar between all groups. However laparoscopic cystectomy had lower rate of minor complications compared to open cystectomy. Laparoscopic cystectomy is safe and associated with lower blood loss, decreased postoperative ileus and lower length of stay compared with open radical cystectomy. Laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications. Moreover, if performed following the oncologic principles of open surgery, our results and literature data suggest that LRC is safe and determines non-inferior long-term cancer control compared with open surgery.

[Minimally invasive surgery with therapeutic effect in cancer patients]

During recent years ablative technologies have become very popular in tumor treatment. They are used in treatment for inoperable primary and metastatic tumors of the liver and the lung and also localized renal tumors of small sizes. The most studies on thermoablation in oncology are focused on the evaluation of tissue destruction and optimization of physical mechanisms, while potential mechanisms of immune response in thermoablation are still far from understanding. This study shows that with thermoablation of tumor within one month after the procedure the formation of a protective immune response is observed by increasing the content of activated T-helpers and cytotoxic T-lymphocytes.

[Comparative analysis of histological and long-term oncological outcomes after radical prostatectomy in patients matching johns hopkins and the royal marsden hospital criteria for active monitoring]

A retrospective comparative analysis of results of treatment of patients with prostate cancer who met the most stringent (Johns Hopkins - JH; 74 patients) and the most mild (Royal Marsden Hospital - RMH; 263 patients) selection criteria for the management according to the strategy of active monitoring was performed. Significant differences in the frequency of detection of adverse histological features and biochemical recurrence-free survival after radical prostatectomy in patients eligible for JH and RMH criteria were not identified. Extracapsular extension occurred in 2.7 and 4.9% (P=0,33), seminal vesicle invasion - in 1.4 and 2,6% (P=0.43), positive surgical margins - in 6, 8 and 7.2 % (P=0.56) Gleason score increase - at 6.8 and 9.1 % (P=0.49), respectively. Five-year disease-free survival rates were 95.7 and 95,8% (P=0.41). Regardless of the protocol selection for active monitoring, precise examination of patients and staging of the disease are absolutely necessary, as well as the future well-designed studies on the comparative analysis of the effectiveness of active monitoring and early curative treatment in the settings of national health care.

[Testicular germ cell tumors, the state of diagnostics and staging in Saint-Petersburg]

In the last 25 years germ cell tumors have become one of the few cancers with high cure rate. However, there is a lack of information on testicular germ cell tumors in the male population and even among general practitioners leading to late or false diagnoses. The shortening of timespan between the first clinical signs appearance and diagnoses can result in earlier diagnosis, fewer therapy interventions and better overall survival rates.

[Physico-chemical characteristic of medicinal preparations for intrabladder electrophoresis in patients presenting with bladder diseases (an experimental study)]

The physico-chemical characteristic of medicinal preparations used for the treatment of various bladder diseases is provided including their electrophoretic activity and the ability to penetrate into bladder tissues, e.g. during electrophoresis. The optimal parameters of intracavitary electrophoresis are considered.

[Using dietary supplement containing dietary fiber, fermented wine yeasts, vitamins and minerals, under the influence of dust-gas mixture. The experiments on laboratory animals]

In chronic experiment in rats pro for show, what of food biologically active "Rekitsen-RD", promotes increase of efficiency of mechanisms of detoxication, antioxidant activity and immune protection of an organism.

[Prevalence of different types of urinary incontinence and concomitant diseases in elderly patients]

This article presents the data on the prevalence of different types of urinary incontinence and concomitant diseases on the basis of answers to questions obtained from 398 patients over 65 years. We have analyzed the relationship among certain diseases in patients with urgent and stress incontinence. Lower urinary tract symptoms were more common in men over the age of 70 years; no such a tendency in women was observed. Among the patients older than 70 years, the probability of urgency and urgent incontinence increases significantly, regardless of gender. In older women the urgent and mixed urinary incontinence associates with the concomitant diseases. Stress urinary incontinence in women was not associated with any of the indicators of general health and social activity.

[Nocturia in elderly patients]

This study demonstrates a comparative assessment of the causes of nocturia in young and elderly patients with overactive bladder (OAB). We used the database of 245 patients over 18 years (117 men, 128 women) with OAB (more than 8 micturition per day), with presence or absence of urgent urinary incontinence and nocturia (an average of 2.5 episodes per night). All the patients had to complete a diary within 3 days indicating the time of the urge to urinate, urine volume per micturition and sleep time (when the patient is actually asleep before waking time). These patients were divided by sex and also into three age groups: younger than 60 years, 61-69 years and over 70 years. A diary was used to determine the nocturia index, nocturnal polyuria index, index of nocturnal bladder capacity. The most obvious reason for nocturia in patients with OAB was the polyuria and reduced nocturnal bladder capacity, which are not dependent on age. In young patients (< or = 60 years) nocturia was the result of the decrease of nocturnal bladder capacity and was evaluated by IBC. For the patients older than 70 years, the most common cause of nocturia was nocturnal polyuria, which was estimated by the index of nocturnal polyuria.

[Long-term results of retropubic radical prostatectomy]

Retropubic radical prostatectomy (RPPE) is the most aggressive method of treatment in patients with prostate cancer (PC), but maximally radical. The observations of men after RPPE have shown that 10.13% (40 patients) died: half of them (5.06%)--due to progress of PC, the rest because of coexisting diseases. The total, corrected and relapse-free 5 and 10 years survival was 90%, 95%, 65% and 84%, 91%, 55%. The quality of life of the men after RPPE was investigated at long-term periods of followup. RPPE is an effective method of treatment of PC patients. The most frequent complication of this intervention was erectile dysfunction and urinary incontinence which made the quality of life of such patients considerably worse. Postoperative dynamic follow-up of such patients is necessary for early detection of relapses and determination of indications for medicamentous and/or surgical treatments of the complications.

[Functional results of partial nephrectomy for kidney tumors]

The aim of the investigation was to analyze functional results of organ-sparing operations using radioisotopic method in combination with the investigation of serum creatinine in 31 patients. The data obtained suggest that the functional results of organ-sparing operations for neoplasms of the kidney directly depend on the time of warm renal ischemia. Warm ischemia about 15 minutes long is able to result in an ultrastructural damage of the nephron and decreased filtration level by 20-30%. A sudden change of serum creatinine on the next day after operation can be taken as a long-term prognostic factor of the kidney function. If the suggested time of stopped renal blood flow is more than 10-15 minutes, local hypothermia is advisable to protect the kidney.

Immunohistochemical analysis of lens cells on formation of different types of age-related cataract in humans

The aim of the present work was to perform a comparative immunohistochemical study of the ocular lens in normal conditions and after formation of various type of age-related cataract in humans. The control group consisted of lenses from young men dying from accidents and serving as corneal donors (n = 10, not more than one hour after death). Lenses from patients (aged 60-70 years) undergoing surgery for cortical (n = 20) and nuclear (n = 20) cataracts were studied. The investigations demonstrated plasticity in the phenotype of lens cells in age-related cataract. Changes in the phenotype of lens cells were found to depend on the type of age-related cataract. Development of the cortical variant of age-related cataract was associated with positive reactions with monoclonal antibodies to neuron-specific enolase, S-100 protein, and vimentin only within the lens cortex. Formation of age-related nuclear cataract was associated with positive reactions with antibodies to alpha-smooth muscle actin and pancytokeratin, which were detected only in the lens nucleus. This provides evidence of the need to develop a differential approach to the treatment of different types of age-related cataract.

[Expression of apoptosis and proliferation markers in progression of ovarian cancer]

Immunohistochemical investigation of intraoperative biopsy specimens of ovarian cancer at different clinical stages of the disease has revealed enhanced proliferation of the index Ki-67 and PCNA expression as well as Mt p53 and Bcl-2 expression correlating with the disease stage. Cancer progression may be accompanied with a selection of p53+ cells with hyperexpression of Bcl-2 and high proliferative activity.

[Efficacy and safety of revocarin in patients with impaired micturition due to prostatic adenoma. An open non-comparative study: results of a multicenter trial]

Patients with impaired micturition caused by prostatic adenoma received revocarin for 12-weeks. After the treatment all the patients showed relief of clinical symptoms proved by subjective assessment of urination quality (IPSS and QoL) and objective data (uroflowmetry, ultrasonography). Allergic reactions or other serious side effects were not registered. Thus, a 12-week course of revocarin demonstrated good clinical efficacy and safety in patients with urination problems because of prostatic adenoma. Revocarin can be recommended as an alternative to an original drug omnik.

[Correction of stress urinary incontinence in women with a free suburethral sling]

The most serious problem which must be solved in surgical treatment of stress urinary incontinence is providing adequate support for the middle urethra or urinary bladder neck with minimal sling tension. High frequency of positive results of implantation of a free synthetic sling is explained by the fact that a prolen tape does not extend and reliably arrests shift of the vesico-urethral angle in elevation of intraperitoneal pressure unlike other artificial supports (a fascial loop, fixing ligatures, ect.). Thus, the TVT operation is an effective treatment of stress urinary incontinence in women. The success of the surgical intervention depends primarily on adequate choice of patients and technically perfect conduction of the operation.

[Estimation of predictive prostate cancer probability with logistic regression equation]

Low specificity of PSA for early diagnosis of prostate cancer (PC) is the cause of search for new tests. The aim of our study was to develop the logistic regression model and estimate the value of the regression equation as a diagnostic tool for prostate cancer detection. A total of 518 male patients aged 47-83 years (mean 65.5 +/- 6.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. PC detection rate in our study was 43.8%. The logistic regression model with PC detection as a response and age, prostate volume, PSA, induration on DRE and hypoechoic lesion on TRUS as effects was designed. With regression equation PC probability for any patient was calculated. The regression equation was tested as a PC diagnostic tool. As the combination of model effects (chi-square 87.9; p < 0.0001; R2 = 0.124) any of the effects independently may predict prostate cancer detection. The obtained regression equation is: P(Pca) = 1/{1 + 2.718(-[-4.029 + (0.068 x AGE) + (0.022 x PSA) + (-0013 x PROSTATE VOLUME) + (0.375 x DRE) + (0.254 x TRUS)])} Accuracy (area under ROC-curve) of our regression equation as a PC detection diagnostic tool was 73%. Probability cutoff of 0.26 leads to sensitivity of 90% and specificity of 30% and eliminates 12% of unnecessary biopsies in patients with benign prostate diseases (chi-square 10.91; p < 0.0001). Thus, the obtained logistic regression equation may be used as a PC diagnostic tool in the suspects. Multicenter trial may improve regression equation diagnostic performance.

[Immunohistochemical analysis of the lens cells during development of the various types of age-associated cataract in man]

The objective of this investigation was a comparative immunohistochemical study of the crystalline eye lens under normal conditions and in different types of age-associated cataract in man. Control group included the lenses of young men, who died in the accidents and served as lens donors (n = 10, material collected within 1 hr since death). The lens was taken from the patients (age: 60-70 years) during the operation on the occasion of cortical (n = 20) and nuclear (n = 20) cataract. The study has demonstrated phenotype plasticity of lens cells in different types of age-associated cataract. The changes of cell phenotype were shown to depend on cataract type. During the development of cortical age-associated cataract, positive reaction with the monoclonal antibodies against neuron-specific enolase, S-100 protein and vimentin was detected only within the lens cortex. During the formation of nuclear age-associated cataract, positive reaction with the antibodies against alpha-smooth muscle actin, pancytokeratin was found only within the lens nucleus. These data suggest that the differentiated approach to the treatment of different types of age-associated cataract should be worked out.

[Medical control on the state of pilots' health suffering from urologic diseases]

The complexity of flying work and human factor significance increase the responsibility of aviation physician for health and high working capacity of the flying staff. The early diagnosis of potentially dangerous urological pathology is of particular importance because the renal and urinary tract diseases are revealed unexpectedly among the flying staff. The incidence of surgical pathology including the urologic one takes the third place in the RF Armed Forces. That's why the main directions to improve the urologic care in the Armed Forces medical service are the optimization of urologists' numerical staff, the development of new organizing-and-staff structure and the number of specialized urologic departments (centers, rooms, and wards) on the basis of central, district and garrison hospitals, the increase in urologists' professional training quality, the improvement of treatment-and-prophylactic work. It is necessary to conduct the quarterly, half-yearly and yearly analysis of urological diseases, connected with flying incidents.

[Resistance of causative agents of uncomplicated urinary tract infections in Russia]

A prospective epidemiological study of the spectrum of causative agents (CA) of uncomplicated urinary tract infections (UTI) in adult patients and CA resistance to antimicrobial drugs was conducted in nine cities of the Russian Federation in 2004-2005. Minimum inhibiting concentrations were ascertained by dilution in agar according to NCCLS (2000-2002) recommendations. The study has found that uncomplicated UTI are most frequently caused by E.coli (73.9%). Other CA occur much less frequently: K.pneumoniae--6.4%, E. faecalis--4.4%, S. epidermidis--4.1%, Staphylococcus spp--3.4%, others--2% patients. E. coli demonstrated high resistance to ampicilline (33.1%), co-trimoxasol (19.4%). Most active against E. coli were fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacine), the resistance being 4.8%; cefalosporins of the second and third generation (cefuroxim, ceftibuten), nitrofurantoin, no resistant strains were found.

[Pilot results of using tamsulone-FS in patients with prostatic adenoma according to the results of a randomized multicenter comparative trial]

Tamsulone-FS--a novel Russian alpha1A/D-adrenoblocker (Farm-Syntez)--was studied in a randomized multicenter comparative trial in patients with prostatic adenoma. Pilot results agreed with other trials published in the literature and demonstrated tamsulone-FS efficacy and safety for management of lower urinary tract symptoms caused by prostatic adenoma. The efficacy and safety of tamsulone-FS was comparable to those of omnik. This drug can be recommended for wide clinical practice in prostatic adenoma. It is registered by Roszdravnadzor (certificate N LC-000859 of 03.11.2005) and allowed for production and sale.

[Quality of life of patients after retropubic radical prostatectomy for prostatic cancer]

We studied quality of life in males after retropubil radical prostatectomy (RRP) for local prostatic cancer (LPC). A total of 159 men aged 41-80 years (mean age 67 years) 7-75 months after RRP responded questionnaires. The questions concerned urination and urine retention, erectile function, quality of life, satisfaction with results of operative treatment. 20.75% patients had no urine retention; 59.12% patients had some episodes of such retention, 20.13% had urine retention. In the postoperative period erection recovered in 13.87% patients; 26.42% observed weak force of the urine; 37.11%--improvement of quality of life and 30.19%--aggravation of quality of life. Most of the responders were satisfied with the treatment. Thus, quality of life after RRP worsens. Now, complications of RRP can be corrected and quality of life of such patients can be improved.

[The role of a positive surgical margin after retropubic radical prostatectomy in prognosis of recurrent prostatic cancer]

To estimate the occurrence of positive surgical margins (SM) in conduction of radical retropubic prostatectomy and SM role in development of the recurrence, we studied 216 surgical patients with prostatic cancer aged 41 to 73 years. Stages T2a,b, T3a, T1 and T3b were detected in 41.8, 35.6, 18.7 and 3.9% patients, respectively. A positive SM was verified in 68 of 193 (35.2%) patients. Of them, 36 (52.9%) patients had a focal (a single or short SM), while 32 (47.1%) patients had a long SM. The recurrence occurred in 31 (16.1%) cases, primarily in a long SM. In SM-free patients (group 1) one-year survival was 82% being very close to that in group 2 with a focal SM (83%). The differences between the groups were also minimal by three-year survival (75 and 73.6%, respectively). Thus, recurrence-free survival in the focal process and a short SM differs by three-year survival in the groups insignificantly. The period between month 12 and 24 is most risky in respect to recurrences in a short SM. Patients with a long SM had maximal number of prostatic cancer recurrences.

[Efficacy of ciprofloxacine antibiotic prophylaxis of infectious complications after TUR of the prostate]

We compared efficacy of preoperative prophylactic antibiotic treatment (PPAT) with cyprofloxacine used orally (0.5 g), intravenously (0.4 g) and routine antibiotics in TUR of the prostate. A multicenter open randomized study covered 120 patients. PPAT efficacy was estimated by the rate of urinary infection (UI), frequency and duration of antibiotic treatment in the postoperative period, hospitalization duration. All the patients were divided into three groups: 39 patients of group 1 received oral cyprofloxacine 90-120 min before TUR of the prostate, 38 patients of group 2 received intravenous cyprofloxacine 30-60 min before TUR, 43 patients of group 3 (control) received routine antibiotic prophylaxis. The following results were obtained: 24-48 hours after the operation no cases of UI in group 1, 11.5 and 11.6% in groups 2 and 3, respectively, (p = 0.048); 7 days after TUR--UI in all the groups (2.6, 20, 23.3%, respectively); 14 days after TUR--UI in 5.1, 28.6, 27.9% patients, respectively. Mean duration of hospital stay was 11.7 +/- 7.6 days in group 1, 12.1 +/- 8.1 days in group 2, 12.5 +/- 7.8 days in group C (p > 0.05). Postoperative antibiotics were given to 16.7, 34.1 and 68.9% patients, respectively. Thus, cyprofloxacine in group 1 lowered UI risk and postoperative antibiotics significantly, in group 2 it had no influence on UI rate but reduced postoperative antibiotics significantly.

[Diagnosis of localized cancer of the prostate]

The study was made to improve preoperative diagnosis of the stage of prostatic cancer (PC) to raise efficacy of subsequent treatment. A total of 152 patients entered the study who had undergone in 1997-2002 a radical prostatectomy for local PC. Basing on pathomorphological findings, the patients were divided into two groups: with localized CP (68 patients) and spread CP (84 patients). The comparison of clinical and pathomorphological diagnosis in the same patients demonstrated that there is a correlation between them, therefore it is possible to predict pathomorphological diagnosis at the stage of clinical diagnosis. The formula of establishment of a pathomorphological stage of the disease has been developed and its efficacy was tested in 30 control patients. The mathematical model of complex evaluation of the symptoms allows in 81% of cases to correctly determine the spread of CP while examination of separate symptoms provides a correct diagnosis in less than half the cases. The model can prognosticate radicality of the future operative intervention and duration of recurrence-free course and, consequently, to reduce the rate of intra- and postoperative complications and design further treatment policy.

[Radical perineal prostatectomy]

The authors have compared results of the first 9 perineal prostatectomies to a similar group of patients who underwent radical retropubic prostatectomy. In the group of patients after perineal prostatectomies the time of operation was at the average two hours less and the volume of blood loss was also two times less. Perineal radical prostatectomy is an effective modem method of treatment of localized prostate cancer. For many patients it will be a valuable alternative of the retropubic radical prostatectomy.

[The rate and location of the positive surgical margin and its role in predicting recurrence of prostatic cancer]

To estimate the rate of positive surgical margin (SM) in radical retropubic prostatectomy and its role in emergence of prostatic cancer (PC) recurrence, we operated 216 PC patients aged 41 to 73 years. Most of the patients had clinical stages T2a,b (41.8%) or T3a (35.6%). Stages T1 and T3b were in 18.7 and 3.9% patients, respectively.A positive SM was registered in 68 of 193 patients (35.2%). Thirty six (52.9%) patients had a focal (solitary or short) SM, thirty two (47.1%) had a long SM. The recurrence occurred in 31 (16.1%) patients who, as a rule, had long SM. Recurrence-free one-year survival in 104 patients who had no SM reached 82%, in 34 patients with focal SM (group 2) it was 83%. Such three-year survival in group 1 and 2 was 75 and 73.6%, respectively. Thus, recurrence-free survival in organ-limited process and short SM differed little within 3 years. The period between 12 and 24 months of follow-up is most risky in relation to detection of recurrence in short SM. The group of patients with long SM had maximal number of recurrences.

[Antibacterial therapy of complicated urinary infections in outpatients]

The term complicated urinary infections (CUIs) includes infections developing in the presence of anatomic anomalies, metabolic or hormonal disorders, immunodeficiency or infection with atypical microorganisms. Complicating factors diminish efficiency of antibiotic treatment, raise probability of recurrence. CUIs account for 45.2% of all cases of outpatient urinary infections in adults in Russia. Nephroliths, diabetes mellitus and renal cysts are most prevalent complicating factors. CUIs causative agents' spectrum is wider and resistance bacteria isolation is more frequent compared to uncomplicated urinary infections. In addition to antibiotic therapy, CUIs treatment should be focused on detection and elimination of the complicating factor. If complicating factors are unremovable, antibiotic therapy should be directed to management of clinical symptoms of urinary infection, prevention of complications and damage to renal parenchyma. CUIs demand longer courses of antibiotics than uncomplicated urinary infections: 7-14 days in infection of the lower urinary tracts, at least 14 days in infection of the upper urinary tracts and 4-6 weeks in failure of the standard course. Fluoroquinolones are drugs of choice in adults.

[Results of treatment of irritative symptoms and urinary retention in patients 1 year after radical retropubic prostatectomy]

AIM

To assess function of urinary retention and irritative symptoms from the lower urinary tracts in patients after radical prostatectomy for local prostatic cancer.

MATERIAL AND METHODS

From November 1997 to May 2001 radical prostatectomy was performed in 181 patients. One year after the operation 86 patients with pT1c-T2b filled in the questionnaire on urinary retention (UR) and irritative symptoms.

RESULTS

One year after radical prostatectomy complete UR was registered in 76% of the patients, partial UR in 20.5% and unsatisfactory UR in 3.5%. Uroflowmetrical and ultrasound investigations, urine seeding made possible to select 16 patients with irritative symptoms. 11 patients of this group received alpha-adrenoblocker terazosin with a good response.

CONCLUSION

One year after radical prostatectomy UR (complete or partial) was observed in 96.5% patients. Irritative symptoms unrelated to stricture of vesicourethral anastomosis and inflammation can be climinated by administration of terazosin.

[Caudal epidural anesthesia for transurethral resection of benign hyperplasia of prostate]

Caudal epidural anesthesia was used as a basic method of anesthesia in 300 elderly patients for transurethral resection of prostate adenoma. There were no complications during and after operation in spite of frequent concomitant diseases in these patients.

[Current aspects of the diagnosis and treatment of prostatic cancer]

Prostate cancer is becoming the most frequent malignant disease in men. Its present-day diagnosis in based on the combination of digital rectal examination, detection of the prostate-specific antigen in blood serum and multifocal transrectal biopsy of the prostate under ultrasonic control. The elevation of the level of prostate-specific antigen correlates with spread of the process and extracapsular penetration of the tumor. Asymmetry of the prostate and hypoechogenic foci represent the main ultrasonic signs of adenocarcinoma of the prostate. When the histological findings speak about the absence of atypical cells, another complex examination with rebiopsy is indicated in 6 months. The principal radical method of treatment of prostate cancer is prostatectomy performed mainly for the T1-T2 stages. At the preoperative period the neoadjuvant androgen deprivation can be performed in order to lessen the tumour volume and risk of a positive surgical margin.