[Practical use of Adenoprosin in combination therapy in men with lower urinary tract symptoms].

AIM: The aim of the observational cohort study is to study and evaluate the efficiency of the drug Adenoprosin in combination with other drugs in comparison with monotherapy. MATERIALS AND METHODS: Data from 6,442 patients at 221 medical institutions in 39 cities from November 2020 to December 2022 were analyzed. The drug Adenoprosin in the form of rectal suppositories was prescribed as monotherapy in group I, while patients in group II received Adenoprosin in a combination with other drugs. The efficacy of treatment was assessed using uroflowmetry data, prostate volume, postvoid residual volume and validated scales (NIH-CPSI, IIEF-5, IPSS, QoL). RESULTS: The diagnosis was validated in 6375 cases, including BPH (n=1498), chronic prostatitis (CP; n=3060), and in combination of both disorders (n=1817). A total of 3580 patients received Adenoprosin as monotherapy, while 2761 received combination therapy. In most cases, a combination therapy was prescribed in case of more severe disease. In patients with BPH, positive changes after treatment were noted in favor of group I according to change in postvoid residual volume (p<0.001) and prostate volume (p<0.001). Combination therapy demonstrated significant positive changes compared with monotherapy when assessing NIH-CPSI scores (p=0.005), IPSS scores (p<0.001) and the mean maximum urine flow rate (Qmax; p<0.001). Qmax increased significantly in both groups (from 14 ml/s to 17 ml/s in group I and from 12 ml/s to 14 ml/s in group II). CONCLUSION: Treatment of BPH, CP and their combination is a complex clinical task. The multiple nature of complaints often dictates the need for simultaneous administration of two or more drugs. Combination therapy involves the use of multiple therapeutic strategies to treat different aspects of BPH and CP. In patients with BPH, a combination therapy has been shown to be more effective than monotherapy with either class of drugs, as it reduces the risk of disease progression, acute urinary retention, and the need for surgery. However, combination therapy should be considered on an individual basis, taking into account symptoms, prostate size and overall health. There is no universal treatment method for BPH suitable for any patient. The treatment strategy should be chosen individually, considering all medical and social factors. All of the above applies to a large extent to the treatment of CP and CP + BPH. According to our results, Adenoprosin demonstrated efficacy both as monotherapy and in combination with other traditional drugs in the treatment of men with lower urinary tract symptoms.

[Lower urinary tract symptoms and COVID-19].

The data presented in the review showed that the coronavirus affects not only the lungs, but also the organs of the urinary system. The new virus causes a mosaic, multi-organ disease with severe consequences after the egg and has a wide organotropism. The role of SARS-CoV-2 in the development of lower urinary tract symptoms (LUTs), which are manifested by frequent, imperative urges, dysuria, nocturia, is not entirely clear. It is assumed that biologically active substances, the activation of which is caused by a virus, play a certain role in the development of SNMP, namely the expression of angiotensin converting enzyme 2 (ACE2), cytokines, activation of toll-like receptor 4 (TLR4), etc. An increase in cytokines that are released into the urine and / or expressed in the bladder and the presence of SNMP in patients with coronavirus infection have been called de novo urinary symptoms or COVID-19 associated cystitis (CAC) in the literature. Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. Despite the unusual manifestation of coronavirus infection, similar mechanisms of damage to urothelial cells in viral and bacterial infections give us the right to think about the use of pathogenetically justified prevention of the development of an inflammatory reaction in the urinary tract, as well as short-and long-term consequences of this disease. For this purpose, it is necessary to recommend drugs that have a multifactorial effect: diuretic, anti-adhesive, anti-inflammatory and regulate the local immunity of the bladder mucosa. We assume that against this background, we can expect a decrease in the number of complications from the organs of the urinary system, and more successful rehabilitation of patients with coronavirus infection and in the post-ovarian period. Final conclusions and recommendations will be available after well-planned clinical trials have been conducted.

[Duties, rights and activity monitoring of the head of a medical organization worldwide].

The quality of medical care in a medical organization is largely determined by the effectiveness of its Head. The article looks at current regulatory acts, main factors of healthcare organization process in developed countries (France, Switzerland, Australia and South Korea) and methods for assessing the quality of health services. This work analyzes the world practice of appointment, functioning and activity effectiveness of the heads of healthcare system.

[Art therapy in treatment, rehabilitation, micro- and macrosocial adaptation of children with autism spectrum disorders by means of a special rehabilitation and adaptation program "Art therapy (drama therapy): 'Because You are Needed ' for children with general disorders of psychological development and other mental disorders"].

For the first time, the effectiveness of art therapy (drama therapy) in children with mental disorders has been studied on substantial clinical data. Psychotherapeutic work involved certain form of drama therapy that included patients watching Moscow theaters performances and then discussing them with family and in group therapy sessions with psychologists. Researchers have developed drama therapy methods for children with mental disorders, determined indications and contraindications for this treatment. The study shows effects of art therapy on the child adaptation to the conditions of the micro-social environment, particularly on his family adaptation, formation of harmonious, supportive, rehabilitative family relations. It is noted that art therapy influences adolescent's adaptation to the conditions of the macrosocial environment, particularly his adaptation in a peer group, behavior in various situations and formation of normal behavioral patterns in different environmental conditions.

[Regulatory Support for Monitoring the Effectiveness of Medical Managers].

Authors considered the issue of regulatory support for dynamic control methodology concerning the performance efficiency of a head (head physician) of the medical organization of Moscow healthcare system. The regulatory framework for assessing the performance of managers in the public healthcare management system is described. The indicators for assessing the execution effectiveness of the state program "Development of Healthcare in the Russian Federation" and Moscow program "Development of Healthcare in Moscow (Capital Health)" are given. Authors analyzed recommendations of the federal executive authorities on the development of performance indicators of social organizations, as well as experience of their implementation by the constituent entities of the Russian Federation. Proposals to improve the system for assessing performance efficiency of head managers of medical organizations were developed.

[Creating Organizational Conditions for Healthy Lifestyle Formation Among Population].

The key role in healthy lifestyle (HLS) formation among the population belongs to medical specialists, who possess reliable scientific knowledge in this field. The effectiveness of spreading healthy living message is connected with organizational conditions: principles of segmentation and patient routing, role of non-physician staff, development of remote forms of work and staff training system. Much attention is given to healthy living attitudes among medical specialists. According to the conducted sociological study and review of foreign and national experience, the authors present practical recommendations which include organizational changes aimed at greater effectiveness of HLS promotion by healthcare professionals.

[Medical Errors: Medical, Social and Legal Aspects].

The article examines the main types of medical errors and their causes. It systemizes typical iatrogenic diseases. The work defines leading directions for medical errors prevention, including the effective usage of simulation learning technologies. Authors analyze current regulatory acts and the main rule-making trends in the field of medical errors.

[Quality of life in patients with lower urinary tract symptoms after TURP for benign prostatic hyperplasia].

INTRODUCTION: To date, the gold standard for the surgical management of BPH is transurethral resection of the prostate (TURP). Most patients who undergo TURP for BPH experience immediate effects and complete relief of lower urinary tract symptoms and do not need further urological care. However, some patients after this operation have some level of persistent residual lower urinary tract symptoms, which may require additional therapy. AIM: To investigate voiding function and the need for medical therapy in patients who underwent TURP for LUTS due to BPH. MATERIALS AND METHODS: This study was performed as an anonymous survey among male patients presenting to a urology clinic. During the visit, the patients were offered to fill out I-PSS and SF-36 questionnaires. Also, they were asked about their socio-economic status, history of BPH, their perception of surgery and the postoperative period up to the day of the interview, presence or absence of symptoms of voiding dysfunction and any drug therapy at the time of the interview or after surgery. The patients also rated the severity of the symptoms using the IPSS questionnaire. The study comprised patients after 12 months to 3 years following successful TURP for LUTS due to BPH. A total of 1100 questionnaires were forwarded to researchers for interviewing patients who underwent TURP for prostatic hyperplasia. RESULTS: After collecting and reviewing all the questionnaires, 921 questionnaires were found eligible. The findings of the survey showed that a significant proportion of patients who underwent TURP require a long-term postoperative medical therapy. At the same time, in the Russian Federation, there are no standard approaches to medical management of this category of patients.

[Bacterial prostatitis and prostatic fibrosis: modern view on the treatment and prophylaxis].

Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidase. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men].

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[PROSPECTS FOR THE TREATMENT OF IDIOPATHIC AND NEUROGENIC OVERACTIVE BLADDER].

Overactive bladder (OAB) is a common problem in modern population. The main line of medical treatment of this condition is the use of M-cholinoblockers. Solifenacin has shown high selectivity for the bladder in preclinical studies. Data on the efficacy and safety of high-dose (10 mg/day) of solifenacin are insufficient. The study was aimed to the comparative evaluation of the effectiveness and safety of solifenacin at a dose of 5 and 10 mg/day. The study included 28 patients (17 women and 11 men), mean age was 41.3±6.7 years. All patients were divided into two groups. In Group 1 included 12 patients with idiopathic overactive bladder, the Group 2 (n=16) - with neurogenic overactive bladder. Depending on the effect obtained, in some patients the dose was increased to 10 mg/day 1 month after starting treatment. The duration of treatment was 12 weeks. Application of solifenacin at a dose of 5 mg in patients with overactive bladder significantly reduces the severity of symptoms. Increasing the dose was required in 3 (25%) patients with idiopathic OAB and in 10 (62.5%) - with neurogenic OAB. Patients unsatisfied by therapy with solifenacin 5 mg/ day initially had more severe symptoms of the disease - significantly more urgency frequency, incontinence episodes, and nocturia. The use of high doses of solifenacin increased the effectiveness of treatment. Statistical significance was achieved for all parameters evaluated. Against the background of increasing doses, the number ofadverse effects may increase, but within a month of therapy in most cases they are reduced.

Efficiency assessment of shock wave therapy in patients with pelvic pain employing harmonic analysis of penile bioimpedance.

In searching for novel objective methods to diagnosticate pelvic pain and assess efficiency of analgesic therapy, 37 male patients were examined prior to and after the course of extracorporeal shock wave therapy (5-10 sessions) with the waves directed to projections of prostate and/or crura and shaft of the penis. The repetition rate of mechanical pulses was 3-5 Hz. The range of energy pulse density was 0.09-0.45 mJ/mm(2). The overall number of pulses in a session was 1500-3000 in any treated zone with total energy smaller than 60 J. The applicator was relocated every other series of 300-500 pulses. Effect of the shock wave therapy was assessed according to subjective symptomatic scales: International Prostate Symptom Score, International Index of Erectile Function, Quality of Life, and nociceptive Visual Analog Scale. The objective assessment of shock wave therapy was performed with harmonic analysis of penile bioimpedance variability, which quantitatively evaluated the low-frequency rhythmic and asynchronous activities at rest as well as the total pulsatile activity of the penis. The magnitude of spectrum components of bioimpedance variations was assessed with a novel parameter, the effective impedance. The spectral parameters were measured in 16 patients prior to and after the treatment course. The corresponding control values were measured in the group of healthy patients. Prior to the shock wave therapy course, all spectrum parameters of penile bioimpedance significantly differed from the control (p<0.05). After this course, low-frequency rhythmic and the total pulsatile activity decreased to normal, while asynchronous activity remained significantly different from the normal. The novel objective physiological criteria of pelvic pain diagnostics and efficiency of its treatment reflecting the regional features of circulation and neural activity corresponded to the clinical symptom scaling prior to and after the shock wave course, and on the whole, these criteria corroborated improvement of the patient state after this therapy.

[Combined treatment of patients with erectile dysfunction and urination disorders].

The article presents the results of the study aimed to the evaluation the efficacy of combination therapy with alpha1-blocker (tamsulosin) and phosphodiesterase type 5 inhibitor (sildenafil) in patients with urination disorders and erectile dysfunction (ED). A pilot observational study involving 60 men aged from 50 and 80 years divided into 3 groups of 20 people was performed. Group 1 of patients received sildenafil 25 mg daily (dynamico), Group 2--tamsulosin 0.4 mg daily (Omnic-Ocas), and Group 3--tamsulosin 0.4 mg (Omnic-Ocas) and sildenafil 25 mg (dynamico) daily. The visits were carried out at the stage of screening, further--every 10 days (a total number--4 visits). Combination therapy of urination disorders and ED contributed to the significant improvement in uroflowmetry, the stopping of complaints according to the IPSS and IIEF-15 questionnaires, and improving the quality of life (according to the QoL questionnaire). Combination therapy significantly decreased obstructive and irritative symptoms, increased the maximum urine flow rate within the period of observation, as well as significantly decreased the residual urine volume, more pronounced when compared with monotherapy. Significant positive effect on erectile component and all components of the overall satisfaction in the sexual sphere were registered, that as a consequence led to the positive impact on the quality of life in patients treated with PDE5 inhibitor. Given the high prevalence of urinary disorders and erectile dysfunction, combined therapy with alpha1-blockers and PDE5 inhibitors in this case should be a promising area for drug therapy.

[The use of tolterodine in patients with recurrent chronic cystitis].

The article presents the results of evaluation of effect of M-cholinoblocer tolterodine on the symptoms of lower urinary tract diseases (LUTD) and quality of life of patients with recurrent chronic cystitis. The study included 47 patients with chronic recurrent cystitis at acute stage with non-obstructive type of urination and LUTS. Group 1 included 23 women aged 45 to 56 years, who received tolterodine on the background of antibacterial therapy, taking into account the sensitivity of the isolated strain. Control group included 24 patients who received standard antibacterial therapy, also taking into account the sensitivity of the pathogen, and spasmolytics. The groups were almost homogeneous and did not differ on the basic characteristics. Analysis of the results of the study showed that tolterodine as a symptomatic therapy can reduce the time of rehabilitation. Therapy with tolterodine has shown clinical efficacy for 85.7% of women, has improved the quality of life by 24.8% compared with the control group, and provided relief of urgent and irritative symptoms in the short time.

[Phytotherapy in combined treatment of chronic infection of the upper urinary tract in patients exposed to extracorporeal shock-wave lithotripsy].

Multicomponent biologically active additive Uroprofit made by Russian company Ecomir is used for phytotherapy of urolithiasis and urogenital infectious and inflammatory processes. Of 60 patients with urolithiasis and chronic pyelonephritis exposed to extracorporeal shock-wave lithotripsy (ECSWL), 30 patients received additional anti-inflammatory therapy with Uroprofit. As shown by reduction of leukocyturia and crystalluria, increased 24-h diuresis in patients with urolithiasis after exposure to ECSWL, a positive effect was achieved on urethral inflammation. Thus, Uroprofit phytotherapy has antiinflammatory, diuretic, lithokinetic effects which makes it appropriate for treatment and prophylaxis of infectious-inflammatory process in the urethra.

[Combined treatment of patients with prostatic adenoma and overactive bladder].

Of late, we observe a trend to a progressive rise of overactive bladder (OB) morbidity with age. M-cholinolytic drugs are most effective in management of OB but old patients with prostatic adenoma (PA) and comorbid pathology have a risk of acute urinary retention and serious side effects. We have the experience in combined treatment of 30 old patients with PA and OB with M-cholinolytic and alpha-adrenoblocker. The results of the treatment show its efficacy and absence of complications in the control of residual urine for 3 months. Combination of M-cholinolytic with alpha-adreboblocker significantly reduced daily diuresis, improved an accumulation function of the bladder and life quality.

[Tamsulosin in combind treatment of patients with urolithiasis].

In administration of tamsulosine (focusin, Zentiva, Czech Republic) in combined treatment of urolithiasis concrement evacuation after extracorporeal lithotripsy occurred in 83% cases in patients with the concrement stay in the ureter for less than one month. The size of the concrement after successful lithotripsy had no significant effect on subsequent stone-eliminating therapy but long-term stay of the concrement in one place promoted inflammatory and urodynamic disturbances in the ureter treated surgically. The comparative analysis of the contractile function of the distal ureteral comparment in patients given tamsulosin showed a less active (amplitude of the contractions) and passive (tonicity) resistance to urine flow than in patients given a standard therapy. These changes were accompanied with lower pressure in the renal pelvis and suppression of enzymuria. Thus, tamsulosin addition to combined treatment of urolithiasis has a positive effect on ureteral urodynamics, concrement evacuation and functional structures of the kidney by indirectly lowering intrapelvic pressure.

[Optimisation of early diagnosis of prostatic diseases in megapolis setting].

One of the aims in the strategy of Moscow health service is perfection of early diagnosis of urological diseases. Examination of about 1.500000 males over 50 years was conducted in 2002-2007. The number of PSA tests rose 5-fold for 5 years. The number of ultrasonographies and transrectal ultrasonic investigations of the prostate rose from 21650 (2002) to 128890 (2007), the number of polyfocal biopsies--from 2165 (2002) to 12219 (2007). The rate of detection of prostatic diseases increased from 1146 cases per 100000 adult male population (1999) to 2097 (2007). Chronic prostatitis was registered in 17.8%, prostatic adenoma in 29.6% examinees, new cases of prostatic cancer were detected in 0.86% examinees. Standard prostatic cancer morbidity rose from 30.4 to 47.0 per 100000 male population. Percentage of early detected prostatic cancer increased from 42.9% in 2000 to 62% in 2007, detection of prostatic cancer stage III-IV reduced from 27.3% in 2000 to 16.6% in 2007. Thus, new prophylactic measures improved efficacy of outpatient urological service, raised rate of detection of chronic prostatitis, prostatic adenoma, prostatic cancer