[Onto-phylogenetic prerequisites for development of chronic cystitis in women].

INTRODUCTION: Urinary tract infections (UTIs) are among the most common bacterial infections. At the request "cystitis", there are 12,067 publications in the RSCI system (e.library) as of 10/08/2023 and 16,332 articles were screened in the Pubmed. This is evidence that the problem of cystitis is far from being resolved. MATERIAL AND METHODS: A total of 425 patients with bacterial vaginosis and 77 women with chronic recurrent cystitis were included in the study. In all patients, the vaginal biocenosis was assessed through molecular genetic testing. The examination included filling out the Russian version of the Acute Cystitis Symptom Score (ACSS), urinalysis, and urine culture. In addition, local microcirculation was measured using laser Doppler flowmetry (LDF). After examination, patients were prescribed basic therapy and randomly assigned to one of three groups. In a control group (n=17), only basic therapy, consisting of fosfomycin 3.0 once at night + furagin 100 mg after meals 3 times a day for 5 days was prescribed. In the main group 1, 29 women received basic therapy plus Superlymph suppositories 10 units 2 times a day vaginally for 10 days. In the main group 2, 31 patients received basic therapy plus suppositories Superlymph 10 units (rectally in the morning) and Acylact Duo (vaginally in the evening) for 10 days. RESULTS: Among 425 patients with bacterial vaginosis, 78 (18.3%) complained of various urinary disorders, but only 21 women (4.9% of those with vaginal dysbiosis and 26.9% with dysuria) had a diagnosis of cystitis. In all cases, it was an exacerbation of a chronic disease. Among 77 patients with chronic cystitis, normal vaginal flora was initially present in 32 patients (41.6%), and bacterial vaginosis was found in 45 (58.4%) cases. After therapy, positive results were noted in patients of all groups. Complete eradication of the pathogen occurred in 15 women (88.2%) who received only basic therapy; in the main groups 1 and 2, uropathogens were not detected in 27 (93.1%) and 28 (90.3%) cases, respectively. In the control group, the proportion of patients with normal vaginal flora remained virtually unchanged (41.2% [n=7] vs. 47.1% [n=8]). In the main group 1, the proportion of patients with normal vaginal flora almost doubled: from 41.4% (n=12) to 79.3% (n=23). In main group 2, restoration of vaginal flora was noted in 87.1% of cases. CONCLUSION: According to our data, only 4.9% of patients with bacterial vaginosis were diagnosed with chronic cystitis, however, 58.4% of patients with chronic cystitis had vaginal dysbiosis. The use of a complex of antimicrobial peptides and cytokines has significantly increased the bidirectional effect of therapy. Suppositories Superlymph in a combination with vaginal use of Acylact Duo allow to obtain the best results.

[Chronic cystitis: how to prolong the relapse-free period?]

INTRODUCTION: Chronic cystitis predominates in the structure of urinary tract infections (UTIs). International guidelines are mainly focused on the treatment of acute uncomplicated cystitis; the approaches for managing patients with chronic cystitis has not been sufficiently developed. MATERIAL AND METHODS: A total of 91 patients were included in prospective multicenter randomized comparative controlled study. They were divided into three groups. In the group 1, 32 women received only standard antibiotic therapy for 5 days. In the group 2, 28 patients (received standard therapy plus rectal suppositories Superlymph 25 IU 1 time per day for 10 days). In the main group, 31 women received standard therapy in combination with the use of rectal suppositories Superlymph at a dose of 10 IU 1 time per day for 20 days. Standard antibiotic therapy included fosfomycin trometamol 3.0 g once and furazidin 100 mg three times for 5 days. To assess the long-term results, patients were invited for a follow-up 6 months after the end of therapy. AIM: To determine the long-term results of combined etiologic and pathogenetic therapy, including Superlymph rectal suppositories at a dose of 10 U and 25 U, in patients with chronic cystitis. RESULTS: Six months later, 82/91 (90.1%) women were examined to assess the long-term results. At 6 months, in group 1 a relapse of the cystitis developed in 17 women (60.7%) after an average of 67.3+/-9.4 days. In group 2, recurrence was observed in 12 patients (44.4%), and the relapse-free period was longer, averaging of 84.3+/-9.2 days. The best results were demonstrated in the main group, in which the relapse-free period lasted an average of 123.5+/-8.7 days, and a relapse developed in only 8 cases (29.6%). In 19 patients (70.4%) there were no symptoms after six months. Differences between groups were highly significant (p<0.001). In all groups, none of the patients had more than one recurrence of the cystitis during the follow-up. CONCLUSION: Combined antibiotic therapy results in the absence of recurrence within six months in 39.3% of patients with chronic cystitis. Complex etiologic and pathogenetic therapy, including Superlymph rectal suppositories, allows to significantly reduce the number of recurrences and prolong the relapse-free period. Among the patients who received a course of local cytokine therapy at a dose of 25 units for 10 days, 55.6% did not have a recurrence of chronic cystitis within 6 months. In the group of patients who, along with etiologic therapy, received Superlymph rectal suppositories at a dose of 10 IU for 20 days, a relapse was absent in 70.4% of patients.

Structural and Functional Bases of Genitourinary Syndrome of Menopause.

We performed a comprehensive clinical and morphological examination of 70 menopausal patients aged 42-62 years with dysuria and chronic pelvic pain. Assessment of the bladder and vaginal microcirculation by laser Doppler flowmetry in menopausal patients with genitourinary syndrome revealed reduced (by 12-65%) microcirculation parameters. Analysis of the quantitative and qualitative composition of the bacterial microflora of the urethra and vagina revealed abnormalities of microbiota of varying severity, which can be the cause of infectiousinflammatory processes in the pelvic organs leading to chronic pelvic pain syndrome and incontinence. During menopause, the genitourinary syndrome in women is associated with the combined development of atrophic changes in the bladder and uterine mucosa that by their morphological characteristics differ from age-related involutive changes. Atrophy (hypoplasia) of the endometrium and bladder mucosa develops against the background of pronounced fibrosis and is accompanied by hyperemia and hemorrhages.

Ultrastructural Analysis of Urethral Polyps against the Background of Urogenital Infection.

We performed an electron microscopic study of samples of urethral polyps obtained from 90 women (mean age 52.5±4.9 years). According to PCR and culture studies, the most common infectious agent in patients with urethral polyps is U. urealyticum (100% cases). In 70% cases, this infectious agent was present as monoinfection, of these, clinically significant concentration (>106 CFU/ml) were found in 53.3% cases. In 30% cases, associations with C. trachomatis, T. vaginalis, and M. genitalium were found. We observed significant ultrastructural heterogeneity of the epithelial cells in urethral polyps, which manifested in a combination of hyperplastic and metaplastic changes and signs of cytodestruction. Detection of mycoplasma-like bodies in connective tissue mononuclear cells and viral particles in epithelial cells during ultrastructural study, including cases with negative PCR results, indicates the pathogenetic role of latent infection in the formation of urethral polyps.

Status of the Microcirculatory Network as a Factor of Prognosis and Evaluation of Therapeutic Efficiency in Prostate Cancer Treated by High-Intensity Focused Ultrasound in Combination with Androgen Deprivation.

Immunohistochemical and morphometric analysis of the microcirculatory bed in the tumor and non-tumor parenchyma of the prostate was carried out with the use of endothelial cell marker CD34 in patients treated by high-intensity focused ultrasound (HIFU). The numerical density of microvessels in the adenocarcinoma focus did not correlate with the degree of its differentiation, while high values of this parameter were associated with lower incidence of local progression after HIFU. Effective HIFU ablation led to progressive fibrosis and significant reduction of the microcirculatory bed in zones of intact non-tumor glands in control samples; an inverse relationship between the degree of reduction of the microcirculatory bed and the probability of relapse was revealed. The use of HIFU in combination with androgen deprivation was associated with a decrease in numerical density of microvessels in zones of tumor and non-tumor parenchyma in patients with relapses.

[Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women].

AIM: To evaluate the effectiveness of a new method of treatment for stress urinary incontinence in women using an ER: YAG laser in SMOOTH mode and investigate pathophysiological and pathomorphological changes induced by erbium laser. MATERIALS AND METHODS: This study comprised 98 women aged 37-63 years, who between 2014 and 2016 were diagnosed with SUI (type 1 and 2a, 2b) and grade 0-2 vaginal prolapse. The treatment was performed with a 2940 nm Er:YAG laser (Fotona, Slovenia) using a SMOOTH mode. Clinical assessment included PFIQ-7 and PISQ-12 questionnaires, uroflowmetry, laser Doppler flowmetry and biopsy of the anterior vaginal wall. The examination was carried out at baseline and 1-2 months after the treatment. RESULTS: The effectiveness of treatment was 73%. There was no deterioration after the procedure. Analysis of PFIQ-7 and PISQ-12 questionnaires showed that patients with mild incontinence had the greatest difference between pre- and posttreatment results. Uroflowmetry parameters improved in a majority of patients. Results of laser Doppler flowmetry demonstrated the improvement of blood flow in the microvascular bed. An important feature of the vaginal biopsy after laser exposure was an increase in neoangiogenesis. DISCUSSION: The findings of questionnaires and clinical evaluation of patients with SUI and vaginal prolapse before and after treatment with Er: YAG laser showed high therapeutic effectiveness of this treatment modality. CONCLUSION: Clinical effectiveness of ER: YAG laser in SMOOTH mode was 73%. Patients with type 1 and 2a SUI and mild or moderate incontinence have the best prognosis after treatment with this method.

[The effects of combination therapy with 5-reductase inhibitor and -blocker on the prognosis of BPH].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a polyethological disease of elderly and old men. The symptomatic pharmacological treatment of BPH involves the use of drugs that reduce either the dynamic component of obstruction or the size of the prostate (a mechanical component of obstruction). 5-reductase inhibitors (5-ARI) and -blockers are considered first-line therapy in the management of prostate adenoma. AIM: To investigate the efficacy of combination therapy with Fokusin and Penester in BPH patients. MATERIALS AND METHODS: The study is based on the analysis of medical records of 67 BPH patients aged over 50 years. All patients included in the study were randomized to 3 groups and had comparable age, sex, clinical manifestations and severity of the disease. Group 1 comprised 21 patients (mean age 63.8+/-9.7 years), who received a 5-reductase inhibitor (5-ARI) Pentester (Sanofi, France) 5 mg once daily. Group 2 included 22 patients (mean age 65.2+/-7.8 years), who received an -blocker Fokusin (Sanofi, France) 0.4 mg once a day. Group 3 comprised 24 patients (mean age 64.2+/-8.6 years) who received combination therapy with 5-reductase inhibitor (5-ARI) (Penester 5 mg once daily) and blocker (Fokusin 0.4 mg once daily). RESULTS: The study findings showed that in comparison with monotherapy, the concurrent administration of Fokusin and Penester was more effective in reducing the clinical manifestations of BPH, slowing the growth of adenomatous tissue thus reducing the size of the enlarged prostate. CONCLUSION: Combination therapy with Fokusin and Penester can be recommended to improve the treatment results of BPH patients.

[Morphological changes in tumor and nontumor tissue in the treatment of prostate adenocarcinoma with high-intensity focused ultrasound in combination with androgen deprivation]. / Morfologicheskie izmeneniia opukholevoi i neopukholevoi tkani pri lechenii adenokartsinomy predstatel'noi zhelezy vysokointensivnym fokusirovannym ul'trazvukom v sochetanii s androgennoi deprivatsiei.

OBJECTIVE: To investigate structural changes in the tumor and nontumor tissues of the prostate in patients with its cancer (PC) after treatment with high-intensity focused ultrasound (HIFU) in combination with androgen deprivation to clarify criteria for evaluating the efficiency of treatment. SUBJECT AND METHODS: Comparative morphological, immunohistochemical, and morphometric analyses were carried out to examine 253 pre- and postoperative biopsy specimens, as well as transurethral resection specimens from 32 patients with localized PC and with or without a local recurrence within 3 years after a HIFU session. RESULTS: HIFU ablation was accompanied by coagulation necrosis and progressive pancreatic fibrosis with complete tumor regression or by a reduction in the number of positive columns (by an average of 58%) in cases with recurrence. An inverse relationship was found between the degree of a reduction in the nontumor parenchyma in the control specimens and the probability of a recurrence - a less than 20% reduction in the non-tumor glands corresponded to a 3.4-fold increased risk of tumor progression. The development of recurrence was associated with less differentiated PC (GS ≥4+3) and the presence of cribriform structures in the pretreatment samples. Combined androgen deprivation as the maximum blockade was associated with the most pronounced signs of therapeutic pathomorphism, with a reduction of the microcirculatory bed in the focus of residual tumor, and a decrease in the frequency of local progression. CONCLUSION: Neoadjuvant hormone therapy contributes to the enhanced efficiency of HIFU treatment for PC. A less than 20% reduction in nontumor parenchyma volumes in the control biopsy specimens may indicate insufficient ablation in pancreatic tissue and serve as a marker for increased risk of local progression.

[Afalaza in the management of patients with chronic pelvic pain syndrome].

INTRODUCTION: Currently, chronic pelvic pain syndrome (CPPS) is one of the most prevalent urological diseases, but due to the multifactorial nature of the disease and the lack of consensus on its pathogenesis, the issue of adequate therapy remains open. Since the vascular factor plays the major role in the pathogenesis of CPPS, we hypothesized that this category of patients has microcirculatory disturbances of the prostate. AIM: Detection of microcirculatory disturbances of the prostate, their correction, and evaluation of the effect on the course of CPPS. MATERIALS AND METHODS: The study comprised 60 healthy, sexually active men with clinical manifestations of CPPS lasting from 6 months to 5 years. After a comprehensive examination, all patients received Afalaza 2 tablets twice daily for 16 weeks. At the end of week 16, patients were re-examined. RESULTS: In patients with CPPS, therapy with Afalaza resulted in a significant improvement in microcirculation in the prostate thus leading to the reduction of the severity of disease manifestations.

[Immediate and long-term effectiveness of combined application of magnetolaser therapy and red light in complex treatment of patients with chronic nonbacterial prostatitis].

The aim of the study was to increase the efficiency of complex treatment of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with the combined effect of magnetolaser therapy (MLT) and red light. MATERIALS AND METHODS: We examined and included in the study 120 men with a verified diagnosis of CP/CPPS (III B), at the stage of exacerbation. By envelope method, patients were divided into two randomized groups. The main group consisted of 60 patients who received a basic treatment complex, including medicamentous therapy, prostate massage, diet therapy, a complex of therapeutic gymnastics, and the combined effect of MLT and red light of 10 procedures per course. The comparison group consisted of 60 patients who received only a basic therapeutic complex. Evaluation of the effectiveness of treatment was carried out in dynamics before complex treatment, immediately after the course of treatment and 6 months later for analysis of long-term results using the questionnaire "System of summary evaluation of chronic prostatitis symptoms", dopplerography of urethral arteries of the prostate, laser Doppler flowmetry in the prostate. RESULTS AND DISCUSSION: In the main group of patients with CP/CPPS immediately after complex treatment and after 6 months, a positive therapeutic effect was noted in the form of relief of pain syndrome, dysuria, improving the quality of life, improvement of blood circulation in the urethral arteries of the prostate and microcirculation. In the comparison group, the positive effects from the complex baseline treatment were less pronounced. Comparative analysis of the results of the study between the main group of patients with CP/CPPS and comparison group showed the presence of statistically significant differences in all indicators of clinical symptoms of the disease, dopplerography in the urethral arteries of the prostate and microcirculation in the prostate, both immediately after treatment and after 6 months of follow-up. CONCLUSION: The method of complex treatment of patients with CP/CPPS with the combined effect of MLT and red light has greater immediate and remote efficacy in comparison with baseline treatment.

[Patients with newly diagnosed benign prostatic hyperplasia].

The study aimed to characterize patients with newly diagnosed benign prostatic hyperplasia (BPH) and identify patterns that lead to late diagnosis of the disease. STUDY DESIGN: Simple open retrospective non-comparative study. MATERIAL AND METHODS: To determine the frequency of requests for medical care for BPH, the study analyzed medical records of 3544 patients who sought outpatient urological care at the municipal polyclinic # 26 in Novosibirsk in 2013. Outpatient medical cards of 165 patients with newly diagnosed BPH were analyzed. RESULTS: Among 3544 patients seen by the urologist of the polyclinic, 960 (27.1%) had BPH. Analysis of medical records of 165 men with newly diagnosed BPH showed that the disease was associated with age. The shortest duration of the disease (0.8+/-0.5 years) was noted in patients under 50 years old, the longest (4.7+/-2.1 years) in men over 70 years old. The smallest prostate volume was 32 ml, the largest 150 ml. The mean size of the gland naturally increased with age. The mean PSA level also naturally increased with age: from 1.1+/-0.8 ng/ml in individuals up to 50 years to 3.0+/-0.7 ng/ml in patients older than 70 years. The maximum IPSS was in the 61-70 year age group (16.7+/-5.9 points); the minimum IPSS was in the age group up to 50 years (9.5+/-3.6 points). The duration of the symptoms directly correlated with the prostate volume. At the prostate volume of 60 ml and more, symptom scores showed a 1.5 fold increase. In married patients, the mean IPSS was 13.8+/-5.4, while in single men it was 16.3+/-5.5 (p=0.008). CONCLUSION: Patients with BPH account for 27.1% of all patients seeking urological care at the polyclinic. In young men, symptom severity is lower than that in senior men. However, the elderly are more concerned about their symptoms, they have worse quality of life, and they seek medical attention earlier. Married patients are more likely to see a urologist with significantly less severe symptoms than single men.

[The effectiveness of Uroprofit in women with chronic cystitis].

AIM: To evaluate the effectiveness of the biologically active dietary supplement Uroprofit in the comprehensive management of exacerbations of chronic recurrent cystitis in women. MATERIALS AND METHODS: We examined 40 women with chronic cystitis aged 20-68 years. All patients were allocated to receive either monotherapy with fosfomycin (Monural) (control group, n=20) or combination therapy with fosfomycin and biologically active dietary supplement Uroprofit (study group, n=20). The results were evaluated at 1 and 2 months after treatment initiation. All patients before and after treatment underwent diagnostic work-up including standard laboratory tests, uroflowmetry, cystometry, cystoscopy, and laser Doppler flowmetry to assess microcirculation. RESULTS: The patients of the study group showed faster improvement in clinical manifestations of the disease, laboratory indicators, the dynamics of the endoscopic pattern and had positive changes in the bladder mucosa microcirculation. DISCUSSION: Uroprofit produces an antimicrobial and anti-inflammatory effect, helps normalize urodynamics of the lower urinary tract, improves microcirculation in the bladder wall and reduces the risk of repeated relapses of chronic cystitis. CONCLUSION: Uroprofit could be recommended as a component of the comprehensive management of exacerbations of chronic recurrent cystitis in women and as the means of preventing relapses in disease-free periods.

Study of Proliferative Activity of Vaginal Epithelium in Women with Stress Urinary Incontinence Treated by Er:YAG Laser.

The expression of Ki-67 proliferation marker was studied in vaginal biopsy specimens from women with stress urinary incontinence treated using a Fotona nonablative erbium laser. Cells expressing Ki-67 were located in all cases in the parabasal and basal levels of stratified squamous epithelium, the index of labeled nuclei before Er:YAG laser exposure was 19.05±2.86%. After 1-2 months of laser therapy, the index of labeled nuclei in the epithelium increased significantly and reached 31.79±2.25%. These changes were interpreted as a result of epithelial-stromal interactions. Presumably, the increase in proliferative activity of the vaginal epithelium after exposure to Er:YAG laser was due to the presence of an appreciable level of synthetically active fibroblasts in the subepithelial stroma.

[Cryopresipitate in comprehensive conservative therapy of patients with acute purulent pyelonephritis].

AIM: To investigate the effectiveness of cryoprecipitate in the comprehensive conservative therapy of patients with acute purulent pyelonephritis. MATERIALS AND METHODS: We conducted a retrospective analysis of medical records of patients who were diagnosed with acute non-obstructive pyelonephritis from 2007to 2015. During this period, a total of 3912 patients with acute non-obstructive pyelonephritis were treated at the Department of Urology. Patients were assigned to either receive or not receive cryoprecipitate in the comprehensive conservative therapy. The comprehensive conservative therapy of both groups included antibacterial agents, detoxification, anti-inflammatory therapy. In the study group, patients received additional treatment with cryoprecipitate. By that way we estimated the number of patients who avoided surgery in both groups. RESULTS: There were 3912 patients divided into two groups. The first group included 756 patients (19.3%) who received cryoprecipitate in the comprehensive therapy of pyelonephritis. Of them, 735 patients (97.3%) did not require surgical treatment, and only 21 patients (2.7%) underwent surgery. The second group comprised 3156 patients (80.7%) who did not receive cryoprecipitate. Of them, 2974 patients (94.2%) were treated conservatively without surgical intervention and 182 patients (5.8%) received conservative therapy concurrently with surgical treatment. Therefore, including cryoprecipitate in the comprehensive conservative therapy of acute non-obstructive pyelonephritis results in twice smaller percentage of patients (2.7% vs 5.8%) requiring surgery compared to the comprehensive conservative therapy alone.

[X-ray-guided endovascular surgery in patients with benign prostatic hyperplasia and prostate cancer].

AIM: To evaluate the efficacy and safety of superselective embolization and chemoembolization of the prostatic artery as an independent method of treating prostate cancer and BPH. MATERIALS AND METHODS: From 2004 to 2015, 116 patients with BPH (mean age 73.2+/-5.2 years) underwent prostatic artery embolization. Mean prostate volume ranged from 55 to 296 cc3. From 2011 to 2015, 37 patients with prostate cancer (mean age 72.3+/-2.06 years) were treated with X-ray-guided endovascular chemoembolization. All patients had confirmed PCa, of whom 7 had stage T2a and 30 stage T2c disease. PSA ranged from 0.8 to17 ng/ml (mean 13.1+/-3.9). Prostate volume ranged from 61 to 93 cc3 (mean 69.4+/-9.3). The follow-up ranged from 8 to 42 months. RESULTS: Prostatic artery embolization in BPH patients resulted in a significant reduction in IPSS symptom score and increase in Qmax. The volume of prostate and nodular mass decreased on average by 53% and 47%, respectively, maximum by 82%. Chemoembolization was effective in 31 (83.7%) patients. An objective response was achieved in reducing the PSA level and prostate volume measured by TRUS, and improved urination. The median PSA at 6 months was - 3.4 +/- 0.02 ng/ml. In all patients, chemoembolization resulted in a marked reduction in the prostate volume. The greatest decrease in the prostate volume was observed at 6 months after treatment. Chemoembolization led to a marked improvement in the quality of urination confirmed by uroflowmetry and IPSS symptom scores. At 12 months, 16 patients with prostate cancer underwent the follow-up biopsy. In 12 cases pathology showed fibrosis and epithelial degeneration without signs of atypia and in 2 cases curative pathomorphosis was observed. Chemoembolization was well tolerated and did not cause any significant complications. CONCLUSION: Embolization techniques for BPH and chemoembolization for localized PCa showed good effectiveness and safety in patients who had medical contraindications to traditional treatments.

Structural Reorganization of the Vaginal Mucosa in Stress Urinary Incontinence under Conditions of Er:YAG Laser Treatment.

Structural characteristics of the vaginal mucosa in stress incontinence and its correction by IncontiLase technology were studied. Studies of vaginal biopsy specimens before the exposure showed degenerative and atrophic changes in the stratified squamous epithelium, disorganization of fibrillar structures of the intercellular matrix, and microcirculatory disorders. Studies after Er:YAG laser exposure showed signs of neocollagenogenesis and elastogenesis, foci of neoangiogenesis, reduction of epithelial degeneration and atrophy, and an increase of the fibroblast population. Morphometry showed that the volume density of blood capillaries and the thickness of the epithelial layer increased by 61.1 and 64.5%, respectively. The use of IncontiLase technology in stress incontinence led to structural reorganization of the vaginal mucosa, improving its morphology and function and alleviating the symptoms of incontinence.

Pathogenic Features of Dysuria in Young Women with Secondary Amenorrhea Caused by Body Weight Loss.

We examined 11 women aged 19-26 years (mean age 22.5±3.5 years) with secondary amenorrhea complaining frequent urination over 1.5 years and repeatedly, but unsuccessful treated for overactive bladder and chronic cystitis. The rare cause of sustained urination disorders in young female patients of reproductive age was established: development of secondary amenorrhea caused by weight loss ("cosmetic" amenorrhea) with subsequent estrogene deficit and urogenital atrophy. Morphological examination of the bladder mucosa, an important clue to the diagnosis, helps to identify the true cause of dysuria, urogenital atrophy of the bladder mucosa, in secondary ("cosmetic") amenorrhea, and determine future course of etiopathogenic treatment of sustained dysuria in young women. The treatment is often effective in case of proper and timely diagnosis and the absence of irreversible changes.

[Effect of hypercapnic hypoxia on chronic abacterial prostatitis].

AIM: To improve treatment results of patients with CAP using hypercapnic hypoxia as a part of an integrated therapy. MATERIALS AND METHODS: The study involved 37 men aged 20 to 50 years diagnosed with CAP. The subjects were randomly divided into 2 groups. The control group consisted of 17 (46%) patients who received only the basic therapy. The study group comprised 20 (54%) patients, who were treated with the basic therapy combined with a course of 10 treatment sessions of hypercapnic hypoxia using a respiratory device. Two study visits were organized before and after treatment, including medical history, physical examination, filling out questionnaires, DRE and TRUS of the prostate, uroflowmetry and laser flowmetry. RESULTS: In the both groups, the treatment resulted in reduction or relief of pain and dysuria that is a natural effect of the standard therapy. However, the study group showed significantly greater improvement. The findings of DRE and TRUS of the prostate in the study and control group did not differ significantly; the size of hypoechoic areas in the prostate decreased in the both groups. Laser flowmetry showed improvement in microcirculatory disturbances of the prostate, which were observed before treatment. CONCLUSION: Basic therapy has a clinical effect, but it is limited regarding hemodynamics and microcirculation of the prostate. These indices are lower than in the study group. Thus, the study findings show a high clinical efficacy of hypercapnic hypoxia as an add-on therapy in treating patients with CAP. There was a significant decrease in clinical manifestations of the disease which was caused by improving microcirculation. This resulted from improved blood circulation, increased blood perfusion and blood volume in the arterioles, increased blood inflow in the microcirculatory system, reduced tissue hypoxia and ischemia, improved blood flow regulation. The findings of the present study give us ground to recommend training using breathing simulator "Karbonik" in the combination therapy of patients with CAP, which significantly increases the treatment effectiveness.

[Estrogen deficiency and urinary incontinence in menopausal women].

By analyzing relevant domestic and international literature and their own long-standing experience, the authors discuss the problem of urinary incontinence in the context of estrogen deficiency. They outline the conservative management of patients with mild incontinence and recurrent forms after plastic surgery with taking into account the morphological findings of paraurethral tissue.