[Therapeutic efficacy and safety of monotherapy Alfuprost MR 10 mg/day in clinical practice].

INTRODUCTION: Alpha-blockers are the first-line therapy for men with BPH/LUTS. They have similar efficiency, but different uroselectivity. Therefore, when choosing a-blockers, their safety and adverse events should be taken into account. AIM: To evaluate the efficiency and safety of using Alfuprost MR 10 mg/day for 12 months in clinical practice. MATERIALS AND METHODS: A total of 55 men aged 55-80 years with BPH/ LUTS were included in the study, which was carried out on the basis of 6 outpatient clinics in St. Petersburg from June 2020 to September 2021. Along with standard methods, the examination included an assessment of male sexual function, hemodynamic parameters, and satisfaction with the treatment of patients and physicians using the Likert scale. The follow-up scheme included 7 visits (every 60+/-5 days) and lasted 12 months. RESULTS: After 2 months of therapy with Alfuprost MR, a significant decrease in the number of patients complaining of pain was observed. The proportion of patients with urgency and difficulty with urinating decreased by 50% and 30%, respectively. By the end of the treatment, the total IPSS score decreased by 1.9 times and averaged 9.98 points, the quality of life improved by 2.5 points, the average maximum urine flow rate significantly increased by 1.4 times, reaching 17.4 ml/sec, and the post-void residual volume decreased to 12.5 ml (3.8 times). By the last visit, there was a decrease in prostate volume by 4.3%. Moreover, the proportion of patients with an initial level of total PSA 2.5-4 ng/ml decreased by 25.4%. The level of PSA after treatment less than 2.5 ng/ml was seen in 70.9% of cases. All patients were satisfied with the treatment after 2 months, as well as investigators at visit 5. There was a significant improvement in all components of the sexual function, especially erectile function. In addition, there were no significant changes in ejaculation. CONCLUSION: Long-term therapy with Alfuprost MR 10 mg/day has high therapeutic efficacy and safety in elderly patients with LUTS/BPH, regardless of comorbidities.

[Assessment of the safety and efficacy of medicinal product PPR-001 based on regulatory polypeptides of the testes].

OBJECTIVE: Evaluation of the effectiveness and safety of the drug PPR-001 (lyophilizate) in comparison with placebo in men with impaired spermatogenesis. MATERIALS AND METHODS: This study was a randomized, double-blind, placebo-controlled, prospective, multicenter, parallel-group research. RESULTS: It was found that the drug has clinical efficacy and a positive effect on the concentration of spermatozoa in the ejaculate, the percentage of progressively mobile forms and the number of morphologically normal forms of spermatozoa was increased in the group of PPR-001. The primary end point was defined as a proportion of patients who had a therapeutic response (TO) at Visit 3. TO meant at least 20% increase in the concentration and/or progressive motility of spermatozoa compared to the baseline level. The hypothesis of Superiority of PPR-001 over placebo based on primary end point was confirmed (the limit of Superiority was more than 27%). In total, AEs were identified in 65 patients out of 100 (34 patients in the PPR-001 group and 31 patients in the placebo group). When assessing the number of patients who had AEs, there were no statistically significant differences between the groups. All identified AEs were of mild severity; during the study. No negative dynamics was found according to the results of the assessment of vital functions, biochemical and clinical blood tests, clinical urinalysis, ECG indicators. CONCLUSION: The study demonstrated the superiority of PPR-001 over placebo in terms of increasing concentration and motility of spermatozoa in the ejaculate. A significant increase in the number of morphologically normal forms of spermatozoa in the PPR-001 group was also revealed.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[Technical features of intestinal ureteroplasty. art 6: simultaneous ureteral and bladder substitution].

AIM: To present the results and technical features of different methods of simultaneous ileal ureteral and bladder substitution. MATERIALS AND METHODS: From 2001 to 2016, 154 patients (mean age 52+/-9.2 years) underwent ileal and appendicular ureteroplasty. Of them, 70 (45.4%) were men and 84 (54.6%) women. Among them, 49 (31.8%) patients underwent ureteroplasty concurrently with orthotopic ileocystoplasty. The Studers ileal-ureter cystoplasty and Y-shaped bladder and ureteral reconstruction were performed in 38 (77.5%) and 11 (24.5%) cases, respectively. RESULTS: Early postoperative complications occurred in 8 (16.3%) patients: 4 of them suffered recurrent bouts of pyelonephritis, 3 experienced an acute adhesive intestinal obstruction, and another one had a failure the right-sided pouch-ureteral anastomosis. Late postoperative complications occurred in 7 (14.3%) patients. Of them, 3 suffered recurrent bouts of chronic pyelonephritis, 2 developed a pouch-ureteral-pelvic reflux, and 2 had strictures of ileoureteral anastomosis, requiring antegrade dilation with ureteral stenting. CONCLUSION: Simultaneous ureteral and bladder substitution is one of the most challenging and traumatic surgical interventions. Sometimes, due to severe comorbidities, disorders of upper tract urodynamics and decreased renal function, two-stage surgery may be necessary. At the first stage, cystectomy with cutaneous ureterostomy should be performed, and then, after the patients stabilization ileal substitution of the bladder and pelvic parts of ureters may be done.

[Results of open and laparoscopic partial nephrectomy for localized renal cancer].

AIM: To compare the results of laparoscopic and open partial nephrectomy. MATERIALS AND METHODS: From February 2000 to June 2016, 178 patients (mean age 58.2 years) with stage T1 kidney tumors underwent partial nephrectomy. This cohort included 106 (59.5%) men and 72 (40.5%) women. Open partial nephrectomy was performed in 102 (57.3%) patients (group 1) and laparoscopic partial nephrectomy (LPL) - 76 (42.7%, 2nd group). The majority (92.2%) of patients underwent resection for elective and 14 (7.8%) for absolute indications. Preoperatively, 163 (91.6%) and 15 (8.4%) patients had stage T1a stage T1b, respectively. The tumor size ranged from 2.4 to 6.2 cm and from 2 cm to 5.4 cm in group 1 and 2, respectively. A comparative analysis included operative time, warm ischemia time, blood loss, duration of drainage and the length of hospital stay. RESULTS: Open partial nephrectomy was associated with shorter operative time (105 min versus 125 min) and warm ischemia time (14.5 vs. 20.8 min) compared with laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was characterized by a smaller blood loss (180 ml vs. 365 ml, p<0.05) and a shorter length of hospital stay (2.5 days vs. 5.6 days, p<0.05). One patient from each group was found to have positive surgical margins. CONCLUSION: Currently, laparoscopic partial nephrectomy is the method of choice for stage T1 kidney tumors. Despite the comparatively longer operative time and warm ischemia time, laparoscopic partial nephrectomy leads to faster patient recovery and fewer complications.

[Innovative activity of dental faculty staff of Omsk State Medical University: results, problems and prospects].

The article summarizes innovative activity in Omsk State Medical University (OSMU) and contains the review of innovative developments of staff of dental faculty of OSMU (a line of gels for caries prevetion, the DENTEST diagnostic unit, technology of tooth shape modular restoration, personified therapy.of patients with periodontal disease, caries diagnosis and periodontontal disease prognosis software, a set of the training materials on esthetic modeling of teeth, personification of clinical approaches in oral bioaesthetic rehabilitation, etc.). The analysis of the factors stimulating and complicating innovative detail in medical school, problems of introduction of medical innovations, lack of system of an assessment of medical technologies in Russia, regulations of the organization of innovative activity in medical schools is carried out, the prospects of their solution connected with decision-making at the state level are formulated.

[Endothelial and metabolic effects of perindopril in patients with essential hypertension].

OBJECTIVE: To elucidate endothelial and metabolic effects of perindopril and their interaction in patients with uncomplicated essential hypertension. METHODS: The study involved 30 patients treated with perindopril (5-10 mg/day) for 3 months. The following parameters were registered at baseline and at the end of the study: body mass index, waist circumference, blood lipids and glucose, flow-mediated vasodilation (FMVD) of brachial artery assessed by ultrasound. RESULTS: Treatment with perindopril was associated with significant improvement of FMVD (6.7 ± 4.1% versus 8.7 ± 5.4% at the end of the study, p<0.05) as well as decrease of blood triglycerides (-18%, p<0.05) and glucose (-9%, p<0.01) with no significant changes of other metabolic parameters. Correlation analysis showed no relationship between changes of FMVD and blood pressure during the study (r= -0.14, p=0.42 r= -0.13, p=0.46 for systolic and diastolic blood pressure, respectively) whereas inverse association was observed with changes of blood glucose (r= -0.50, p<0.01). CONCLUSIONS: Thus our data confirm the ability of perindopril to restore impaired endothelial function in patients with essential hypertension independently of blood pressure reduction and make possible to propose its positive metabolic effect relative to changes associated with insulin resistance. It seems that endothelial effect of perindopril may in part be related to diminished adverse influence of metabolic changes on vascular wall.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Extracorporeal partial nephrectomy for kidney neoplasms].

The results of 11 extracorporeal partial nephrectomies for neoplasm with subsequent autologous transplantation of kidney are presented. In 4 patients, resection was performed ex vivo in the presence of a large centrally located tumor in a solitary kidney. Another two patients had bilateral tumor process. In 2 patients, a large, centrally located tumor in solitary kidney was the indication for extracorporeal resection. 3 patients had elective indications for the operation. Early postoperative complications occurred in 5 patients. 3 patients had oligoanuria. One patient developed postoperative bleeding; one patient developed obliteration of the upper third of ureter. Recurrence of renal cell cancer has not been identified; the functional state of the kidney vessels and vessels of upper urinary tract was regarded as satisfactory. Good results of these operations indicate the feasibility of expanding the indications for extracorporeal organ-sparing surgery.

[Morphological and functional changes of organs of female and male reproductive systems at change of sex].

The aim of the study was to identify the effects of virilizing and feminizing hormone replacement therapy on the morphology and function of the male and female reproductive systems in the application of technology for change of sex. The results of the pathomorphorogic examination of the uterus with appendages, testes, the corpora cavernosa, and biopsies of the prostate and mammary glands at different times of treatment in transsexual patients aged from 22 to 43 years are presented. It was found that prolonged exposure to high concentrations of exogenous hormones in the women and men significantly increases the risk of tumors and tumor-like processes, such as endocervicosis, cervical intraepithelial neoplasia, metaplasia of the endometrium, endocervical and endometrial polyps, endometrial hyperplasia, proliferative processes in tubular epithelium, ovarian polycystic disease, mammary tumors, hyperplasia and metaplasia of the ductal epithelium of the prostate gland.

[First experience of monoport laparoscopic surgery in the treatment of kidney diseases].

The results of research on the effectiveness of monoport laparoscopic surgery for kidney disease are presented. Operations using LESS method (Laparo-Endoscopic Single-Site Surgery) were performed in 21 patients, including 14 nephrectomies and 7 cyst resections. In five cases, nephrectomy was performed due to terminal hydronephrosis, in two cases--due to presence of arteriolosclerotic kidney, in seven cases--due to renal cell carcinoma (T1a-bN0M0). "Pain DETECT" questionnaire was used for assessment of pain symptom. Maximum longitudinal size of a removed organ was 14 cm, the average volume of intraoperative blood loss--80 ml. Duration of monoport laparoscopic radical nephrectomies ranged from 125 to 230 min (mean duration, 164 min). The time for renal cyst resection ranged from 40 to 120 minutes. Moderate intensity pain was observed in all patients but only at the first day after surgery. The average hospital stay was 4 days. The length of postoperative skin scar varied from 2.5 to 6.0 cm. Early and late postoperative complications were not observed. During follow-up period 6 to 8 months, tumor or cyst recurrence were not registered.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Results of monopolar versus quasibipolar transurethral resection of the prostate and urinary bladder].

We compared efficacy and safety of mono- vs quasibipolar transurethral resection (TUR) for 198 patients treated with TUR. The patients were randomized into two groups by the TUR variant: mono-or quasibipolar. Comparison ofpre- and postoperative examinations data in the above two groups demonstrated: blood sodium decreased more in patients from monopolar TUR group, the absence of TUR-syndrome and less frequent and severe symptoms of obturator nerve irritation after quasibipolar TUR. Use of salt solution in quasibipolar TUR allowed us to avoid such a severe postoperative complication as TUR-syndrome. Thus, transurethral resection in physiological solution is an operation of choice in surgical treatment of prostatic adenoma and superficial cancer of the urinary bladder.

[Place of transurethral contact nephrolithotripsy in the treatment of patients with kidney stones].

Currently, the question of choosing the optimal treatment for patients with large (> 20 mm) concretions is still open. Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolitholapaxy (PNL) are the main methods for removing of such concretions, with efficiency of 45-63, and 86-100%, respectively. Development of semirigid and flexible endoscopes, the creation of new types of contact lithotriptors have expanded the possibilities for use of transurethral treatment of urolithiasis. Results of treatment of 63 patients who underwent transurethral nephrolithotripsy (TUNL) for the large concretions in pelvicalyceal system (PCS) were analyzed. Selection of energy type for contact lithotripsy depended on the location, size, density of stone and type of uretherorenoscope. According to ultrasound and urography data after 30 days, stones and their fragments in the urinary tract were not found in 36 (57.1%) patients, clusters of small residual fragments were identified in 21 (33.3%) patients. In these cases, the stent was removed. During re-examination at 3 months, the full discharge of the fragments was observed in 19 (90.5%) of 21 patients. A separate group consisted of 6 (9.52%) patients, in whom residual concrements in PCS of operated kidneys were found after 30 days. In this group, two patients underwent one session of ESWL; repeated endoscopic interventions were performed in other patients, culminating in the complete removal of stone from PCS. According to the ultrasound and x-ray examinations, 55 (87.3%) patients achieved full exemption from concretions in PCS and urinary tract after 60 days. Thus, TUNL in the treatment of large and multiple kidney stones is comparable with ESWL and PNL on clinical efficacy, and in some clinical situations can be considered as a method of choice for surgical treatment of nephrolithiasis.

[Western blot as a confirming test in the laboratory diagnosis of syphilis].

Two hundred and ninety-five patients who had been found to have Treponema pallidum antibodies detected by enzyme immunoassay were additionally studied by a Western blot test to confirm their presence. Every four cases were ascertained to be false-positive, false seropositivity being more frequent in the presence of IgM antibody against T. palladium. Spinal fluid analysis provided evidence for the course of neurosyphilis in 5 cases. The diagnosis of congenital syphilis was verified in 2 children who had p15, p17, p45, and 47. The findings demonstrate it necessary to extensively use a Western blot in the health care system.

[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.

[Vaginoplasty with inverted penile skin in male-to-female sex reassignment surgery].

The article presents the results of vaginoplasty in male-to-female sex reassignment surgery, technique of this operation, complications, long-term consequences, functional and social changes.

[Radiodiagnosis of early-stage nephroangiopathy in children with arterial hypertension].

A total of 115 children aged 13-17 years (mean age 15.77 +/- 1.89 years, 98 boys and 17 girls) with essential arterial hypertension (EAH) were examined. Of them, 70 children had stable arterial hypertension (SAH), 45 children - labile arterial hypertension (LAH). 24-h monitoring of blood pressure, triplex ultrasound study of the renal vessels were performed in all the patients. The assessment of renal hemodynamics showed that blood flow was more active in SAH patients. The clinostatic test revealed inhibition of circulation at the level of the basic trunk (by 26% in SAH and by 22% in LAH) and segmentary renal arteries (by 28% in SAG), IR ( < 0.52). The above findings confirm the action of arterioveinous bypass blood flow mechanism and provide diagnosis of nephroangiopathy at early stages of EAH.