[Hydrophilic and lipophilic nutrients for the treatment of male idiopathic infertility: a randomized, comparative, open-label, multicenter, prospective, controlled study].

INTRODUCTION: the efficiency of nutrient therapy for idiopathic male infertility remains controversial. In particular, it is not unclear if hydrophilic or lipophilic nutrients are more effective. AIM: to compare the efficiency of a complex containing hydrophilic components (L-carnitine, zinc, selenium, vit. C, etc.) with a complex of lipophilic nutrients (docosahexaenoic and other omega-3 acids, vitamin E) in men with idiopathic subfertility. MATERIALS AND METHODS: a randomized, comparative, open-label, prospective, controlled, multicenter study was carried out. A total of one hundred and sixty patients with idiopathic oligo-, and/or astheno-, and/or teratozoospermia aged 18-45 years were randomized into three groups. In the group 1, patients received a complex of mainly hydrophilic nutrients (BESTFertil dietary supplement, 4 capsules per day), while in group 2 lipophilic nutrients (dietary supplement "BrudiPlus", 3 capsules per day) were prescribed. In the group 3 (control) patients didnt receive any treatment. All participants were given recommendations for a healthy lifestyle. Sperm analysis, sperm DNA fragmentation, and achievement of pregnancy were evaluated at baseline and after 3 months. RESULTS: 27 patients did not have a follow-up visit due to pregnancy achievement or other reasons, or were excluded from the study since pyospermia was detected or compliance was poor. Patients of group 1 (n=46) who remained in the protocol had an increase in sperm concentration by 16 million/ml (+ 41% vs. baseline; p=0.046), in comparison to 3 million/ml (+ 7% vs. baseline; p>0.05) in group 2 (n=45) and a slight decrease by 0.5 million/ml in the group 3 (n=42; - 1.2% vs. baseline; p>0.05). Positive changes were seen in 63, 58 and 52% of cases, respectively (in all cases, p>0.05). DNA fragmentation in all groups changed in similar fashion. In group 1 (n=31) it decreased by 6% (-33% vs. baseline; p=0.002), compared to - 5% in group (n=29; -29% vs. baseline; p=0.002) and -11% in group 3 (n=15; -48%; p<0.001). Positive changes were seen in 65% (p>0.05), 79% (p<0.01) and 73% (p>0.05) cases, respectively. Over a 3-month period, other sperm indices in all groups changed in different directions and there was no significant difference (p>0.05). There were 6 pregnancies in group 1 and 2 (11%), compared to 2 pregnancies in group 3 (4%; p>0.05). Intergroup comparison between the groups for all the values assessed did not reveal significant differences (p>0.05). CONCLUSIONS: 3-month therapy with hydrophilic or lipophilic antioxidant nutrients in men with idiopathic oligo-, and/or astheno- and/or teratozoospermia does not have significant effect on sperm analysis, sperm DNA fragmentation, and pregnancy rate. There is an urgent need to carry out additional comparative randomized trials to clarify indications for nutritional therapy. Statistical power of maximum 0.69 does not allow to exclude the type II error, non-rejection of a false null hypothesis.

[The experience of using drug Afalaza for treatment of lower urinary symptoms in treatment-nave patients with benign prostatic hyperplasia].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 50 years. The prevalence of the BPH increases with age, and pathologic features of BPH are found in about 90% of men over 80 years. AIM: The aim of the study was to study the efficacy and safety of Afalaza for the treatment of lower urinary tract symptoms (LUTS) in treatment-nave patients with BPH. MATERIALS AND METHODS: A multicenter study of using Afalaza for the treatment of LUTS in treatment-nave patients with BPH was carried out in 9 urological centers in Moscow. A total of 80 treatment-nave patients with BPH were enrolled. The improvement in the total score of IPSS, IIEF-5 and QoL after 30 weeks of therapy was evaluated as well as changes in prostate volume and maximum urinary flow rate (Qmax). RESULTS: After 30 weeks of therapy, there was a significant decrease in the total IPSS score. A decrease in the total IPSS score by 5.5 points (+37.9%) from 14.5+/-4.0 at the baseline to 9.0+/-4.1 at the visit 9 was seen. The QoL decreased by 1.8 (-38.3%) points from 4.7+/-1.0 at the baseline. The Qmax also changed from 12.7+/-4.6 to 16.4+/-5.7 (+28.3%) after 30 weeks of therapy. At the visit 9, the total IIEF5 score increased by 3.4+/-4.4 (+19.9%) from 17.1+/-4.3 at the baseline. In addition, prostate volume decreased from 42.7+/-11.1 at baseline to 41.0+/-9.8 cc post-treatment (-5.15%). A reduction of post-void residual urine volume from 26.0+/-25.3 at baseline to 17.7+/-24.2 (-31.9%) post-treatment was also shown. CONCLUSION: The results of a multicenter study demonstrate the efficacy of Afalaza for treatment of treatment-nave patients with LUTS/BPH. Afalaza reduces prostate volume and improves an erectile function.

[Using L- and acetyl-L-carnintines in combination with clomiphene citrate and antioxidant complex for treating idiopathic male infertility: a prospective randomized trial].

The most common cause of male infertility is idiopathic oligo-, and or astheno-, and /or teratozoospermia. In such cases, anti-estrogens, antioxidants (vitamins and trace elements) or carnitines are used, but the evidence on their effectiveness is inconsistent; there are currently no published studies exploring their concurrent use. AIM: To investigate the efficacy and safety of the L- and acetyl-L-carnitine complex, vitamins A, E, C, selenium, zinc and other antioxidants ("SpermActin" + "More than vitamins") in combination with clomiphene citrate (CC) in managing male idiopathic infertility in the form of oligo, and/or astheno-, and/or teratozoospermia. MATERIALS AND METHODS: The study comprised 173 men from infertile couples aged 25-45 years who were divided into two groups - the study group (n=88) and control group (n=85). All the patients were examined according to the WHO recommendations. Patients of the study group received L-carnitine fumarate (1 g), acetyl-L-carnitine (0.5 g) twice daily, a complex of vitamins and microelements and CC 25 mg twice daily orally. Patients of the control group were administered the same dosages of CC and a complex of vitamins. Ejaculate was evaluated before and after 3-4 months of treatment. Six months after the start of treatment, information about the onset or absence of pregnancy over the last six months was collected via telephone or online survey. RESULTS: Co-administration of L- and acetyl-L-carnitines concurrently with CC and antioxidant complex (vitamins and minerals) in patients with idiopathic oligo- and/or asteno- and/or teratozoospermia provides some additional positive effect on the concentration of spermatozoa, more pronounced in patients with multiple impaired semen parameters - oligoasthenoteratozoospermia, but does not improve the morphology, progressive sperm motility and pregnancy rates compared to patients receiving basic treatment.

Male fertility and varicocoele: role of immune factors.

The role of antisperm antibodies (ASA) in the aetiopathogenesis of varicocoele-related male infertility remains unclear. The objective of this study was to determine whether varicocoele is associated with antisperm immune response and whether this factor provides additional affect on male fertility. We performed a multicentral, prospective study that included the clinical examination of 1639 male subjects from infertile couples and 90 fertile men, the evaluation of the absolute and relative risks of immune infertility associated with varicocoele and the impact of the autoimmune response on the semen quality. The methods used were as follows: standard examination of seminal fluid according to WHO criteria; ASA detection in seminal fluid using mixed antiglobulin reaction (MAR) and direct flow cytometry; measurement of spontaneous and ionophore-induced acrosome reactions; oxidative stress evaluation with luminal-dependent chemiluminescence method and evaluation of DNA fragmentation by sperm chromatin dispersion. The prevalence of varicocoele-related immune infertility is about 15% and does not depend on the grade of vein dilatation both in primary and secondary fertility disorders. Varicocoele is not an immediate cause of autoimmune reactions against spermatozoa, but is a cofactor increasing ASA risk; the OR of immune infertility after a testicular trauma in varicocoele patients increases twofold. In varicocoele patients, the autoimmune antisperm reaction is accompanied by a more significant decrease in the semen quality (concentration and number of progressively motile and morphologically normal spermatozoa in the ejaculate), acrosome reaction disorders (presence of pre-term spontaneous and lack of induced reactions) and an increase in the proportion of spermatozoa with DNA fragmentation. These disorders correlate with the level of sperm oxidative stress; reactive oxygen species (ROS) production in ASA-positive varicocoele patients is 2.8 and 3.5 times higher than in ASA-negative varicocoele patients and fertile men respectively. We did not find correlation between the grade of spermatic cord vein dilatation and ROS production.

[Prostate biopsy in the outpatient setting].

The article describes the methodology of transrectal diagnostic prostate biopsy under ultrasound guidance with regard to settings of municipal polyclinic; existing complications are listed. The analysis of the results of 876 biopsies performed within 3 years is presented. The distribution of the results of histological examination depending on the level of total PSA, ratio of free and total PSA, and PSA density was followed-up. Relationship between PC detection rate using standard biopsy and prostate volume is shown. The analysis of the degree of PC differentiation (Gleason score) depending on the level of total PSA, the ratio of free and total PSA, and PSA density was performed. Practical recommendations to improvement of PC detection rate are presented. Based on the analysis, it was concluded that the screening for prostate cancer for the purpose of its earlier diagnosis is reasonable.

[Combined treatment of chronic cystitis in postmenopausal women with application of AMUS-01-INTRAMAG device and rectomassager attachment].

Sixty eight postmenopausal women with chronic recurrent cystitis received local antibacterial treatment consisting in bladder ionophoresis and vaginal exposure to estrogens and vibromagnetic action of RECTOMASSAGER attachment and AMUS-01-INTRAMAG device. This local treatment proved superior to systemic one as 1-year follow-up registered a 3.1-fold reduction in recurrence rate vs control patients.

[Clinicomicrobiological characteristics of community-acquired infections of the urinary tracts in Moscow].

The structure and sensitivity of the agents of community-aquired urinary infections (CUI) in Moscow were studied in a prospective clinicomicrobiological trial carried out in 2005 with participation of 8 Moscow outpatient clinics. Minimal inhibitory concentration (MIC) of antimicrobial drugs was estimated using agar dilution test according to NCCLS recommendations (2000-2002). Acute and chronic cystitis, chronic pyelonephritis and acute pyelonephritis were most frequent CUI (49.1, 39.8 and 5.3%, respectively, while among complicating factors most frequently occurred urolithiasis (48.5%), diabetes mellitus (24.2%), renal cysts (7.6%), infravesical obstruction (6,1%). CUI in Moscow were primarily caused by E.coli (72.5%). Compared to complicated CUI, uncomplicated ones were characterized by less frequent E. coli isolation (53 and 80.9%, respectively), but significantly more frequent isolation of P.aeruginosa (4.5 and 0%) and E. faecalis (9.1 and 4.2% isolation. High resistance of E.coli isolated from patients with uncomplicated CUI was seen to cotrimoxasol (28.7%) and ampicillin (39.1%), low resistance--to amoxicilline/ clavulanate (6.3%), fluoroquinolones (6.3%), nitrofurantoin (0%), cefuroxime (6.3%), cefotaxime (0%), phosphomicine (0%). Patients with complicated CUI compared to uncomplicated CUI significantly more often had E.coli strains nonsensitive to amoxicilline/clavulanate (14 and 6.3%), cotrimoxasol (25.6 and 18.8%), nalidixic acid (18.6 and 6.3%, respectively). Polyresistant E. coli strains were significantly more prevalent in complicated CUI than in uncomplicated CUI (45.4 and 25.1%, respectively). Thus, E. coli, a main causing agent of uncomplicated CUI, demonstrates high resistance to ampicilline and cotrimoxasol. High microbiological activity is shown byfluoroquinolones, nitrofurantoin, oral cephalosporines of the second-third generation.

[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.