Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up.

Chronic prostatitis (CP) is one of the diseases that reduce the quality of life (QoL) of young men. To date, there is no consensus on the management of these patients. It is essential to continue research into the treatment of CP, despite the use of various therapies, including low-energy extracorporeal shockwave therapy (ESWT). The main objective of this study is to observe and record the clinical symptomatology of patients during a 48-week follow-up period after ESWT treatment. Between 2019 and 2021, 28 patients with type IIIB CP/chronic pelvic pain syndrome were enrolled. Patients underwent ESWT once weekly for 4 weeks (3,000 individual sessions, maximum total energy flux density 0.25 mJ/mm2, frequency 3 Hz). Participants were assessed at 0, 4, 12, 24, 36 and 48 weeks post-treatment using the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function (IIEF)-5. The mean age of patients was 47.1 ± 13.7 years (range 28-4 years). The positive effect of LI-ESWT was reflected in improvements in VAS, NIH-CPSI, and IIEF-5 scores. Regression of patients' symptoms was observed as early as 4 weeks after treatment. The greatest progress was achieved at week 24. In addition, a slight worsening was observed at week 36 and 48, with stable progress. The treatment significantly improved the QoL of the patients, with the most significant improvement in the VAS score. In conclusion, this treatment approach is safe, most effective in the first 6 months. Thereafter, the efficacy of the treatment diminishes, but is sustained over a longer period.

Diagnostic Approaches to Adult-Type Diffuse Glial Tumors: Comparative Literature and Clinical Practice Study.

Gliomas are the most frequent intrinsic central nervous system tumors. The new 2021 WHO Classification of Central Nervous System Tumors brought significant changes into the classification of gliomas, that underline the role of molecular diagnostics, with the adult-type diffuse glial tumors now identified primarily by their biomarkers rather than histology. The status of the isocitrate dehydrogenase (IDH) 1 or 2 describes tumors at their molecular level and together with the presence or absence of 1p/19q codeletion are the most important biomarkers used for the classification of adult-type diffuse glial tumors. In recent years terminology has also changed. IDH-mutant, as previously known, is diagnostically used as astrocytoma and IDH-wildtype is used as glioblastoma. A comprehensive understanding of these tumors not only gives patients a more proper treatment and better prognosis but also highlights new difficulties. MR imaging is of the utmost importance for diagnosing and supervising the response to treatment. By monitoring the tumor on followup exams better results can be achieved. Correlations are seen between tumor diagnostic and clinical manifestation and surgical administration, followup care, oncologic treatment, and outcomes. Minimal resection site use of functional imaging (fMRI) and diffusion tensor imaging (DTI) have become indispensable tools in invasive treatment. Perfusion imaging provides insightful information about the vascularity of the tumor, spectroscopy shows metabolic activity, and nuclear medicine imaging displays tumor metabolism. To accommodate better treatment the differentiation of pseudoprogression, pseudoresponse, or radiation necrosis is needed. In this report, we present a literature review of diagnostics of gliomas, the differences in their imaging features, and our radiology's departments accumulated experience concerning gliomas.

Analysis of Morphological and Morphometric Changes in a Parenchymal Tissue after the Radiofrequency Ablation Procedure.

Background and Objectives: Prostate cancer is on the rise in the European Union, and radiofrequency ablation (RFA) is one of the minimally invasive treatment options used for its treatment. Therefore, the aim of this study was to investigate and analyze the effects of RFA on prostate tissues. Materials and Methods: A standard prostate RFA procedure was performed on 13 non-purebred dogs in three sessions: no cooling (NC), cooling with a 0.1% NaCl solution (C.01), and cooling using a 0.9% NaCl solution (C.09). Microtome-cut 2-3 µm sections of prostate samples were stained with hematoxylin and eosin and further examined. Results: A histopathologic evaluation identified four zones of exposure: direct, application, necrosis, and transitional, as the damage on tissues decreased going further from the ablation site. The areas and perimeters of these zones were calculated, and geometric shapes of ablative lesions were evaluated using the quotient formula. Areas and perimeters of prostate tissue lesions in the NC and C.09 sessions were of similar size, whereas those found in C.01 were statistically significantly smaller. Lesions observed in session C.01 were of the most regular geometric shape, while the most irregular ones were found in session C.09. The shapes of lesions closest to the ablation electrode were the most irregular, becoming more regular the further away from the electrode they were. Conclusions: Prostate RFA leads to tissue damage with distinct morphological zones. Notably, the prostate lesions were the smallest and the most regular in shape after RFA procedures using the 0.1% NaCl cooling solution. It can be argued that smaller ablation sites may result in smaller scars, thus allowing for faster tissue healing if the blood flow and innervation at the ablation site are not compromised.

Effect of Clinical Parameters on Risk of Death from Cancer after Radical Prostatectomy in Men with Localized and Locally Advanced Prostate Cancer.

Background: The study aimed to assess predictors and to identify patients at increased risk of prostate-cancer-specific mortality (CSM) after radical prostatectomy (RP). Methods: A total of 2421 men with localized and locally advanced PCa who underwent RP in 2001−2017 were included in the study. CSM predictors were assessed using multivariate competing risk analysis. Death from other causes was considered a competing event. Cumulative CSM and other-cause mortality (OCM) were calculated in various combinations of predictors. Results: During the median 8 years (interquartile range 4.4−11.7) follow-up, 56 (2.3%) of registered deaths were due to PCa. Cumulative 10 years CSM and OCM was 3.6% (95% CI 2.7−4.7) and 15.9% (95% CI 14.2−17.9), respectively. The strongest predictors of CSM were Grade Group 5 (GG5) (hazard ratio (HR) 19.9, p < 0.0001), lymph node invasion (HR 3.4, p = 0.001), stage pT3b-4 (HR 3.1, p = 0.009), and age (HR 1.1, p = 0.0007). In groups created regarding age, stage, and GG, cumulative 10 years CSM ranged from 0.4−84.9%, whereas OCM varied from 0−43.2%. Conclusions: CSM after RP is related to GGs, pathological stage, age, and combinations of these factors, whereas other-cause mortality is only associated with age. Created CSM and OCM plots can help clinicians identify patients with the most aggressive PCa who could benefit from more intensive or novel multimodal treatment strategies.

Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome.

BACKGROUND: Prostatitis is the most commonly diagnosed disease in men younger than 50 years and accounts for about 8% of all urologists' consultations. OBJECTIVE: After evaluating clinical trials and demonstrating the efficacy of chronic non-bacterial prostatitis treatment, it remains of clinical importance to continue studies on the use of low-energy extracorporeal shock wave therapy (ESWT) in men. MATERIALS AND METHODS: From May 2017 to April 2018, 40 patients with chronic prostatitis (CP) type IIIB/chronic pelvic pain syndrome (CPPS) were enrolled in the study. The patients underwent ESWT once a week for 4 weeks. RESULTS: The mean age of the patients was 47.8 years. A statistically significant improvement in all the parameters, i.e., the International Prostate Symptom Score (IPSS), the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and the International Index of Erectile Function (IIEF), was observed at week 4. The effect of the treatment was maintained during the entire 12-week period. The NIH-CPSI total score showed the best improvement at week 4, but a slight deterioration without a statistically significant change was noticed at week 12. The greatest improvement at week 4 was documented for the NIH-CPSI and IPSS (43% and 37%, respectively). At week 12, an improvement of 52% and 39% was recorded for VAS and IPSS, respectively. CONCLUSIONS: Our findings confirmed the effectiveness and safety of ESWT in resistant cases of CPPS in the short term. ESWT is cost-effective, which takes little time or requires a small amount of staff, and is easily conducted.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

OBJECTIVES: The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). METHODS: A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). RESULTS: Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. CONCLUSION: the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

The effect of Echinacea purpurea extract on sexual glands of male rats.

UNLABELLED: Fifty percent of men over the age of fifty are diagnosed benign prostate hyperplasia. It is caused by disorders in the balance of androgens and estrogens, depending on the activity of sexual glands; therefore it is advisable to examine the functioning of these organs and to determine the pathogenetic mechanism of effect of this pathology. The antiandrogenic effect of Echinacea preparations was examined in our previous study and hypoplasia of histological structures and the mass reduction of prostate were determined. This encouraged more detailed investigation of the effect of the preparation directly to the organs, participating in the synthesis of the male hormone - testosterone. The effect of Echinacea extract on a testicle and epididymis was examined, the mass of these organs was determined, the proportion between the mass of the organ and the mass of a body was calculated, the changes in histological structures were evaluated in this study. MATERIAL AND METHODS: Experiments with the Wistar line 3-month-old male rats were carried out. There were three experimental groups of rats. The first one was control group. The rats of the second group were fed on the usual food enriched with the Echinacea extract additive with the proportion of 50 mg/kg for 4 weeks. The rats in the third group were fed equally to the second one for 8 weeks. The clinical death of the animals was caused by overdosage of the solution of phenobarbital (1 mg/kg). The rats were weighed, the testicles and epididymis were eliminated, and pathohistological examinations were carried out. RESULTS: The average weight of the male rats in the control group was 1530+/-166.37mg, in the second group - 1520+/-164.62mg, and in the third group -1499+/-158.81 mg. Calculations of the relative quantity between the mass of the organs and the body weight were made and it was estimated that the testicles of the rats in the first group made up 0.496+/-0.399% of a body mass, in the second one -0.459+/-0.419%, and in the third one - 0.429+/-0.410%. The epididymis in the control group made up 0.189+/-0.332% of a body mass; in the second one - 0.1733+/-0.328%, and in the third one - 0.1723+/-0.198%. The histological structural changes were traced after 4 weeks of using the preparation, however they became more obvious after 8 weeks. CONCLUSION: Results of the study enabled to determine statistically significant reduction in the percentage of a testicle and the body mass, as well as changes in histological structures after 8 weeks of consuming extract of Echinacea purpurea.

Effect of Echinacea (Echinacea Purpurea L. Moench) preparations on experimental prostate gland.

This work has investigated the effect of echinacea extract on the weight of prostates in rats as well as on alterations of hystological structure and separate blood cells. This preparation was chosen for investigations due to its possible antiandrogenic effect and good immunostimulating features. Experiments were carried out with three-month old male Wistar rats, divided by six into three different groups. The first group was the control one. The rats of the second group were fed for 30 days with the usual food ration plus 50 mg/kg of echinacea extract. The third group was fed for 60 days in the same way as the second one. Clinical death of rats was caused by sodium phenobarbital, later a cervical dislocation was performed. After weighing the rats their prostates were removed and weighed. Patohystological investigations of the removed organs were carried out. Blood test for Shiling's analysis was taken. The weight of prostates in the first group of rats was 412.0+/-14.93 mg, in the second group - 403.0+/-13.33 mg, and in the third group it was 388.0+/-14.66 mg. Having calculated the proportion between prostates of rats and their body weight it was estimated that in the first group it made 0.125+/-0.009%, in the second group - 0.105+/-0.005%, and in the third group - 0.091+/-0.007%. The percentage of lymphocytes in the first group was 72+/-1.41; in the second group - 73+/-0.81; in the third group - 79+/-1,86. The percentage of segmented neutrophyle in the first group was 23+/-3.31; in the second group - 23+/-2.25; in the third group - 18+/-2.33. Having conducted analysis of the experimental results, a significantly important decrease of prostate weight of investigated rats, an increase in the number of lymphocyte as well as the alterations of hystological structures after using echinacea extract for eight weeks were observed.