[Treatment of chronic prostatitis caused by chlamydial and ureaplasmic infection and complicated with male infertility].

Etiologically, chronic prostatitis can result from urogenital latent infections caused by chlamydia, ureaplasma and others. First of all, such patients should be examined for urethritis. We examined 306 patients aged 23-45 years with chronic prostatitis caused by chlamydial and ureaplasmic infection. The samples were taken from the urethra, urine, prostatic secretion, ejaculate and were examined using direct immunofluorescence, polymerase chain reaction, culturing. We found spermatogenetic disorders in 50% patients, 35 (11.4%) patients had a deferent duct obstruction. The patients had also immunointerferon deficiency and alterations in prostatic echostructure. In chronic prostatitis caused by chlamydial-ureaplasmic infection the treatment must combine antibacterial drugs (vilprophen, unidox, solutab) with interferons (lavomax, genferon). Male infertility treatment should be started only after elimination of the bacterial infection.

[Clinicoimmunological disorders in patients with chronic prostatitis caused by latent urogenital infection].

The study enrolled 506 males 20 to 50 years of age (mead age 30.8 +/- 0.5 years) with chronic prostatitis (CP). Group 1 consisted of 332 (65 +/- 4.1) patients with CP caused by lateral urogenital infection (LUGI) due to chlamydias, ureaplasmas, mycoplasmas, gardnerellas, herpes virus type 2. Group 2 comprised 174 patients free of LUGI. T-cell and humoral immunity parameters were assessed by T-lymphocytes CD3, T-helpers CD4, T-suppressors CD8, CD4/CD8, natural killer cells CD16 using indirect immunofluorescence. Phagocytic activity of T-lymphocytes was estimated with latex as the antigen. An etiological factor was ureaplasmas, chlamydias and others in 170 (51.2 +/- 5.4%) and 155 (46.7 +/- 5.4%) patients, respectively. Mixed infection was diagnosed in 94 (28.3 +/- 4.8%) patients. Secondary immune and interferon deficiencies were detected in 155 (30.6%) patients of both groups. The patients received etiological (antimicrobial) and pathogenetic (immunological) therapy. The highest effect was obtained in prostatitis caused by mono-LUGI. Pain and pollakiuria attenuated, the copulative function improved. The conclusion is made that CP, especially secondary to LUGI, should be treated by combination of etiotropic with immunotropic methods.

[Immune male infertility: correction with efferent therapy]. / Korrektsiia immunnogo besplodiia u muzhchin metodami éfferentnoi terapii.

Effects of plasmapheresis and hemosorption on efficacy of the treatment of autoimmune male infertility (AMI) were studied in 289 AMI males with oligoasthenozoospermia aged 19 to 37 years. The males were divided into three groups by the levels of antisperm antibodies (ASAB) in the blood and ejaculate. The study was made of cellular and humoral immunity, intensity of protein and lipid free radical oxidation and antioxidant defense. Patients of group 1 with high ASAB in the blood but low in ejaculate received a course of plasmapheresis. Patients of group 2 with high ASAB both in the blood and ejaculate were subjected to hemosorption and plasmapheresis in one contour. Group 3 patients with high ASAB in ejaculate but low in the blood received efferent therapy only after medication and photomodification of the blood. The treatment reduced elevated levels of ASAB in the blood and ejaculate, normalized free radical oxidation, cellular and humoral immunity, antioxidant defense. This resulted in improvement of spermogram parameters, efficacy of assisted reproductive technologies, higher probability of natural pregnancy in the patients' wives.

[Experience in wilaprafen treatment of chlamydial prostatitis, complicated by infertility]. / Opyt lecheniia vil'prafenom khlamidii prostitia, oslozhnennogo besplodiem.

The antichlamydial action of wilprafen was studied in patients suffering from urogenital chlamydial prostatitis complicated by infertility. An individual approach to etiotropic and pathogenetic therapy with wilprafen alone and in combination with vobenzim introduced by the authors in men with chlamydial prostatitis complicated by infertility produced a high curative effect.

[Electrolaser therapy on the Iarilo device in patients with chronic chlamydial prostatitis]. / Elektrolazernaia terapiia na apparate "Iarilo" u bol'nykh khronicheskim khlamidiinym prostatitom.

Multiple-modality treatment (antibiotics, immunocorrectors, vascular medication, physiotherapy) for chronic chlamydial prostatitis (CCP) was conducted in 141 patients. They were assigned to two groups which differed only by physical methods applied. Group 1 patients (n = 84) were exposed to electrolaser radiation (Yarilo unit), group 2 patients (n = 57) were treated by conventional physiotherapeutic methods. The advantages were reported in the group treated simultaneously with He-Ne laser introduced into the urethra, infrared laser, electrostimulation (Yarilo unit). Perineal pain and dysuria ceased in 58.9 and 9.8%, 62.1 and 13.2% of patients from group 1 and 2, respectively. Erection recovered in 90% of group 1 patients. In group 2 this percentage was 50%.

[The role of sexually transmitted diseases in the childless marriage]. / Rol' zabolevanii, peredaiushchikhsia polovym putem, v besplodnom brake.

The effect of urogenital infection on reproductive function was studied in 326 infertile males. They were found to carry Chlamydia, Ureaplasma, Mycoplasma, Herpes, Gardnerella and mixed Chlamydia-Ureaplasma infections in 132, 84, 28, 16, 12 and 56 patients, respectively. Oligozoospermia of the first, second and third degree was diagnosed in 164, 128 and 34 males, respectively. Intermittent-course therapy included macrolid, chephalosporin and fluoroquinolone drugs, sometimes rifampicin, immunocorrection. Husbands and wives received treatment simultaneously. Secretory infertility was managed later. Oligozoospermia declined in two-thirds of the patients. 119 wives got pregnant.

[The role of testosterone undecanoate in correcting disorders of the copulative function]. / Rol' testosterona andekanoata v korrektsii narushenii kopuliativnoi funktsii.

Testosterone andecanoate (andriol) was used for treatment of copulative dysfunction in 18 young and middle-aged males in a dose 160 mg/day (a 10-12-day treatment course) or 40-80 mg/day (up to 6 week maintenance course). Clinical responses concerning such sexual symptoms as libido, erection, ejaculation and orgasm were achieved in most of the patients. Pretreatment blood levels of testosterone were not decreased. The treatment aroused these levels which persisted higher that pretreatment ones for 3 months. Estradiol was slightly higher after the treatment. Andriol is recommended for treatment of copulative dysfunction in young and middle-aged males.

[Extracorporeal lithotripsy in patients with the renal form of primary hyperparathyroidism]. / Distantsionnaia litotripsiia u bol'nykh s pochechnoi formoi pervichnogo giperparatireoidizma.

The role of PH in initiation of lithogenesis recurrences after extracorporeal lithotripsy (ECLT) was studied in 206 patients. Renal PH was diagnosed in 35 from 56 patients of group 1 with recurrent lithogenesis after ECLT. All the 35 patients underwent parathyroidectomy and repeated ECLT. The recurrence was seen only in 1 patient (2.9%). 150 patients of group 2 had complicated urolithiasis, 86 of them had renal PH. Prior to ECLT the above patients were subjected to prophylactic parathyroidectomy. Uroliths recurred in 2 patients (2.2%). It is thought valid before ECLT to examine urolithiasis patients for renal PH. In its presence the authors recommend to perform parathyroidectomy.

[The characteristics of calculus formation in the kidneys of patients in families predisposed to urolithiasis]. / Osobennosti kamneobrazovaniia v pochkakh u bol'nykh v sem'iakh, otiagoshennykh po urolitiazu.

To specify the implication of the genetic factors in formal genesis of urolithiasis, the pattern of stone formation was investigated in 206 probands with urolithiasis hereditary loading versus 324 patients rejecting family history of this disease. Distribution of the disease forms was considered in correlation with mineral metabolism derangement and hereditary loading in the proband. It was found that severe urolithiasis occurs more frequently in the groups with phosphorus-calcium urolithiasis. These groups also included many families with the disease history. Numerous cases of urolithiasis of hyperparathyroidism etiology suggest endocrine disorders involvement in urolithiasis onset. Clarification of hereditary loading and its distribution in the families of urolithiasis patients allows a purposeful control of the families members to render them prophylactic aid.

[The pathogenesis of sexual disorders in men with diabetes mellitus]. / K patogenezu narushenii polovoi funktsii u muzhchin pri sakharnom diabete.

The examination of 217 males suffering from diabetes mellitus revealed copulative dysfunction in 111 (51.1%) of them. The investigation of sex, gonadotropic hormones, testicular reserves, sexual constitution and sexual formula was carried out in 22-55-year-old males with sexual dysfunction and healthy controls. It was an erectile phase of the sexual cycle that suffered most frequently. Reduced libido was observed in 19% of the patients. All the diabetes examined showed constitutional predisposition to impaired potency. The patients had high serum concentrations of prolactin, lutropin and dihydroepiandrosterone in low testosterone and insignificantly elevated follitropin and estradiol. There was also low gonadal resistance to choriogonin stimulation. These findings and literature data lead to the conclusion that insulin insufficiency entailing hyperglycemia brings about a rise in prolactin and dihydroepiandrosterone levels which may reduce the sensitivity of the receptors and lutropin in the testes and inhibit testosterone secretion. This is confirmed by inactive gonadal response to stimulation of chorionic gonadotropin. Spermatogenic disorders observed in 25% of the patients were associated with sexual affections and local structural changes (hypotrophy) of the testes.

[Sexual function after the surgical treatment of acute epididymitis]. / Polovaia funktsiia posle operativnogo lecheniia ostrogo épididimita.

Operative management of acute epididymitis performed in 150 patients aged 18-67 produced better therapeutic results compared to 150 patients treated conservatively (9.1 patient day versus 13.3 days). Follow-up for 2-4 years showed marked intergroup differences as regards anatomic changes in the epididymis revealed by palpation and ultrasound scanning. Echographic pattern was altered in 25 operated on and 92 patients treated conservatively. Copulative function was diminished in few cases in those operated on and much more frequently after conservative treatment, libido and erection in particular. Reproductive function was impaired more profoundly after conservative treatment as well. These patients demonstrated lower levels of testosterone and estradiol but higher content of LH and FSH. The latter hormones did not vary with age among the groups. Better effect of scrotal drainage in acute nonspecific epididymitides is attributed to the influence of inflammation-affected epididymis on the contralateral testicle more intensive under conditions of closed (nondrained) inflammation.

[Marelin in the treatment of urolithiasis]. / Marelin v lechenii mochekamennoi bolezni.

The paper provides the results of a study into a therapeutic effect produced by the Soviet agent Marelin used in the treatment of urolithiasis. The study was undertaken to examine 52 patients with severe nephrolithiasis, of them 33 had undergone an operation. The purpose of the study was to investigate spasmolytic, lithagogue, and anti-inflammatory effects of the drug, its impact on phosphorus and calcium exchange, uric acid metabolism, bacterial flora, urine excretion and pH. A pronounced spasmolytic effect was found almost in all the patients. Expelling of small concrements and fragments was observed in 14 cases, almost in all (80%) had crystallines of uric salts, mucus, and pus. Some of them had small calculi moved from the calyces and pelves into the ureter. No pathogenic urinary bacterial flora was found in 12.2% of the cases. Calciuria was normalized in 18 patients, reduced on an average of up to 5.2 mmol/l in 16. Phosphaturia (false or true) occurred in 20 of 52 patients, its severity diminished in two thirds of the cases. Hyperuricemia improved in 6 out of 13 patients who had oxalate calculi. With Marelin, diuresis increased in 48 of 52 patients by 25-30% and 10-20% within the first 2-9 days and the subsequent 20 days, respectively. There was a decrease in pH from 7.8 to 6.8 in some patients with urinary alkaline reaction. The findings suggest that Marelin should be recommended for its wide clinical application.

[The role of thermography in the diagnosis of testicular diseases]. / Rol' teplovideniia v diagnostike zabolevanii iaichek.

Combined clinical and thermovision investigation was carried out in 104 patients with various scrotal diseases. Acute epididymitis and orchidoepididymitis (42 patients) were associated with the following thermographic signs: thermo-asymmetric intensity of infrared emission with hyperthermia (0.6 to 2 degrees C) on the affected side, a greater glow area, as compared to actual anatomical size of the organ, "truncal" inguino-iliac hyperthermia in cases of ascending lymphangitis. Asymmetry of heat pattern diminished or disappeared altogether in cases of successful treatment. Hydrocele (32 patients) was associated with enlarged heat outlines on the affected side of the scrotum, without any apparent heat pattern asymmetry. Malignant testicular tumors (30 patients) were associated with enlarged outline of the affected scrotal side with a temperature difference of 1.2 degrees C and more, as compared to the normal side, persistent hyperthermia at repeated examinations, small- and medium-sized hyperthermic foci over the projected liver, lungs, mediastinum, meso- and hypogastrium, lumbar region and in the area of lateral neck surface in cases of metastatic growth. A clear-cut homogeneous hyperthermia over the anterior abdominal wall and in the lumbar region is registered as a post-gamma teletherapy condition. Thermovision is an effective instrument for the diagnosis of benign and malignant scrotal diseases; it makes possible early detection of complications (lymphangitis, lymphadenitis, metastases) providing for an objective assessment of treatment efficiency. The accuracy of thermovision diagnosis was 100% in cases of hydrocele and acute orchidoepididymitis, and 89.6% in cases of testicular tumors.