[Evolution of views on the etiology and pathogenesis of lower urinary tract symptoms for men].

The review article in the format of a "Lecture for Doctors" examines the evolution of terminology reflecting various disorders of urination and understanding their etiology and pathogenesis from a methodological and historical point of view. Symptoms of the lower urinary tract (LUTS) is a new term that replaced the term "Dysuria" that previously existed in the literature and suggests the allocation of various groups of symptoms depending on the violation of key functions of the bladder, which greatly facilitates obtaining reliable information about the state of urination in a particular patient. However, for a long time, LUTS were identified exclusively with urological pathology. Thanks to the fundamental research of recent decades, it has become obvious that LUTS is an interdisciplinary problem involving various specialists in the process of diagnosis and correction. One of the current trends in the study of the urination pathophysiology is the influence of systemic hormonal and metabolic disorders in men, which are considered as independent factors of the LUTS. The role of testosterone deficiency in the pathogenesis of LUTS is highlighted and the safety and effectiveness of testosterone replacement therapy (TRT) in hypogonadal men with LUTS is shown.

[The role of obesity in the pathogenesis of benign prostatic hyperplasia].

The pathophysiological role of obesity as one of the most significant and actual metabolic non-infectious diseases and the key component of the metabolic syndrome based on results of modern epidemiological and clinical-experimental studies is discussed in the review. General information on the prevalence of obesity and its negative effect on the quality of life of men is presented. The endocrinology of adipose tissue and associated hormonal and metabolic disorders are discussed in more detail. The analysis of pathophysiological mechanisms explaining an influence of obesity on prostate metabolism, which leads to the initiation and progression of the benign prostatic hyperplasia, is carried out. Currently, there is a large body of evidence that obesity and benign prostatic hyperplasia have a lot of common interacting pathogenetic mechanisms. An opinion that, considering a global increase in the prevalence and severity of obesity in men and its negative effects on the prostate, treatment for obesity in men can be considered as an effective primary preventive measure, and in patients with benign prostatic hyperplasia as an effective secondary preventive measure.

[Justification of a use of additional antioxidant therapy in experimental models of chronic bacterial prostatitis].

AIM: To study the changes of the main parameters of the oxidative status in prostate after standard antimicrobial monotherapy and to justify a use of additional antioxidant therapy in various experimental models of chronic bacterial prostatitis (CBP). MATERIAL AND METHODS: A total of 60 outbred adult male healthy rats weighing 180-200 grams were used in the experiment. In a control group, 20 intact rats were included. Two experimental groups of 20 animals each were formed and in each group two subgroups (n=10) were distinguished. Two series of experiments were performed in the episodic and relapse models of CBP (based on the Nickel J.C. (1990) and Goto T. (1991)), respectively, with an evaluation of the efficiency of antimicrobial monotherapy (levofloxacin 12.5 mg/kg/day per os for 20 days) in each of the subgroups. In prostate homogenates the levels of CFUs, active forms of oxygen (ROS), diene conjugates and malonic dialdehyde, as well as an activity of superoxide dismutase (SOD) and succinate dehydrogenase (SDH)) were evaluated. RESULTS: The microbiological efficiency of standard antimicrobial monotherapy in the episodic model of CBP was higher than in the recurrent model (90.0% vs 80.0, respectively, p<0.05). The degree of free radical aggression and a severity of lipid peroxidation in recurrent CBP were significantly higher, and the activity of SOD and SDH was significantly lower than in the episodic model of CBP (p<0.05). In both models, residual oxidative stress persisted in the prostate tissue after antimicrobial therapy, indicating an incompleteness (in the case of episodic model of CBP) or decompensation (in case of recurrent CBP) of the antioxidant defense system. CONCLUSION: A persisting of residual oxidative stress after a course of etiotropic antimicrobial monotherapy in the prostate has justified a necessity of the additional administration of antioxidants (antihypoxants) for a combined pharmacotherapy of CBP.

[Vitamin D deficiency, metabolic syndrome, and prostate adenoma: current epidemiological trends and pathophysiological mechanisms of interaction].

This review, based on the results of modern epidemiological and clinical-experimental studies, highlights the important pathophysiological role of vitamin D and the disturbances of its metabolism (deficiency/insufficiency) in the pathogenesis of the metabolic syndrome (MS) in men, which according to available literature, is associated with adenoma of the prostate (AP). General information about the endocrinology of vitamin D and its role in maintaining various aspects of mens health is presented. The authors analyze currently known pathophysiological mechanisms involving vitamin D interacting with each other within the framework of the pathogenesis of MS and AP. At present, there is much evidence that MS and AP have common universal interacting mechanisms of pathogenesis (obesity, insulin resistance, dyslipidemia, systemic chronic subclinical inflammation, endothelial dysfunction) that are realized with the direct participation of vitamin D. The authors argue that taking into account a global prevalence of vitamin D deficiency in the modern population, accompanied by an increasing incidence of both MS and AP affecting younger populations, a rational management of vitamin D metabolism in men can be regarded as a promising and effective pathogenetic prevention of MS and BPH.

[FEATURES OF CLINICAL COURSE AND MORPHOMETRIC PARAMETERS OF BENIGN PROSTATIC HYPERPLASIA IN MEN WITH METABOLIC SYNDROME AND ANDROGEN DEFICIENCY].

The study was aimed to the evaluation of the effect of the components of the metabolic syndrome (obesity, insulin resistance (IR)) and androgen deficiency on the clinical course of lower urinary tract symptoms against the background of benign prostatic hyperplasia (LUTS/BPH) and nocturia, as well as on some of the parameters of BPH (prostate volume, residual urine volume, total prostate-specific antigen (PSA) blood level). The comprehensive survey of 160 men with LUTS/BPH (mean age 56.7 ± 3.3 years) was performed; based on the results of survey, three comparison groups were formed: Group 1 (n = 70)--patients with isolated obesity; Group 2 (n = 36)--patients with obesity and insulin resistance; and Group 3 (n = 54)--patients with obesity, insulin resistance and androgen deficiency. The control group consisted of 30 patients with LUTS/BPH without these metabolic and hormonal disorders. In patients with LUTS/BPH and obesity, higher frequency of nocturia compared with the control group was revealed (63.7% vs 23.3%; P < 0.05), as well as the relationship between the waist circumference and free testosterone level (n = 160; r = -0.322; P = 0.005) and waist circumference and total prostate volume (n = 160; r = 0.121; P = 0.005). In patients of Group 2, significant positive correlation between waist circumference and blood insulin level was identified (n = 36; r = 0.461; P = 0.005). Patients with obesity, insulin resistance and androgen deficiency had the highest average prostate volume and residual urine volume compared with those of other groups (P < 0.05). Thus, obesity, insulin resistance, androgen deficiency are associated pathological conditions, greatly aggravating the clinical course of LUTS/BPH due to adverse impact on the BPH parameters, acting both together and separately. The most severe LUTS/BPH were associated with the presence of all three of the above systemic disorders.