[The efficiency of pre-administration of a peptide mimicking the spatial structure of erythropoietin -chain B in modeling experimental post-contrast acute kidney injury].

AIM: To study the efficiency of pre-administration of a peptide mimicking the spatial structure of erythropoietin -chain B in modeling experimental post-contrast acute kidney injury. MATERIALS AND METHODS: In this study, an experimental model of post-contrast acute kidney injury was created using a non-steroidal anti-inflammatory drug, a nitric oxide synthase inhibitor, and injection of iopromide to mature male mice. After 48 hours, a comprehensive assessment of the concentration of creatinine, urea, glomerular filtration rate, the ratio of urea/albumin in the serum, as well as the level of proteinuria and interleukin 6 in the urine was carried out. RESULTS: A peptide mimicking the spatial structure of erythropoietin -chain B, administered at a dose of 100 g/kg 30 minutes before modeling of pathologic process, contributes to a significant decrease in creatinine and urea concentrations by 2.5 and 1.8 times, respectively, with an increase in glomerular filtration rate 4.4 times. In addition, in the group with pharmacological correction, there was a significant decrease in the ratio of urea/albumin by 2.2 times, a decrease in the level of proteinuria by 61.9% and a decrease in the concentration of pro-inflammatory interleukin-6 in the urine by 2.1 times. CONCLUSION: Thus, the preliminary administration of a peptide that mimics the spatial structure of the erythropoietin -chain B helps to reduce the severity of post-contrast acute kidney injury in the experiment, due to anti-inflammatory properties.

[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.

[The choice of individual treatment strategy in geriatric patients with benign prostatic hyperplasia with consideration of indications and contraindications for elective isolated and simultaneous interventions].

AIM: To develop a rationale treatment strategy for elective isolated and simultaneous interventions in geriatric patients with benign prostatic hyperplasia (BPH) aimed at decreasing of complications rate and grade, based on current approach to indications and contraindications. MATERIALS AND METHODS: From 2000 to 2015 yy. a total of 639 elderly and senile patients with BPH were undergone to isolated simple prostatectomy, transurethral prostatic resection and simultaneous surgery. Two timeframe were allocated, from 2000 to 2006 and from 2007 to 2015 yy. During the first period, the conventional indications and contraindications were used for determination of the type and volume of the the surgery. During the second period, a novel authors approach to the structure indications and contraindications for the surgical treatment was introduced. RESULTS: For the first time in the geriatric urology a modern structure of the indications and contraindications for elective interventions in patients with BPH has been developed, which allowed to clarify the treatment strategy on the individual basis. The new criteria for absolute and relative contraindications are included as well as, for the first time, temporary, specific and organizational contraindications for the simple prostatectomy and TURP. There is a need for review some conventional contraindications for the TURP in elderly and senile patients, considering that in specialized geriatric urological hospital for patients with severe concomitant diseases (therapeutic, neurologic, etc.), TURP should be the method of choice regardless prostate volume, often exceeding 60 cc. The use of a new structure of indications and contraindications allowed to establish absolute contraindications for the elective surgery in 19%, relative contraindications in 21% and temporary contraindications in 8% cases, respectively. These patients were undergone to palliative surgeries or drug treatment which helped to prevent possible postoperative complications and mortality. CONCLUSION: In order to determine the treatment strategy in elective isolated and simultaneous interventions in geriatric patients with BPH it is necessary to consider the current general and specific indications as well as absolute, relative, specific, temporary and organizational contraindications. The introduction of the novel structure of the indications and contraindications for the elective isolated and simultaneous surgeries with priority of TURP had a pronounced clinical effect, contributing to the marked reduction of postoperative complications and deaths in geriatric patients with BPH.

[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.

[Systematic approach in performing isolated and simultaneous operations in elderly patients with prostate adenoma].

AIM: To develop a scientifically based system for treating elderly patient with prostate adenoma (AP), aimed at reducing the incidence and severity of complications and mortality after isolated and simultaneous operations. MATERIALS AND METHODS: Between 1995 and 2015, 1170 elderly and older patients with prostate adenoma (PA) underwent isolated adenomectomy (AE) or transurethral resection of the prostate (TURP) or simultaneous operations (SO). Simultaneous interventions were performed in 335 (28.6%) patients. RESULTS: Immediate treatment results were significantly better in patients who underwent isolated TURP or TURP as a part of SO than that of those who had isolated AE or AE as a part of SO. SO was not associated with greater incidence of local or general postoperative complications and mortality compared with isolated AE or TURP. CONCLUSION: Continuous advancements in diagnostic and treatment methods contributed to a significant reduction in the incidence of postoperative complications and deaths in geriatric patients with PA. The study findings confirm the superiority of TURP over AE, as previously reported by other authors.

[Condition of the immune status at patients with the serous and purulent pyelonephritis according].

AIM: Studying of a condition of the immune status on for standard treatment at an acute serous and purulent pyelonephritis. MATERIALS AND METHODS: The immune status of 62 patients with various forms of an acute pyelonephritis, randomized on age, sex, the minimum quantity of associated diseases in a remission stage is surveyed. RESULTS: and their discussion. Purulent form of acute pyelonephritis was accompanied by higher levels of pro-inflammatory cytokines with decreased levels of anti-inflammatory cytokines. In serous form, imbalance in the cytokine system was found. Both serous and purulent forms of pyelonephritis were characterized by the imbalance in the complement system, increased production of immunoglobulins with simultaneous reduction of circulating immune complexes, decreased activity and the intensity of phagocytosis with increased metabolic activity of neutrophils. CONCLUSION: At serous and purulent forms of a pyelonephritis there are differences in an orientation and expression of changes of the immune indicators demanding development of methods of the differentiated immunorehabilitation.

[CLASSICAL RADICAL EXTRAURETHRAL METHOD OF ADENOMECTOMY--BEYOND 30 YEARS].

Introduction of transvesical extraurethral adenomectomy into clinical practice was preceded by the clinical and morphological study of the prostate, prostatic urethra, bladder, upper urinary tract and renal function. It was found that at any volume of adenomatous (hyperplastic) tissue in the prostate, front semicircle around the prostatic urethra remains intact, and changes occur only in the proximal part of its back semicircle. Front semicircle adherent to the anterior commissure of the prostate has no adenomatous tissue. Extraurethral method enables you to perform a prostatectomy at any size of adenomatous tissue (fragmentarily) with preservation of the prostatic urethra, urethral vascular plexus and, if necessary, to carry out the vesico-urethral segment correction without blood loss. Free independent urination is recovered at days 10-12 after the healing of the suprapubic surgical wound and removal of drainage tube. Since the introduction of transvesical extraurethral prostatectomy into clinical practice, more than 3,000 radical adenomectomies at different stages in patients with co-morbidities were performed only at Burdenko Central Military Clinical Hospital and the 2nd Mandryka CMCH.

[Etiological and prognostic aspects of renal failure in patients with prostatic adenoma].

The aim of our study was to assess the causes of renal failure in patients with prostatic adenoma (PA) and outcomes after draining of the urinary bladder. A retrospective study comprised 239 PA patients with a serum creatinine level over 120 mcmol/l. Outcomes were assessed after 3-5 day and 2.5 month bladder draining. The Spearman test was used for statistical analysis. We found that age, prostate volume, PA growth pattern, urinary tract infection, concomitant pathology (arterial hypertension, diabetes mellitus, atherosclerosis) do not correlate with a serum creatinine level. The presence of bilateral retention of the upper urinary tract was associated with a higher serum creatinine level. There is a significant correlation between lowering of a serum creatinine concentration after bladder draining and the level of upper urinary tract retention.