[Urogenital tuberculosis today].

In order to analyze the structure of urogenital tuberculosis, retrospective analysis of medical records of 131 patients with newly diagnosed urogenital tuberculosis observed in the Novosibirsk Regional TB Dispensary from 2009 to 2011 was performed. The renal tuberculosis is main form in the structure is urotuberculosis, detected in 75% of patients, and widespread destructive forms of the disease were diagnosed in more than half of cases. Isolated nephrotuberculosis was more often diagnosed in women--56.8%. 15.9% of patients had asymptomatic nephrotuberculosis; one-third of patients complained of pain in the lumbar region and frequent painful urination (35.2 and 39.8%, respectively); symptoms of intoxication were present in 17% of patients, renal colic--in 9.1%, and gross hematuria--in 7.9% of patients. Mycobacteriuria in isolated nephrotuberculosis was detected in 31.8% of cases. Acute tuberculous orchiepididymitis developed in 35.7% of patients, hemospermia was observed in 7.1% of patients, dysuria was in 35.7% of patients. The pain in the perineum, frequent painful urination (both by 31.6%), hemospermia (26.3%) were main complaints in prostate tuberculosis. Mycobacteria was detected in 10.5% of cases. It was found that urogenital tuberculosis has no pathognomonic symptoms; the most alarming manifestations include long-term dysuria, hematuria, hemospermia.

[Features of the incidence of cystitis depending on the type of contraception].

For the purpose of evaluation the effect of contraceptive methods on the incidence of recurrent bacterial cystitis in women, 215 clinical records of patients with cystitis were analyzed. In addition, incidence of recurrent cystitis in three groups of sexually active women of reproductive age was compared: 26 patients (Group 1) received conventional therapy and used condom as a method of contraception; 31 patients (Group 2) received combined oral contraceptives (COC), and 32 patients (Group 3) received COC and two courses of treatment with canephrone. A negative correlation between COC use and the risk of cystitis was detected. After conventional therapy, recurrences were observed in 43.3% of patients in Group 1, in 25.8% of patients in Group 2, and only in 15.6% of women in Group 3. Thus, the choice of COCs for contraception lead to 2-fold reduction of risk of recurrence of bacterial cystitis, and additional use of canephrone--to 3-fold reduction.

[Overactive bladder as a mask of chronic prostatitis].

In order to investigate the frequency of symptoms of overactive bladder (OAB) in patients with chronic prostatitis and determine the effectiveness of trospium chloride in their treatment, the analysis of case histories of 154 patients referred to a urologist for the exacerbation of chronic prostatitis was performed. 27 (17.5%) patients had a diagnosis of overactive bladder; in 19 patients it was accompanied by chronic prostatitis, and in 8 patients OAB was diagnosed as separate disease. All of them have received trospium chloride 30 mg once daily for a month; patients with prostatitis simultaneously have received standard etiopathogenic therapy for this disease. A month later, a comprehensive treatment led to significant positive effect. Urinary frequency decreased by 56.1%, the functional bladder capacity increased by 82.8%, the number of urgent vesical tenesmus was reduced more than by half.

[A comparative study of efficacy of 2-, 3- and 4-glass tests in patients with chronic prostatitis].

To compare informative value of three tests (2-, 3- and 4-glass) in diagnosis ofprostatitis we examined 177 patients with chronic prostatitis (CP) who were randomized into 4 groups. Group 1 patients (n = 33) were examined with standard 4-glass test (Mearls and Stamey), patients of subgroup 2a (n = 42) were examined with 2-glass test before finger rectal test (FRT), FRT was made in subgroup 2b (n = 45) before urine collection (2 portions), group 3 (n = 57) was examined by an original technique proposed by the authors. While performing the latter test special focus was given to urination continuity, then the secretion obtained at FRT was studied. Efficacy of each of the tests was assessed by comfort of the procedure for the patient and the doctor, a proportion of false-positive results. The 3-glass test proved most informative and significant. Also, it is sensitive in detection of urogenital tuberculosis. The 4-glass test is not comfortable for both the patient and the doctor. The 2-glass test often produced false-positive results.

[Ejaculatory disorders in some regions of the Russian Federation].

Ejaculatory disorders are one of the most frequent sexual dysfunction. To study this problem in different climatic regions, we made a population-based trial with participation of 543 Russian men (149 from the south of Russia, 394 from Siberia). Correlation of ejaculatory disorders with IELT duration, a testosterone level, comorbid chronic prostatitis was estimated. We found that 59.2% of young men had normal ejaculation but only 20% of men over 50 years of age. In the latter group of patients delayed ejaculation predominated. 43.6% of the southerners and 33.5% of the Siberians had premature ejaculation, and 6.1 and 16.9%--delayed ejaculation, respectively; 26.7 and 31.2% were hypogonadal, respectively. Ejaculation was normal in 74.6% men with a normal testosterone level. Hypogonadal patients had premature ejaculation in 48.2% cases, delayed ejaculation in 28.3%. Of the total 543 men, 67.2% had chronic prostatitis. Only 46% of patients with chronic prostatitis had normal ejaculation, 43.3% had premature ejaculation and 10.7% had delayed ejaculation. Thus, in cold climate delayed ejaculation occurs more often, in the South premature ejaculation predominates. A low testosterone level as well as chronic prostatitis resulted in ejaculatory disorders. There are significant differences in ejaculation between young and old men, whose living in the South and Siberia, eugonadal and hypogonadal. Therefore, when characterizing a copulative act as "normal" it is necessary to take into account age, comorbidity, region of living and other factors.

[Approaches to raising efficacy of treatment of patients with chronic prostatitis associated with intracellular infections].

The efficacy of indigal plus containing indol-3-carbinol, epigallocatexin-3-gallat and Serenoa repens extract in combination with sparfloxacin was studied in a trial with participation of 30 patients with chronic infectious prostatitis associated with intracellular agents. Group 1 (n=15) received indigal plus (2 capsules twice a day for 3 months) and sparfloxacin (200 mg twice a day for 1 month). Group 2 including 15 matched controls received sparfloxacin alone according to the same schedule. The examination included questionnaire survey (IPSS, QoL, NIH-CPSI), blood count, urinalysis, PSA test, microscopy, bacteriological study of prostatic secretion, uroflowmetry, transrectal ultrasound investigation of the prostate with residual urine assay, laser doppleroflowmetry. The examinations were performed on the treatment day 30, 60 and 90. After the antibacterial treatment chlamidia, ureaplasma and E.coli were detected in 13.3, 6.7 and 26.7% patients of the control group, in 6.7, 6.7 and 6.7% patients of the study group, respectively. Thus, the addition of a pathogenetic drug indigal plus to sparfloxacin treatment promoted normalization of apoptosis of the infected cells, led to more effective bacterial eradication, enhanced regression of the symptoms. It is recommended to include indigal plus in a basic scheme of treatment of patients with chronic infectious prostatitis.

[New trends in the epidemic situation of extrathoracic tuberculosis in Siberia and the Far East].

The statistical reports by 21 subjects of the Russian Federation (the Siberian and Far-Eastern Federal Districts) have been analyzed to define the rates of extrathoracic tuberculosis morbidity in these regions and its structure. It has been established that new trends have been recently evident in the pattern of extrathoraric tuberculosis. Firstly, there has been an increase in the incidence of bone and joint tuberculosis, young men and old women being predominant in its structure. Secondly, the steep rise in the incidence of genital tuberculosis, caused by the appearance of an experienced phthisiological gynecologist in one of the regions emphasizes that the fact that there is a large proportion of undetected extrathoracic tuberculosis cases is pressing. There is concern for the high percentage of children with extrapulmonary tuberculosis--this fact reflects the tense epidemic situation in the areas.

[Tuberculosis of the urinary bladder: diagnosis and treatment].

Tuberculosis of the urinary bladder (UB) is registered in 10-45.6% patients with urogenital tuberculosis. It is a severe incapacitating complication of kidney tuberculosis which significantly lowers quality of life. The results of the standard therapy of 76 patients with tuberculous cystitis are analysed. UB tuberculosis is diagnosed more often in women, outcomes of their treatment are worse. Twenty six patients with UB tuberculosis at the stage of overactive bladder received polychemotherapy and adjuvant trospium. After 3 months urination frequency decreased 4.3 times, on the average; UB volume increased 4.7 times, on the average. Complications were not registered.

[A diagnosis for active urinary tract tuberculosis].

The paper details the procedure of a modified tuberculin challenge test, by keeping in mind the new parameters--the microcirculation of the urinary tract mucosa, which is recorded by Doppler laser flowmetry. The efficiency of the procedure was evaluated in 55 patients, including 25 patients diagnosed as having urinary tract tuberculosis and 30 with nonspecific infections. The urethral microcirculatory parameters studied during the tuberculin challenge confirmed the changes available in all the patients with urinary tract tuberculosis while they were absent in patients with nonspecific pathology. The proposed procedure may objectively record a diagnostic parameter. which improves the quality of diagnosis.

[Extrathoracic tuberculosis in Siberia and the Far East].

The incidence and pattern of extrathoracic tuberculosis in the Siberian and Far Eastern areas are analyzed. The statements are illustrated by two clinical cases.

[Analysing effectiveness of traditional treatment for urogenital tuberculosis by outpatients follow-up]. / Analiz éffektivnosti traditsionnogo lecheniia mochepolovogo tuberkuleza po materialam dispansernykh nabliudenii.

The paper presents the social and clinical structure of patients with urogenital tuberculosis through studies of 518 outpatient case histories. It has been ascertained that there is a prevalence of common and complicated forms of nephrotuberculosis, 82.4% of patients undergo surgery. Taking into account the fact that a fifth of patients cannot have long-term inpatient treatment, the incidence of Mycobacteriuria (67.9%), the prevalence of the disease, requiring organ-saving operations, the high degree of patients' disability, methods for intensifying urinary tuberculosis should be developed.