[Herpes viruses and human papillomavirus in prostate cancer: first results].

INTRODUCTION: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are among the most common urological diseases in men. It has been repeatedly suggested that viral infection plays an important role in prostate carcinogenesis. AIM: To assess the relationship between viral infection and PCa, as well as the clinical and morphological features of BPH and PCa. MATERIALS AND METHODS: A total of 98 patients undergoing treatment for BPH (n=48) or PCa (n=50) between 2019 and 2021 were included in the study. Real-time PCR on the surgical specimens for human papillomaviruses (HPV), herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes virus type 6 (HSV-6) was performed. RESULTS: In patients with PCa, viruses in prostate tissue were found more often compared to those with BPH (50.0 vs. 31.3%, respectively, p=0.046.) The most common virus in both PCa and BPH was EBV (22.0 vs. 16.7%, respectively). The second most common virus in patients with PCa was HSV-6 (20.0%), which was not detected in any men with BPH (p=0.003). There was a trend toward higher prevalence of CMV among patients with PCa (16.0% vs. 4.2%), but the difference was not significant (p=0.09). There was no association of viral infection with clinical and morphological features. CONCLUSIONS: The resulting trend toward a higher prevalence of HSV-6 and CMV in patients with PCa compared to those with BPH creates the prerequisites for further study of viruses in prostate diseases involving a larger cohort, which will provide an idea of the multi-stage process of malignant transformation and, possibly, open new therapeutic options for prevention and treatment.

[Surgical treatment of Zinner syndrome].

Zinners syndrome (SC) is a rare congenital disease characterized by ejaculatory duct obstruction, seminal vesicle cyst in combination with ipsilateral renal agenesis. This syndrome is due to development arrest of the Wolffian duct (mesonephros). Before the onset of sexual activity, the disease is asymptomatic. The main symptoms are nonspecific, including dysuria, urinary frequency, perineal and scrotal pain after ejaculation. A clinical case with the presentation of our own experience of surgical robot-assisted treatment of a patient with Zinners syndrome is presented in the article.

[Super-selective prostatic artery embolization as minimally invasive surgical treatment in patients with BPH].

Benign prostatic hyperplasia (BPH) is a widespread socially significant disease. Minimally invasive surgical treatments can reduce the surgical and anesthetic risk. One of the most effective methods of minimally invasive surgical treatment of BPH is superselective prostatic artery embolization (prostatic artery embolization; PAE). PAE is a method with proven effectiveness and has been included in the clinical recommendations of the Ministry of health of the Russian Federation for the treatment of BPH since 2019.

[Phenotyping of angiotensin-converting enzyme in the prostate in patients with prostate cancer and benign prostatic hyperplasia].

BACKGROUND: Angiotensin-converting enzyme (ACE) is expressed by all epithelial cells of the human body. Although the main proportion of ACE is synthesized by the lungs, in men, ACE is also secreted by the testes (testicular form), seminal vesicles and the prostate. In semen, the level of ACE is up to 50 times higher than in blood plasma. The substitution of highly specific epithelial cells of the prostate by tumor cells causes a dramatic decrease in ACE production by the prostate cells. AIM: To assess the possibility of using prostatic ACE as a new marker of prostate cancer (PCa). MATERIALS AND METHODS: ACE phenotyping in prostate of patients with PCa and benign prostatic hyperplasia (BPH) included measurement of the activity of two ACE substrates (HHL and ZPHL); calculation of the ratio of their hydrolysis rates (ZPHL/HHL ratio); quantitative assessment of the ACE immunoreactive protein, the ratio of the immunoreactive protein to the ACE activity, as well as the conformation of ACE using a panel of monoclonal antibodies (mAb) to different epitopes of ACE. RESULTS: ACE activity in tumor cells was markedly reduced and the ratio of immunoreactive ACE to its activity increased. The ratio of the hydrolysis rates of two substrates (ZPHL/HHL ratio) in patients with PCa increased compared to control group, while it was not observed in the vast majority of patients with BPH. There were several tissue samples with a histological diagnosis of BPH, but ACE phenotype was typical for PCa. DISCUSSION: Since a decrease in ACE activity was found in all patients with PCa, we suggest that it may serve as a reliable and early marker of the tumor development. Changes in the ACE phenotype, which are typical for PCa, but found in patients with BPH, may indicate earlier malignant changes in prostate cells, which are not visible on routine prostate biopsy. CONCLUSIONS: ACE activity and its conformation in prostatic biopsies has the potential to be an early biomarker or a differential criterion for PCa. In PCa, the ACE activity in the prostate is significantly reduced, and the ZPHL/HHL ratio is markedly increased in comparison to control group. However, there were no such changes in patients with BPH. In hyperplastic processes of the prostate (BPH, PCa), there is a change in ACE sialylation, which is accompanied by an increase in the binding of ACE to mAb 3F10 compared to the control group. Patients with negative biopsy result, but properties of prostate ACE, which are typical for PCa, require close follow-up, since they may have an increased risk of subsequent developing PCa. However, due to a small sample of patients, the diagnostic potential of prostate ACE for PCa and BPH requires to be validated in a larger number of patients to confirm its predictive accuracy.

[Super-selective embolisation of bladder arteries for treatment of patients with bladder tumors complicated by recurrent macrohematuria].

The prevalence of bladder cancer in Russia over the past 10 years has increased from 49.6 to 74.1 patients per 100,000 population. Hematuria is a life-threatening complication and one of the common causes of mortality in advanced stages of bladder cancer. Conservative methods of hemostasis do not always allow to achieve a stable effect. In addition, in the cases of intractable bleeding, the patients may require surgical treatment. Due to the prevalence of patients with a high anesthetic risk group in bladder cancer patients cohort, the minimally invasive hemostasis technologies are more preferable. This review is devoted to one of such methods - superselective embolization of the urinary bladder arteries.

[Super-selective prostatic artery embolization for bph treatment.]

Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system. BPH prevalence increases in men with advancing age, highlighting the necessity of minimally invasive surgical procedure including super-selective prostatic artery embolization (PAE). The current role of the PAE for BPH treatment according to recent national and international publications is discussed in this review. The data from the largest studies are structured and presented along with our experience in PAE. In addition, a need to continue research on this topic is underlined.

[Biomarkers of prostate cancer and potential for using ace produced in prostate gland for diagnosis of prostate cancer and benign prostatic hyperplasia].

Prostate cancer (PCa) is the 4th most commonly diagnosed cancer in the male population and incidence of different stages is increasing every year. The efficiency of PCa treatment is strongly dependent on the its stage. Prostate Specific Antigen (PSA) is the most widely used and universal biomarker of PCa worldwide. Considering its limited predictive value, particularly in patients older than 50 with PSA level ranging from 4.5 to 10 ng/ml, there is a need to introduce new serum biomarkers of PCa. Current data on different PCa biomarkers are reviewed in the article as well as a role of angiotensin-converting enzyme (ACE) as a novel PCa biomarker.

[Results of a multicenter non-interventional study on the efficacy and safety of NeyroDoz complex for sexual dysfunction in men].

The article presents the results of a multi-center observational study carried out in 2014-2015 comprising 630 male patients from 23 Russian health care institutions. The study aimed to accumulate epidemiological data on sexual dysfunction in men and test the efficacy and safety of biologically active complex NeyroDoz. Data for the study were collected using questionnaires. The study findings showed a high prevalence of premature ejaculation (PE) in 38.2% of patients with chronic prostatitis (CP) and in 33.25% of patients with erectile dysfunction (ED). The data were analyzed for the total study population (n=630) and separately for three groups of patients selected according to the presence of PE (n=582), orgasmic disorders without PE (n=17) and increased anxiety related to urological diseases without PE (n=31). In all patients of the study, NeyroDoz intake produced a statistically significant increase in the intensity of orgasm from 5,0+/-2,2 to 7,6+/-1,8 points, duration of sexual intercourse from 3,3+/-5,4 to 6,5+/-4,8 min, and satisfaction with sexual intercourse from 1,4+/-0,7 to 3,1+/-1,1 points. In 81% of PE patients the duration of penetration phase of sexual intercourse increased by 50% of the baseline values. The intensity of orgasm increased on average by 60% and 75% in men with PE and orgasm disorders without PE, respectively. Reduction of psycho-emotional burden was observed in 90% of patients with anxiety and depression. The dietary supplement NeyroDoz showed clinical efficacy and safety in the combined treatment of sexual dysfunction in men.

[Urinary bladder substitution using combined membrane based on secretions of human mesenchymal stem cells and type I collagen].

AIM: Despite the widespread use of intestinal cystoplasty, urinary bladder substitution remains a challenging problem due to the complexity of operations and the potentially high risk of complications. A promising alternative may be bio-engineered collagen-based matrices containing stem cells or their secretions. MATERIAL AND METHODS: To evaluate the effectiveness of this bladder substitution modality, an experiment was conducted on 14 male rabbits. The animals underwent resection of urinary bladder, and the formed defect was substituted with a membrane of type I collagen (series 1, 5 rabbits) or a membrane of the same composition containing a conditioned medium with secretion of mesenchymal stem/stromal cells derived from human adipose tissue (series 2, 5 rabbits). In the comparison group (4 rabbits) resection of the bladder and the closure of the defect was carried out without bladder substitution (series 3). RESULTS: At 1 month after surgery, there was a complete epithelization of the inner surface of the implant, and body tissues replaced the collagen matrix. In series 1, the collagen implant was replaced mainly by connective tissue ingrown with occasional solitary smooth muscle cells. In series 2, the newly formed bladder wall contained numerous smooth muscle cells, growing into the collagen matrix and forming the muscular coat. In series 3, the muscular layer regeneration at the scar site was also noted, but it was less intense, which was confirmed by morphometry. In series 2, more active vascularization of the collagen implant occurred due to neo-angiogenesis, which was more intense than that in series 3, and especially in series 1. Functional studies revealed a reduced bladder functional capacity in series 1 and 3, while in series 2 it was close to normal. During filling cystometry, changes in intra-vesical pressure profile in series 2 were close to normal, while in series 1 and 3 infusion of a small volume of saline resulted in a marked increase in intra-vesical pressure, showing a reduced compliance of the reconstructed bladder. Discussion The study findings show that implants based on type I collagen can be effectively used to substitute a part of the urinary bladder wall, but bio-engineered collagen matrix grafts containing cell regeneration stimulants secreted by stem cells in their culture medium seem to be more promising.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Building of defects of the bladder wall by membrane, created on the basis of type I collagen (an experimental study)].

Experimental study was performed on 24 Chinchilla rabbits, which underwent resection of the bladder with building of defect by membrane "Collost", created on the basis of type I collagen. The functional state of the bladder in situ was assessed by infusion cystomanometry during repeated surgery at 7, 14 day and at 1, 3, 6 months, and at 1 and 1.5 years. It is found that developing detrusor pressure during bladder contractions was decreased by 10 times in the first week of the study; it was in line with the subcompensation after 3 months, and was restored at 6 month. At 1 and 1.5 years, increase of cumulative function of bladder while saving detrusor pressure was observed. Dilating cystoplastics using biopolymer "Collost" provides good long-term functional results.

[Using energetic Doppler-angiography in combined diagnostics of prostatic abscess].

Diagnostic possibilities of conventional clinical-laboratory, physical methods, seroscale echography and energetic dopplerangiography (EDA) were compared in 32 patients with prostatic abscess (PA). Nonspecific symptoms hamper conventional PA diagnosis. PA is detected, as a rule, at transrectal ultrasonic investigation (TUI) which is effective in formed PA (sensitivity 100%) but is low effective in early PA (sensitivity 50%). Minimal size of PA detectable by TUI is 7 mm (mean 12 +/- 1.2 mm). EDA improves diagnostic potential of TUI in infiltrative PA (sensitivity 91.7%). In established PA, EDA confirms TUI findings. Transabdominal ultrasonography has insufficient resolution and must be used for PA screening.

[Doppler technologies in combined diagnosis of acute pyelonephritis].

We studied diagnostic potentialities of conventional clinical, device, x-ray and ultrasonic methods including current Doppler technology in differentiation of serous and purulent stages of acute pyelonephritis (AP) in 50 patients (mean age 25.5 +/- 5.5 years). Energetic dopplerangiography (EDA) showed the highest diagnostic significance. EDA was highly informative in renal carbuncle and total purulent destruction of the kidney and low informative in serous and apostematous AP, renal abscess. Conventional ultrasonic, x-ray, clinical and device investigations as well as impulse dopplerography and color Doppler mapping of blood flow are of secondary importance in AP.

[Use of proscar in preoperative preparation of patients with benign prostatic hyperplasia before transureteral resection]. / Primenenie proskara v kachestve predoperatsionnoi podgotovki bol'nykh s dobrokachesvennoi giperplaziei prostaty pered transuretral'noi rezektsiei.

Effects of proskar-MSD used before transurethral resection (TUR) of the prostate in patients with benign prostatic hyperplasia (BPH) were studied with specification of the drug action on hematuria during and after operation. Patients with histologically verified BPH received proskar for 3 and 6 months in a dose of 5 mg/day. Control patients did not receive preoperative proskar. Of patients who received proskar for 3 months, TUR with estimation of the intraoperative blood loss and changes in microcirculation and structure of prostatic tissue induced by proskar was made in 20 patients (mean age 68 years). A 3-month course of proskar reduced prostatic volume and its hyperplasia by 18-20 cm3, on the average. Mean blood loss was about 111 ml vs control 223 ml. Dopplerography revealed consolidation of adenomatous tissue and decline of volumic blood flow in the prostate after 3-month proskar course. Thus, preoperative proskar administration before TUR of prostatic adenoma results in sclerosing of prostatic tissue, decrease of microcirculation manifesting intraoperatively with diminished hematuria and less number of subsequent complications; promotes a favourable outcome of the operation; improves life quality.

[Minimally invasive method of the treatment of prostatic abscess]. / Maloinvazivnyi metod lecheniia abstsessa predstatel'noi zhelezy.

In discussion of advantages and shortcomings of different surgical procedures in the treatment of a prostatic abscess (PA) which rarely complicates acute prostatitis the authors focus on a thin needle transcutaneous puncture of PA under ultrasound control. This low invasive operation made under local anesthesia was performed in 15 PA patients. The abscess cavity was drained using a polyethylene catheter "pigtail". The manipulation was well tolerated by all the patients with no complications in the postoperative period. A mean time of the abscess cavity draining was 4 days. A follow-up for 1.5 years discovered recurrence in none of the patients. This low invasive method is proposed as an alternative to the existing traumatic methods of PA management.

[Differential diagnostic value of prostate-specific antigen in prostatic hyperplasia]. / Differentsial'no-diagnosticheskoe znachenie prostaticheskogo spetsificheskogo antigena pri giperplazii predstatel'noi zhelezy.

Diagnostic value of prostate specific antigen (PSA) was studied in 163 patients with prostatic hyperplasia. As PSA is not a cancer-specific test, it is recommended to obtain biopsy in patients with prostatic hyperplasia and PSA > 4 ng/ml to diagnose prostatic cancer early. Methods raising PSA specificity for differential diagnosis of prostatic hyperplasia are not absolutely reliable.

[The transurethral microwave thermotherapy of benign prostatic hyperplasia]. / Transuretral'naia mikrovolnovaia termoterapiia dobrakachestvennoi giperplazii predstatel'noi zhelezy.

The authors have treated benign prostatic hyperplasia (BPH) in 50 patients aged 54-89 years (mean age 67.5 years) including 10 patients with cystostoma. The patients were exposed to transurethral microwave thermotherapy (TUMT) performed on the prostcare unit. Only 1 session (60 min at 45 degrees C) was conducted. Inflammatory complications of TUMT occurred in 4(8%) patients. A 1.5-year follow-up covered 45 patients. A subjective response was obtained in 86% of patients. An objective response by urination rate and prostatic size 3 months after TUMT was reached in 80 and 90% of patients, respectively; 1.5 years after in 48, 34 and 47%, respectively. TUMT is recommended in uncomplicated BPH as an alternative to chemotherapy or surgical treatment (in patients with cystostoma and serious intercurrent diseases).