[Overactive bladder: urodynamic characteristics of detrusor overactivity due to the etiology of low urinary tract dysfun- ction].

The aim of the study was to detect features of detrusor overactivity as an urodynamic phenomenon in patients with different etiology of low urinary tract dysfunction. MATERIALS AND METHODS: The study included 283 patients (61% females and 39% males) aged 18-82 years (49.2+/-13.5) with neurogenic overactive bladder (n=197), idiopathic overactive bladder (n=41), radiation cystitis (n=8) and chronic pelvic pain (n=37). All patients underwent an urodynamic study (UDS) in Sverdlovsk Regional Clinical Hospital in the period from 2017 to 2020. RESULTS: Detrusor overactivity was detected by UDS in 63.4% patients with idiopathic, 94.2% with neurogenic overactive bladder (OAB) and 2.7% in patients with pelvic pain. Maximal amplitude of detrusor pressure during involuntary bladder contraction was significantly higher in neurogenic dysfunction than in idiopathic (25.76+/-26.21 cm 2 and 10.1+/-3.4 cm 2 respectively, =0.003). According to the ROC-analysis, detrusor pressure amplitude has a high predictor value in the diagnosis of a neurogenic origin of overactive bladder (AUC=0.863, p=0.045). The sensitivity of pressure more than 9.5 cm 20 was 88%. Bladder volume at the time of first involuntary contraction was 137+/-120 ml and 218+/-120 ml (=0.07) for neurogenic and idiopathic OAB respectively. Neurogenic detrusor overactivity followed by urgency incontinence more often than idiopathic (59.5% vs 19.2%). CONCLUSION: Neurogenic detrusor overactivity is characterized by larger amplitude and higher rate of urgency incontinence.

[The closed injury of a kidney and posttraumatic arterial hypertension: condition of study of a problem].

The article summarizes the worlds information on the history of the study, classification, management tactics of patients with closed kidney injury, analysis of the development of post-traumatic arterial hypertension (AH). In a research of renovascular and renoparenchymal mechanisms of a syndrome of AG there is no consensus of dependence on severity of injury of a kidney, a type of treatment, about the temporary period between getting injured and emergence of a complication that defines relevance of further studying.

[Interaction of immune-competent blood components in patients with isolated blunt renal trauma].

INTRODUCTION: Blunt renal trauma manifest at macro- and microstructural levels as concussions, bruises or lacerations. The pyelonephritis predominates in structure of posttraumatic compli- cations. AIM: To study immune changes in patients with renal trauma and their effect on the development of inflammatory post-traumatic complications. MATERIALS AND METHODS: Multivariate statistical analysis of immunological parameters in the immediate post-traumatic period in 92 patients with 2-3 degrees of isolated blunt renal trauma, according to the classification OIS/OI AAST, 2018), was carried out. RESULTS: three main components were identified: the first was associated with the lymphocyte count; the second component included high indicators of adaptive cellular immunity CD+19, CD+8, while the third component represented indicators of nonspecific humoral immunity. They accounted for 43.7%, 37.5% and 18.9% of the variance of intergroup differences, respectively. A strong negative correlation between neutrophils and lymphocytes and a weak positive correlation between IgM and IgG were revealed, which altogether indicated the preserved adaptive response of the immune system. CONCLUSION: The multivariate analysis of immunological reactivity suggests a sufficient degree of mobilization of the immune system for the adequate adaptive response in patients with isolated blunt kidney trauma, which makes the prediction of the development of post-traumatic pyelonephritis doubtful.

Prevalence and risk factors for erectile dysfunction and lower urinary tract symptoms in Russian Federation men: analysis from a national population-based multicenter study.

An analysis of prevalence and associated common risk factors of ED and lower urinary tract symptoms (LUTS) was performed in Russian Federation by cross-sectional multicenter survey. International Index of Erectile Function (IIEF) score and International Prostate Symptom Score (IPSS) were used for data collection in 1225 men between 20 and 77 years interviewed in six regions of Russian Federation. In addition, each participant's social, demographic, lifestyle, sexual and medical history was taken with special emphasis on risk factors for ED. Upon the basis of IIEF erectile domain score interpretation, ED was found in 530 (48.9%) men, consisting of mild and mild to moderate, moderate and severe ED in 375 (34.6%), 78 (7.2%) and 77 (7.1%) respondents, respectively. According to IPSS assessment, LUTSs were present in 649 (59.9%) responders; inclusive 370 (34.2%), 216 (19.9%) and 63 (5.8%) men with mild, moderate and severe LUTS, respectively. Men with both ED and LUTS shared common co-morbidities and lifestyle risk factors with age-adjusted odds ratio between 1.2 and 5.2. In logistic regression model (R(2)=0.361), the strongest associated with ED factor found was IPSS symptom score, followed by hypertension, IPSS-related quality of life, age, diabetes mellitus, obesity and unmotivated fatigue.

[Feasibility of using connective tissue prosthesis for autoplastic repair of urinary bladder wall defects (an experimental study)].

Experiments on laboratory rats have shown the feasibility of autoplastic repair of urinary bladder wall defects using a connective-tissue capsule formed as the result of an inflammatory response to the presence of a foreign body. The formation of connective tissue prosthesis is characterized by developing fibrous connective tissue, ordering of collagen fibers, reducing the number of cells per unit area with a predominance of more mature cells - fibroblasts. With increasing time of observation, connective tissue prostheses were found to acquire a morphological structure similar to that of the urinary bladder wall. By month 12, the mucosa, the longitudinal and circular muscle layers were formed. The proposed method of partial autoplastic repair of urinary bladder wall is promising, has good long-term results, but requires further experimental studies.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Determinants of risk of the development of erectile dysfunction in the Russian Federation: analysis of epidemiological studies].

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

[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.

[Particular features of detection of patients with urogenital tuberculosis and their management].

The rate and trend in extrapulmonary tuberculosis (TB) incidence including urogenital tuberculosis (UTB) were estimated in population of the Sverdlovsk region for the last 25 years. Long-term results of treatment of 591 patients with different forms of UTB (renal parenchyma TB, tuberculosis papillitis, monocavernous and polycavernous renal TB, male genital TB) were studied. Ureter was involved in tuberculosis process in 24.7% of UTB cases, urinary bladder--in 20.1%, renal TB combined with male genital TB. Early (non-destructive) forms incidence increased 2.8-fold while advanced forms incidence decreased 1.7-fold. This shows an increased level of detection. Total number of patients operated in state hospitals with undetected, mostly complicated urogenital male tuberculosis remains high--from 7.3 to 16% from all newly detected patients.

[Analysis of the results of epidemiological study on prevalence of erectile dysfunction in the Russian Federation].

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

Sexual functions of men with obstructive sleep apnoea syndrome and hypogonadism may improve upon testosterone administration: a pilot study.

This study examined 72 patients with obstructive sleep apnoea syndrome (OSAS), confirmed by polysomnography. Thirty-two patients were suffering from erectile dysfunction (ED) assessed by IIEF-5 questionnaires and confirmed by nocturnal penile tumescence examination. Their testosterone levels were measured. Eight patients had normal testosterone levels and were treated with a PDE-5 inhibitor (vardenafil) only; after 6 months of treatment, 6 of these patients (75%) showed significant improvement in erectile function. The remaining 24 patients with OSAS, ED and hypogonadism (total testosterone <12 nmol l(-1)), were divided into two groups based on the indication for continuous positive airway pressure (CPAP) therapy: five patients received CPAP therapy (group 1) and 19 patients did not (group 2). The patients of group 2 received only a PDE-5 inhibitor (vardenafil 20 mg) for ED; and eight patients (42%) showed an improvement after 3 months of treatment. The five patients receiving CPAP therapy were treated with a combination of parenteral testosterone undecanoate and a PDE-5 inhibitor (vardenafil) and all had normal erectile function after 3 months of therapy. The results suggest positive effects of addition of testosterone to treatment with PDE-5 inhibitors in hypogonadal men with OSAS, which should be confirmed in larger controlled studies.

[Efficacy and safety of revocarin in patients with impaired micturition due to prostatic adenoma. An open non-comparative study: results of a multicenter trial].

Patients with impaired micturition caused by prostatic adenoma received revocarin for 12-weeks. After the treatment all the patients showed relief of clinical symptoms proved by subjective assessment of urination quality (IPSS and QoL) and objective data (uroflowmetry, ultrasonography). Allergic reactions or other serious side effects were not registered. Thus, a 12-week course of revocarin demonstrated good clinical efficacy and safety in patients with urination problems because of prostatic adenoma. Revocarin can be recommended as an alternative to an original drug omnik.

[Erectile dysfunction and obstructive sleep apnea syndrome].

Of 72 patients with obstructive sleep apnea syndrome (OSAS) 32 had erectile dysfunction (ED). OSAS patients with erectile dysfunction had hypogonadism in 24 cases, in 8 men testosterone level was normal. A polysomnographic investigation with monitoring of nocturnal spontaneous erections showed that 32 patients had severe sleep fragmentation with reduced or complete absence of REM and deep sleep phases. In nocturnal penile tumescencia quantitative and qualitative characteristics were abnormal suggesting organic nature of erectile dysfunction in these patients. Eight ED and OSAS patients with normal testosterone received standard OSAS therapy with administration of FDE-5 type inhibitors. Six months later improvement of the erectile function was observed in 6 patients. OSAS patients with hypogonadism were divided into 2 groups. Group 1 (n = 5) received CPAP therapy and group 2 (n = 19) received OSAS standard therapy. Group 2 was treated with inhibitors of FDE-5 type. Three months later improvement of erectile function was seen only in 8. Group 1 received the inhibitors and testosterone replacement. Three months later all 5 patients had no ED complaints, their testosterone was normal. It is recommended to perform monitoring of nocturnal spontaneous erections in the algorithm of examination of all men with OSAS. All patients with OSAS, ED and documented hypogonadism need testosterone replacement therapy if its level persists low despite adequate therapy of OSAS.

[Use of levofloxacin in transcutaneous nephrolithotripsy].

The aim of the study was elucidation of levofloxacin (tavanik) efficacy in transcutaneous nephrolithotripsy (TNLT) made to prevent or treat infectious-inflammatory complications. We performed 211 transcutaneous endoscopic operations on the kidneys for urolithiasis (71 males and 117 females). Of them, 47 (25%) patients received tavanik. The concrement was located in the pelvis (n=9), calyx (n=9), pelvoureteral segment (n=5). Coral concrements were found in 24 cases (K1--in 12, K2--in 6, K3--in 3, K4--in 3 patients). Nephrolitholapaxy was performed in 39 patients, nephrolithoextraction--in 8 patients. Duplex ultrasound dopplerography conducted in all the examinees before surgery and on day 5-6 after it gave information about renal blood flow. Duration of the operation varied from 20 minutes in nephrolithoextraction to 136 minutes in nephrolitholapaxy of the coral concrements (mean time 40 +/- 6 min). Tavanik' was given according to the following scheme: 24 hours before the operation 500 mg tavanik was given orally, on the day of surgery and 3 consequent days 500 mg intravenously dropwise, the next 4 days 500 mg orally. Thus, a course of tavanik lasted 8 days. Nephroliths were removed in all the patients. Mean hospital stay was 7 days. In the group of 47 patients intraoperative complications were not observed. Pelvic microperforation (1 case) and loss of the concrement fragment in the paranephria (1 case) were not considered as complications and had no effect on postoperative period and recovery of the patient. Postoperative complications occurred in 6 (12.7%) patients: late hemorrhage (1), pyelonephritis (4), bacteriotoxic shock early after surgery (1). Thus, postoperative infectious-inflammatory complications arose in 5 (10.63%) patients. These patients received the same antibacterial treatment as the other patients except one patient with bacteriotoxic shock in whom a daily dose of tavanik was raised to 1 g in the course of 2 days. As success of transcutaneous nephrolithotripsy depends much on adequate pre- and postoperative antibacterial therapy, tavanik (levofloxacin) can be effectively used as monotherapy in transcutaneous nephrolithotripsy to prevent and treat postoperative infectious-inflammatory complications.

[State of hemostasis system at transurethral prostatic resection].

Hemostasis system was examined at 58 patients who underwent transurethral prostate resection due to benign prostatic hyperplasia. All the patients were divided into 2 groups: the study group where the surgery was performed under spinal anesthesia, and control - under intravenous anesthesia. The hemostasis system was examined before surgery and on 1st, 3rd and 5th day after it. It is revealed that the surgery under intravenous anesthesia is associated with increase of coagulation potential and decrease of fibrinolytic activity that is the most marked on 3rd and 5th day.

[Results of a multicenter trial of serenoa repens extract (permixon) in patients with chronic abacterial prostatitis].

Chronic prostatitis (CP) morbidity now makes up 8 to 35% in males aged 20-40 years (N.A. Lopatkin et al., 1998; O.L. Tiktinsky, 1999). In general population CP incidence rate is 5 to 8% (J.C. Nickel, 1999). Phytotherapy is now widely practiced in CP. A multicenter trial conducted by the authors demonstrates high efficacy ofpermixon in the treatment of chronic prostatitis/chronic pelvic pain syndrome. The results of 6-month follow-up are presented.

[Acute gestation pyelonephritis in terms of systemic inflammatory reaction syndrome].

Laboratory indices reflecting phases and level of systemic inflammatory reaction were analysed in 30 patients with acute gestation pyelonephritis (AGP). The patients were divided into two groups depending on clinical manifestations and drainage of the kidney. AGP course runs according to major regularities of systemic inflammatory reaction the analysis of which enables formulation of principles of optimal AGP treatment.