Sexual dysfunction in males with concomitant urological diseases

A clinical data was studied for 117 males without complaints for copulative disorders admitted to urological clinic electively for benign prostatic hyperplasia (BPH)--44 (37.6%), urolithiasis--25 (21.4%), external genital diseases--17 (14.5%), renal cyst and hydronephrosis--16 (13.7%), renal and vesical tumors--15 (12.8%). Mean age of the patients was 56.2 +/- 16.1 years. The patients filled in IPSS and IIEF questionnaires. Mean score set (+/-SD) for IIEF and IPSS was 35 +/- 23 and 12 +/- 10, respectively. The majority of the patients (n = 61) were not sexually active. Erectile dysfunction (ED) was detected in 23 (19.7%) patients: mild and moderate in 19 (16.2%) and 4 (3.4%), respectively). 24 (73%) patients with normal erectile function, 10 (44%) patients with ED and the majority (n = 37) of sexually inactive men were satisfied with their sexual activity. Those males who needed improvement of sexual life quality had higher (p < 0.05) parameters of erectile function and sexual satisfaction. Age of the patients (R2 = 33.1; p < 0.0001) and IPSS index (p < 0.015) were leading indices in determining condition of the copulative function. IIEF correlated with tumors of the kidney or urinary bladder (p < 0.004) and benign prostatic hyperplasia (p < 0.015). Erectile dysfunction in men with urological diseases was closely related with age and severity of lower urinary tract symptoms. Other sexual disorders may be due both to general causes and urological diseases.     

Prognostic implication of morphometric stromal parameters of renal pelvis and ureteral transitional cell carcinomas

To evaluate prognostic value of morphometric studies of the stroma of transitional cell carcinomas of the renal pelvis and ureter, we studied retrospectively the data of primary examination and follow-up of 75 patients (49 males, 65% and 26 females, 35%; mean age 61.9 +/- 1.2 years) given radical surgical treatment for cancer of the renal pelvis and ureter. Five-year survival in the absence of tumor progression was 23%. Morphological examination diagnosed transitional cell carcinoma with invasion pT1, pT2, pT3 and pT4 in 3(4%), 15(20%), 47(63%) and 10(13%) cases and differentiation degree G1, G2, G3 in 31(41%), 15(20%) and 29(39%) cases, respectively. In addition to the standard morphological examination of the tumor, we made morphometry of stromal and tumor area, analysed composition and count of stromal effector cells (lymphocytes, eosinophilic and neutrophilic leukocytes, macrophages, mast and plasmic cells), the degree of stromal vascularization. Prognostic value of the above parameters was estimated according to significance of their correlation with postoperative survival of the patients. The survival correlated with the depth of cancer invasion (p = 0.005) and differentiation of tumor tissue (p = 0.006), high cell infiltration of tumor stroma is prognostically unfavourable (R2 = 0.03; F = 3.41; p = 0.069) as well as weak presentation of stromal component of the tumor (p = 0.056). The lowest survival was observed in patients with cancer of the renal pelvis and ureter with a great number of mast cells (p = 0.056), macrophages (p = 0.037) and neutrophils (p = 0.029) in the tumor stroma. According to the results of multiple regression analysis (R2 = 0.08; F = 5.42; p = 0.024), five-year postoperative survival most closely correlated with cancer invasion depth (p < 0.001), degree of tumor cells differentiation (p < 0.001) and number of macrophages infiltrating tumor stroma (p < 0.001). Significance of survival prognosis for patients with cancer of renal pelvis and ureter can be raised by estimation of mean number of free stromal cells and expression of stromal component.     

Clinical significance of the determination of R-proteins in the ejaculate of patients with chronic prostatitis

Products of cell receptor (R-proteins) catabolic lysis were measured in ejaculate of 121 patients with chronic prostatitis and 15 healthy males. R-protein levels were higher in the patients (U = 172.5; p = 0.047). When immunological indices of the ejaculate (IgA, sIgA, IgG, IgM, interleukin-8) were measured, it was found that in patients with chronic prostatitis there is a positive correlation between concentration of interleukin-8 and content of R-proteins (r = 0.43; p = 0.028). Positive correlation also exists between R-protein content and prostate volume (r = 0.24; p = 0.034) while negative one--between R-proteins concentration and size of the hypoechogenic sites in the prostate (r = -0.25; p = 0.039), between R-proteins in the ejaculate and serum level of fibrinogen B (r = -0.25; p = 0.021). It is inferred that elevation of ejaculate R-protein level occurs in alteration of the prostate. The test for R-proteins in ejaculate can be helpful in detection of early stages of chronic prostatitis.     

Contact laser lithotripsy--an effective minimally traumatic method of treatment of cholelithiasis with calculi of the kidney, ureter and urinary bladder

An experience with using contact laser lithotripsy is presented in treatment of such actual disease as cholelithiasis. This kind of modern minimally traumatic lithotripsy used in 73 patients has shown it to be effective independent of localization of the calculi: both in the urinary bladder and the kidney and ureter.     

Application of fibrinolysis inhibitor tranexam in transurethral resection of the prostate

Prostatic surgery is often accompanied with increased intra- and postoperative bleeding which is caused, among other reasons, by enhancement of general and local fibrinolysis due to mechanical impact on prostatic tissue in operation. We proposed to inhibit enhanced fibrinolysis with preparation of tranexamic acid tranexam and tried it in 53 patients with prostatic adenoma undergoing transurethral prostatic resection (TUR). The comparison of bleeding severity in surgery with and without tranexam administration before, in and early after prostatic TUR showed that tranexam significantly lowers blood loss.     

Value of combined urodynamic examination of patients with unsatisfactory outcomes of surgical treatment of prostatic adenoma

Forty three patients with unsatisfactory outcomes of surgical treatment of benign prostatic hyperplasia (BPH) were examined urodynamically. Thirty five patients complained of daily and nocturnal pollakiuria, incomplete evacuation of urine from the bladder, imperative voiding. Eight patients had postoperative enuresis. Seventeen control patients had satisfactory surgical results. The urodynamic findings showed that postoperative dysuria was caused by detrusor pathology: detrusor hyperactivity (n = 27, 62.8%), contractile hypoactivity (n = 4, 9.3%), infravesical obstruction (n = 4, 9.3%). Diuresis patients had low maximal cystometric capacity of the urinary bladder, detrusor hyperactivity was diagnosed in 5 (62.6%) patients. Enuresis patients had also very low indices of urethral profilometry characterizing function of the sphincter. The urodynamic examination detected true stress urine incontinence in 3 enuresis patients due to sphincter impairment. Five patients had enuresis of mixed nature. Thus, urodynamic examination of patients with unsatisfactory results of surgery determined cause of dysuria. Accurate diagnosis of characteristics and causes of lower urinary tracts dysfunction decides choice of adequate therapeutic policy.     

Prostatilen treatment of prostatic adenoma

We studied efficacy of repeated courses of prostatilen in suppositories with dimexide in prostatic adenoma patients with normal micturition. Rectal suppositories contain 30 mg prostatilen and 90 mg dimexide. The course consisted of 15 suppositories. The treatment reduced clinical symptoms of infravesical obstruction, residual urine volume in administration of prostatilen in 15-day courses each 3 months. This suggests possibility of suppository prostatilen use not only as an alternative for expensive drugs but also in combination with them in treatment of initial prostatic adenoma.     

Prostatilen effects on voiding disorders in patients with benign prostatic hyperplasia

The authors review the experience with prostatilen treatment gained in the urological clinic of the St-Petersburg State Medical University and analyze treatment outcomes for 96 patients with benign prostatic hyperplasia (BPH) aged from 51 to 89 years. Prostatilen proved its efficacy in relieving manifestations of infravesical obstruction in BPH, therefore, prostatilen administration in the treatment of patients with initial or moderate subjective and objective symptoms is justified. Dimexide suppositoria containing 30 mg of prostatilen are preferable.     

Vitaprost efficacy in patients with chronic abacterial prostatitis

We studied efficacy of a new cytomedine drug--vitaprost--in 98 patients with chronic abacterial prostatitis. Vitaprost was found to relieve symptoms of the disease, improved blood flow in the prostate, normalized blood rheology and immunological indices, increased mobility of spermatozoa in ejaculate.