Recurrent cystitis in women: principles of rational therapy

Introduction. Urinary tract infections (UTIs) are one of the most common disease among women.Aim. To determine the efficacy and tolerability of furazidin in the treatment of patients with exacerbation of chronic recurrent cystitis.Material and methods. a purpose was to determine the efficacy and tolerance of furazidin in the treatment of patients with chronic recurrent cystitis. In the study 56 female patients were enrolled, 28 of whom received ciprofloxacin (CG) and 28 – furazidin (FG). The patients received furazidin 100 mg three times a day for seven days (FG) or 500 mg of ciprofloxacin twice a day for seven days (CG). As well we analyzed the histories of 37 patients with bladder tuberculosis (TMP) stage 4in order to estimate the negative effect of non-optimal antibiotic therapy for UTI on the timely diagnosis of urogenital tuberculosis.Results. At the end of antibacterial therapy, dysuria persisted in one patient in the FG and in two in the CG. Urinalysis was normal in both groups in 96.4% of patients. The growth of uropathogens was in one case in each group. For 6 months, there were 5 recurrence episodes in the FG, and there were 11 relapses in the CG (p < 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed. Conclusion. Immediate results did not show statistically significant differences between the  groups of  patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p >< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis. >< 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed.Conclusion. Immediate results did not show statistically significant differences between the  groups of  patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p < 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis.>< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis

Restoration of erectile function in men after prostate surgery in the immediate postoperative period: the needs assessment for patients and their partners to maintain sexual relations

Introduction. Despite the advances in the modern pharmacopoeia, a significant place is given to surgical methods of treating benign prostatic hyperplasia (BPH) and prostate cancer (PCa). In the postoperative period in men, sexual function usually deteriorates.Purpose of the study. To study the needs of men after prostate surgery and their sexual partners in restoring their previous sexual life.Materials and methods. The pilot open-label prospective randomized non-comparative study included 50 patients in the age range of 53 – 74 years (average 58.3 years). All patients were consistently admitted and operated on at the “Avicenna” Medical Centre, Ltd. (Novosibirsk) from January to December 2020. Upon admission, all patients completed the International Index of Erectile Function (ICEF) questionnaire; one month later, this questionnaire was re-completed, supplemented with five questions.Results. Twenty-one patients were admitted with a diagnosis of PCa T1c – T2N0M0, all of them underwent laparoscopic prostatectomy with lymphadenectomy. Twenty-nine patients were operated on for BPH. They underwent transurethral resection with a bipolar resectoscope. Only 6 patients (12%) had no comorbidities. Surgical intervention worsened sexual function in all patients, while in men aged 50 – 59 years, the IIEF score decreased by 61.0%, at the age of 60 – 69 years by 39.0%, in patients over 70 years old by 55.2%. Eighteen (36.0%) patients showed interest in restoring sexual function. Thirty-two (64%) patients were against the continuation of sexual activity with the following motivation: 19 (59.4%) – lack of desire for a sexual partner, 8 (25.0%) – lack of desire of the patient himself, 5 (15.6%) – unwillingness to re-operated. Nineteen women out of 36 stable couples (52.8%) objected to the restoration of the sexual function of their sexual partners.Conclusion. Prostate surgery affects male sexual function more severely in younger patients. Thirty-two patients after surgery refused to restore sexual activity, in more than half of cases (59.4%) due to the unwillingness of the sexual partner to resume sexual relations

Редкий случай туберкулеза уретры

Urethral tuberculosis is a rare disease since the advent of highly effective anti-tuberculosis drugs. The article describes an extremely rare clinical observation of a 34-year-old patient with the transition of tuberculous inflammation from the subcutaneous tissue to the wall of the urethra with intact kidneys. Since the first blood discharge from the urethra, the diagnostic process took 3.5 years, all these years, multiple examinations for tuberculosis were carried out and the results were negative, while the disease progressed. The diagnosis was differentiated between acute purulent anterior subcutaneous paraproctitis and festering pararectal cyst. There were repeated openings of the perineal abscess, no bacterial growth was observed, histological tests revealed chronic purulent inflammation. In view of the persistent recurrent course of perineal abscess, tuberculosis was repeatedly suspected. Acid-resistant mycobacteria were found in the discharge from the fistula by fluorescent microscopy: 10-99 in the sample. Tuberculous mycobacteria were not found in the urine by polymerase chain reaction. The patient was diagnosed with A18.4. Tuberculosis of subcutaneous fat (perineum). Mycobacterium tuberculosis (+). The course of disease was complicated by perineal fistula. With the anti-tuberculosis treatment, the fistulous opening healed within a month.Туберкулез уретры является редким заболеванием с момента появления высокоэффективных противотуберкулезных препаратов. В статье представлено крайне редкое клиническое наблюдение пациента 34 лет с переходом туберкулезного воспаления с подкожной клетчатки на стенку уретры при интактных почках. С момента появления выделения крови из уретры диагностический процесс занял 3,5 года, все эти годы многократно проводилось обследование на туберкулез без результатов, а процесс прогрессировал. Дифференциальный диагноз проводили между острым гнойным передним подкожным парапроктитом и нагноившейся параректальной кистой. Были повторные вскрытия абсцесса промежности, роста флоры не получено, гистологически ‒ хроническое гнойное воспаление. С учетом упорного рецидивирующего течения абсцесса промежности вновь был заподозрен туберкулез. В отделяемом из свища методом люминесцентной микроскопии обнаружены кислотоустойчивые микобактерии: 10-99 в препарате. В моче методом полимеразной цепной реакции патоген не найден. Пациенту установлен диагноз: А18.4. Туберкулез подкожно-жировой клетчатки (промежности). МБТ (+). Осложнения: свищ промежности. На фоне противотуберкулезного лечения свищевое отверстие облитерировалось в течение месяца

ПРАВОВЫЕ ОСНОВЫ ПРОВЕДЕНИЯ BCG-ТЕРАПИИ ДЛЯ ЛЕЧЕНИЯ РАКА МОЧЕВОГО ПУЗЫРЯ В УСЛОВИЯХ МУНИЦИПАЛЬНЫХ ПОЛИКЛИНИК

The article presents brief data from the literature about the history of BCG vaccine development (Bacille bilie' Calmette-Gue'rin), results of meta-analyses aimed at the evaluation of BCG-therapy efficiency in Ta-T1 bladder cancer. Below one can read descriptions of clinical cases when side effects and complications of this method developed according to the literature data and results of authors' personal observations. The main reason of low level of BCG-therapy use in Russia is low awareness of medical workers about the legal grounds for application of this method. The article gives the list of acting legal acts regulating provision of epidemiological safety when applying BCG-therapy and describes the technique for using this method in municipal polyclinics in compliance with the above legal acts.Представлены краткие данные литературы по истории создания вакцины BCG (Bacille bilie' Calmette-Gue'rin), результаты метаанализов по оценке эффективности BCG-терапии при раке мочевого пузыря Та-Т1. Приведены описания клинических случаев возникновения побочных реакций и осложнений данной методики по данным литературы и результатам собственных наблюдений. Основной причиной низкого уровня применения BCG-терапии в России является недостаточная осведомленность медицинских работников правовых норм проведения данной методики. Представлены перечень действующих нормативных документов, регулирующих обеспечение эпидемиологической безопасности при проведении BCG-терапии, и в соответствии с ними технология проведения данного метода в условиях муниципальных поликлиник

Рецидивы урогенитального туберкулеза

The objective of the study: to characterize the cases of tuberculosis relapses with lesion in urogenital organs.Subjects and methods. Out of 140 case histories of patients with urogenital tuberculosis (UGTB; tuberculosis of the urinary and male reproductive system), registered for follow-up by the phthisiourologist, all files of patients with tuberculosis relapses were picked up, totally, there were 13 of them.Results. Men prevailed among cases of relapses (61.5%). Patients at the age of 30-50 years old made 46.1%, and 53.9% were 51 years old and above. In the first episode of tuberculosis, lesions of the genitourinary system were observed in 53.9% of patients, bacterial excretion was found in 38.5%. On the average, the relapse developed in 9.1 years after successful cure of the first episode of tuberculosis: after respiratory tuberculosis – in 5.6 years and after UGTB – in 12.3 years. In 3 (23.1%) patients with relapse, mycobacteriuria was documented, in 1 of them, drug resistance (to streptomycin and isoniazid) was detected. In general, in the relapse of tuberculosis with urogenital lesions, the kidneys were most often (69.2%) affected. The treatment of relapse was effective in 12 out of 13 patients. During chemotherapy of tuberculosis, 3 (23.1%) patients developed toxic and allergic reactions that required treatment interruption or cancellation of the drug.Цель исследования: охарактеризовать случаи рецидива туберкулеза с поражением урогенитальных органов.Материал и методы. Из 140 амбулаторных карт больных урогенитальным туберкулезом (УГТ; туберкулез мочевой и мужской половой системы), находящихся на диспансерном учете у фтизиоуролога, выбраны все карты больных с рецидивом туберкулеза, их оказалось 13. Результаты исследования. Среди больных с рецидивом преобладали мужчины (61,5%). Пациентов в возрасте 30-50 лет было 46,1%, в возрасте 51 года и старше – 53,9%. При первом эпизоде туберкулеза поражение органов мочеполовой системы было у 53,9% пациентов, бактериовыделение установлено у 38,5%. Средний срок рецидива после успешного излечения первого эпизода туберкулеза составил 9,1 года: после туберкулеза органов дыхания ‒ в среднем 5,6 года; после УГТ ‒ в среднем 12,3 года. У 3 (23,1%) больных с рецидивом зафиксирована микобактериурия, у 1 из них выявлена лекарственная устойчивость микобактерий туберкулеза (к стрептомицину и изониазиду). В целом при рецидиве туберкулеза с урогенитальным поражением наиболее часто (69,2%) в процесс вовлекались почки. Курс лечения рецидива был эффективен у 12 из 13 пациентов. У 3 (23,1%) больных во время химиотерапии туберкулеза были токсико-аллергические реакции, требовавшие перерыва в лечении или отмены препаратов

ОПРЕДЕЛЕНИЕ УРОВНЯ НАСТОРОЖЕННОСТИ (INDEX SUSPICION) В ОТНОШЕНИИ МОЧЕПОЛОВОГО ТУБЕРКУЛЕЗА У СПЕЦИАЛИСТОВ РАЗЛИЧНОГО ПРОФИЛЯ

Polymorphism of clinical manifestations and absence of pathognomic symptoms are typical of urogenital tuberculosis. Since anti-microbial agents are widely used (fluoruquinolones, amikacin, rifampicin), it is more difficult to verify the diagnosis by pathomorphologic and bacteriological methods. The index of suspicion and certain required minimum level of knowledge on urogenital tuberculosis are crucial for its early diagnostics.Materials and methods. In order to assess the level of knowledge in doctors specializing in different fields (urologists, gynecologists, general practitioners, phthisiologists) about specific symptoms and early diagnostics of urogenital tuberculosis and to evaluate the level of their awareness of this disease, 265 specialists had a test in the form of a questionnaire. To define preferences of specialists when choosing specific therapy of infectious inflammatory disorders of the urogenital system, the answers to the questionnaire given by 2 groups of doctors were analyzed, Group 1 (103 persons) included urologists, gynecologists and phthisiologists from medical units of Novosibirsk Region and city of Novosibirsk, Group 2 (298 persons) included interns and residents of Novosibirsk State Medical University by the Russian Ministry of Health.Results. There was no significant difference between the level of knowledge about urogenital tuberculosis among the specialists: urologists, gynecologists, and general practitioners gave the right answers in 59.2-63.7% of cases; phthisiologists had a better level of knowledge and 77.2% of their answers was right. In every third case, the choice of anti-microbial agents for empiric therapy of acute and chronic cystitis was not the best option regarding the drug resistance and inhibiting action against M. tuberculosis.Conclusion: The results of the questionnaire survey showed the low level of knowledge about urogenital tuberculosis among the specialists of general medical services (urologists, gynecologists, general practitioners). The high number of antibacterial agents with tuberculostatic action which were mentioned as drugs for the empiric treatment of urogenital disorders reflects the fact that importance of urogenital tuberculosis is underestimated by the specialists. Мочеполовой туберкулез (МПТ) характеризуется полиморфизмом клинических проявлений и отсутствием патогномоничных симптомов. В связи с широким применением в общей практике антимикробных препаратов (фторхинолоны, амикацин, рифампицин) возможность верификации диагноза патоморфологически и бактериологически резко снижена. Настороженность врача (index suspicion) и определенный минимум знаний в отношении МПТ выходят в ранней диагностике на первый план.Материал и методы. С целью определения уровня знаний врачами разных специальностей (урологи, гинекологи, терапевты, фтизиатры) особенностей клинической картины и ранней диагностики МПТ, уровня их настороженности в отношении этого заболевания проведено тестирование 265 специалистов. Для определения предпочтений специалистов в выборе эмпирической терапии инфекционно-воспалительных заболеваний мочеполовой системы проанализированы результаты анкетирования врачей урологов, гинекологов и фтизиатров лечебных учреждений Новосибирской области и г. Новосибирска (1-я группа ‒ 103 человека), а также интернов, ординаторов ГБОУ ВПО «НГМУ» Минздрава России (2-я группа ‒ 298 человек).Результаты. Существенной разницы между уровнем знаний особенностей МПТ у специалистов не выявлено: урологи, гинекологи и терапевты дали правильные ответы в 59,2-63,7% случаев; закономерно лучшую подготовку по этому вопросу продемонстрировали фтизиатры, которые верно ответили в 77,2% случаев. Выбор антимикробных препаратов в качестве эмпирической терапии острого и хронического цистита в трети случаев не был оптимальным в точки зрения резистентности возбудителя и ингибирующего действия на M. tuberculosis.Вывод. Результаты исследования показали, что уровень знаний по МПТ у специалистов общей лечебной сети (урологи, гинекологи, терапевты) недостаточен. Высокая доля группы антибактериальных препаратов, обладающих туберкулостатическим действием, которые были указаны как препараты для эмпирической терапии мочевой инфекции, отражает серьезную проблему недооценки значимости мочеполового туберкулеза среди специалистов.

Surgical treatment of kidney tuberculosis: a comparative analysis of open and laparoscopic approaches

Introduction. Tuberculosis remains a global problem of our time. Kidney tuberculosis, especially complicated by tuberculosis of the urinary tract, becomes a surgical disease if it diagnosed late or the therapy was not optimal.Materials and methods. 93 patients with urogenital tuberculosis (UGTB) was included in this study who were admitted to the Novosibirsk Scientific and Research Institute of Tuberculosis consecutively. All of them underwent surgical intervention on the kidney. 51 patients underwent open surgery, and 42 patients underwent laparoscopic surgery. The results of treatment and the incidence of complications in both groups were analyzed and compared.Results. The age of the patients ranged from 23 to 75 years, averaging 50.9 ± 6.7 years; there were 45 men and 48 women. Tuberculosis of the left kidney was diagnosed in 41 patients, on the right - in 52 patients. The indication for nephrectomy was polycavernous tuberculosis of the kidney with no function in 74 cases, while in 11 cases polycavernous tuberculosis was complicated by stage 4 bladder tuberculosis. In 9 patients, nephrectomy was performed with cystectomy simultaneously. In 2 patients with severe renal dysfunction, cystectomy for microcystis was not performed, preferring laparoscopic nephrectomy with heterotopic urine diversion. In the group of patients operated on with an open approach, complications developed in 14 patients (27.4%), in the group of laparoscopic operations - in 5 (11.9%). The laparoscopic approach made it possible to activate the patients much earlier: after 2.4 hours, while in the openaccess group - after 38.7 hours.Conclusion. Due to the peculiarities of the pathogenesis of UGBT, it is accompanied by the local development of gross deforming scars, which significantly complicates the implementation of the surgical procedure - both open and laparoscopic access. Nevertheless, modern technology allows to perform the entire spectrum of operations laparoscopically to UGTB, and the complication rate is 2.3 times lower than in open operations. Early activation of the patient, less need for analgesics are also positive factors of minimally invasive surgery for UGTB

Bladder tuberculosis: therapy and surgery

Bladder tuberculosis is one of the most serious complication of nephrotuberculosis. Efficiency of current therapy is 42.1% only; it was a reason for creation of new scheme of etiopathogenetic therapy and surgical treatment. 63 patients were enrolled in study: 1st group received standard therapy and 2nd — modified. 9 patients from control group were operated with creation of neobladder. Results of therapy for patients treated with levofloxacin and trospium chloride were twice higher than after standard