WAYS OF PROSTATE TUBERCULOSIS DETECTION

Prostate tuberculosis was confirmed by morphological testing during life time in 77% of those died of tuberculosis of any localization and in 28% of respiratory tuberculosis patients. Prostate tuberculosis occupies the important place from social and medical point of view, since it leads to infertility and sexual dysfunction and also it can be sexually transmitted. Detection structure of prostate tuberculosis has been analyzed for Novosibirsk Region

ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ТУБЕРКУЛЕЗА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Prostate tuberculosis is difficult to be diagnosed, especially if lesions are limited only by this organ. The article analyses the experience of differential diagnostics of prostate tuberculosis based on the data of examination of 84 patients. 45 of them were diagnosed with prostate tuberculosis, and 39 patients were diagnosed with chronic bacterial prostatitis. Pathognomonic diagnostics criteria of prostate tuberculosis were the following: detection of tuberculous mycobacteria in the prostatic fluid or ejaculate, signs of granulomatous prostatitis with areas of cavernous necrosis in prostate biopsy samples, and prostate cavities visualized by X-ray or ultrasound examinations. Should the above criteria be absent, the disease can be diagnosed based on the combination of indirect signs: symptoms of prostate inflammation with active tuberculosis of the other localization; large prostate calcification, extensive hyperechoic area of the prostate, spermatocystic lesions, leucospermia and hemospermia, failure of the adequate non-specific anti-bacterial therapy.Туберкулез предстательной железы – труднодиагностируемое заболевание, особенно при изолированном ее поражении. В статье проанализирован опыт дифференциальной диагностики туберкулеза простаты на основании данных обследования 84 пациентов. У 45 из них диагностирован туберкулез предстательной железы, у 39 пациентов установлен диагноз хронического бактериального простатита. Патогномоничными диагностическими критериями туберкулеза простаты являлись: выявление микобактерий туберкулеза в секрете простаты или эякуляте; картина гранулематозного простатита с зонами казеозного некроза в биоптатах предстательной железы, а также каверны простаты по данным рентгенологического и/или ультразвукового исследований. В отсутствие этих критериев диагноз может быть установлен на основании сочетания косвенных признаков: симптомы воспаления предстательной железы в сочетании с наличием активного туберкулеза других локализаций; крупные кальцинаты простаты, обширные гиперэхогенные зоны в предстательной железе, поражение семенных пузырьков, лейко- и гематоспермия, неэффективность адекватной неспецифической антибактериальной терапии

ПУТИ ВЫЯВЛЕНИЯ ТУБЕРКУЛЕЗА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Prostate tuberculosis was confirmed by morphological testing during life time in 77% of those died of tuberculosis of any localization and in 28% of respiratory tuberculosis patients. Prostate tuberculosis occupies the important place from social and medical point of view, since it leads to infertility and sexual dysfunction and also it can be sexually transmitted. Detection structure of prostate tuberculosis has been analyzed for Novosibirsk Region.У 77% больных, умерших от туберкулеза всех локализаций, и у 28% больных туберкулезом органов дыхания прижизненно подтвержден туберкулез простаты при морфологическом исследовании. Туберкулез простаты имеет важное социальное и медицинское значение, поскольку приводит к бесплодию и сексуальной дисфункции, а также может передаваться половым путем. Проведен анализ структуры выявления туберкулеза предстательной железы в Новосибирской области

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.

Influence of the lifestyle of a patient with chronic prostatitis on its quality

Introduction. Currently, the quality of life of the patient is regarded as a primary criterion and is certainly assessed as an important parameter of the overall effectiveness of treatment.Purpose of the study. To assess the quality of life and the severity of symptoms in young active men with chronic abacterial prostatitis IIIa category.Materials and methods. 105 patients were divided into two groups: the 1st is mobile, who had 15 and more air flights during the year, and the 2nd is not mobile. Quality of life and symptoms were assessed using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale. Additionally, the quality of life was assessed by the adapted MOS SF-36 questionnaire.Results. Patients whose work was associated with frequent business trips showed more intense pain and therefore lower quality of life. The total score on the scale of chronic prostatitis symptoms in mobile patients was also one and a half times higher. They significantly more often relapse of the disease developed.Conclusion. Frequent flights affect the symptoms of chronic prostatitis negatively. Additional research is needed to find methods for correcting this aggravating factor

THE RESULTS OF LONGTERM USE OF HERBAL VITAMIN COMPLEX IN THE TREATMENT OF MENOPAUSAL WOMEN WITH CHRONIC CYSTITISTHE RESULTS OF LONGTERM USE OF HERBAL VITAMIN COMPLEX IN THE TREATMENT OF MENOPAUSAL WOMEN WITH CHRONIC CYSTITIS

The study evaluated the quality of life and incidence of recurrent cystitis in perimenopausal women who had received the first course of herbal vitamin complex 5 years ago, followed by the annual two-month course (twice a year). The initial study included 29 patients of which 18 were followed-up. The patients completed a special questionnaire which focused on the degree of dysuria, dyspareunia (only in patients who had sexual intercourse) and quality of life with respect to the urogenital problems which occurred 5 years back when the study was undertaken. Additionally, outpatient medical records and history were analyzed to confirm the incidence of recurrent cystitis over the past 5 years

DIFFERENTIAL DIAGNOSTICS OF PROSTATE TUBERCULOSIS

Prostate tuberculosis is difficult to be diagnosed, especially if lesions are limited only by this organ. The article analyses the experience of differential diagnostics of prostate tuberculosis based on the data of examination of 84 patients. 45 of them were diagnosed with prostate tuberculosis, and 39 patients were diagnosed with chronic bacterial prostatitis. Pathognomonic diagnostics criteria of prostate tuberculosis were the following: detection of tuberculous mycobacteria in the prostatic fluid or ejaculate, signs of granulomatous prostatitis with areas of cavernous necrosis in prostate biopsy samples, and prostate cavities visualized by X-ray or ultrasound examinations. Should the above criteria be absent, the disease can be diagnosed based on the combination of indirect signs: symptoms of prostate inflammation with active tuberculosis of the other localization; large prostate calcification, extensive hyperechoic area of the prostate, spermatocystic lesions, leucospermia and hemospermia, failure of the adequate non-specific anti-bacterial therapy