Efficacy of focused shock-wave therapy in the treatment of chronic prostatitis / chronic pelvic pain syndrome in men

Introduction. Chronic prostatitis / Chronic pelvic pain syndrome (CP / CPPS) is an extremely common condition for which no effective treatment has been found yet. Focused shockwave therapy (fSWT) is a safe method of physical intervention that could potentially be effective in CP / CPPS treating.Objective. To evaluate the efficacy and quality of life of patients after treatment of CP / CPPS with fSWT.Materials and methods. A prospective cohort study included 48 patients diagnosed with CP / CPPS. The patients attended the clinic three times a week for 4 weeks (12 sessions). Each time, patients received fSWT therapy sessions by “Chronic pelvic pain” protocol. One month after the last therapy session, the men completed the validated NIH-CPSI, IPSS, and QoL questionnaires.Results. The mean age of the patients was 40 ± 9 years. After the course of therapy, the score of Domain I “Pain” from 10.0 ± 4.7 to 6.3 ± 1.9 (p < 0.001). At the same time, no statistically significant decrease was obtained in Domain II 'Urination' scores ((5,88 ± 2,40 vs 5,42 ± 1,64; p = 0,11). By the end of therapy for Domains III and IV, the scores had changed from 4.42 ± 0.90 and 4.04 ± 1.27 to 4.48 ± 1.01 and 3.08 ± 1.22, respectively (p < 0,001). It is noted that the mean IPSS questionnaire score showed no statistically significant change over the treatment period (17,2 ± 4,8 vs 17,8 ± 4,8; p = 0,074)). QoL changed from 4.48 ± 0.99 to 2.46 ± 1.03 (p < 0.001).Conclusion. The study demonstrated the efficacy of fSWT as a standalone method in the treatment of CP / CPPS

Ischemic preconditioning: prospects of application for the correction of physical performance in military, extreme and sports medicine

The essence of the preconditioning effect is the activation of urgent defense mechanisms of adaptation as a result of a short episode of weak, non-damaging hypoxic or ischemic exposure, which contributes to an increase in the tolerance of the subsequent delayed, more severe exposure to hypoxia or ischemia. Aim of the study was to assess the literature data on the possibility of using the method of remote ischemic preconditioning (RIP) as a non-pharmacological method for correcting physical performance. Material and methods. In the Scopus, PubMed and eLibrary databases, a selection and analysis of modern literature sources devoted to the issues of increasing human performance, especially by nonpharmacological methods, as well as the use of distant preconditioning to increase physical performance and the mechanisms for implementing this effect, were carried out. Results. Since the discovery of the phenomenon until now, researchers have considered RIP, mainly as a way to protect organs and cells from ischemic damage in clinical practice. The article presents the literature data on the use of RIP as a non-drug method for improving physical performance with single and course use cases. In addition, the article focuses on the mobilization of the body’s own resources through the mechanisms of adaptation to hypoxia developing during RIP. Conclusions. Among the non-pharmacological methods of increasing physical performance, one of the most promising, in our opinion, is RIP that mobilizes the body’s own resources through the mechanisms of adaptation to hypoxia. The advantage of the method based on short-term cessation of blood circulation in the lower extremities and subsequent reperfusion does not apply to the ways prohibited in sports, does not require the use of drugs and the availability of special equipment, signifcant costs of economic and organizational resources

Possibilities of peripheral magnetic neuromodulation in the treatment of lower urinary tract symptoms in men

Introduction. Lower urinary tract symptoms (LUTS) are common in men and are associated with a significant decrease in quality of life. To date, there is no universal approach to the treatment of LUTS, which determines the need to search for new methods for influencing the lower urinary tract.Purpose of the study. To test the hypothesis that the use of peripheral magnetic neuromodulation (PMN) in male patients with LUTS will reduce the severity of LUTS.Materials and methods. Sixty-eight men with LUTS were enrolled in a prospective, randomized study. Patients were randomized in a 1:1 ratio for PMN or drug therapy with an alpha-1-blocker (tamsulosin). The primary endpoint was a reduction the LUTS severity such as urinary frequency during the day, nocturia and urgency as assessed using the IPSS questionnaire and urination diary. Improvements in urodynamic parameters such as maximum urine flow rate (Q max), mean urine flow rate (Q ave), and residual urine volume (PVR) were the secondary endpoint of the study. The results were evaluated on equal terms (10 days and 1 month) in both groups.Results. Sixty-seven (98.5%) subjects were included in the final base. Ten days after the start of therapy in the magnetic stimulation group, symptom relief was noted by 21 people (61.7%), the mean IPSS score showed a decrease from 18.1 ± 2.1 to 16.9 ± 3.2 points (p = 0.037). The number of urinations per day decreased from 14 (6 - 20) to 10 (6 - 14) times (p < 0.001). Objective indicators of urodynamics did not change in both groups. At a period of 1 month, PMN occurred in 22 (64.7%) patients, the IPSS score was 16.6 ± 3.7 points (p = 0.032), the number of urinations 9 (6 - 14) times (p < 0.001). Objective indicators have not changed. In the tamsulosin group, IPSS score changed from 19.27 ± 5.08 to 15.4 ± 4.85 (p < 0.001), Q max 14.36 ± 2.82 ml/s increased to 15.94 ± 2.71 ml/s (p = 0.032), while the Q ave did not change (p = 0.17). The number of urinations decreased from 13 (6 - 19) times to 10 (6 - 14) times (p <0.001).Conclusion. The study demonstrated the promise of PMN in men with LUTS in terms of improving the quality of life. The proposed method may be preferable for patients dissatisfied with drug therapy. Further placebo-controlled studies are required to help determine the role of PMN in the management of patients with LUTS

Радикальная простатэктомия в России: особенности периоперационного ведения и нюансы технического исполнения

Despite constant improvements in radical prostatectomy technique, some questions on standardization of both perioperative management stages and surgical intervention itself remain.We conducted an anonymous online survey of 45 oncological urologists from 15 regions of the Russian Federation who are actively involved in the surgical treatment of patients with prostate cancer.According to the results of the survey, there is huge variability associated, to a great extent, with equipment availability in clinics and the lack of sufficient evidence-based information in some matters of perioperative management.A detailed study of each step of surgical treatment, clinical trials, and involvement of professional societies will contribute to the standardization of perioperative management of patients and radical prostatectomy technique. Несмотря на  продолжающееся совершенствование техники радикальной простатэктомии, все  еще есть ряд вопросов по стандартизации этапов периоперационного ведения пациентов и самого оперативного вмешательства. Мы   провели  анонимный онлайн-опрос  45  онкоурологов из  15  регионов  России, активно  занимающихся хирургическим лечением больных раком предстательной железы.По результатам анализа полученных данных выявлена значительная вариативность подходов, связанная в большей степени с техническими возможностями клиник и отсутствием в некоторых вопросах достаточной доказательной базы. Детальное изучение каждого этапа хирургического лечения, проведение клинических исследований с привлечением профессиональных ассоциаций будут способствовать унификации стандартного периоперационного ведения пациентов и техники радикальной простатэктомии

ТРАНСОБТУРАТОРНЫЙ СИНТЕТИЧЕСКИЙ СЛИНГ В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ НЕДЕРЖАНИЯ МОЧИ У МУЖЧИН

The article analyses the first experience of male urinary incontinence surgical treatment using transobturator sling system “UroSling male”. This new device is specially designed for transobturator placement with atraumatic fixation onto the inferior rami of pubic bones. The results of the study showed that synthetic sling implantation is an effective and safety option (overall effectiveness of operation 79,5 %).В работе представлен первый опыт хирургического лечения недержания мочи у мужчин с использованием трансобтураторной слинговой системы «УроСлинг мужской». Данное инновационное устройство специально разработано для трансобтураторного размещения с атравматичной фиксацией на нижних ветвях лонных костей. Результаты исследования показали, что имплантация синтетического слинга эффективна и безопасна (общая эффективность операции составила 79,5 %)

УСОВЕРШЕНСТВОВАННАЯ ТЕХНИКА ДОСТИЖЕНИЯ ГЕМОСТАЗА ПРИ РЕЗЕКЦИИ ПОЧКИ С НОВООБРАЗОВАНИЕМ

Due to the better diagnostic feasibilities of health care facilities, the proportion of patients with small renal tumors (T1a) has substantiallyincreased in recent years. In accordance with the international standards, these patients should undergo nephron-sparing surgery: neoplas-tic kidney resection. At Russian hospitals, organ-preserving treatment is not in adequate use for the technical difficulties associated withresection and for the likelihood of postoperative complications. The performed study has yielded a simple highly effective procedure ofnephrectomy in neoplasms, by using vasoselective parenchymatous sutures enhanced with polymer stripe-implants.  Усовершенствованная техника достижения гемостаза при резекции почки с новообразование

Urinary pH: its regulation and relevance in urolithiasis metaphylaxis

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence

TRANSOBTURATOR SYNTHETIC SLING FOR SURGICAL TREATMENT OF MALE URINARY INCONTINENCE

The article analyses the first experience of male urinary incontinence surgical treatment using transobturator sling system “UroSling male”. This new device is specially designed for transobturator placement with atraumatic fixation onto the inferior rami of pubic bones. The results of the study showed that synthetic sling implantation is an effective and safety option (overall effectiveness of operation 79,5 %)

IMPROVED TECHNIQUE FOR ACHIEVING HEMOSTASIS DURING NEOPLASTIC KIDNEY RESECTION

Due to the better diagnostic feasibilities of health care facilities, the proportion of patients with small renal tumors (T1a) has substantiallyincreased in recent years. In accordance with the international standards, these patients should undergo nephron-sparing surgery: neoplas-tic kidney resection. At Russian hospitals, organ-preserving treatment is not in adequate use for the technical difficulties associated withresection and for the likelihood of postoperative complications. The performed study has yielded a simple highly effective procedure ofnephrectomy in neoplasms, by using vasoselective parenchymatous sutures enhanced with polymer stripe-implants

TRANSOBTURATOR SYNTHETIC SLING FOR SURGICAL TREATMENT OF MALE URINARY INCONTINENCE

<p>The article analyses the first experience of male urinary incontinence surgical treatment using transobturator sling system “UroSling male”. This new device is specially designed for transobturator placement with atraumatic fixation onto the inferior rami of pubic bones. The results of the study showed that synthetic sling implantation is an effective and safety option (overall effectiveness of operation 79,5 %).</p