HistoScanning techinque for detection of local relapse after high-intensity ultrasound ablation for prostate cancer

Objective. To determine a possible role for HistoScanning technique in surveillance for patients who underwent HIFU-ablation for prostate cancer. Material and methods. Eighty patients who underwent transurethral resection and HIFU-ablation in university clinic with different follow-up duration (range: 36 – 84 months; median – 52 months) were included in this study. All patients underwent prostate specific antigen (PSA) testing, transrectal ultrasound examination and HistoScanning of residual prostatic tissue during follow-up. Results. Overall, 72 patients of 80 had suspicious lesions on HistoScanning during post-HIFU surveillance. Eleven patients had VHS value, which is the sum of volume of suspicious lesions, exceeding 1 cm3; 10 patients experienced biochemical relapse by Stuttgart definition (90.9%). Significant predictors of biochemical relapse were PSA nadir over 1.0 ng/ml (hazard ratio [HR]: 3.1; confidence interval [CI]: 1.7 – 3.5) and VHS / Vres. ratio over 0.5 (HR: 4.9; CI: 3.9 – 5.5). Ten patients reached VHS / Vres. threshold value (> 0.5) ≥ 3 months before meeting criteria for Stuttgart biochemical failure. Conclusion. HistoScanning may prove useful for surveillance for patients who underwent HIFU-ablation for prostate cancer, but it still requires further standardization and validation in this setting.Цель исследования. Установить возможную роль применения методики HistoScanning в наблюдении за пациентами, перенесшими HIFU-аблацию по поводу рака простаты. Материал и методы. В исследование вошли 80 пациентов, которым в клинике урологии СГМУ в разные сроки (диапазон: 36 – 84 месяцев; медиана – 52 месяца) была выполнена трансуретральная резекция и HIFU-аблация. Всем пациентам в ходе наблюдения выполнялся анализ крови на простат-специфический антиген (PSA), трансректальное ультразвуковое исследование и гистосканирование резидуальной ткани. результаты. У 72 пациентов из 80 были обнаружены подозрительные очаги при гистосканировании на протяжении наблюдения. У 11 пациентов показатель VHS, характеризующий суммарный объём подозрительных очагов, достигал более 1 см3; у 10 из них был зафиксирован биохимический рецидив по Stuttgart (90.9%). Значимыми предикторами биохимического рецидива являлись надир PSA более 1.0 нг/мл (отношение рисков [ор]: 3.1; доверительный интервал [ДИ]: 1.7 – 3.5) и показатель VHS/Vрез. более 0.5 (ор: 4.9; ДИ: 3.9 – 5.5). У 10 пациентов достижение порогового значения VHS/Vрез. (> 0.5) предшествовало рецидиву на ≥ 3 месяца. Заключение. HistoScanning может оказаться полезным при наблюдении за пациентами после HIFU-аблации при раке простаты, но требует дальнейшей стандартизации и валидации

Role of salvage radical prostatectomy, cryoablation and HIFU-ablation in management of patients with prostate cancer recurrence after radiation therapy

Several options for salvage treatment of radiation-recurrent prostate cancer exist. The main option is a salvage radical prostatectomy, which offers optimal cancer control and allows to perform specimen pathology, but it is technically challenging and poses increased risk for certain complications. Alternative modalities of salvage therapy are HIFU-ablation and cryoablation. This review covers the role for those methods, their oncological efficacy and morbidity.Существует несколько вариантов сальважного лечения при рецидивах рака простаты после лучевой терапии. Основным вариантом является сальважная радикальная простатэктомия, которая обеспечивает оптимальный онкологический контроль и даёт возможность гистологического стадирования, но является технически трудной и грозит рядом осложнений. альтернативными вариантами сальважной терапии являются HIFU-аблация и криоаблация. В обзоре представлена роль каждого из этих методов, их онкологическая эффективность и частота развития осложнений

Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermiaMaterials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function

Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest

Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods

Surgical correction of urinary incontinence associated with orgasm (climacturia) using a compression graft (clinical cases)

Climacturia is a rarely discussed functional complication of radical prostatectomy. Various methods of medical and surgical treatment of climacturia have been described. In this article we present two clinical cases of successful surgical treatment of climacturia which involved three-piece penile prosthesis implantation and placement of compression graft made of porcine dermal collagen on urethra

POWER DOPPLER IMAGING IN PATIENTS WITH SUSPECTED PROSTATE CANCER

Abstract. This study was aimed to evaluate the role of power Doppler imaging in diagnosis of prostate cancer and prediction of its aggressiveness. This study included 118 patients with prostate cancer suspected due to elevation of prostate specific antigen (PSA) values to > 4.0 ng/ml. All patients underwent transrectal prostate biopsy with ultrasound guidance for histological verification. Prostate was scanned in power Doppler mode and one of vascularization patterns was assigned, as described by Zhao et al. Power Doppler imaging results and biopsy results were compared. Forty eight patients had normal results of power Doppler imaging. Fifty five patients had focal enhancement of blood flow, which allowed to perform a targeted biopsy of suspected lesion. Fifteen patients had diffusely enhanced blood flow. Sensitivity of power Doppler imaging was 82.4%, specificity was 70.5%, positive and negative predictive values were 66.7% and 72.3% correspondingly. Overall accuracy for prostate cancer detection was 81.1%. Association between observed vascular patterns and Gleason score, tumor dissemination and PSA level was detected. Power Doppler imaging allows efficient detection, staging and prediction of aggressiveness of prostate cancer, when compared to standard transrectal ultrasound imaging

New approaches to management of erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia

This paper addresses the background of phosphodiesterase-5 inhibitors use in erectile dysfunction and lower urinary tract symptoms, as well as a special position which is held by tadalafil as an only drug from its class suitable for daily intake. Tadalafil pharmacodynamics and hypotheses concerning its mechanism of action on prostatic tissue are discussed. Special attention is paid to drug»s efficacy and safety in elderly men, who often require therapy for benign prostatic hyperplasia with lower urinary tract symptoms. It is mentioned that tadalafil may be used in penile rehabilitation programs in men who underwent radical prostatectomy

The use of tadalafil on demand in specific categories of patients

Patients with erectile dysfunction require special approach. Any therapy should be prescribed with patient’s individual features, comorbidities and concominant medication in mind. Considering good efficacy and safety profile of tadalafil, together with appearance of its generic forms on the market, making such treatment more accessible for our patients, soon it may become the most commonly prescribed drug from phosphodiesterase-5 inhibitors class. Therefore, evidence on its use in special groups of men with specific anamnestic features should be systematized. In this article we discuss the use of 20 mg tadalafil on demand in specific categories of patients suffering from erectile dysfunction: in men with metabolic syndrome, benign prostate diseases, neurological conditions and, finally, in men who express wish to become fathers

Assessment of influence of “BESTFertil” supplement on semen analysis parameters, oxidative stress markers and sperm DNA fragmentation index in infertile males

Background. Idiopathic male infertility remains an important problem in andrology and reproduction, despite steady advances in diagnostics and treatment of conditions associated with impaired fertility in men. Only available option of conservative treatment for idiopathic male infertility is an empiric antioxidant therapy.Materials and methods. Fifty five men from infertile couples without any identifiable cause of male infertility who received “BESTFertil” supplement were enrolled in this study. Semen analysis parameters (sperm density, percentage of sperm with progressive motility (categories A and B), sperm morphology, leukocyte concentration), MAR-test results, reactive oxygen species concentration as measured by chemiluminescence assay and sperm DNA fragmentation index evaluated using TUNEL method were registered and compared with baseline values after 90 days of treatment. Patient compliance was assessed by a number of capsules taken throughout the study period.Results. There was a significant difference in percentage of sperm with normal morphological features (median 2 % vs 4 %; p <0.001) and in percentage of A + B motile sperm (medium 31.2 % vs 41.15 %; p <0.001). Also, a statistically significant decrease in sperm DNA fragmentation index (median 17.8 % vs 15 %; p <0.001) and reactive oxygen species concentration in seminal plasma (median 0.7 mV/s vs 0.5 mV/s; p = 0.002). Forty-three (78.2 %) patients were fully compliant, 11 (20 %) patients had compliance over 90 %, and 1 patient was 89 % compliant. No treatment-related adverse events were observed.Conclusion. “BESTFertil”supplement may be used in empiric therapy of idiopathic male infertility and has a good safety profile. Separate intake of morning and evening supplement doses increases efficacy of multicomponent antioxidant therapy by preventing possible interaction between biochemically incompatible components. Treatment with “BESTFertil”supplement leads to a decrease in reactive oxygen species seminal concentration and sperm DNA fragmentation index

Sperm oxidative stress: clinical significance and management

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species.  Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general