Platelet-rich plasma: application for interstitial cystitis and erectile dysfunction

Up-to-date, the platelet-rich plasma (PRP) treatment method is actively used in many fields of medicine. In traumatology, PRP is used to treat bone and cartilage defects, ligamentous apparatus. In combustiology for the healing of burns, in surgery ¾ trophic ulcers. There is evidence of the feasibility of using PRP in some dermatological diseases, as well as in dental practice. For urology, the method is new and is just beginning to be studied. The article discusses the methods of treatment of interstitial cystitis (IC) and erectile dysfunction (ED) using PRP. During the review, we relied on existing data on the effectiveness of intravesical injections of PRP in the treatment of IC, as well as on the successful treatment of ED with activated, nonactivated PRP and PRP augmented phosphodiesterasetype 5 (PDE-5) inhibitors

New-generation synthetic implants for the surgical correction of pelvic organ prolapse and stress urinary incontinence: design and testing

Introduction. Up to 50.0% of postpartum women experience stress urinary incontinence (SUI) and pelvic organ prolapse (POP). One of the most common and pathogenetically substantiated methods for surgical correction of severe SIU and POP is prosthetic reconstruction of the pelvic floor, involves the use of monofilament polypropylene surgical meshes through vaginal or laparoscopic access.. However, this way is associated with specific problems, i.e., primarily mucosal erosions, and pelvic pain. This has served as a trigger for the development of new materials that reduce the likelihood of such side effects.Objective. To develop the new-generation synthetic implants for surgical correction of stress urinary incontinence and pelvic organ prolapse.Materials and methods. The main development stages: 1. design of an experimental sample of a synthetic implant (evaluation of basic, physical and mechanical properties). 2. test of an experimental sample obtained in vitro.Results. A bioresorbable polypropylene ligature delivery system was developed and manufactured in two variants: for the POP correction (mesh tape with a width of 13 – 15 mm) and for the SUI correction (mesh tape with a width of 10 – 11 mm).Conclusion. Based on the results of the in vitro tests, we can conclude that the synthetic implants developed are able to provide physiological longitudinal (axial) support of the necessary pelvic floor sections and reduce the risk of postoperative complications. Further in vivo studies are required to assess the response of living tissue to the implantation of this type of synthetic implants

Non-antibacterial methods for the prevention and treatment of recurrent lower urinary tract infections

Urinary tract infections are widespread throughout the world and occupy one of the leading places among infectious diseases. Antibacterial methods are the basis of modern treatment standards. At the same time, a widespread increase in antibiotic resistance of the main uropathogens is currently observed. In clinical practice, recurrent lower urinary tract infections are increasingly common. Following this, the main task of the doctor is to maximize the recurrence-free interval. Given the obvious negative collateral effect of long-term antibiotic prophylaxis, specialists are increasingly turning to alternative methods. Non-antibacterial preventive measures are aimed at key links in the pathogenesis of the disease, such as counteracting the penetration and adhesion of uropathogens, as well as stimulating the immune system of the macroorganism. The available physicians' toolkit includes pharmacological agents (d-mannose, methenamine hippurate, estrogens, non-steroidal anti-inflammatory drugs, probiotics, intravesical glycosaminoglycans, immunostimulants and vaccines), natural uroantiseptics (medicinal herbs and cranberry products), as well as behavioural therapy. The main advantages of non-antibacterial methods for the treatment and prevention of lower urinary tract infections are environmental friendliness. It is associated with the absence of a negative effect on the commensal flora, as well as a reduction in the risk of developing antibiotic resistance. The current guidelines provide very limited information on the application of this approach to treatment. Published studies indicate the high potential of non-antibacterial methods, some of which are comparable in effectiveness to standard therapy. However, the quality of studies and the lack of drug use standards do not allow including this approach in the existing guidelines. The need for new, high-quality clinical trials is evident

The peptide regulator Vezusten in the management of overactive bladder syndrome: an efficacy evaluation

Introduction. Overactive bladder (OAB) remains one of the most difficult-to-treat conditions in neurourology. The number of patients seeking help for OAB symptoms does not decrease each year, while a pathogenetic treatment has not yet been developed. This motivates the search for new approaches.Objective. To assess the efficacy of the peptide regulator Vezusten for women with idiopathic OAB based on their health condition and urodynamic assessment of bacterial detrusor overactivity (DO).Materials & methods. A prospective cohort study included 20 patients diagnosed with OAB, which was confirmed by a comprehensive urodynamic study of DO. The patients visited the clinic three times a week. Each patient received ten intramuscular injections of the peptide regulator Vezusten. Within one month after the last injection, the women were given a monitoring voiding diary, a validated Continental Society OAB Symptom Questionnaire, the Overactive Bladder Questionnaire (OAB-q), and a follow-up urodynamic study (UDS).Results. We obtained statistically significant differences in the following indicators: the number of daily urinations according to the urination diary decreased from 14.0 [13.0; 16.3] to 11.0 [8.8; 12.0] (p < 0,001), patient’s episodes of urge incontinence began to be noted for the first time (p = 0.004). At the same time, the urodynamic maximum cystometric capacity (MCC) increased from 267 [158; 332] to 320 [267; 433] ml. Subjectively, participants noted an improvement in the scores of the OAB questionnaire (OAB-q) — the score decreased from 28 [22; 30] to 19 [14; 24] (p = 0.001), and the number of episodes of nocturia decreased from 4 to 2 (p < 0.001). No side effects from therapy were observed in any of the patients.Conclusion. This study demonstrated a statistically significant improvement in subjective symptoms of OAB in DO-women treated with the peptide regulator Vezusten, but further large placebo-controlled studies are required for confirmation

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

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

Efficacy of a synthetic middle urethral sling in patients with mixed urinary incontinence

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p < 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p < 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence

Comparison of pathomorphologic properties of non-resorbable and partially resorbable implants for reconstructive surgery of pelvic organ prolapse and stress urinary incontinence: an animal model study

Introduction. It is well-known that the use of transvaginal mesh implants is not devoid of specific complications that meaningfully impair the quality of life of female patients. The volume of permanent material used has been shown to correlate closely with the risk of implant-associated complications. Thus, there is a need to develop a new generation of implants that retain the advantages of a permanent mesh implant but with minimal risk of implant-associated complications. Meanwhile, there are insufficient data on the organism's response to this type of synthetic implant.Objective. To compare the histological changes in the soft tissues of the rabbit anterior abdominal wall in the implantation zone of the new generation partially resorbable implant and non-absorbable polypropylene mesh implant on the animal model.Materials & methods. We have previously developed a partially resorbable ligature delivery system for axial fixation of pelvic floor structures, performed technical analysis, and compared biomechanical and pathomorphological properties after implantation in an animal model experiment. The present study was conducted on 39 male rabbits of Chinchilla breed, randomised into three groups according to the type of implanted material: a partially resorbable ligature delivery system Axilen and Axilen Rapid [Lintex, LLC], and a non-resorbable polypropylene mesh implant Urosling. After the rabbits were removed from the experiment, the obtained biomaterial was subjected to histological study.Results. In the group with partially resorbable implants Axilen and Axilen Rapid, less inflammation and better tissue integration were observed compared to the polypropylene implant Urosling. This indicates a potential reduction in the risk of postoperative complications and an improvement in the quality of life for patients.Conclusion. The results of the experimental study confirm the advantages of using partially resorbable implants over traditional polypropylene meshes in pelvic floor reconstructive surgery. However, further research is needed to confirm the long-term safety and effectiveness of the new generation of implants

Сomparison of biomechanical properties of non-absorbable and partially absorbable mesh implants used in surgery for urinary incontinence and genital prolapse: experimental study

Introduction. The amount of non-absorbable synthetic material used in the surgical treatment of pelvic organ prolapse and stress urinary incontinence has been shown to directly correlate with the risks of mesh-associated complications. Previously, we developed a partially absorbable implant. Currently, there are insufficient data on the use of partially absorbable implants in female pelvic floor reconstruction, which requires comparative biomechanical and pathomorphological studies.Objective. To compare the biomechanical properties of a new generation partially absorbable implants and nonabsorbable polypropylene mesh implants during animal model.Materials & methods. Thirty-nine rabbits weighing 3200 ± 250 g were randomised into three groups depending on the implanted endoprosthesis: group 1 (n = 15) — “Axilen” implant (polydioxanone 98%, polypropylene 2%), group 2 (n = 15) — “Axilen Rapid” implant (polyglycapron 98%, polypropylene 2%), group 3 (n = 9) — “Urosling 1” implant. After implantation, rabbits of all 3 groups were divided into 3 subgroups according to the withdrawal period from the experiment: 14 days, 60 days, and 180 days. The biomaterial obtained was subjected to two studies: evaluation of the macroscopic view of the explanted mesh endoprosthesis with the formed capsule and the surrounding tissues, study of the biomechanical properties of the formed connective tissue capsule with the implant.Results. According to macroscopic evaluation, there was a less significant tissue reaction to partially absorbed implants. A comparative analysis of biomechanical indices revealed no statistically significant difference in rupture elongation at all follow-up periods among the presented groups. Tensile strength, at 60 and 180 days, was not statistically different between the groups described. At 14 days, there was a statistically significant difference in tensile strength between groups 1 and 3 (p = 0.003).Conclusion. During biomechanical animal experiments, the connective tissue capsule formed on the partially absorbable implant was not inferior to the similar parameter of the non-absorbable sample in its tensile strength, which explains a great potential for the use of partially absorbable implants in reconstructive surgery of pelvic organ prolapse and stress urinary incontinence

The role of electroneuromyography evaluation of the bulbocavernosal reflex in the diagnosis of pelvic nerve damage in patients with chronic pelvic pain syndrome

Introduction. One of the additional instrumental methods for diagnosing pudendal neuropathy is needle electroneuromyography (ENMG) of the bulbocavernosus reflex (BCR). The accumulated data on ENMG BCR in patients with primary chronic pelvic pain syndrome (CPPS) are insufficient due to the specificity of the procedure and its performance only in expert centres that specialise in the treatment of pelvic pain. Therefore, a study to investigate the features of ENMG BCR in patients with CPPS is of increased interest.Objective. To assess the representativeness and informativeness of the ENMG BCR technique in patients with CPPS and to identify factors influencing changes in the main parameters of the BCR M-response such as latency, amplitude, and duration.Materials & methods. Retrospective cohort study, which included 75 data from patients with (CPPS) who underwent needle-guided ENMG recording of BCR. Subjective complaints of patients were recorded using validated questionnaires: visual analogue scale (VAS) and chronic prostatitis and male pelvic pain syndrome symptom scale index (NIH-CPSI). Basic ENMG parameters such as the amplitude, latency, and duration of the M-responses were recorded.Results. We found statistically significant correlations between the duration and height of the M response of the patients (r = 0.31, p = 0.03) and their body weight (r = 0.34, p = 0.02). Anthropometric data did not correlate with amplitude and latency. Significant excess latency above 45 ms was observed, confirming nerve tissue destruction, in 11 (55%) women and 24 (44%) men. Although there were no statistically significant differences in any of the M-response parameters between men and women, there was a tendency for an increase in response amplitude in men and an increase in BCR latency time in women.Conclusion. The results of our study show that the duration of the M-response of BCR can correlate positively with the anthropometric data of the patient. At the same time, the mean latency and amplitude of the response are independent of anthropometric data, and the difference between them may be more determined by sex differences