Vol 18, No 7 (2016)


An open label, non-controlled, multicentre, interventional trial to investigate the safety and efficacy of Canephron® N in the management of uncomplicated urinary tract infections (UUTIs)

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Study design. An open label, non-randomized, multicentre clinical trial. Purpose of the study. Efficacy and safety of Canephron® N in the management of women with uncomplicated urinary tract infections. Introduction. Despite of increasing prevalence of bacterial resistance to antibiotics and possible adverse drug reactions, uncomplicated lower urinary tract infections are usually treated with antibiotics. Canephron® N, a herbal medicinal product, was investigated for safety and efficacy in women suffering from uncomplicated urinary tract infections. Methods. The study included 125 patients suffering from uncomplicated urinary tract infections. Cases with the sum score of at least 6 for the symptoms of dysuria, frequency and urgency were enrolled. Patients were treated with 3.2 tablets Canephron® N for 7 days. Symptom assessment was performed by the patient on a daily basis and by the investigator at Day 0, Day 7 and Day 37. Incidence of adverse drug reactions during the treatment was considered as primary endpoint; clinical cure on Day 7, severity of uncomplicated urinary tract infections symptoms on Day 7 and Day 37, patients requiring antibiotic treatment until Day 7, duration of uncomplicated urinary tract infections symptoms and patients with early recurrence - as secondary endpoints. Changes in laboratory parameters were also analyzed. Results. None of the 19 adverse reactions reported in the study was not associated with the use of the drug and not characterized as "serious". The response rate was 90.4% and 93.6% on Day 7 and Day 37 with a significant improvement of all symptoms (p<0.001). Only 2.4% of patients required antibiotics during the treatment. None of the patients met the definition of recurrence until Day 37. The mean changes of the main symptoms on Day 7 and Day 37 compared to Day 0 were: -1.9/-2.3 (dysuria); -1.8/-2.4 (frequency); -1.6/-1.9 (urgency). Decreased nitrite, leukocytes as well as erythrocyte levels accompanied symptomatic improvement from Day 0 to Day 7 and Day 37. Conclusion. The study confirmed the safety and efficacy of the Canephron® N without antibiotics.
Consilium Medicum. 2016;18(7):8-13
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Bacterial prostatitis and prostatic fibrosis: modern view on the treatment and prophylaxis

Zaitsev A.V., Pushkar D.Y., Khodyreva L.A., Dudareva A.A.


Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidaza. Treatment results showed that Longidaza is highly effective in bacterial and abacterial CP. Longidaza addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.
Consilium Medicum. 2016;18(7):14-18
pages 14-18 views

Rational treatment of benign prostatic hyperplasia: efficacy of long-term treatment with dutasteride

Tkachuk V.N., Borovets S.Y., Tkachuk I.N., Iziev M.M.


The article shows the results of treatment of 311 patients with benign prostatic hyperplasia with dutasteride. Duration of the drug intake has ranged from 6 to 48 months. It turned out that in order to achieve a stable clinical effect duration of treatment of benign prostatic hyperplasia with this drug should not be less than 48 months.
Consilium Medicum. 2016;18(7):19-21
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The effectiveness of therapy based on sperm-protective Selzink plus in patients with tuberculosis of the prostate

Kulchavenya E.V., Osadchiy A.V.


Introduction. Tuberculosis of genitals leads to disruption of reproductive function. Given that 77% of men who died of tuberculosis in all locations, tuberculosis of the prostate (PT) was diagnosed at autopsy, the problem of high relevance. The purpose of research is to develop and test a way to restore/preserve fertility patients with pancreatic tuberculosis and to evaluate its effectiveness. Material and methods. An open, prospective, comparative, randomized study in which 72 patients with pancreatic tuberculosis were included. Patients of the main group (n=49) received standard tuberculosis (TB) treatment in combination with pathogenetic spermatoprotektivnoy therapy include Selzink plus and chorionic gonadotropin. The comparison group (n=23) received only men etiotropic TB treatment. Results. Treatment for TB had a negative effect on the ejaculate 2-month administration of drugs in the comparison group led to a decrease in sperm count of 23.9%, the number of actively motile sperm forms - by 10.6%, the number of normal spermatozoa - by 32.3%. Carrying sperm-protective pathogenetic therapy helped to increase the number of sperm by 47.8%, the number of active mobile forms of spermatozoa (total of A and B) - by 40.5%, the number of normal sperm forms - by 41.9%. Conclusions. Sperm-protective therapy including Selzink plus and human chorionic gonadotropin, allows to significantly increase the fertility of an ejaculate. We need long-term use of drugs to prevent the negative effects of tuberculous inflammation and TB treatment in respect of spermatogenesis.
Consilium Medicum. 2016;18(7):22-26
pages 22-26 views

Encrusted cystitis in men

Siniakova L.A., Seregin A.V., Morozov A.D., Nezovibatko Y.I.


Rather rare occurrence of encrusted cystitis led to that by today prominent researches haven’t been done both at Russian and foreign clinics on this form of cystitis, while scientists' works contain only description of unit cases of this disease, seeing standards of diagnostics and treatment could not have been worked out. The aim of our research was to analyze experience in treating patients with encrusted cystitis at S.P.Botkin City Clinical Hospital, to suggest the most optimal algorithm of diagnostics and treatment and to reveal roots of disease and possible ways of prevention from it.
Consilium Medicum. 2016;18(7):27-29
pages 27-29 views

Lower urinary tract symptoms: drug treatment accumulation phase symptoms (clinical lecture)

Rasner P.I., Pushkar D.Y.


In recent years, there has been a trend in which the basis for selection of the optimal treatment strategy is the analysis of the specific complaints of the patient, taking into account their individual expectations from this treatment. The introduction of the wide practice of some elements of artificial intelligence, such as validated questionnaires, expert systems and nomograms, greatly facilitates the diagnosis. Statistical analysis of the requirements of patient complaints indicates obviously a greater prevalence of the accumulation phase problems, which is probably a consequence of the fact that many of the patients overactive bladder symptoms is present 8-16% of the adult population in Europe and 60% of patients with severe bladder outlet obstruction. Drug therapy of lower urinary tract symptoms (LUTS) accumulation phase may be carried out as monotherapy, or in combination stepwise prescribing a format with a different mechanism of action. The basis of such therapy are .-blockers, anticholinergics M and recently appeared the .3-adrenergic receptor agonists. Such a wide variety of treatment options allows an individual approach to each patient and provides a high probability of getting rid of LUTS.
Consilium Medicum. 2016;18(7):30-36
pages 30-36 views

Cystitis in ambulatory practice urologist (lecture)

Kulchavenya E.V.


Introduction. Urinary tract infections (UTIs) have a leading role in the structure of outpatient reception of the urologist. This issue is dedicated to a great number of publications in domestic and foreign literature. However, unacceptably high relapse rate that underscores the urgency does not reduce the problem. Material and methods. Critically evaluate the results of studies on the epidemiology and characteristics of UTI treatment for 37 and sources. Results. Among all inflammatory diseases of the genitourinary system in the structure of municipal polyclinic receiving 60.9% are chronic pyelonephritis and acute cystitis - it was diagnosed in 7.5% of ambulatory patients of urologists. Revealed heterogeneity spectrum shows uropathogens and volatility of microflora resistance. It is likely that treatment failure and a tendency to chronic urinary tract infections caused by spread spectrum uropathogens and increasing their resistance to standard antibiotics. The issue of antibiotic selection can not fully rely on the data in the literature, it is necessary to know the range of flora and its resistance in the region, and have fresh, not older than 2 years, the results of bacteriological research, since these parameters are highly variable. 82.4% of young pregnant women with acute uncomplicated cystitis, were cured without the use of antibiotics, by combined use of nonsteroidal anti-inflammatory drug and herbal medicine Canephron. Conclusions. Within the structure of acute cystitis UTIs share is minimal. Sub-optimal treatment leads to chronic disease and diagnostic errors. The selection of treatment should take into account the data of bacteriological research.
Consilium Medicum. 2016;18(7):37-42
pages 37-42 views

Acute kidney injury: a modern view on the problem

Batiushin M.M., Rudenko L.I., Kastanayan A.A., Vorobiev B.I.


Acute kidney injury (AKI) is the term that has come to replace the concept of «acute renal failure», it is a syndrome of sharp decline in renal function, which is characterized by decreased urine output up to anuria, accumulation products of nitrogen metabolism, and the violation of water-electrolyte metabolism, and is associated with high mortality and the subsequent development of chronic renal failure. Diagnostic criteria of AKI are serum creatinine, glomerular filtration rate and the magnitude of the volume of urine output. At the base of AKI are the following groups of reasons: prerenal, renal and postrenal. The therapyshould be selected taking into account the underlying disease and the degree of severity of the AKI. To evaluate the effectiveness of AKItherapy it must be constantly monitor diuresis, creatinine, urea and electrolytes.
Consilium Medicum. 2016;18(7):43-48
pages 43-48 views

Gestational pyelonephritis: modern diagnostic and treatment

Enikeev D.V., Spivak L.G.


The paper presents the current data on the diagnosis and treatment of gestational pyelonephritis. Currently, there are opportunities for a reliable diagnosis of pyelonephritis in pregnancy due to the introduction of modern techniques such as magnetic resonance imaging, Doppler ultrasound. Scientific progress and the emergence of innovative diagnostic methods also influenced the formation of a new approach to the treatment etiopathogenetic gestational pyelonephritis. Modern possibilities of evaluation of structural and functional state of the parenchyma of the kidneys and urinary tract in the early stages of the disease (magnetic resonance imaging, Doppler ultrasound), the emergence of minimally invasive technologies and highly efficient broad-spectrum antibiotics significantly reduced the number of open surgical benefits with gestational pyelonephritis. This article discusses the clinical samples to more fully acquainted with this disorder and its treatment.
Consilium Medicum. 2016;18(7):49-54
pages 49-54 views

Trospium chloride in the treatment of overactive bladder in elderly patients with neurological diseases (data multicenter observational program “Resource”)

Krivoborodov G.G., Tur E.I., Efremov N.S.


Symptoms of overactive bladder (OAB) in neurological patients of middle and old age lead to a decrease in quality of life (QOL). In our study, we investigated the possibility of using different doses of trospium chloride in 197 patients with neurogenic OAB elderly. Patients taking the drug at a dose of 30 mg/day, the number of episodes of urge incontinence decreased from 3.7±0.02 to 2.2±0.09 (p.0.05); urination at night - with 13.5±0.4 to 11.8±0.2 (p.0.05). Average quality of life on a visual analog scale (VAS) increased from 60.1±2.2 to 76.1±2.7 (p.0.05). In the group receiving 45 mg of trospium chloride per day, the average number of episodes of urge incontinence decreased from 4.1±0.02 to 1.7±0.1 (p.0.05). Number of urination - with 13.9±0.6 to 10.8±0.9 (p.0.05). Average VAS increased from 57.9±1.8 to 82.6±2.5 (p.0.05). Patients taking the drug at a dose of 60 mg/day, the mean number of episodes of urge incontinence before treatment was 3.9 ± 0.08; after treatment - 1.2±0.07 (p.0.05). The average number of daily micturition have decreased from 14.1±0.7 to 10.5±0.3 (p.0.05). Average VAS increased from 59.4±2.7 to 86.1±3.0 (p.0.05) after 12 weeks of treatment with trospium chloride. Thus, all three main groups, was noted a significant improvement in symptoms of urgent and frequent urination, as well as improving the quality of life of patients. For optimal results, individual selection of doses. The profile and incidence of adverse events trospium chloride, including the related effects on the central nervous system in patients with middle and old age, are no different from other age groups.
Consilium Medicum. 2016;18(7):55-59
pages 55-59 views

Urinary tract infection in patients with spinal cord injury

Salukov R.V., Kolmakov A.S., Martov A.G.


Urinary tract infection is one of the most common complication of spinal cord injury. Its influence on the course of the underlying disease is possible in the acute period of spinal shock, and can be traced throughout the subsequent recovery period. The literature review assesses the factors, which cause development of urinary tract infection in spinal cord injury patients, shows the impact of catheter-related infection and issues of diagnosis, treatment and prevention of urinary tract infection.
Consilium Medicum. 2016;18(7):60-65
pages 60-65 views

Erectile disfunction: current issues diagnosis and treatment of primary stage and specialized health care

Trukhan D.I., Makushin D.G.


This article discusses various aspects of the interaction of the first contact doctor and urologist at step of primary and specialized health care to patients with erectile disfunction.
Consilium Medicum. 2016;18(7):66-71
pages 66-71 views

Clinical and diagnostic aspects of some forms of balanoposthitis

Zabirov K.I., Kisina V.I., Khodyreva L.A., Musakov V.Y., Zhukovskiy R.O., Levanovich T.V., Sizova I.D., Vechtomova L.V.


To help the practitioner in the article the modern data on infectious / parasitic and non-infectious forms of balanoposthitis. Outlines etiology, clinical manifestations, diagnosis and treatment balanoposthitis with clinical observation of his rare form - syndrome larva migrans. Each form balanoposthitis is illustrated by a photograph.
Consilium Medicum. 2016;18(7):72-77
pages 72-77 views

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