Vol 20, No 7 (2018)


Prostate cancer: when need testosterone therapy?

Sukhikh S.O., Vasilyev A.O., Govorov A.V., Pushkar D.Y.


The problem of testosterone deficiency (or hypogonadism) remains one of the most urgent in urology. It is known that testosterone deficiency is associated with a decrease in libido, loss of muscle mass and bone mineral density, as well as with the onset of depressive disorders. A low level of testosterone is combined with an increase in insulin resistance, a level of triacylglycerides, an excess body weight. Nevertheless, the appointment of hormone replacement therapy with testosterone is often impossible because of fears of urologists associated with the existence of a hypothesis about certain interrelations between the development of prostate cancer and the level of androgens.
Consilium Medicum. 2018;20(7):8-10
pages 8-10 views

A modern view of prostate biopsy

Demin A.A., Govorov A.V., Vasilyev A.O., Okishev A.V., Kim Y.A., Pushkar D.Y.


Active introduction of programs for early diagnosis of prostate cancer, including the implementation of digital rectal examination, determination of prostate-specific antigen and transrectal ultrasound made it possible to identify the disease at an early stage and offer patients radical treatment. Currently, in addition to the standardized cancer diagnostic methods of prostate cancer, patients may be asked a lot of non-invasive diagnostic methods: the definition of the prostate health index, the PCA3 (Prostate Cancer gene 3), carrying out magnetic resonance imaging, various fusion technology, as well as varieties of prostate ultrasound (histoscanning, sonoelastography, etc.). The emergence of new non-invasive imaging techniques has shown considerable potential in diagnosing prostate cancer, choosing a method of treatment, planning the course of the operation and subsequently monitoring patients.
Consilium Medicum. 2018;20(7):11-14
pages 11-14 views

Assessment of measured in multiparametric magnetic resonance imaging diffusion coefficient potential for low malignancy score determination in PC after radical prostatectomy

Goncharuk D.A., Veliev E.I., Sokolov E.A., Shabunin I.V., Paklina O.V., Setdikova G.R.


Objective. To evaluate correlation of measured diffusion coefficient - MDC (tumor MDC and MDS ratio) with final malignancy degree after radical prostatectomy (RP). Materials and methods. The study included 118 patients with prostate cancer in whom RP was performed between 2012 and 2017 after 3 Tesla contrast-enhanced multiparametric magnetic resonance imaging (mpMRI) in one medical center. After MRI results analysis mean MDC of tumor tissue (tumor MDC) and normal tissue (normal tissue MDC) were determined according to MDC records and MDC ratio was calculated (division of tumor MDC by normal tissue MDC). Results. A significant negative moderate correlation (Spearman correlation coefficient = -0.733, p=0.000) was found between tumor MDC and postoperative tumor cells differentiation degree. Similar correlation was also found for MDS ratio with higher Spearman correlation coefficient = -0.802, p=0.000. In ROC-analysis of PC discrimination Gleason 6 from Gleason ≥7 area under ROC-curve (AUC) for tumor MDC was 0.898 (95% confidence interval - CI 0.835-0.961) and for MDC ratio - 0.950 (95% CI 0.909-0.992). When tumor MDC≥0,78 was used as a criteria for Gleason 6 (grade group 1) sensitivity was 78% and specificity - 98%. When MDC rate ≥0.4501 was used sensitivity and specificity comprised 92 and 93%, respectively. Conclusion. When measured in postoperative pathomorphological study tumor MDC measurement has significant negative correlation with final malignancy rate of PC Gleason 6 (grade group 1). MDS ratio had somewhat stronger correlation that is more precise after Gleason score division 6 (3+3) from ≥(3+4).
Consilium Medicum. 2018;20(7):15-19
pages 15-19 views

Effectiveness of levofloxacin (Eleflox) use in combined therapy for patients with chronic bacterial prostatitis

Dendeberov E.S.


Objective - to evaluate clinical effectiveness of step-down and peroral therapy with levofloxacin in combined therapy for patients with bacterial prostatitis and comorbid gastrointestinal pathology. Study design - a simple open comparative retrospective non-randomized study. Materials and methods. The study included 116 patients with chronic bacterial prostatitis who attended “Andromed” clinic in the period fr om 2014 to 2017 years. For quantitative symptoms evaluation in assessment and for treatment effectiveness evaluation a questionnaire “Chronic prostatitis symptoms index” developed by National Institute of Health, USA was used. Safety was assessed on the basis of fixed adverse events. All patients received levofloxacin for 28 days: patients in step-down therapy group received levofloxacin 500 mg/d intravenously for 10-12 days with subsequent transition to peroral administration of 500 mg/d, Another group received levofloxacin 500 mg/d in peroral therapy for 28 days. Patients in both groups received adjunctive therapy and physiotherapy in accordance with existing guidelines. All study participants were examined a month after antibiotic therapy was finished. Results. According to clinical examination results no significant differences between two groups were found. Levofloxacin course resulted in pathogen eradication in 82% patients in step-down therapy group and in 81% patients in peroral therapy group wh ere patients received levofloxacin for 28 days. In none of the cases significant adverse events were observed in step-down and peroral therapy with levofloxacin. Conclusion. Levofloxacin is effective in patients with chronic bacterial prostatitis. It is reasonable to use step-down therapy in patients with comorbid gastrointestinal pathology.
Consilium Medicum. 2018;20(7):20-25
pages 20-25 views

Influence of urethrovesical anastomosis reconstruction variants use in radical prostatectomy on urinary continence recovery

Golubtsova E.N., Tomilov A.A., Veliev E.I.


The use of radical prostatectomy as the main surgical treatment method in patients with prostate cancer allowed to achieve satisfying results. At present time scientific research is focused on functional results evaluation and improvement. The question of early continence recovery in the early stages after operation has become increasingly important. Robot-assisted radical prostatectomy demonstrates several advantages in small pelvis anatomy and sphincters preservation. At present the use of various techniques for urethrovesical anastomosis reconstruction and neurovascular tracts preservation is discussed. There are possibilities of front and back semi-circle of urethrovesical anastomosis reconstruction and total reconstruction. In some instances these methods complement one another. Knowledge and experience accumulation will allow to choose the optimal method and probably to standardize the operation technique in order to improve functional results and patients' quality of life.
Consilium Medicum. 2018;20(7):26-29
pages 26-29 views

Comorbid viral infection in patients with bladder cancer

Kosova I.V., Loran O.B., Sinyakova L.A., Gundorova L.V., Kosov V.A., Pogodina I.E., Kolbasov D.N.


The role of combined viral infection in the genesis of various cancers, such as breast cancer, cervical cancer, oropharyngeal localization of the tumor process is being actively discussed. The aim of the study was to identify possible morphological, immunohistochemical features of the bladder tumor against the background of a combined viral infection. 100 patients (72 men and 28 women) aged 38 to 90 years (mean age 65±10) with a diagnosis of bladder cancer were examined and treated. In addition, molecular genetic, serological methods for the diagnosis of viral infections (herpes type 1 and 2, cytomegalovirus - CMV, Epstein-Barr virus - EBV, human papillomavirus - HPV of high oncogenic risk), morphological and immunohistochemical studies were performed. The indicators of proliferative activity, factors of angiogenesis, growth factors depending on the degree of anaplasia and the stage of the process are analyzed. Results. The expression of EGFR in patients with the presence of viral DNA in tumor tissue correlated with the presence of HPV in the tumor (R=0.354, p=0.115), p63 (R=0.707, p=0.182), p53 (R=0.499, p=0.025), Ki67 (R=0.747, p=0.05) and also with the level of anti-EBV Ig-VCA (R=0.47, p=0.032). In patients with the presence of EBV in tumor tissue, expression of growth factors correlated with the level of anti-EBV Ig-VCA (R=0.577, p=0.049), the presence of coylocytosis (R=0.368, p=0.24) and intranuclear inclusions (R=0.485, p=0.11) as manifestations of HPV infection. In patients with no viral DNA there is a slight degree of cytopathic changes (2 points: 10.3% vs. 28.6%, p=0.046), whereas in the presence of viral DNA the degree of these changes is higher (3 points: 27.6% vs. 9.5% respectively, p=0.06). The same situation can be observed in the case of the presence of intra-nuclear inclusions (1 point: 10.7% vs. 28.6%, p=0.046; 2-3 points: 17.9% vs 9.5% and 11.9% respectively). High correlation links between proliferative activity and the presence of high oncogenic risk HPV in tumor tissue were obtained (R=0.706, p=0.05), koilocytosis and factors of angiogenesis (R=0.576, p=0.008) and markers of proliferation (R=0.408, p=0.316). Moderate correlations were found between the presence of intracardiac inclusions and the presence of EBV in tumor tissue (R=0.303, p=0.04), coilocytosis (R=0.411, p=0.005), focal hyperplasia (R=0.459, p=0.001), perivascular infiltration (R=0.335, p=0.023). The presence of CMV in tumor tissue was correlated with focal hyperplasia in the form of follicles (R=0.362, p=0.012), coilocytosis (R=0.32, p=0.028), the presence of leukocytes (R=0.439, p=0.012) and eosinophils (R=0.439, p=0.012). Conclusion. The signs of a combined viral infection are to be determined both in patients with the presence and absence of viral DNA in the tumor tissue. Correlation interrelations between morphological, molecular genetic, immunoenzyme indicators of presence of virus co-infection in patients with bladder cancer are determined. Increased proliferative activity, expression of apoptosis factors, growth factors in patients with the presence of viral DNA in tumor tissue indicates an unfavorable course of the tumor process
Consilium Medicum. 2018;20(7):30-36
pages 30-36 views

Photodynamic diagnostics of non-invasive bladder cancer with the use of Russian fluorescent viewing system

Loran O.B., Seregin A.V., Dadashev E.O., Babaev A.B., Loshenov V.B.


Bladder cancer (BC) makes about 4.5% in the malignant diseases incidence pattern in Russia. Among malignant tumors of urinary tract ВС comprises about 70%. An increase in BC incidence on 11.76% in 10 years over the 2006 to 2016 period is reported. Superficial BC is characterized with progressive course and frequent relapses. Misassessment of bladder tumor results in frequent relapses after transurethral resection that consequently leads to tumor progression that excludes organ-preserving treatment. Many authors associate substantial progress in non-invasive BC diagnostics with the use of photodynamic diagnostics that is highly sensitive in tumor detection. Presented in the review clinical results clearly demonstrate the large potential of fluorescent methods use in superficial BC diagnostics. The main benefits of photodynamic diagnostics with the use of Russian fluorescent viewing system include fluorescent contrast detection between healthy and pathologic tissue that allows to reduce the amount of diagnostic mistakes, perform targeted biopsies and define the tumor borders.
Consilium Medicum. 2018;20(7):37-40
pages 37-40 views

Hyperactive bladder in multimorbid patients. What should be remembered?

Korshunova E.S., Korshunov M.N.


Multimorbidity (comorbidity) is a presence of two or more co-occurring chronic diseases in one patient that are pathogenically inter-related or simultaneous irrespective of disease activity. According to the World Health Organization analysis, between 2000 and 2050 years the percentage of people older than 60 years will double from 11% to 22%. The proportion of patients with comorbid chronic diseases will also increase. Apart from therapists, specialized doctors also face the problem of multimorbidity nowadays. The article discusses treatment of hyperactive bladder patients from the perspective of comorbidity and understanding of major diseases pathogenesis and pharmacologic agents pharmacokinetics.
Consilium Medicum. 2018;20(7):41-45
pages 41-45 views

Application of a new improved model of a urethral catheter in the treatment and prevention of major pathological conditions of the urinary system

Vasilyev A.O., Govorov A.V., Schneiderman M.G., Bykov P.I., Kim Y.A., Pushkar D.Y.


From the time of the first clinical application to the present day, the urethral catheter is one of the most sought-after medical devices. Whether short-term catheterization or prolonged drainage of the bladder, the urethral catheter is an integral part of the treatment process in almost all nosologies. With all the potential benefits, finding a urethral catheter in the bladder cavity can lead to the formation of bacterial colonization, the formation of stones and secondary bacteremia, and to promote the growth of resistance to antibacterial drugs. The continuing high rate of nosocomial infection due to bladder drainage involves a number of requirements for the urethral catheter: it should be easy to use, convenient for patient and medical personnel, and, if possible, reduce the potential risk of infection of the urinary system. The introduction of urethral catheters impregnated with antibacterial, antimicrobial and antiseptic drugs significantly contributed to a decrease in the incidence of catheter-associated infection. This article describes the experience of using new models of the urethral catheter in reducing the risk and preventing the development of catheter-associated infection of the urinary system
Consilium Medicum. 2018;20(7):46-50
pages 46-50 views

Therapeutic potential of tadalafil use in sexual disorders treatment

Tsukanov A.Y., Kutukov A.S.


Tadalafil is the first long acting phosphodiesterase 5 inhibitor that is used in erectile dysfunction treatment. The effectiveness of its use was shown in treatment of erectile dysfunction of various ethiology and severity. At the same time the medication has other therapeutic effects, therefore its use is recommended in patients with comorbid erectile dysfunction. As it is highly safe, tadalafil is the treatment of choice for many patients with erectile dysfunction.
Consilium Medicum. 2018;20(7):51-55
pages 51-55 views

Is preputium an unnecessary vestigial organ or an important one?

Kulchavenya E.V.


A literature review on preputium role is presented. From ancient times preputium caused contradictory feelings. In some ethnic groups circumcision was considered necessary in infancy, others, like ancient greeks were proud of their preputium. Long preputium was regarded as beautiful, a bare penis balanus, on the contrary, as indecent. Susceptibility of preputium to a variety of inflammatory infectious diseases resulted in circumcision performance in medicinal as well as in preventive purposes. Preputium diseases also include psoriasis, lichen sclerosus, lichen sclerosus et atrophicus, lichen ruber planus, and seborrheic eczema. Phymosis, complicated with fissurae, is a highly accurate diabetes mellitus predictor. Statistically significant differences of sexual sensitivity between circumcised in infancy men compared with men with preserved preputium were not found.
Consilium Medicum. 2018;20(7):56-60
pages 56-60 views

Resolution on the results of the expert meeting on overactive bladder treatment

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Итоги обсуждения вопросов лечения гиперактивного мочевого пузыря (ГМП) и определения места препарата мирабегрон в лечении пациентов с ГМП. Председатель: профессор О.Б.Лоран. Участники: профессор М.И.Коган, профессор С.Х.Аль-Шукри, профессор Г.Р.Касян, доктор медицинских наук З.К.Гаджиева, профессор Г.Г.Кривобородов.
Consilium Medicum. 2018;20(7):61-62
pages 61-62 views

Microelements selenium and zinc in female and male body: problems and solutions

Borisov V.V.


The article discusses problems of selenium and zinc microelements deficit in female and male body in the form of a clinical lecture. Characteristics of mastopathy, breast cancer in menopause development, genitourinary atrophy and osteoporosis problems in females are presented. We emphasize the problem of male infertility in Russia, roles of social processes, environmental conditions, vicious habits, inflammatory diseases of male genitourinary tract, and co-morbid conditions. We also highlight the role of oxidative stress, discuss mechanisms of its development and influence on male fertility. For the first time we draw attention to connection of selenium deficit and breast cancer and ovarian cancer incidence in women and prostate cancer incidence in men. Taking the example of Selzink Plus we demonstrate the potential of effective oxidative stress therapy in males and females, male infertility treatment and outline the perspectives of further research on this problem
Consilium Medicum. 2018;20(7):63-68
pages 63-68 views

How the microbiome is influenced by the therapy of urological diseases: standard versus alternative approaches (article summary)

Lokshin K.L.


Until recently it was considered that urine of healthy people is sterile. However, with the use of new diagnostic methods it was demonstrated that microbiome with many various bacteria species is present in urinary bladder. Potential damage from bacteria in urinary bladder depends not only on their virulence but also on inflammatory response of the body. A protective effect of asymptomatic bacteriuria on urinary tract infections relapses was demonstrated. It was also established that some bacteria in the gut microbiome such as Oxalobacter formigenes protect from calcium oxalate stone formation. A fast increase in uropathogens antibiotic resistance is observed all over the world. The main reason for this is improper and sometimes unreasonable antibiotic use. It appears that instead of combating the pathogens it would be more useful to target the inflammatory body reaction and to preserve the protective bacterial flora. Due to its antiadhesive, antiinflammatory, spasmolytic, and antinociceptive effects the use of three herbs combination - centaury, lovage, and rosmary leaves, CLR (Canephron® N, Bionorica SE, Neumarkt, Germany) in the pilot study demonstrated excellent results in acute uncomplicated cystitis treatment. Also a phase 3 clinical study of CLR and fosfomycin trometamol use comparison has started. Gut microbiome assay in mice showed that even a single dose of fosfomycin as well as nitrofurantoin course result in substantive microbiome changes, whereas phytotherapy with CLR did not show any negative influence
Consilium Medicum. 2018;20(7):69-72
pages 69-72 views

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