Vol 21, No 7 (2019)

In recent years, a contribution of the “male factor” to problems of human reproduction has increased significantly. This is due to a decrease in parameters of seminal fluid and male fertility, as well as an increase in knowledge in the field of andrology, reproductive medicine and genetics. Impaired fertility in men can be caused by various reasons and is associated with genetic and environmental factors or a combination thereof. It manifests itself in different clinical diseases or conditions and is often due to a change in spermatological parameters. The presence or absence of syndromic male infertility, a type of pathozoospermia, largely determine a strategy for genetic examination of the patient. Diagnosis of male infertility which is associated with severe azoospermia and severe oligozoospermia includes a standard cytogenetic analysis (karyotyping), analysis of Y chromosome microdeletions at the AZF region, and CFTR gene variants. Chromosomal abnormalities, structural anomalies and variations in the copy number of autosomes and sex chromosomes, gene mutations / variants and epigenetic abnormalities, aneuploidy in spermatozoa can have a negative effect on male fertility, leading to impaired sex formation, impaired development of the reproductive system, impaired spermatogenesis and meiosis and to a decrease in fertility parameters of sperm. Heterogeneity of genetic causes of many forms of pathozoospermia and a relative rarity of syndromic disorders of the reproductive system and male infertility significantly complicate diagnosis, and therefore, patients with impaired fertility of unknown origin, genetic or presumably genetic etiology, need a comprehensive examination using genomic and metagenomic technologies. Genetic testing and counseling of patients with infertility should not be carried out at late stages of examination as “exclusion of the genetic factor”, but they should be an integral part of a comprehensive clinical examination of patients and couples with impaired reproduction.

Urinary incontinence (UI) is a common condition that affects women of all ages, cultures and races all over the world. The disorder frequency increases with age. UI has a significant impact on patients’ well-being, psychosomatic condition, quality of life, it decreases social mobility by decreasing employment and labor efficiency, and also makes a lot of women to give up paid or unpaid activities. Besides it has a negative impact on sexual health and relationship with partner. UI is not a life threatening disorder but is results in many negative medical and social consequences and also in additional financial losses. According to literature data up to 25% of women experience decrease of quality of life due to involuntary urination. Notwithstanding the fact that UI incidence is comparable with one of other chronic disorders, the studies of its influence on patients’ quality of life were started only lately and are presented in the literature over the last 15 years. Studies estimating the influence of UI on the quality of life and daily activity with the use of validated questionnaires are of particular interest. After a literature study it may be concluded that there is a consensus on various questionnaires use for estimation of quality of life of patients with UI, the importance of questionnaires use is emphasized in numerous studies.

The article is addressed to doctors of various specialties and devoted to the history of bacteriophages and the experience of their use in clinical practice. Modern data on their medical use form our image of their mechanism of action, their potential application in clinical practice, their advantages and disadvantages in comparison with more common methods of antibacterial treatment and prophylaxis. Improving the technology for the production of preparations containing bacteriophages will make them more specific for bacteria that cause infections. Various forms of drugs, such as suppositories, gels, tablets, solutions, and others, simplifies the clinical use of bacteriophages. The current problem of biofilms in urology can be solved by using bacteriophages. Phages, like other viruses, have antigenic properties and contain group-specific and type-specific antigens. Due to their high specificity, many bacteriophages serve as diagnostic tools for identifying bacterial cultures. The bacteriophages undeservedly forgotten in the middle of the last century were again enabled to be useful. Worldwide growing interest in phagotherapy contributes to the widespread implementation of new clinical research.

Background. One in two women over 50 years old suffers from one or another form of genital prolapse that is followed by pelvic organs dysfunction. Modern methods of this pathology treatment are focused on improvement of patients’ quality of life with reconstruction of pelvic diaphragm natural anatomy. Aim. To evaluate subjective effectiveness of pelvic diaphragm hybrid reconstruction in patients after anterior apical prolapse of pelvic organs surgery at 3 or more years of postoperative period. Methods. A retrospective analysis of medical records data of patients in whom hybrid surgical reconstruction of pelvic diaphragm anterior apical part was performed between April 2015 and April 2016. Evaluation of subjective effectiveness of the surgery was performed using phone survey. In those patients who agreed to come to medical examination, vaginal examination was performed by POP-Q system and validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12) were filled. Results. During the studied period 679 hybrid surgical reconstructions of pelvic anterior apical part prolapse were performed in the clinic. The mean follow-up period was 38±3.6 months. We succeeded to get in touch with 593 (87.3%) patients, of which 189 (31.8%) came to medical examination. According to POPDI-6 questionary results only 3.1% of patients had a foreign body sensation in vagina and 2.6% felt bladder incomplete emptying. CRAD-8 questionary results analysis showed that only 2 patients had defecation problems after the surgery. According to UDI-6 questionary results most of the patients noted improvement of overactive bladder symptoms and urination improvement. Sexual life quality evaluation showed that only 1 patient had dyspareunia de novo. Medical examination showed relapse in apical part in 2 (1.0%) and in anterior part - in 14 (7.4%) of female patients. Phone survey results analysis showed that most of the patients noted significant improvement of quality of life. In total 97.4% (578/593) said that they would recommend such surgery to friends and relatives. Conclusion. Hybrid surgical pelvic diaphragm reconstruction in follow-up for 3 and more years showed high subjective effectiveness, low percent of repeated surgeries and significantly improved patients’ quality of life.

Symptoms of the lower urinary tract are typical manifestations of spinal cord injury. One of the manifestations of neurogenic dysfunction of the lower urinary tract, observed in patients with spinal cord injury, is urinary bladder overactivity, which can be seen in combination with or without detrusor-sphincter dyssynergy. Currently, the most promising method of neurogenic bladder overactivity treatment is intravesical onabotulinumtoxin A injections. This method is considered is highly effective and minimally invasive. It is pathogenetically reasonable, since it leads to a blockade of acetylcholine production in the presynaptic gap, which causes a suppression of the parasympathetic effect on the detrusor. The authors present modern data of onabotulinum toxin injection technology and effective doses of its use. The article highlights promising changes in the technology of botulinum toxin type A administration.

The individual pharmacological profile of an antimicrobial drug (AMP) is determined by its pharmacokinetic/pharmacodynamic properties and is referred to as the PK/PD profile. Based on the estimated PK/PD index, various types of antimicrobial activity were identified: concentration-dependent and time-dependent AMP. Fluoroquinolones are antimicrobial agents with a concentration-dependent effect, for which the peak concentration of the active substance is important to achieve a bactericidal effect. Along with the minimum inhibitory concentration, for assessing the microbiological efficacy of ciprofloxacin, an indicator of the minimum concentration preventing mutations, which reflects the presence of the “mutation selection window”, is important. The main obstacle to increasing bioavailability and the formation of maximum plasma concentrations of ciprofloxacin is a “narrow absorption window”. The original prolonged dosage form of ciprofloxacin 1000 mg for a single dose per day (Cifran® OD 1000 mg) is based on FDD technology: flotation, dispersion and diffusion. Due to the higher Cmax values created, the tablet form of the sustained release allows overcoming the “window of selection mutation” of the main uropathogens. The proven reduction in the frequency of therapeutic failures when using the ciprofloxacin 1000 mg dosing regimen 1 time per day is due to the possibility of slowing down the mutation rate and preventing the selection of resistant strains of uropathogens against the background of antimicrobial therapy, as well as increasing adherence to therapy.

The presented literature review deals with the analysis of data on clinical use of a drug from the group of phosphodiesterase enzyme 5 inhibitors in the conservative treatment of patients with a combination of benign prostatic hyperplasia and erectile dysfunction. A similarity of pathophysiological mechanisms which provide and support main manifestations of these two diseases and, as a consequence, complaints presented by patients are showed. The pathophysiological rationale for the use of drugs from the group of phosphodiesterase enzyme 5 inhibitors is given, among which the tadalafil molecule has obvious competitive advantages due to its pharmacological and pharmacokinetic characteristics, in particular the half-life. The data of preclinical and clinical international studies are presented, in which various applications of tadalafil are analyzed: both in the form of monotherapy and in combination with the main drugs used for impaired urination - alpha-1-blocker and 5a-reductase inhibitor. The review provides data on the main studies which design meets the modern requirements of evidence-based medicine. All of these options for the use of this drug for the treatment of patients with impaired urination against a background of prostate adenoma in combination with erectile dysfunction have fairly high efficacy criteria and a favorable safety profile.