Vol 21, No 7 (2019)


Slovo glavnogo redaktora

Kogan M.
Consilium Medicum. 2019;21(7):9
pages 9 views

Russian demography, ways of male and female health improvement in aspects of fertility. Urologist and fertility specialist opinion

Borisov V.V.


The article discusses problems of Russian demography and factors affecting male and female health and fertility. It considers economic, social and biological causes of female and male infertility as well as pathogenetic effects of oxidative stress and lack of natural antioxidants and microelements and provides ways to correct them in everyday life, including the use of dietary supplements. It was emphasized that dietary supplements, in particular the medicine Selzinc Plus, can only help drug therapy, but are not its independent element.
Consilium Medicum. 2019;21(7):10-18
pages 10-18 views

Male infertility: genetic focus on actual problem

Chernykh V.B., Solovova O.A.


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.
Consilium Medicum. 2019;21(7):19-24
pages 19-24 views

Some aspects of sexual dysfunctions mental pathology

Kibrik N.D., Yagubov M.I., Kan I.Y.


The article describes special aspects of mental pathology that occur in patients with various sexual dysfunctions. They are often not recognized by medical practitioners of related specializations as they are presented by indistinct affective and somatoform disorders such as somatized, subdepressive and asthenic disorders. Analysis of modern literature data on this problem is presented. Principles and tactics of treatment and rehabilitation procedures are described.
Consilium Medicum. 2019;21(7):25-27
pages 25-27 views

Quality of life, mental health, and sexual disorders assessment in women with urinary incontinence

Gvozdev M.I., Baranova E.O.


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.
Consilium Medicum. 2019;21(7):28-30
pages 28-30 views

Psychogenic erectile dysfunction, correction with sildenafil citrate (clinical lecture)

Borisov V.V.


The article presents in the form of a clinical lecture the background and global impact of nitrogen oxide discovery as a signal molecule that contributes to lots of physiological and pathophysiological processes including sexual ones. The history of sildenafil citrate use as a first phosphodiesterase type 5 inhibitor, its clinical establishment and world-wide distribution are described in details. On the basis of key concepts formulated by the World Health Organization special attention is given to the concept of sexual health, its role in the community and the whole civilization existence. Aspects of sexual life in different world countries and frequency of related problems are considered in detail. Male sexual capabilities, sexual activity and concomitant energy expenditure, its influence on health and cardiovascular disorders, role of sports activities take an important place. Incidence of erectile dysfunction depending on the males’ age is presented according to statistical data. Its psychological and psychogenous causes as well as so called sexual anorexia, role of smoking and drug abuse are described thoroughly. The problems of erectile dysfunction treatment with phosphodiesterase type 5 inhibitors and, in particular, sildenafil citrate and its role in alcohol addicted patients, its influence on fertility are considered from multidisciplinary perspective.
Consilium Medicum. 2019;21(7):31-37
pages 31-37 views

Bacteriophages in treatment of low urinary tract infections

Vasilyev A.O., Zaitsev A.V., Kalinina N.A., Shiriaev A.A., Kim Y.A., Pushkar D.Y.


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.
Consilium Medicum. 2019;21(7):38-41
pages 38-41 views

Chronic prostatitis/chronic pelvic pain: what do we treat?

Krupin V.N., Krupin A.V., Belova A.N.


Introduction. High prevalence of the disease with set of symptoms of chronic prostatitis (CP), low efficacy of current treatment options, unclear origin of the disease’s symptoms requires a fundamental change in attitude towards to the disease called "chronic prostatitis". Aim. To determine pathogenesis of the disease symptoms and to suggest treatment options for patients with chronic bacterial prostatitis using data of studies on clinical and laboratory manifestations and morphological changes in the prostate gland as well as on assessment of hemodynamic changes in the pelvis. Outcomes and methods. The study included 916 patients with CP, 24 to 52 years of age. Hemodynamics in the small pelvis and prostate was examined by pelvic rheography, reoprostatography and laser Doppler fluometry. Comparison group included 12 healthy volunteers aged 28-49 years. Results. An analytical review on the problem of CP and the results of examination and treatment of 916 patients with CP led to the conclusion that a fundamental change in attitude towards these patients are needed. An absence of a link between changes in the prostate gland and CP clinical manifestations as well as a presence of pelvic hemodynamics disorder which are often due to myofascial syndrome, dictate the need to begin diagnosis of CP not with identifying inflammation, but with searching for the disease symptoms origin. Conclusions. CP should be considered not as an inflammation of prostate tissue, but as a set of symptoms which are not related to the prostate gland; thus changes in prostate tissue result from non-inflammatory microcirculation disorders and they are considered hemodynamically mediated.
Consilium Medicum. 2019;21(7):42-48
pages 42-48 views

Hybrid surgical pelvic diaphragm reconstruction: 3 years of follow up

Shkarupa D.D., Kubin N.D., Petrov A.D., Shapovalova E.A.


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.
Consilium Medicum. 2019;21(7):49-52
pages 49-52 views

Neurogenic and idiopathic overactive bladder: stumbling blocks

Korshunova E.S., Korshunov M.N., Darenkov S.P.


Overactive bladder syndrome (OAB) is a chronic condition that has a significant influence on the quality of life of both men and women. OAB symptoms limit daily and social activity of patients. This disorder is not a separate disease but is included in clinical presentation of several diseases. The most frequent of them are brain disorders (Parkinson’s disease, dementia and others), genitourinary syndrome of menopause and benign prostate hyperplasia. Bladder overactivity can be confirmed with urodynamic methods (cystometry) where involuntary detrusor contractions that can be spontaneous and provoked are detected at the bladder filling phase. If a neurological disorder is present, detrusor hyperactivity is considered neurogenic, if it is absent - idiopathic. The article discusses treatment of patients both with neurogenic and idiopathic OAB as well as special aspects of medical therapy choice. In M-cholinoblockers choice patient cognitive function and comorbid disorders should be evaluated. The use of quaternary amines (trospium chloride) is reasonable in any OAB syndrome form. Trospium chloride is safe for use in older patients as a result of decrease of risk of cognitive function impairment and pharmacodynamics modulation in polypharmacy. Rapid therapeutic effect supports high adherence to treatment with trospium chloride.
Consilium Medicum. 2019;21(7):53-57
pages 53-57 views

Onabotulinumtoxin A in treating detrusor hyperactivity in patients with spinal cord injury (literature review)

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


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.
Consilium Medicum. 2019;21(7):58-63
pages 58-63 views

Stone-dissolving therapy of coral calculus

Bazhenov I.V., Zyryanov A.V., Danilov V.O., Philippova E.S., Makaryan A.A., Bessonov P.D., Burcev S.A.


Uric acid stones make up about 10% of the total nephrolithiasis structure. Low urine pH is the primary risk factor for the formation of such stones. Additional factors include a high content of urate in the urine and small diuresis. To dissolve uric acid stones, oral medications are used to increase urine pH. According to literary sources, the litholysis of stones against the background of citrate therapy is achieved within 1.5-6 months or more. At the same time, data on the size of which stones can be dissolved using citrates is very limited. The analysis of the use of stone-dissolving therapy by the course of oral medication with citrate mixtures in 2 patients with coral-shaped (K-4) kidney stones treated in the Regional Urological Center on the basis of Sverdlovsk Regional Clinical Hospital №1 in 2018 has been carried out. The possibility of using litholytic therapy to dissolve large urate kidney stones is presented.
Consilium Medicum. 2019;21(7):64-68
pages 64-68 views

Effect of antibacterial agent PK/PD index on efficacy of lower urinary tract infection therapy

Dukhanin A.S.


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.
Consilium Medicum. 2019;21(7):69-74
pages 69-74 views

Urinary tract infections: proven potentials of plant pharmacotherapy

- -.


Urinary tract infection (UTI) is one of the most frequent infectious disorders. In modern protocols of acute uncomplicated UTI treatment antibiotics use is recommended as a first-line therapy. Although its frequent and unreasonable use may result in increase of antibiotic resistance development risk and microbiome alteration that leads to necessity of new approaches for UTI treatment development. Herbal based medications are a potential alternative for antibiotic use in acute uncomplicated UTI treatment. To compare the efficacy of herbal drug Canephron® H (BNO 1045) and fosfomycin trometamol (FT) for treatment of acute uncomplicated lower urinary tract infections (uLUTI) was carried out a multicentre double-blind controlled randomized trial in parallel groups (registration number NCT02639520), the results of which were presented in the article of principal investigator: F. Wagenlehner et al. Non-Antibiotic Herbal Therapy (BNO 1045) versus Antibiotic Therapy (Fosfomycin Trometamol) for the Treatment of Acute Lower Uncomplicated Urinary Tract Infections in Women: A Double-Blind, Parallel-Group, Randomized, Multicentre, Non-Inferiority Phase III Trial. Urol Int 2018; 101 (3): 327-36. DOI: 10.1159/000493368. Epub 2018 Sep 19. Aim. Тo prove non-inferiority of herbal medication Canephron® N (BNO 1045) use in comparison with FT in acute uLUTI treatment. Materials and methods. Women aged 18-70 years with newly diagnosed acute uLUTI with typical symptoms were randomized for BNO 1045 (n=325) or FT (n=334) or placebo use. Results. In between Day 1 and Day 38 238 (83.5%) patients in BNO 1045 group and 272 (89.8%) patients in FT group did not use additional antibiotics. With the equivalence limit 15%, BNO 1045 demonstrated non-inferior effectiveness compared with FT in uLUTI treatment. The incidence of adverse events was equal in both groups, although in FT group incidence of gastrointestinal disorders was higher, and in BNO 1045 group - pyelonephritis incidence was higher. Conclusions. BNO 1045 has a potential to decrease antibiotics use in uLUTI treatment and its use, consequently, can result in significant changes in the strategy of antibacterial drugs rational use.
Consilium Medicum. 2019;21(7):75-80
pages 75-80 views

The question of the treatment of patients with symptoms of the lower urinary tract on the background of benign prostatic hyperplasia with combined erectile dysfunction

Tsukanov A.I., Semikina S.P.


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.
Consilium Medicum. 2019;21(7):81-85
pages 81-85 views

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