Vol 24, No 7 (2022)


Comparative assessment of the intra- and early postoperative period in patients of elderly and old age after various methods of surgical treatment of large benign prostatic hyperplasia

Kostenkov N.Y., Nevirovich E.S., Gorelik S.G., Kuzmin I.V., Novitsky A.V., Tkachuk I.N.


Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men. Its significance is determined not only by a decrease in the quality of life of men, but also by the development of a number of complications as a result of infravesical obstruction. About 70% of patients with symptomatic BPH require surgical treatment due to the ineffectiveness of conservative therapy. At the moment, there are many methods of surgical treatment of this pathology in the arsenal of urologists, but there is no consensus on the choice of one or another method of surgical treatment of BPH.

Aim. To study the results of modern and most common surgical methods of large BPH in patients of the older age group.

Materials and methods. The study included 243 patients who were hospitalized at Saint Petersburg City Hospital No. 15 for BPH in the period from November 2019 to November 2021. Control examination after surgery was carried out on days 5–7, 3 and 6 months after surgery.

Results. The first group of patients underwent bipolar transurethral resection of the prostate (n=67), the second group underwent bipolar plasma-kinetic enucleation of prostate adenoma (n=69), the third group of patients underwent thulium laser enucleation (n=75), and the fourth group of patients performed laparoscopic adenomectomy (n=32). An assessment of intraoperative parameters was carried out: the duration of the operation, the duration of postoperative irrigation, bladder catheterization, bed-day spent in the hospital. In the late postoperative period (after 3 and 6 months), patients were invited for a follow-up examination. In comparison with the initial values, a significant increase in indicators was determined, characterizing the improvement in the quality of life of patients.

Conclusion. In the study, thulium laser enucleation proved to be the most effective and sparing method of BPH surgery in age-related comorbid patients, demonstrating a relatively short operation time, radical method, reduced hospital stay, early rehabilitation of patients, and high efficiency in the late postoperative period.

Consilium Medicum. 2022;24(7):447-450
pages 447-450 views

Etiological factors of voiding disorders in females

Kosova I.V., Barsegian V.A., Loran O.B., Sinyakova L.A., Luk'ianov I.V., Kolbasov D.N., Kruzhalov A.N., Alieva M.I.


Background. Voiding disorders in females are a serious medical and social problem. Various urological, gynecological, and neurological factors contribute to the development of these disorders.

Aim. To study etiological factors of voiding disorders in females.

Materials and methods. A total of 52 women 19 to 81 years of age with various voiding disorders were inspected. Examination algorithm included collection of a comprehensive medical history, filling in voiding diaries, gynecological exam, various laboratory tests (including PCR-diagnostics of urethral scrapings; ELISA tests for IgM and IgG to herpes simplex virus types 1 and 2, Varicella Zoster virus, Epstein–Barr virus, cytomegalovirus; vaginal discharge culture for flora and sensitivity to antibiotics, with mandatory determination of the lactobacilli count) and diagnostic methods, as well as consultations by related specialists.

Results. Chronic herpesvirus infection contributed to urinary dysfunction in 28 (53.8%) women, bacterial urinary tract infection – in 15 (28.8%), bacterial vaginosis – in 15 (28.8%), papillomavirus infection – in 12 (23.1%), and interstitial cystitis – in 10 (19.2%) patients. Thirty-five (76.9%) women had several simultaneous factors that contributed to the development of voiding disorders.

Conclusion. The combination of disorders of the vaginal microflora with viral and/or bacterial infections most often contributes to the development of voiding disorders.

Consilium Medicum. 2022;24(7):451-455
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Features of various methods of surgical treatment of kidney cysts

Simonov P.A., Firsov M.A., Laletin D.I., Alekseeva E.A., Sukhoverkhov A.O.


Background. According to foreign and domestic authors, a kidney cyst is one of the most common urological diseases and accounts for up to 20–50%.

Aim. To evaluate the results of various methods of surgical treatment of patients with kidney cysts.

Materials and methods. An analysis was made of 124 case histories of patients who underwent inpatient treatment for symptomatic kidney cysts at the urology department of the Regional Clinical Hospital for the period 2016 to 2019. Also, an analysis of 50 case histories of patients who were hospitalized with the same diagnosis on the basis of the urological department of the emergency hospital for the same period.

Results. Puncture methods of treatment were used only in patients whose cysts radiologically corresponded to categories I and II according to Bosniak. On the basis of the urological department of the emergency hospital, 50 people were operated on in this way, of which 22 (44%) women and 28 (56%) men. The mean age of the patients was 58.2±5 years. Punctures of cysts with evacuation of contents without sclerotherapy – 3 (6%) cases, and puncture of cysts with sclerotherapy with 96% ethyl alcohol – 47 (94%) cases. The average age of patients who underwent surgery in the regional hospital was 56.6±12 years. According to MSCT, cysts of category I according to Bosniak were diagnosed in 96 patients (77.4%), category II in 11 (8.9%), category IIF in 11 patients (8.9%), category III in 6 (4.8%). Laparoscopic excision of the cyst wall was performed in most cases – 109 (88%), laparoscopic nephrectomy was performed in 1 case (0.8%), laparoscopic nephrectomy in 10 (8%) cases, retroperitoneoscopic excision of the cyst wall – 1 (0.8%), open intervention by lumbotomy access – 3 (2.4%), of which nephrectomy was performed in two patients, one patient underwent kidney resection.

Conclusion. Surgical treatment of symptomatic kidney cysts was justified and necessary, as evidenced by the relief of symptoms and verification of cysts suspicious in terms of the likelihood of oncological pathology. Puncture methods of drainage and sclerotherapy are less radical, but justified in patients with high surgical risk. Excision of a cyst or resection of a kidney by laparoscopic access is an effective method of treatment that meets modern safety requirements for treatment.

Consilium Medicum. 2022;24(7):456-460
pages 456-460 views

Possibilities of adjuvant use of a combination of butyric acid and inulin in antibacterial therapy of inflammatory diseases of the pelvic organs

Borzykh E.V., Sviridova T.N., Lomanova G.A., Alexeev N.I., Olkhovik I.I.


Aim. To evaluate the efficacy and tolerability of antibiotic therapy in patients with pelvic inflammatory disease during the use of a fixed combination of butyric acid and inulin (Zakofalk®) as an adjuvant therapy.

Materials and methods. The study included 60 patients with inflammatory diseases of the pelvic organs who underwent antibiotic therapy. The diagnosis was confirmed by an objective examination, ultrasound of the pelvic organs, the results of a smear from the cervical canal. After inclusion in the study, the patients were randomized into 2 groups: the main group received standard antibiotic therapy and Zakofalk®, the control group received only standard antibiotic therapy.

Results. The incidence of dyspeptic symptoms in the first week of observation in the main and control groups did not differ significantly. When comparing the severity of antibiotic-associated side effects in the second week of observation, statistically significant differences (p<0.01) were found in terms of: bloating, rumbling, stools up to three times a day, which were more common in the control group. In addition, a more significant decrease in the level of leukocytes in the cervical mucus was recorded in the main group compared to the control group. The absence of pathogenic and opportunistic pathogens in the first control study, in comparison with the primary diagnosis, was also more pronounced in the main group. Adherence to treatment in the control group, 3.8 points on the Morisky–Green scale – insufficiently adherent, was lower than in the main group – 5 points – compliant.

Conclusion. The inclusion of Zakofalk® as an adjuvant drug in the antimicrobial therapy regimen for pelvic inflammatory diseases improves the tolerability of this type of treatment, prevents the aggravation of symptoms of idiopathic antibiotic-associated diarrhea, increases the effectiveness of eradication of the pathogen and contributes to the normalization of the vaginal microbiota.

Consilium Medicum. 2022;24(7):461-465
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Is high normotension a norm or a risk factor for perinatal complications: prospective cohort study

Podzolkova N.M., Skvortsova M.Y., Denisova Y.V., Denisova T.V.


Aim. Comparative assessment of the effect of high normotension and hypertension 1–2nd stage on the risk of gestational and perinatal complications.

Materials and methods. A prospective cohort study (n=110) assessing the effect of high normotension on the risk of gestational complications and pregnancy outcomes was conducted. The main group (n=70) included 30 patients with high normotension – subgroup A, and 40 patients with hypertension 1–2nd stage – subgroup B. The comparison group included 40 patients with "white coat hypertension".

Results. The most frequent complications in the 2nd and 3rd trimesters of pregnancy were toxaemia, threatened miscarriage, edema (detected in more than half of patients with high normotension and hypertension 1–2nd stage) and well as threatened preterm labor (p<0.05). The frequency of pre-eclampsia development in subgroups A and B did not differ significantly, however, in patients with high normotension in the 3rd trimester during a test of endothelium-dependent vasodilation were detected signs of endothelial dysfunction, which may be one of the mechanisms for the subsequent formation of hypertension in these patients. Placental insufficiency of varying severity was detected only in subgroups A and B. Placental insufficiency, along with intrauterine fetal hypoxia of different etiologies, were the most frequent causes of emergency caesarean section, occurring only in the main group – 3 (75.0%) in subgroup A and 6 (66.67%) in subgroup B – and associated with blood pressure above 130/85 mm Hg.

Conclusion. The importance of preventing blood pressure increase to high normal rate is explained by the development of endothelial dysfunction at late gestation, which can serve as the mechanisms of hypertension formation in this category of pregnant women.

Consilium Medicum. 2022;24(7):466-472
pages 466-472 views

Federal innovation platform: reproductive health of 1st year students of Smolensk State Medical University

Minchenkova E.A., Gustovarova T.A., Kirakosyan L.S., Krikova A.V., Dmitrieva E.V.


Aim. To study the state of reproductive health of female students of Smolensk State Medical University according to the 2020 monitoring data. To analyze the real picture of sexual life and reproductive health of first-year female students. To consider the necessity of including additional medical examinations in the dispensary monitoring plan.

Materials and methods. We examined 507 first-year female students aged 18–27 years at Smolensk State Medical University. The examination included the collection of complaints, general and obstetric-gynecological history, questionnaires, gynecological examination, general clinical examination, pelvic ultrasound, microscopic and oncocytological smears, pH-metry of vaginal secretions, colposcopy. Statistical data processing included methods of descriptive statistics. Construction of the 95% confidence interval was done according to the formula for fractions and frequencies by the Wald method. Significance of the difference between the studied features was assessed using Fisher's angle transformation. Statistical significance was considered at >95% (p<0.05) and 99% (p<0.01) probability. Statistical analysis of the results was performed in Microsoft Excel 2016 using the AtteStat 12.0.5.

Results. The examination of female students of Smolensk State Medical University revealed reproductive health disorders and lack of awareness of modern contraceptives. The study concluded that an ultrasound examination of the ovarian tract, colposcopy, endocrinologist consultation, examination of hormonal background, and STI examination should be added to the plan of dispensary observation.

Conclusion. The data obtained in the course of the present study indicate that modern first-year female students have an insufficient level of reproductive education that does not meet the requirements of our time. In our opinion, the scientific and practical project will help to increase competence and responsibility in health saving issues to improve and strengthen reproductive health, to develop and implement a set of measures in the form of clinical and diagnostic research of the reproductive system, informational and educational lectures on the prevention of abortion, infertility and other diseases, sexual education, and in the future to affect the demographic situation.

Consilium Medicum. 2022;24(7):485-489
pages 485-489 views

В помощь клиницисту

Iron deficiency in women: ways to reduce prevalence

Vinogradova M.A.


Iron deficiency states (IDSs) are common disorders at the nexus of various fields. The etiology and pathogenesis of IDSs have been well studied in recent decades, but their prevalence is still high. The highest incidence of IDSs is reported in women of reproductive age. The timely correction of iron deficiency improves women's quality of life and reduces pregnancy complications and infant morbidity. To achieve and maintain the improvement, caution in risk groups, early diagnosis, physiology-based therapy, and follow-up are necessary. Iron sulfate agents are well known as an effective way to treat iron deficiency anemia. However, the high rate of previously reported side effects posed significant challenges to the complete course of therapy. The development of a new molecule with prolonged iron release minimizes the complications of therapy, providing new prospects for iron deficiency treatment. The combination of folic acid to iron sulfate in one tablet simplifies prevention regimens and therapy for pregnant women and those planning to become pregnant and reduces the time to improve.

Consilium Medicum. 2022;24(7):473-476
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Viral hepatitis C during pregnancy: prevalence, impact on perinatal outcomes, patient management tactics (literature review)

Yakimova A.V., Mukhamedshina V.R., Kucherenko S.G.


The article presents modern ideas about the impact of viral hepatitis C on the course of pregnancy, the severity of maternal disease associated with it: methods of delivery and possible vertical transmission. Epidemiological data on the prevalence in the world and the Russian Federation, risk factors for perinatal HCV transmission, and the course of pregnancy in women infected with HCV are shown. The search for the necessary literary sources was carried out in the databases Scopus, PubMed, MedLine, The Cochrane Library, RSCI.

Consilium Medicum. 2022;24(7):477-480
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Prospects for the use of autologous platelet-rich plasma in reproductive medicine. Analysis of literary data

Zabrodina Y.V., Akhmedyanova G.U., Khamidullina Z.G.


A brief review of the literature summarizing PubMed (MEDLINE) data is presented, which describes the use of autologous platelet-rich plasma in reproductive medicine. The main biologically active factors included in the composition of platelets are indicated: vascular endothelial growth factor, transforming growth factor, platelet growth factor and epidermal growth factor. The main biological changes occurring under the action of platelet activation are noted: control of migration, differentiation and proliferation of cells, accumulation of extracellular matrix, etc. The main methods and methods of using autologous platelet-rich plasma in the treatment of patients with thin endometrium are described, the main advantages of this method are indicated. The prospects of using this therapy in reproductive medicine for the purpose of effective treatment of patients with infertility are shown.

Consilium Medicum. 2022;24(7):481-484
pages 481-484 views

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