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According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

A total of 76 patients with chronic abacterial prostatitis (CAP) in combination with erectile dysfunction were divided into two groups. Clinical symptoms of CAP and severity of erectile dysfunction were the same in both groups. Patients of the study group (n = 36) received pathogenetic treatment (vitaprost plus physiotherapy) and impase. The control group (n = 40) received vitaprost and physiotherapy. The results of the treatment showed that impase addition to combined treatment of CAP patients with erectile dysfunction significantly improves erectile function: 80.6% patients given impase raised their score by International Index of Erectile Function Scale to normal (26 points and higher). Impase efficacy increased with prolongation of the treatment from 4 to 12 weeks.

Our study of efficacy of Prolit-septo phytotherapy following extracorporeal shock-wave lithotripsy (ESWLT) in patients with nephrolithiasis has demonstrated that Prolit-septo noticeably reduces the time of evacuation from the urinary tract of the destructed stone fragments as well as renal colic incidence and renal inflammation exacerbation.

Prostatic surgery is often accompanied with increased intra- and postoperative bleeding which is caused, among other reasons, by enhancement of general and local fibrinolysis due to mechanical impact on prostatic tissue in operation. We proposed to inhibit enhanced fibrinolysis with preparation of tranexamic acid tranexam and tried it in 53 patients with prostatic adenoma undergoing transurethral prostatic resection (TUR). The comparison of bleeding severity in surgery with and without tranexam administration before, in and early after prostatic TUR showed that tranexam significantly lowers blood loss.

Pharmacotherapy of prostatic adenoma is based in present-day practice primarily on two basic groups of medicines--inhibitors of 5alpha-reductase and blockers of alphal-adrenoreceptors. Our trial included 98 patients with prostatic adenoma aged 59-79 years given combined treatment with finasteride (inhibitor of 5alpha-reductase) made in Hungary (prosteride, Gedeon Richter) and an uroselective blocker of alpha1-adrenoreceptors sonisin (Gedeon Richter, Hungary). Prosteride was given for 12 months, sonisine--for the first 6 months of combined treatment. Positive results were achieved in 97 (99%) of 98 patients. After 12-month combined treatment symptoms of the disease reduced by IPSS from 17.9 +/- 1.8 to 3.9 +/- 0.9 points, Qmax rose from 8.8 +/- 0.3 to 14.6 +/- 0.3, residual urine volume diminished from 91.7 +/- 8.5 to 31.7 +/- 4.4, the size of the prostate reduced from 72.4 +/- 2.9 to 50.6 +/- 3.7, quality of life improved 2-fold. Combined administration of finasteride (prosteride) and alpha1-adrenoblocker tamsulosine (sonisine) meet three principles of pharmacotherapy of prostatic adenoma: prevents progression of the disease and surgical treatment, relieves symptoms and improves quality of life.

Symptoms severity was assessed in 533 patients with urinary bladder overactivity (mean age 56.4 +/- 0.6 years). All the patients kept urination diary for 3 days, some patients filled in KHQ questionnaire to find out quality of life, were examined urodynamically. Overactive bladder (OAB) symptoms were studied in 52 patients before and after 12 weeks of solifenacin treatment in a dose 5 mg/day. The statistical analysis identified three degrees of OAB symptoms. The severity was calculated according to the formula in points (S): S = 2 x number of urinations for 3 days + number of urges for 3 days + 1*(*--in the presence of urgent urine incontinence). In 62 points and less the diagnosis was "mild severity" of the symptoms (degree 1), in 63-80 points--"moderate severity" (degree 2), in 80 points and more--"great severity" (degree 3). Of 533 patients, 119 (22.3%) had symptoms of degree 1, 148 (27.8%)--of degree 2, 266 (49.9%)--of degree 3. The patients with more severe disease had more distinct changes in urodynamic indices and worse quality of life. Solifenacin treatment reduced severity of the symptoms in most patients treated. Before solifenacin administration degrees 1, 2 and 3 of the symptoms severity were detected in 12 (23.1%), 13 (25.0%) and 27 (51.9%) patients, respectively. After treatment--in 26 (50.0%), 16 (30.8%) and 6 (11.5%) patients, respectively. OAB symptoms were absent in 4 (7.7%) patients. Thus, it is shown that the proposed system of the system assessment reflects severity of OAB clinical symptoms, the degree of urodynamic disorders and deterioration of quality of life. This classification system can be used for follow-up assessment of OAB symptoms in the treatment process. It is simple and perspective for wide application.

Finasteride effect before transurethral resection (TUR) of the prostatic gland was studied in 88 patients with prostatic adenoma (PA). Forty seven patients received prosteride (Gedeon Richter), forty one patients - proscar (MSD) in a dose 5 mg/day for 3 months. Finasteride reduced blood flow in prostatic tissue, density of the vascular plexus, epithelium/stroma coefficient from 1.26 to 0.84. This decreased intraoperative blood loss, postoperative hematuria, TUR duration, postoperative rehabilitation, number of early and late TUR complications.

Efficacy and tolerance of a novel antimuscarinic drug solifenacin succinate (vesicar) were studied in 55 patients with hyperactive urinary bladder (HUB). All the patients were divided into two groups: 27 patients of group 1 received solifenacin in a dose 5 mg/day, 28 patients of group 2--in a dose 10 mg/day. The 3-month treatment has improved symptoms of the HUB compared to the initial level: a daily number of vesical tenesmus reduced in patients of groups 1 and 2 by 47 and 51%, respectively; a number of episodes of urgent urine incontinence by 53 and 65%, voiding--by 24 and 26%, respectively. Most symptom incidence reduction (by 2/3) occurred within the first month of therapy. Tolerance to 5 and 10 mg/day solifenacine was satisfactory. The most frequent side effect was xerostomia (18.5 and 28.5%, respectively). The results of the study show that solifenacine in doses 5 and 10 mg/day is effective and safe drug for therapy of patients with hyperactive urinary bladder.

We studied efficacy of repeated courses of prostatilen in suppositories with dimexide in prostatic adenoma patients with normal micturition. Rectal suppositories contain 30 mg prostatilen and 90 mg dimexide. The course consisted of 15 suppositories. The treatment reduced clinical symptoms of infravesical obstruction, residual urine volume in administration of prostatilen in 15-day courses each 3 months. This suggests possibility of suppository prostatilen use not only as an alternative for expensive drugs but also in combination with them in treatment of initial prostatic adenoma.

Forty three patients with unsatisfactory outcomes of surgical treatment of benign prostatic hyperplasia (BPH) were examined urodynamically. Thirty five patients complained of daily and nocturnal pollakiuria, incomplete evacuation of urine from the bladder, imperative voiding. Eight patients had postoperative enuresis. Seventeen control patients had satisfactory surgical results. The urodynamic findings showed that postoperative dysuria was caused by detrusor pathology: detrusor hyperactivity (n = 27, 62.8%), contractile hypoactivity (n = 4, 9.3%), infravesical obstruction (n = 4, 9.3%). Diuresis patients had low maximal cystometric capacity of the urinary bladder, detrusor hyperactivity was diagnosed in 5 (62.6%) patients. Enuresis patients had also very low indices of urethral profilometry characterizing function of the sphincter. The urodynamic examination detected true stress urine incontinence in 3 enuresis patients due to sphincter impairment. Five patients had enuresis of mixed nature. Thus, urodynamic examination of patients with unsatisfactory results of surgery determined cause of dysuria. Accurate diagnosis of characteristics and causes of lower urinary tracts dysfunction decides choice of adequate therapeutic policy.

To improve reliability of the diagnosis of infravesical obstruction (IVO) in patients with benign prostatic hyperplasia (BPH), we examined 80 BPH patients (mean age 58.2 +/- 2.1 years). The examination included evaluation of complaints by IPSS, ultrasound investigation with determination of prostatic size and residual urine, and urodynamic tests: uroflowmetry, miction cystometry. We came to the conclusion that symptoms of BPH, size of the gland, amount of residual urine and maximal volumetric miction velocity not always evidence for IVO. To raise reliability of IVO diagnosis we propose the following formula: D1 = 0.818 x S(max) +0.0006 x S(min) +0.215 x Q(max) - 0.478 x Q(aver), where D1 is a discriminant function; S(max) is a maximal linear size of the prostate; S(min) is a minimal linear size of the prostate; Q(max) is maximal volumetric flow rate; Q(aver) is mean volumetric flow rate. If D1 > or = 2.85, IVO is definite. If D1 < or = 2.85, IVO absence is more probable. Thus, the proposed formula provides more reliable diagnosis of IVO in BPH patients than assessment of clinical indices.

We studied efficacy of a new cytomedine drug--vitaprost--in 98 patients with chronic abacterial prostatitis. Vitaprost was found to relieve symptoms of the disease, improved blood flow in the prostate, normalized blood rheology and immunological indices, increased mobility of spermatozoa in ejaculate.

The authors review the experience with prostatilen treatment gained in the urological clinic of the St-Petersburg State Medical University and analyze treatment outcomes for 96 patients with benign prostatic hyperplasia (BPH) aged from 51 to 89 years. Prostatilen proved its efficacy in relieving manifestations of infravesical obstruction in BPH, therefore, prostatilen administration in the treatment of patients with initial or moderate subjective and objective symptoms is justified. Dimexide suppositoria containing 30 mg of prostatilen are preferable.

A clinical data was studied for 117 males without complaints for copulative disorders admitted to urological clinic electively for benign prostatic hyperplasia (BPH)--44 (37.6%), urolithiasis--25 (21.4%), external genital diseases--17 (14.5%), renal cyst and hydronephrosis--16 (13.7%), renal and vesical tumors--15 (12.8%). Mean age of the patients was 56.2 +/- 16.1 years. The patients filled in IPSS and IIEF questionnaires. Mean score set (+/-SD) for IIEF and IPSS was 35 +/- 23 and 12 +/- 10, respectively. The majority of the patients (n = 61) were not sexually active. Erectile dysfunction (ED) was detected in 23 (19.7%) patients: mild and moderate in 19 (16.2%) and 4 (3.4%), respectively). 24 (73%) patients with normal erectile function, 10 (44%) patients with ED and the majority (n = 37) of sexually inactive men were satisfied with their sexual activity. Those males who needed improvement of sexual life quality had higher (p < 0.05) parameters of erectile function and sexual satisfaction. Age of the patients (R2 = 33.1; p < 0.0001) and IPSS index (p < 0.015) were leading indices in determining condition of the copulative function. IIEF correlated with tumors of the kidney or urinary bladder (p < 0.004) and benign prostatic hyperplasia (p < 0.015). Erectile dysfunction in men with urological diseases was closely related with age and severity of lower urinary tract symptoms. Other sexual disorders may be due both to general causes and urological diseases.

Prostatilen was used in 1115 patients with chronic pyelonephritis and prostatitis. It is shown that prostatilen has a corrective effect on hemocoagulation and immunity disorders, restores microcirculation, suppresses inflammation in the kidney and prostate. Thus, prostatilen is a pathogenetically sound drug for treatment in urogenital inflammation while in chronic prostatitis it can be used as a basic therapy.

Ejaculate and blood serum from 40 patients with chronic prostatitis were studied immunologically, IgG, IgA, sIgA, IgM concentrations in ejaculate may be greatly influenced by multicomponent composition of ejaculate. This means that it is impossible to diagnose chronic prostatitis only by changes of immunoglobulin concentrations in ejaculate. Data on IgA, sIgA concentrations plus on leukocyte count in ejaculate give more information for precise diagnosis of chronic prostatitis.

A long-term proskar (finasterid, MSD) treatment was given to 428 patients with benign prostatic hyperplasia (BPH). The response was achieved in 93.8-95.8% patients. The duration of the course should be at least 12 months. Side effects were rare: libido, erection, ejaculate volume diminished in 5.1, 5.6 and 4.2% patients, respectively. 20 patients were operated on after proskar therapy. Such pretreatment reduced glandular prostatic tissue.

Measurements were made of interleukine-8 (IL-8) levels in ejaculate, prostatic secretion, blood serum of 60 patients with latent chronic prostatitis (CP). These levels were higher in CP patients than in healthy subjects. A rise in concentrations of IL-8 in prostatic secretion and ejaculate correlates with other inflammation markers. This may indicate the degree of CP activity. No relationship between IL-8 levels in ejaculate and prostatic secretion, and large dispersion of this marker allow using this criterion for diagnosis in combination with other indices of local immunity.

Products of cell receptor (R-proteins) catabolic lysis were measured in ejaculate of 121 patients with chronic prostatitis and 15 healthy males. R-protein levels were higher in the patients (U = 172.5; p = 0.047). When immunological indices of the ejaculate (IgA, sIgA, IgG, IgM, interleukin-8) were measured, it was found that in patients with chronic prostatitis there is a positive correlation between concentration of interleukin-8 and content of R-proteins (r = 0.43; p = 0.028). Positive correlation also exists between R-protein content and prostate volume (r = 0.24; p = 0.034) while negative one--between R-proteins concentration and size of the hypoechogenic sites in the prostate (r = -0.25; p = 0.039), between R-proteins in the ejaculate and serum level of fibrinogen B (r = -0.25; p = 0.021). It is inferred that elevation of ejaculate R-protein level occurs in alteration of the prostate. The test for R-proteins in ejaculate can be helpful in detection of early stages of chronic prostatitis.

Application of 5-aminolauvulin acid (ALA) fluorescence allows to detect not only exophytic tumors of the bladder but also flat, small tumors-satellites and preneoplastic changes of the bladder. 175 biopsies were performed in 53 patients with suspected superficial tumor of the bladder. 3 hours before surgery all the patients were intravesically instilled 50 ml 3% ALA solution. Cystoscopy employed white and blue light. Visual registration of exophytic masses and red fluorescence of the suspected sites was registered and consequently compared to the histological findings. 96 of 100 sites with malignancy/dysplasia showed red fluorescence. In 13% patients cancer and mucosal dysplasia were detected only under the blue light and were missed by standard cystoscopy. Residual red fluorescence of the resection margins was observed in 41% patients after TUR. Sensitivity of ALA-fluorescent detection reached 96%, specificity 52%. ALA-induced fluorescent diagnosis is more effective than standard cystoscopy. It is most effective in diagnosis of dysplasias, carcinoma in situ, flat, small, multiple superficial tumors of the bladder during primary TUR.

Combined treatment including alpha-1a-adrenoreceptor blocker tamsulosine was given to 92 patients with chronic prostatitis having marked urination disorders (IPSS score 12.1 +/- 2.4). The response was achieved in 98.9% of cases. There was attenuation of the urination symptoms, speeding up of the maximal urine flow, decreased amount of the residual urine. It is recommended to add alpha-1-adrenoreceptors to combined treatment of chronic prostatitis patients with urination disorders.