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An open, prospective, comparative, randomized, placebo-controlled study on the evaluation of the efficacy and safety of combined drug prolit super in patients with chronic abacterial prostatitis without signs of inflammation (NIH 3B category), complicated by sexual dysfunction, was performed. The study included 57 men aged 28 to 50 years. Patients in group 1 (n=29) have received daily 4 capsules of prolit super for 2 months, patients in group 2 (n=28) - placebo for the same period. Excellent results were noted in 58.6% of patients in Group 1 and in 17.9% - in group 2; good results - in 20.7 and 21.4%, satisfactory results - in 20.7 and 17.9%, respectively. Weak effect and its absence were registered only in patients in group 2 - 28.6 and 14.3% of cases, respectively. Significant adverse events or complications against the background of therapy were not observed. The results of the study allows to recommend the appointment of prolit super.in routine clinical practice for patients with chronic abacterial prostatitis without signs of inflammation, complicated by sexual dysfunction.

A comparative analysis of cystoscopic and pathologic patterns in 190 patients hospitalized for differential diagnosis or treatment of genitourinary tuberculosis in 2008-2011 was performed. All patients underwent polyfocal biopsy followed by pathologic examination of biopsy specimens. Furthermore, a comparison of results ofpathomorphological studies of tissue obtained by biopsy and after cystectomy was conducted. Cystoscopy in all patients with tuberculosis of the bladder (TB) revealed the reduced bladder capacity in contrast to patients with other urological diseases. Deformation of orifices, trabecularity and contact bleeding were observed in 66.7 to 94.4% of cases in patients with TB, which were significantly more common than in other diseases. Polymorphism of pathological pattern and the lack of specific changes in the majority of patients with TB were noted; multinucleated Pirogov-Langhans cells were found only in 11.8% of cases, and only in biopsies, whereas in the tissues obtained after cystectomy in same patients, lymphocytic infiltration and fibrosis were observed. The algorithm of diagnosis of tuberculosis of the bladder is suggested.

Reconstructive surgery for contracted bladder (bladder tuberculosis stage 4) was performed in 21 patients: women underwent cystectomy, and men underwent cystectomy and cystprostatectomy. The artificial bladder was formed using segment of the ileum by the Studer method with the implementation of ureteral-intestinal anastomosis by Nesbit or Wallace methods. Criteria for determining the bladder tuberculosis 4 stage, requiring the implementation of reconstructive surgery were as follows: bladder capacity of 100 ml or less (including general anesthesia); bladder volume--150 ml or less in the presence of vesicoureteral reflux. A good results were obtained in 17 (80.9%) patients. Results of 3 (14.2%) patients were regarded as satisfactory; one patient developed a stricture of ureterovaginal-reservoir anastomosis, which required re-anastomosis; 1 patient formed a stricture of membranous urethra, which recurred after optical urethrotomy and required the implementation of anastomotic urethroplasty; and 1 patient had difficulty urinating, requiring intermittent catheterization. Poor result was recorded in 1 (4.7%) patient who was diagnosed with chronic renal failure progression, despite the lack of evidence of retention of the urinary tract and vesicoureteral reflux in the presence of spontaneous urination, and satisfactory bladder capacity. This fact was attributable to the antiretroviral therapy for HIV infection.

The evaluation of potential anti-TB activity and bactericidal activity against opportunistic enterobacteria in urine of healthy people using the automated BACTEC MGIT 960 system for cultivation and determination of drug resistance of mycobacteria and culture on solid media was performed. It has been established that the urine of healthy people do not have bactericidal activity against M. tuberculosis and E. coli in vitro. The one of the possible reasons for the low detection of the pathogen in urogenital tuberculosis--asymptomatic bacteriuria--was identified.

Prevention of recurrence of urinary tract infections by Uro-Vaxom is recommended by domestic and international guidelines; up to date, however, there is no reasonable standard regimen for the use of drug, and long-term results of immunoprophylaxis were not evaluated. The study included 48 patients who received a first course of Uro-Vaxom 5 years ago (2007-2008), including 19 men with chronic bacterial prostatitis/urethroprostatitis and 29 women with recurrent cystitis. Over 5 years, 125 recurrences of urogenital infection were observed; Uro-Vaxom along with antibiotics or uroseptics in combination with phytopreparations was used in 88 (70.4%) cases, and in the remaining 37 (29.6%) cases monotherapy with Uro-Vaxom was used for the relief of inflammatory processes. During the follow-up period, 254 1-month courses of treatment with Uro-Vaxom were conducted; 125 (49.2%) courses were assigned for the treatment of recurrent urogenital infection, and 129 (50.8%)--for the prevention without exacerbation of underlying disease. The main indications for use were intercurrent infection, mainly respiratory--86 (66.7%) cases, stress--14 (10.8%); in 29 (22.5%) cases, the patients have received Uro-Vaxom focusing on their feelings without a doctor's prescription.

Results of use of UroBeam laser diode in 72 patients with benign prostatic hyperplasia (BPH) were analyzed. Average prostate volume was 67.29 +/- 26.72 cm3, the duration of vaporization--69.2 +/- 23.7 min. Blood loss was minimal. In the period from 2 weeks to 4 months after surgery, 9 patients have developed acute urinary retention. In the early postoperative period, acute prostatitis was diagnosed in 7 patients and was jugulated using drug treatment. The laser vaporization of BPH led to a three-fold reduction in the severity of urinary disorders and increase the urinary flow rate. The combination of laser vaporization of the prostate with transurethral resection of the prostate allow to improve the recovery of urination after surgery.

In order to analyze the structure of urogenital tuberculosis, retrospective analysis of medical records of 131 patients with newly diagnosed urogenital tuberculosis observed in the Novosibirsk Regional TB Dispensary from 2009 to 2011 was performed. The renal tuberculosis is main form in the structure is urotuberculosis, detected in 75% of patients, and widespread destructive forms of the disease were diagnosed in more than half of cases. Isolated nephrotuberculosis was more often diagnosed in women--56.8%. 15.9% of patients had asymptomatic nephrotuberculosis; one-third of patients complained of pain in the lumbar region and frequent painful urination (35.2 and 39.8%, respectively); symptoms of intoxication were present in 17% of patients, renal colic--in 9.1%, and gross hematuria--in 7.9% of patients. Mycobacteriuria in isolated nephrotuberculosis was detected in 31.8% of cases. Acute tuberculous orchiepididymitis developed in 35.7% of patients, hemospermia was observed in 7.1% of patients, dysuria was in 35.7% of patients. The pain in the perineum, frequent painful urination (both by 31.6%), hemospermia (26.3%) were main complaints in prostate tuberculosis. Mycobacteria was detected in 10.5% of cases. It was found that urogenital tuberculosis has no pathognomonic symptoms; the most alarming manifestations include long-term dysuria, hematuria, hemospermia.

In order to investigate the frequency of symptoms of overactive bladder (OAB) in patients with chronic prostatitis and determine the effectiveness of trospium chloride in their treatment, the analysis of case histories of 154 patients referred to a urologist for the exacerbation of chronic prostatitis was performed. 27 (17.5%) patients had a diagnosis of overactive bladder; in 19 patients it was accompanied by chronic prostatitis, and in 8 patients OAB was diagnosed as separate disease. All of them have received trospium chloride 30 mg once daily for a month; patients with prostatitis simultaneously have received standard etiopathogenic therapy for this disease. A month later, a comprehensive treatment led to significant positive effect. Urinary frequency decreased by 56.1%, the functional bladder capacity increased by 82.8%, the number of urgent vesical tenesmus was reduced more than by half.

To compare informative value of three tests (2-, 3- and 4-glass) in diagnosis ofprostatitis we examined 177 patients with chronic prostatitis (CP) who were randomized into 4 groups. Group 1 patients (n = 33) were examined with standard 4-glass test (Mearls and Stamey), patients of subgroup 2a (n = 42) were examined with 2-glass test before finger rectal test (FRT), FRT was made in subgroup 2b (n = 45) before urine collection (2 portions), group 3 (n = 57) was examined by an original technique proposed by the authors. While performing the latter test special focus was given to urination continuity, then the secretion obtained at FRT was studied. Efficacy of each of the tests was assessed by comfort of the procedure for the patient and the doctor, a proportion of false-positive results. The 3-glass test proved most informative and significant. Also, it is sensitive in detection of urogenital tuberculosis. The 4-glass test is not comfortable for both the patient and the doctor. The 2-glass test often produced false-positive results.

Our study prospects of urovaxom in improvement of efficacy and prevention of recurrent urogenital infection. One capsule of oral vaccine uro-vaxom was given daily for a month to 127 patients: 23 males with chronic bacterial prostatitis/urethroprostatitis, 75 females with chronic cystitis, 29 females with urolithiasis complicated with secondary chronic pyelonephritis. Control examination was made each two months for a year. In signs of inflammation the patients received one more course of uro-vaxom for a month. It was followed by control examinations each three month for a year. We observed a 6-12 month "cold" period after one course of uro-vaxom in 86.7% patients. After the second course of immunoprophylaxis recurrent urogenital infection occurred 8 times less often. Thus, immunoprophylaxis of urogenital infection with oral vaccine uro-vaxom is highly effective, is well tolerated and, therefore, must enter the standards of medical care for patients with urogenital infection.

In our trial 43 patients with urogenital infections resistant to standard therapy received the same basic therapy (4 tablets of safocid a day for 5 days) which, on demand, was combined with pathogenetic and symptomatic treatment. The effect was achieved by both subjective and objective parameters: pathogenic microflora was not detected after 10 days in 39 (90.7%) patients; none of the patients discharged protozoa, fungi. Tests for chlamidia were negative in all the carriers in 2 months, for ureaplasma--in 94.1% males and 83.3% females, respectively. A significant response was observed in 38 of 43 (88.4%) patients, improvement was seen in 5 (11.6%) patients. The above results persisted for 2 months of follow-up.

The efficacy of indigal plus containing indol-3-carbinol, epigallocatexin-3-gallat and Serenoa repens extract in combination with sparfloxacin was studied in a trial with participation of 30 patients with chronic infectious prostatitis associated with intracellular agents. Group 1 (n=15) received indigal plus (2 capsules twice a day for 3 months) and sparfloxacin (200 mg twice a day for 1 month). Group 2 including 15 matched controls received sparfloxacin alone according to the same schedule. The examination included questionnaire survey (IPSS, QoL, NIH-CPSI), blood count, urinalysis, PSA test, microscopy, bacteriological study of prostatic secretion, uroflowmetry, transrectal ultrasound investigation of the prostate with residual urine assay, laser doppleroflowmetry. The examinations were performed on the treatment day 30, 60 and 90. After the antibacterial treatment chlamidia, ureaplasma and E.coli were detected in 13.3, 6.7 and 26.7% patients of the control group, in 6.7, 6.7 and 6.7% patients of the study group, respectively. Thus, the addition of a pathogenetic drug indigal plus to sparfloxacin treatment promoted normalization of apoptosis of the infected cells, led to more effective bacterial eradication, enhanced regression of the symptoms. It is recommended to include indigal plus in a basic scheme of treatment of patients with chronic infectious prostatitis.

Forty female patients with urethrocystitis received sparfloxacin in a daily dose 400 mg for 20 days in combination with canefron H (50 drops three times a day for 8 weeks). Twenty patients received one more course of canefron H 4 months after etiopathogenetic therapy. The analysis of the treatment results allows the conclusion that sparfloxacin is highly effective in urethrocystitis associated with intracellular infections. Sparfloxacin provides complete urine sterility. 97.5% females after the combined treatment had no recurrences for a year while before the treatment remission lasted for 4.1 +/- 1.7 months. A preventive administration of canefron H improves microcirculation in the bladder wall and prevents recurrence in patients with urethrocystitis associated with intracellular infections given basic sparfloxacin therapy.

Ejaculatory disorders are one of the most frequent sexual dysfunction. To study this problem in different climatic regions, we made a population-based trial with participation of 543 Russian men (149 from the south of Russia, 394 from Siberia). Correlation of ejaculatory disorders with IELT duration, a testosterone level, comorbid chronic prostatitis was estimated. We found that 59.2% of young men had normal ejaculation but only 20% of men over 50 years of age. In the latter group of patients delayed ejaculation predominated. 43.6% of the southerners and 33.5% of the Siberians had premature ejaculation, and 6.1 and 16.9%--delayed ejaculation, respectively; 26.7 and 31.2% were hypogonadal, respectively. Ejaculation was normal in 74.6% men with a normal testosterone level. Hypogonadal patients had premature ejaculation in 48.2% cases, delayed ejaculation in 28.3%. Of the total 543 men, 67.2% had chronic prostatitis. Only 46% of patients with chronic prostatitis had normal ejaculation, 43.3% had premature ejaculation and 10.7% had delayed ejaculation. Thus, in cold climate delayed ejaculation occurs more often, in the South premature ejaculation predominates. A low testosterone level as well as chronic prostatitis resulted in ejaculatory disorders. There are significant differences in ejaculation between young and old men, whose living in the South and Siberia, eugonadal and hypogonadal. Therefore, when characterizing a copulative act as "normal" it is necessary to take into account age, comorbidity, region of living and other factors.

The statistical reports by 21 subjects of the Russian Federation (the Siberian and Far-Eastern Federal Districts) have been analyzed to define the rates of extrathoracic tuberculosis morbidity in these regions and its structure. It has been established that new trends have been recently evident in the pattern of extrathoraric tuberculosis. Firstly, there has been an increase in the incidence of bone and joint tuberculosis, young men and old women being predominant in its structure. Secondly, the steep rise in the incidence of genital tuberculosis, caused by the appearance of an experienced phthisiological gynecologist in one of the regions emphasizes that the fact that there is a large proportion of undetected extrathoracic tuberculosis cases is pressing. There is concern for the high percentage of children with extrapulmonary tuberculosis--this fact reflects the tense epidemic situation in the areas.

The epidemiological situation associated with extrapulmonary tuberculosis was analyzed in the area supervised by the Novosibirsk Research Institute of Tuberculosis (the Siberian and Far Eastern Regions). It was ascertained that despite the fact that the bedspace was sufficient, there was inadequate hospital equipment and low detection rates--this is all with the poor awareness of the problem amongst specialists and the population.

Tuberculosis of the urinary bladder (UB) is registered in 10-45.6% patients with urogenital tuberculosis. It is a severe incapacitating complication of kidney tuberculosis which significantly lowers quality of life. The results of the standard therapy of 76 patients with tuberculous cystitis are analysed. UB tuberculosis is diagnosed more often in women, outcomes of their treatment are worse. Twenty six patients with UB tuberculosis at the stage of overactive bladder received polychemotherapy and adjuvant trospium. After 3 months urination frequency decreased 4.3 times, on the average; UB volume increased 4.7 times, on the average. Complications were not registered.

The paper details the procedure of a modified tuberculin challenge test, by keeping in mind the new parameters--the microcirculation of the urinary tract mucosa, which is recorded by Doppler laser flowmetry. The efficiency of the procedure was evaluated in 55 patients, including 25 patients diagnosed as having urinary tract tuberculosis and 30 with nonspecific infections. The urethral microcirculatory parameters studied during the tuberculin challenge confirmed the changes available in all the patients with urinary tract tuberculosis while they were absent in patients with nonspecific pathology. The proposed procedure may objectively record a diagnostic parameter. which improves the quality of diagnosis.

The incidence and pattern of extrathoracic tuberculosis in the Siberian and Far Eastern areas are analyzed. The statements are illustrated by two clinical cases.

Clinical picture and structure of male genital tuberculosis were analyzed basing on case histories of Novosibirsk regional tuberculous hospital (outpatient department): 42 patients with tuberculous epidydymitis and 58 patients with prostatic tuberculosis. Efficiency of combined etiopathogenetic treatment was estimated in 91 patients admitted to the Urogenital clinic of Novosibirsk Research Institute of Tuberculosis. These patients received polychemotherapy alone (control group) or in combination with laser therapy (study group). Combination of polychemotherapy with laser radiation proved more effective than polychemotherapy alone.

Nine hundred and seventy-three cases of extrapulmonary tuberculosis were analyzed by using the statistical reports from 14 West Siberian areas supervised by the Novosibirsk Research Institute of Tuberculosis, Ministry of Health of the Russian Federation. In 1999, extrapulmonary tuberculosis mortality again increased in Siberia, amounting to 4.4 cases per 100,000. Its incidence was 29.95 per 100,000. In the mortality structure, urogenital tuberculosis held the lead, peripheral lymph nodal tuberculosis and osteoarticular tuberculosis occupied the second and third places, respectively. Cases of advanced and complicated tuberculosis continue to be encountered; one of them is given as an illustration.

The case histories of 299 patients examined at the Urogenital Department, Novosibirsk Research Institute of Tuberculosis, were analyzed to define the etiology of urogenital diseases. The diagnosis of urogenital tuberculosis was established in 112 (37.4%) patients; that of chronic nonspecific pyclonephritis was in 90 (30.1%) patients; chronic nonspecific prostatitis was detected in 49 (16.4%) males; urolithiasis was found in 20 (6.7%) patients. Twelve (4%) and 60 (20.1%) patients were diagnosed as having urinary system cancer and hematuria, respectively. Hematuria most frequently (75%) was indicative of the presence of a tumor. However, in renal tuberculosis, this sign was also revealed in 24.1% of the patients. It should be noted that there is a recent tendency for an increase in the incidence of diseases concurrent with hematuria: the kidney has been found to be concomitantly afflicted with tuberculosis and cancer in 2 patients; tuberculosis is concurrent with nephrolithiasis in 2 other patients.

A prospective study of 150 patients with verified nephrotuberculosis has demonstrated feasibility of essential expansion of the therapeutic limit and of 1/3 reduction in the number of operations due to adjuvant radiation with low-intensity laser beam used in a complex of etiopathogenetic treatment of the urinary system.

To determine the impact of multidrug therapy on male sexual function, isoniazid was tested for their effects on spermatogenesis and the liver in an experiment on laboratory animals, then on spermatogenesis and spermatozoidal function by using the clinical data. There is evidence for that isoniazid given to mice produces no toxic effect on spermatogenesis. The drug in a dose of 0.5% fails to affect the mobility of spermatozoa in vitro. Combined antituberculous therapy does not cause any significant changes in the basic indices of a spermatogram in patients with different forms of tuberculosis. Intermittent combined antituberculous therapy does not result in the derangement of major constituents of a copulative act.

62 patients received polychemotherapy for tuberculosis of the kidney (control group) and 88 patients with the same diagnosis received the same polychemotherapy plus local laser therapy (study group). Efficiency of the treatment in the control group was 40.4 +/- 6.3%, in the study group--76.5 +/- 4.7%. Thus, the effect in the group with laser radiation was by 36.1% higher than in the controls. Indices of urinalysis, bacterial discharge and intoxication to the end of the hospital stay differed significantly (p < 0.05).

To make a differential diagnosis, 274 patients were followed up. Of them 68 patients were further found to have urinary tuberculosis that was verified by hypodermic tuberculin test, 15 patients underwent tuberculin diagnosis without special preparation, and 20 required type 1 ex juvantibus therapy. Challenge treatment with low-spectrum antituberculous agents in usual doses for 2 months confirmed the diagnosis in 3 patients and excluded it in other 3.

The paper reports the results of the study of low-intensity infrared laser radiation effects on partial kidney functions. The course of the laser radiation resulted in improved blood supply to the kidney in 57.9% of the cases. Stimulation of the secretion and urodynamics was registered in 63.1 and 79% of the cases, respectively. Positive changes were also noted in diuresis, nitrogen-excretory and concentration functions of the kidneys.

The paper presents the social and clinical structure of patients with urogenital tuberculosis through studies of 518 outpatient case histories. It has been ascertained that there is a prevalence of common and complicated forms of nephrotuberculosis, 82.4% of patients undergo surgery. Taking into account the fact that a fifth of patients cannot have long-term inpatient treatment, the incidence of Mycobacteriuria (67.9%), the prevalence of the disease, requiring organ-saving operations, the high degree of patients' disability, methods for intensifying urinary tuberculosis should be developed.

The paper analyzes the incidence of adverse reactions caused by tuberculostatics used in the treatment of renal tuberculosis by follow-ups of 117 patients. Current polychemotherapy for renal tuberculosis has been found to be complicated by drug intolerance in 40.1% of cases. Intermittent intravenous injection of tuberculostatics causes side effects in 36.8% of patients while conventional treatment does in 59.1%. Pyrazinamide, streptomycin, and ethambutol are most toxic to patients with renal tuberculosis. There is a higher likelihood of drug intolerance in females with bilateral nephrotuberculosis complicated by chronic renal failure.

Follow-up outcomes of urogenital tuberculosis with involvement of the bladder are provided for patients of the Novosibirsk regional and city hospitals. The cure was achieved in 42.1% of patients, posttuberculous cystalgia (PTC) developed in 36.8% microcystitis in 21.1% of cases. Age-related hormonal insufficiency contributes to the onset of PTC. An original technique of laser thermopuncture is detailed.

Etiotropic therapy in urinary tuberculosis fails to provide adequate repair. Normalization of renal function requires additional pathogenetic measures, laser treatment, in particular. Experience with laser treatment is now available for respiratory tuberculosis only. Mechanism of action of low-intensity laser radiation in nephrotuberculosis and rationale for its use are described.

The paper summarises the experience gained in the use of immozymase in tuberculous patients to advance the disease diagnosis and treatment. Immozymase proved valuable in obtaining sputum enriched with M. tuberculosis in patients who were previously considered noncarriers. M. tuberculosis became detectable in 28.3% of them. Immozymase instillations of the urethra before its massage for stimulation of prostatic secretion led to getting secretion in all the patients (0.35 ml, on the average). Immuzymase inhalations were used in the treatment of purulent bronchitis in patients with destructive pulmonary tuberculosis in conservative and preoperative regimens. Postoperative immozymase inhalations promoted prevention of pleuropulmonary complications. Open treatment of the caverns with immozymase after cavernotomy shortens the treatment duration. Positive results were also reached in the treatment of pleural empyema.

The operative parameters of a new unit for laser thermopuncture manufactured in Russia (Novosibirsk, Ecran) are compared to other equipment characteristics. Preheating of the zone to be exposed to laser increases sensibility to infra-red laser radiation. Laser thermopuncture techniques in cystalgia, algodysmenorrhea, enuresis are provided.

Basic epidemiologic parameters in relation to extrapulmonary tuberculosis were analysed in 6 regions of West Siberia as well as the state of the material-technical base of extrapulmonary service in these areas. Despite a general reduction of the revealed incidence and morbidity of extrapulmonary tuberculosis, the true incidence persists at a high level with predominance of advanced forms of the process. One of the causes of this situation is insufficient material-technical support of extrapulmonary tuberculosis service in West Siberia.

Extrapulmonary tuberculosis morbidity in children of the Novosibirsk region for the period of 10 years was analysed on the basis of the materials presented by the regional antituberculosis center. It was found that 44 children has extrapulmonary tuberculosis which accounted for 17.9% of the total number of sick children and 5.7% of all extrapulmonary tuberculosis patients. Tuberculous lymphadenitis was diagnosed in 50% and bone-and-joint tuberculosis in 27.3% of cases; nephrotuberculosis occupied the third and ocular tuberculosis the fourth place; 20% of sick children were detected after their examination and 80% after surgery for other general diseases. Complications of the main process at the moment of application for help had 18.2% of children. The basic causes of later extrapulmonary tuberculosis diagnosis in children is the absence of awareness for tuberculosis in the general practitioners and inadequate work carried out in tuberculosis infection foci.

The outcomes of using low-energy helium-neon laser radiation in a complex management of 21 patients with complicated forms of nephrotuberculosis are illustrated. LG-75 laser (with 0.63 nm wavelength and 25 mW power) was used in this case. The effects appeared as a larger bladder capacity, cystoscopic picture normalization and an overall cessation of dysuria were observed as a result of 5 to 12 sessions of bladder mucosa radiation.