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Correction of subnormal spermatogenesis caused by chronic prostatitis is made with application of different therapeutic schemes. Our aim was to investigate efficacy of selzink medicine which corrects deficiency of trace elements Se and Zn in ejaculate and thus improves spermatogenesis. One-month course of therapy produced no side effects, had a positive effect on low fertility of ejaculate. Therefore, selzink can be recommended in combined treatment of male infertility.

The trial of efficacy and safety of two doses of the drug cernilton in patients with chronic abacterial prostatitis made in the Research Institute of Urology and I.M. Sechenov Medical Academy in 2008 gave evidence for subjective (NIH-CPSI, Sex-4, IPSS and other scales, QOL) and objective (leucocyte count in prostatic secretion) pronounced anti-inflammatory effects of the drug which persist for at least 6 months. Comparison of the two doses of cernilton showed significant differences in subjective response of the patients (NIH-CPSI and Symptom Frequency Scale). Cernilton is recommended as a medication of choice for treatment of patients with chronic abacterial prostatitis.

Chronic prostatitis (CP) morbidity now makes up 8 to 35% in males aged 20-40 years (N.A. Lopatkin et al., 1998; O.L. Tiktinsky, 1999). In general population CP incidence rate is 5 to 8% (J.C. Nickel, 1999). Phytotherapy is now widely practiced in CP. A multicenter trial conducted by the authors demonstrates high efficacy ofpermixon in the treatment of chronic prostatitis/chronic pelvic pain syndrome. The results of 6-month follow-up are presented.

A double-blind placebo-controlled trial of teraosin efficacy (Kornam, Lek, Slovenia) was made in 51 patients with chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/CPPS) of category IIla according to NIH. All the patients were given a 2-week induction course of placebo followed by teraosin treatment (5 mg/day, n = 29) or placebo (n = 22) for 8 weeks. The participants of the study were followed up for 12 months. Pretreatment differences between the groups by NIH-CPSI system, symptoms frequency scale, leukocyte count of the prostate and uroflowmetry were insignificant. Teraosin and placebo patients showed a noticeable improvement (39.7 and 9.9% by symptoms frequency scale, respectively; by 36.4 and 6.6% by the linear scale, respectively). The drug reduced pain and dysuria, improved quality of life considerably (by 36.2%). Maximal urine flow accelerated by 22.96 and 10.01% in teraosin and placebo groups, respectively. Leukocyte count fell two-fold in the study group and lowered insignificantly in the placebo group. The recurrence-free interval was 25 and 9 weeks, respectively. Thus, teraosin monotherapy improves quality of life in CAP/CPPS patients, significantly relieves symptoms and prolongs recurrence-free interval vs placebo.

Nikolai Alekseevich Lopatkin, Academician of the Russian Academy of Medical Sciences, has contributed much to development of prostatic cancer (PC) diagnosis and treatment in the Russian Federation. N. A. Lopatkin headed specialists from the Research Institute of Urology who were the first in Russia to introduce into clinical practice the method of interstitial radiotherapy (brachitherapy) of local prostatic cancer (PC). A total of 58 PC patients 42 to 76 years of age were treated. They had stages T1bN0M0 (n = 5), T2aN0M0 (n = 36), T2bN0M0 (n = 11), T3aN0M0 (n = 6). Staging was made by the data of finger rectal examination, transrectal ultrasonography, NMR tomography, radionuclide osteoscintigraphy. Mean PSA was 2.5-36 ng/ml in the size of the prostatic gland 14.96-52.76 cm3. All the patients received neoadjuvant hormone therapy. Four patients one year or more before the radiotherapy had TUR of the prostate. Brachytherapy was made under peridural anesthesia which allowed implantation of 40-120 sources with activity of 0.38-0.35 mCi for 20-45 min. A total dose was 120-160 Gy. Mean hospital stay was 4 days. Spontaneous urination recovered within 6 postoperative hours. The procedure was well tolerated, complications arose on postimplantation day 2-8. We attribute complications to inadequate calculation of the doses at the stage of the method introduction. A short follow-up (3 years) is not long enough to allow conclusions about the efficacy of the method. Within 3 years biochemical recurrence occurred in 4 (6.9%) patients on months 14-26 (stage T2b and 2-T3). Four patients were lost for follow-up. Thus, brachytherapy efficacy depended much on adequate selection of the patients and planning of the procedure by the results of previous volumetry. The procedure is safe and reproducible. The studies will be continued.

Chronic prostatitis affects 30-60% males and significantly deteriorates quality of their life. Clinical and experimental investigations have revealed changes in immune status in the onset and development of prostatic inflammation. As some other urologists, we made an attempt to determine the role of cellular immunity and immunoglobulins in the diagnosis of chronic prostatitis. The study was made in 30 patients with chronic abacterial prostatitis (mean age 42.5 years, duration of the disease 1.8 years). In addition to standard examination, all the patients have undergone analysis of the immune status and measurement of proinflammatory cytokines (TNF alpha and IL-12b) in biological media: blood serum, urine, ejaculate, prostatic secretion. The patients had moderate symptoms: IPSS--10.4 scores, life quality index--4.3 scores, on the average. Prostamol-uno was given to all the patients in a standard dose 1 capsule (320 mg) a day for 3 to 6 months. The results were processed statistically. A good effect of prostamoluno was registered in 26 patients, a satisfactory one--in 2. Two patients refused to take prostamol-uno because of lack of a prominent effect. The scores of IPSS lowered from 10.4 to 6.3 (by 39%), life quality improved by 42%. Ultrasound monitoring of the size of the prostate showed no significant changes in the size. Tolerance was good in all 30 patients. Side effects were absent. After 3 months of the treatment serum, urine, ejaculate and prostatic secretion cytokines changed. TNF alpha elevated while IL-1 beta level lowered almost to normal value. In 6 months both IL-1 beta and TNF alpha returned to normal values confirming stabilization of cytokine system and the end of inflammation. Cellular immunity did not change much. Thus, as inflammation in prostatic tissue is characterized by elevation of proinflammatory cytokines, in diagnosis of chronic prostatitis it will be valid to use markers TNF alpha and IL-1 beta as criteria of immune prognosis of prostatic exacerbation. Prostamol-uno does not induce changes in lymphocyte populations and impairment of immune status.

Removal of infravesicular obstruction by transurethral resection (TUR) of the prostate rapidly eradicates obstructive symptoms but irritative symptoms persist. We studied the effect of alpha 1-adrenoblockers (A1AB) in respect of optimization of TUR effects. The trial was performed in 1998-2002 and included 197 patients treated surgically (TUR) for benign prostatic hyperplasia (BPH). 96 patients received no A1AB in the postoperative period (group 1). 52 patients took terazosine (group 2) and 49 patients were given tansulosine (group 3). IPSS symptoms and QoL estimation were registered monthly, the patients recorded the urination. After 3 and 6 months after TUR, maximal urination rate (MUR) and residual urine were assessed. It was found that MUR and QoL did not differ significantly between the groups but in groups 2 and 3 a fall in the overall score by IPSS was greater. The positive symptomatic improvement was achieved due to relief of the symptoms of urinary bladder filling corresponding to an increase in physiological capacity of the organ, the difference being significant (p < 0.05).

Aim: To evaluate effectiveness of alpha 1-adrenoblockers (a1-AB) in patients with chronic non-infectious prostatitis (CP)., Material and Methods: a1-AB effectiveness was studied in 28 volunteers with non-infectious CP (type IIIA). All the patients received terazosin (kornam, Slovenia) in a dose 5 mg/day after dose titration for 2-3 weeks (the initial dose was 1 mg/day). The assessment of the efficiency was standard with the use of frequency and severity of symptoms scales as well as questionnaire NIH CPSI., Results: Symptomatic improvement was achieved in 27 patients (96%). Dysuria and intensity of pain diminished in 24 (82%) and 26 (93%) patients. Voiding disorders proved most sensitive to a1-AB. Quality of life rose 2-fold. Probability of the recurrence 1 month after terazosin therapy was 0.29, after 6 months--0.43. Recurrent dysuria occurred in 33%, pain--in 58%., Conclusion: Terazosin monotherapy in patients with non-infectious CP results in reduction of the symptoms severity and pollakiuria frequency, frequency of recurrences and in improvement of quality of life. a1-AB in CP do not prevent recurrence in half the cases but the symptoms severity in recurrent disease is much weaker.

The authors employed transurethral radiofrequency thermodestruction (TRT) in 27 BPH patients with infravesical obstruction and grave somatic status excluding radical surgery. 17 of them had cystostomic drainage. A single procedure was not long and ran without general anesthesia. In patients able to urinate objective and subjective improvement was recorded, in those with cystostomic drainage suprapubic fistula was eliminated in 10 patients. In some cases TRT produced the results comparable to transurethral resection of the prostate. TRT complications comprise mainly infection and inflammation (11.1%). By efficacy and safety TRT occupies an intermediate position between thermotherapy and prostatic transurethral resection. This method is alternative in BPH patients with cystostoma and severe associated diseases.