Health of Man

Diagnosis and Treatment of Overactive Bladder in Young Men

Oleh Nikitin, Hennadii Reznikov — Thu, 22 Dec 2022 00:00:00 +0200

The objective: to analyze the diagnostic capabilities and various methods of treatment of overactive bladder in young patients with lower urinary tract symptoms (LUTS).

Materials and methods. The study involved 40 men who were divided into two groups. The main group included 24 patients with urodynamic diagnosis of overactive bladder (OAB) who were treated for LUTS. The age of patients ranged from 21-37 years old (mean age – 28.5±2.4 years). The control group included 16 men 21-48 years old (mean age – 36.32±2.34 years) without LUTS.

The patients had complex urodynamic testing (UDT) for the diagnosis, the treatment management, and to determine the degree of functional disorders of the urination.

The clinical task of treatment of OAB was to control the involuntary contractions of the bladder to normalize the quality of patient’s life. In 14 (58.3 %) patients of the main group solifenacin at a dose of 10 mg was used, in 10 (41.7 %) men – mirabegron at a dose of 50 mg.

Results. The results of the first line therapy were studied in 1 month and then a decision was made to continue treatment or to change the medical approach. During the evaluation of the effectiveness of therapy, it was determined that the first line therapy was effective in 11 (45.8 %) patients, and in 13 (54.2 %) patients there was effect.

In the absence of the results of medication treatment of OAB in 1 month in 8 out of 13 patients the treatment with the second line drug was prescribed – intradetruce injections of Botox.

During the analysis of complex UDT after 12-18 months of the first injection of Botox, positive dynamics of therapy was estabslihed.

Conclusions. Complex urodynamic testing is a reliable method of diagnosis and control of therapy. It is performed in the presence of overactive bladder (OAB). It is proved that if initially first-line drug therapy in young men is effective, it remained efficacy in longer period. If the first line therapy by botulotoxin injection in young men with OAB is not effective this led to some reduction in the tone of the detrusor. However, clinically this type of therapy has contributed to a significant improvement in the patient’s quality of life and the normalization of urodynamic.

Comparative Evaluation of the Choice of the Method of Percutaneous Nephrolithotripsy in Patients with Nephrolithiasis

Thu, 22 Dec 2022 00:00:00 +0200

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis.

Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay.

Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p<0.001), mCPNL was more often finished with drainageless methods (41.1% vs. 6.8%; p<0.001).

The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p>0.05) and in treatment of coral-like (90.1% vs. 77.3%; p<0.05) and multiple nephrolithiasis (89.5% vs. 70.8%; p=0.03).

The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p<0.001). The infectious complications frequency and length of postoperative stay in the hospital were less in the mPCNL group than in the sPCNL group – 7.3% vs. 13.2% (p=0.03) and 1.9±0.6 days vs. 4.3± 2.4 days, respectively (p<0.001).

Conclusions. Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.

The Problem of Pyelonephritis in Terms of Medical and Social Significance

Thu, 22 Dec 2022 00:00:00 +0200

Chronic pyelonephritis (CP) is known for the frequency of visits, hospitalizations, adverse effects. Over time, significant advances in diagnosis and treatment have made the study of medical and social issues relevant.

The objective: the above determined the purpose of the study: to assess the features of epidemiological changes in chronic pyelonephritis among different segments of the adult population in the regions of Ukraine and to identify the dynamics of key performance indicators of specialized care for such patients.

Materials and methods. The official sources of reporting for 2013 - 2020 in Ukraine as a whole in Ukraine and its administrative territories are analyzed, taking into account different segments of the population. The data are statistically processed according to the classical estimation of variation series and comparison of statistical values.

Results. A typical sign is a decrease in registered and newly diagnosed patients with CP. Dominated by people of working age and urban population. Areas where the corresponding indicators are below average, average and above them have been identified. Against the background of a widespread decrease in hospitalizations (by 21.3% in Ukraine) its duration (by 12.7%), mortality doubled to 3.49%. It was confirmed that CP is the second leading cause of chronic kidney disease stage III and IV (21.2% and 20.8% in 2020), with stage V – third (14.04%), in the regions the percentage reached 50–85% at III, 30–48% – IV and 20–33% – V stages. There was a positive decrease (from 27.5% to 20.0%) in cases of primary disability due to pathology.

Conclusions. The peculiarities of the prevalence, incidence of CP in the regions and oblasts of Ukraine among all segments of the population, the nature of changes in the main indicators of inpatient treatment and the dynamics of the effectiveness of specialized care were displayed.

Areas have been identified that require the attention of health authorities, specialists (nephrologists, urologists) in order to develop effective clinical and organizational measures based on an in-depth study of the causes of the situation.

Hypercrystalluria as a Factor in the Development of Urine Stone Disease, Diagnosis and Directions of Treatment

Thu, 22 Dec 2022 00:00:00 +0200

Under the action of exogenous, androgenic, genetically determined factors, the metabolism of stone-forming salts of calcium, phosphorus, magnesium, oxalates, uric acid in the blood serum and their active excretion by the kidneys to the state of hypersaturation (oversaturation) is disturbed) urine is formed. When the level of crystallization inhibitors is disturbed, a saturated salt solution crystallizes with the formation of microliths. The formation of stones in the kidneys is possible only in the presence of «building material» – supersaturated saturated urine, therefore, hyperoxaluria is a pre-stone condition. Treatment measures should be aimed at correcting mineral metabolism in the body after establishing the type of hyperoxaluria using laboratory tests: salt transport, calcium load, dietary test – low-calcium diet, thiazide test and determination of the mineral composition of the removed (removed) stone.

Genetically consequential conditions (10–15%) count about 30 varieties in which the main sign or symptom in the manifestation of the disease is urolithiasis. Unfortunately, congenital tubulopathies are not sufficiently studied, so the treatment is symptomatic, in some cases simultaneous kidney and liver transplantation options are possible.

Clinically, 4 main forms of hypercrystalluria are distinguished: hypercalciuria, hyperoxaluria, hyperuricuria, phosphaturia and mixed forms of crystalluria. Acquired forms of hypercrystalluria, of which they are absorptive (type II intestinal hyperabsorption – absorptive hypercalciuria and absorptive hyperoxaluria), are of main clinical interest, which is characteristic of the course of calcium-oxalate urolithiasis. Metaphylaxis of calcium-oxalate urolithiasis is formed on the basis of these data.

Erectile Dysfunction in Men Who Have Been Ill with COVID-19

Thu, 22 Dec 2022 00:00:00 +0200

The rapid spread of COVID-19 among the human population and the occurrence of complications of the disease, including sexual function, lead to the relevance of researches among the medical and scientific community.

The results of epidemiological studies indicate that COVID-19 more often affects men than women. Also, among the significant factors for the development of complications are the age and presence of comorbidities, among which diabetes, hypertension and obesity play an important role.

Erectile dysfunction (ED) in men today is considered as a marker of endothelial dysfunction and systemic inflammation caused by the background disease, and the presence of comorbidities.

Modern views on the pathogenesis of the development of ED in men who had COVID-19, and the features of development of sexual function in the presence of comorbidities are presented in the article.

According to modern positions, one of the main mechanisms of penetration of the SARS-CoV-2 virus is its interaction with angiotensin-converting enzyme 2 and transmembrane serine protease 2. Immunohistochemical studies have established a high expression of these enzymes in the endothelial cells of testicular tissue in men, which is currently considered by researchers as a direct damaging factor for the normal functioning of Leydig and Sertoli cells.

Subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics cause the potential development of ED. Also, in the pathogenesis of ED development in men who have been ill with COVID-19, important attention is paid to the role of systemic inflammation caused by the disbalance of proinflammatory and anti-inflammatory cytokines.

The relevant problem of today is the influence of coronavirus on the reproductive function of men. It is known that now male infertility has been diagnosed more often than before. In addition, there are enough reasonable factors to expect the effects of the negative effects of the COVID-19 not only on reproductive health but also on sexual and cardiovascular health of men, both in the short-term and in the long-term perspective.

Comparative Effectiveness of Antibiotic Prophylaxis of Postoperative Complications After Transurethral Resection of the Prostate

Thu, 22 Dec 2022 00:00:00 +0200

Benign prostatic hyperplasia (BPH) is one of the most common benign diseases in men, as it leads to an enlarged prostate, the development of lower urinary tract symptoms, and worsens the quality of patient’s life. Surgical treatment is indicated to patients after non-effective drug treatment. Most often, transurethral resection of the prostate (TURP) is used.

The objective: to improve the results of TURP in patients with BPH and acute urinary retention by optimizing antibacterial prophylaxis of postoperative complications in the early postoperative period.

Materials and methods. An analysis of the surgical treatment of 179 patients with BPH with acute urinary retention after TURP was performed. The age of the patients varied from 51 to 84 years old, the average age was 64.9±5.1 years. All patients had a complex urological examination in the preoperative period. The patients were divided into two groups: I group – 85 patients after operation who were prescribed ceftriaxone in the early postoperative period; II group – 94 patients who received levofloxacin in the early postoperative period.

Results. It was determined that complications occurred in 43 (24.1%) patients in the early postoperative period. Long-term macrohematuria was found in 23 (12.9%) patients, exacerbation of chronic pyelonephritis was in 13 (7.3%) patients after operation, acute urethritis developed in 7 (3.9%) patients, acute orchiepididymitis – in 9 (5, 0%) patients.

It has been proven that the total frequency of complications in patients with BPH who received levofloxacin in the early postoperative period was statistically significantly lower than in the patients who were prescribed ceftriaxone.

Conclusions. The use of levofloxacin for the prevention of early postoperative complications after TURP in patients with BPH complicated by acute urinary retention improves the results of surgical treatment by reducing the frequency of postoperative complications by 60%.

Ultrastructural Changes in Smooth Muscle Cells of the Urinary Bladder Due to Benign Prostatic Hyperplasia

Thu, 22 Dec 2022 00:00:00 +0200

The objective: to evaluate the ultrastructural changes of smooth muscle cells (SMCs) of the urinary bladder (UB) in benign prostatic hyperplasia (BPH).

Materials and methods. 70 patients with BPH were selected by the random sampling (average age – 67.94±7.42 years old). The patients were divided into three groups according to clinical manifestations. The first group included 20 patients with accumulation symptoms: disease duration – 4±1.8 years, I-PSS – 16±4.5 points, Q_max – 15.8±2.4 ml/s, Q_ave – 12.8±2.8 ml/s, absence of residual urine (RU). The second group included 20 patients with incomplete emptying of UB: disease duration – 5.8±3.5 years, I-PSS – 26±3.9 points, Qmax – 10.8±2.5 ml/s, Q_ave – 4.4±1.4 ml/s, volume of RU – 150.1±80.8 ml. The third group included 30 patients with cystostomy: disease duration – 10.6±3.3 years, before cystostomy: I-PSS – 33.1±1.88 points, volume of RU – 1093.3±458.8 ml.

The study of the ultrastructure of UB myocytes was carried out by standard methods of electron microscopy.

Results. There were the ultrastructural changes of the SMCs in patients with BPH in the first group in the compensation stage UB, the hypertrophied smooth muscle cells with little changed ultrastructure were determined.

In patients with BPH of the second group in the subcompensation stage of UB, hypertrophied SMCs with slightly changed ultrastructure and SMCs with more changed ultrastructure were found, and single dystrophic SMCs were also established, the mitochondria of which were distinguished by focal or total matrix lysis, destruction of cristae, and discomplexation of organelles. Single necrobiotically altered SMCs were found, which are probably subject to elimination. There were cells the ultrastructure of which corresponds to the newly formed SMCs, which indicates the preservation of regenerative potential.

The ultrastructural changes of SMCs were revealed in BPH patients of the third group in the stage of CM decompensation: multiple dystrophically changed “dark” and necrobiotically changed “light” SMCs, which are likely to be eliminated.

Conclusions. Due to the untimely elimination of the obstruction there is a persistent disorder of the evacuator function of the urinary bladder and, as a result, incomplete emptying, violation of the urodynamics of the upper urinary tract, persistence of urinary infection, and in advanced cases – the development of chronic kidney failure.

The formation of clinical symptoms occurs due to the complex process of pathomorphological changes in CM. At the stage of UB compensation with BPH, the SMCs are hypertrophied with little changed ultrastructure, which ensures the contractile capacity of the detrusor. At the stage of subcompensation of CM the hypertrophied SMCs with little changed ultrastructure still predominate, but dystrophically changed “dark” and necrobiotic “light” cells appear. At the stage of CM decompensation, the specific weight of dystrophically changed “dark” SMCs and necrobiotic “light” SMCs increases significantly. At the same time, the absence of “young” SMCs indicates the exhaustion of the regenerative potential and the irreversibility of the ultrastructural changes of the UB.

Reflux-related Complications in Patients with Chronic Calculous Prostatitis and Benign Prostate Hyperplasia After Surgical Removal of Prostatic Hyperplasia and Stones

Mykhailo Ukhal, Oleh Semaniv, Ivan Pustovoit, Heorhii Samunzhi — Thu, 22 Dec 2022 00:00:00 +0200

The objective: to analyze the effectiveness of prevention of reflux-related complications in patients with chronic calculous prostatitis and prostatic hyperplasia after surgical removal of prostatic hyperplasia and stones.

Materials and methods. The study included patients 56–70 years old with prostatic hyperplasia and stones. They were divided into two groups. The first group included 28 patients who underwent a retrospective study of reflux pyelonephritis and epididymitis after surgical removal of hyperplastic tissues and stones of the prostate gland without the use of pathogenetically justified prophylaxis. The second group included 26 patients who underwent a study of reflux pyelonephritis and epididymoorchitis after surgical removal of hyperplastic tissues and stones of the prostate gland with the use of pathogenetic justified drug therapy.

The patients underwent objective, laboratory, bacteriological and biochemical research, ultrasound examination of the prostate gland and bladder. Blood flow in the prostate gland was studied by Doppler.

Results. In 14.2 % of patients in the first group, who received traditional medical treatment in the postoperative period, acute reflux pyelonephritis developed, in 17.8 % – epididymitis. Patients of the second group were prescribed one of the alpha1-adrenoceptor blockers and suppositories with a non-steroidal drug in the postoperative period together with traditional medical therapy. In patients of the second group, acute reflux pyelonephritis was not determined after surgical treatment, and epididymitis developed in 1 (3.3 %) of 26 persons.

Conclusions. It has been determined that the prescription of alpha1-adrenoceptor blocker is an effective method of preventing of reflux-related pyelonephritis and epididymitis development in the patients in the early postoperative period after surgical removal of hyperplastic tissues and stones of the prostate gland in order to eliminate spastic obstruction, as well as prescription of non-steroidal drug to reduce the inflammatory process and edema in the prostate and bladder neck.

Male Hypogonadism (According to the Materials of the European Association of Urology)

Ihor Gorpynchenko, Yurii Gurzhenko, Volodymyr Spyrydonenko — Thu, 22 Dec 2022 00:00:00 +0200

Male hypogonadism is a clinical syndrome which is the result of insufficient production of the sex hormone testosterone by the testicles and the number of spermatozoa.

The article reveals modern views on the physiology and pathophysiology of testosteroneogenesis in the male organism, provides information on the etiology, pathogenesis, classification, diagnosis and modern treatment of hypogonadism in men. Literature on the results of global and European researches in recent years, as well as materials of the Guideline of the European Association of Urology for 2022, were used in the article.

An individual therapeutic approach to each patient with hypogonadism was demonstrated. The importance of diagnosis of chronic and systemic comorbid diseases that cause the risk of hypogonadism, the need to determine the body mass index and the measurement of waist circumference, the size of the testicles, the penis and the presence of secondary sexual characteristic was established.

The article includes necessary biochemical and instrumental studies for the diagnosis of hypogonadism.

Specific contraindications for hormone replacement therapy are identified. Absolute contraindications for testosterone therapy are indicated: topically widespread or metastatic prostate cancer (PC), breast cancer of men; men who desire to have children; hematocrit level >54%; uncontrolled or poorly controlled stagnant heart failure. Relative contraindications include IPSS>19, initial hematocrit of 48-50 %, venous thromboembolism in a family history.

The article also provides recommendations for testosterone therapy. It has been proven that testosterone therapy improves mild forms of erectile dysfunction (ED) and libido in men with hypogonade states; improves the frequency of sexual intercourses, orgasm and general pleasure; increases low-fat mass, reduces fat and improves insulin resistance; normalizes body weight, waist circumference and lipid profile; relieves the symptoms of depression in men with hypogonadism; improves bone mineral density. It has been demonstrated that the use of testosterone therapy in eugonadal men is not indicated. Testosterone therapy should be used as first-line treatment in patients with symptomatic hypogonadism and moderate ED. In addition, it is necessary to use a combination of type 5 phosphodiesterase inhibitors and testosterone treatment in more severe ED forms. It is also necessary to use standard medical treatments for severe symptoms of depression and osteoporosis.

The therapy of hypogonadism, non-medication and medication, the necessary medicines and the peculiarities of their use are widely described. The article shows that weight loss due to low calorie diet and regular physical activity leads to a slight improvement in testosterone levels, testosterone gels and prolonged injection drugs are testosterone drugs have the best safety profile, and gonadotropin treatment can be used in men with secondary hypogonadism.

It is noted that before the treatment with testosterone, it is necessary to treat organic causes of hypogonadism (for example, pituitary tumors, hyperprolactinemia, etc.), improve lifestyle and reduce body weight in persons with obesity; cancel drugs that can impair testosterone production.

Much attention is paid to the risk factors by the treatment with testosterone. Testosterone therapy is contraindicated for men with secondary hypogonadism who wish fertility, men with active PC or breast cancer.

Restoration of testosterone concentration in serum relieves the symptoms and signs of hypogonadism in men after 3 months of treatment. Therefore, testosterone therapy leads to improvement of the quality of patient’s life.

A New Approach for Medicamentous Treatment of Patients with Lower Urinary Tract Symptoms Caused by Benign Prostate Hyperplasia and Chronic Prostatitis. Is It Possible to Prevent the Prostate Cancer?

Thu, 22 Dec 2022 00:00:00 +0200

Today the lower urinary tract symptoms (LUTS) in men are the actual problem. LUTS is an extremely polyetiological problem, but benign prostate hyperplasia (BPH) is the most often reason for its development.

The problem of chronic prostatitis (CP) in patient of the older age with BPH is of great importance. These patients have the most pronounced symptoms of the lower urinary tract dysfunction. The therapy of patients with BPH and CP must lead to reducing of LUTS and improvement of quality of life, as well as to complications prevention associated with prostate enlargement and intravesical obstruction, such as acute urinary retention, recurrent urinary tract infection.

The modern researches have presented that the combinations of herbal preparation with tamsulosin were more effective than monotherapy with α-adrenoblockers. That is why phytotherapy is considered an alternative option in the treatment of CP as first-line therapy and for the BPH initial stages in the complex treatment with other drugs. In contrast to “traditional” measures with one component, today multicomponent herbal preparations are popular.

A natural complex preparation which contains saw palmetto extract (S. Repens), 3.3’ diindolylmethane, pumpkin seed extract, resveratrol, lycopene for hormonal balance normalization for men with BPH was analyzed.

The advantage of the natural complex hormonal balance normalization for men with BPH is that it can be prescribed for the first LUTS signs that can prevent the symptoms progression and development of complications.

Urologist received the preparation for effective LUTS treatment in patients with BPH and CP, as well for removal of postoperative dysuria.