Hypersexual Behavior Due to Premature Psychosexual Development: Clinical Examples

The article contains 3 clinical examples, which demonstrate possible appearance of hypersexuality, caused by premature psychosexual development. The first case (observed by the author) deals with a 13-year-old teenager, who was adopted at the age of 9. His birth mother (BM), who was deprived of parental rights, abused alcoholic beverages. BM had sexual intercourses with men, while her son was with her in the same bed. Besides approximately from the age of 6–7 years she sucked his penis. Soon after his adoption the boy climbed up on his lying adoptive mother (AM), with whom he lived together in one flat, and began pressing his lips to hers (“he lied like a male on a female”). Once, when they were visited by AM relatives and it was necessary to distribute, who would sleep with whom, a decision was made that the adopted son (AS) would sleep with a 7-year-old adopted grandson (AG) of AM. Then AS was 12 and he, as it was found out later, made an attempt to insert his erected penis into the anus of AG, but the latter managed to writhe himself free. At the same age of 12 he attempted a sexual intercourse with a native granddaughter of AM (a little girl), who told her grandmother about it. Then they found a significant amount of blood on her panties and genitals, and decided that he deflowered her. But as a result of forensic examination it was revealed that the blood on the granddaughter’s panties and genitals was not hers, but belonged to AS, whose attempt to insert his penis into her vagina resulted in a rupture of his penile frenulum, that made him stop any further sexual actions. AM informed that AS constantly peeped at her when she was naked or scantly dressed. He did the same with her granddaughter, after what she refused to visit them. Now, in order not “to be in the cross hairs”, AM takes a bath only after he leaves for school. As a result of his talk with AM and examination of AS the author has concluded that the patient has sexual disinhibition associated with his premature psychosexual development, the latter being caused by sexually molesting behaviour on the part of the child’s BM. The second and third cases (observations by other authors) also deal with hypersexual behaviour, caused by premature psychosexual development.

Stage Reconstructive and Restorative Surgical Treatment of Gunshot Wounds of the Groin, Scrotum and Penis (Case Report)

The frequency of external genital lesions in armed conflicts can reach up to 5%. The complexity of gunshot wounds is the presence of significant soft tissue defects, widespread necrosis around the wound, the possibility of progression in the hours and days after injury, the high probability of infection, and the presence of foreign bodies. The tactics of gunshot wounds are determined by the location, nature and extent of damage to soft tissues, organs, large vessels, nerves, bones and includes several stages. At the initial stage, bleeding is stopped, hematomas and foreign bodies are evacuated, non-viable tissues are removed, drainages are installed and skin defects are closed. The stage of reconstructive surgery can be started when the active wound process is over. In this report, we present a clinical case of a 22-year-old man who received a gunshot wound to the right groin, upper third of the right thigh, perineum and external genitalia in a combat zone of Operation Allied Forces, Ukraine. Bullet wound led to: damage to the skin and subcutaneous tissue in the right buttock, right groin, on the inner surface of the upper third of the thigh, penis (skin defect up to 1/3 of the circumference), scrotum, partial destruction of corpora cavernosa, m. iliopsoas and adductor muscles of the thigh, sphincter of the rectum, crushing of the right testicle. The wound was contaminated with earth and foreign bodies At the initial stage, the patient underwent: primary surgical treatment of a gunshot wound, suturing of cavernous bodies with sutures, fixation of the penis in the groin, removal of the right testicle, tamponade of the wound, sigmostomy (due to sphincter damage). Subsequently, the patient underwent regular surgical treatment of wounds, a vacuum suction system VAC was installed. After 7 months (upon completion of the healing process) suturing of the sigmostoma was performed. After 2 months, the penis and the scrotum were reconstructed. Preoperative examination (ultrasound of the penis with assessment of cavernous hemodynamics, MRI) revealed: post-traumatic scarring of the soft tissues of the right groin, inner surface of the right thigh, buttocks, right inguinal canal of the penis and scrotum, deformation of the cavernous cavity, normal indicators of cavernous blood circulation. In the early postoperative period (2 months after the intervention), the patient indicated satisfaction with the cosmetic and functional results, the preservation of morning erections, moderate discomfort in the penis during erection. Prosthetics of the right testicle are planned. The clinical case once again confirms the need for qualified surgical care during the first “golden” hour and subsequent phased treatment at a specialized level using the VAC therapy system in patients with gunshot wounds and large soft tissue defects. The experience of military medicine demonstrates the importance of involving specialists of various profiles in the treatment of combined gunshot wounds of the pelvis. An important stage of treatment in the wounded is plastic and reconstructive surgery in the long term, which is aimed at improving the functional, cosmetic and psychological results of treatment.

Modern Approaches to Examination of Andrological and Sexological Patients During Covid-pandemia

Rapid increase in the overall incidence of pathologies of the reproductive and genitourinary systems in the conditions of a covid epidemic is predictable and requires certain medical and social steps (the formation of a preventive direction of treatment, the restoration of dispensary observation measures, the introduction of social health programs, the ability of citizens to receive qualified and timely specialized medical care etc.). The global spread of the SARS-CoV-2 coronavirus has led to a restriction in the provision of specialized urological care at the time of lockdown, which also negatively affected the dynamic examination of patients, due to a decrease in scheduled examinations. Remotely provided medical recommendations are not always correct due to the lack of the possibility of direct examination of the patient by a doctor. Significant assistance in the classification of patient complaints with the indicated clinical groups of symptoms is provided by questionnaires using generally recognized questionnaires, which must be used when interviewing each patient to establish a clinical syndrome, and it is possible to get a general idea of the state of human health only through a comprehensive analysis of the questionnaire data. The diagnosis by a doctor is established according to the anamnesis in 50% of cases, on the basis of clinical observation – in 30% and according to laboratory data – in 20%. The first remote contact of such patients with a doctor should include a detailed questioning of complaints, a review of the medical history, a review of his own medical, sometimes auto photographic, materials. Such men should always be examined on a second visit. In conditions of remote examination with lockdown, all the above examinations of patients with androgen deficiency are difficult to carry out, therefore, a less short diagnostic protocol can be applied, which will include the data: 1) ultrasound scan of the thyroid gland, abdominal organs, retroperitoneal space, small pelvis, scrotum; 2) data from clinical and laboratory tests. It is mandatory to provide medical information about the somatic and mental (psychological) state of the patient. Andrological patients usually do not have emergency conditions, but diagnostics, especially prescribing treatment, is a painstaking and individually directed process, therefore remote medical procedures are not the best option and require direct contact between the doctor and the patient.

Analysis of the Effectiveness of Various Types of Conservative Therapy for Chronic Bacterial Prostatitis

The management of patients with chronic bacterial prostatitis (CBP) is associated with a number of challenges. In particular, even in case of pathogen identification, targeted antimicrobial therapy does not reliably control the activity of the inflammatory process and pain syndrome. In addition to the pain syndrome, the clinical picture is aggravated by disorders of urination, sexual function and psycho-emotional sphere, which requires the inclusion of appropriate means of correction in the treatment program. In addition, as result of the chronic course of the disease, repeated and long courses of treatment should be carried out, putting forward additional requirements for the safety of the drugs used. Thus, the development of effective and safe protocols for the management of patients with CBP is an actual scientific task. Given the wide range of biological effects, plant and animal extracts have the potential to enhance the effectiveness of standard CBP treatment. The objective: to compare the efficacy and safety of adding to the standard therapy (ST) CBP, regulated by the protocol of medical care of the Ministry of Health of Ukraine, biologically active plant substances (dwarf palm, stinging nettle, ginkgo biloba, Japanese bitterness, lovage, calendula officinalis) and animal (peptides isolated from the prostate of sexually mature gobies) origin in the form of capsules and suppositories. Materials and methods. The study included 105 patients with CBP, aged from 26 to 39 years and duration of the disease from 6 months to 5 years. Depending on the treatment program, patients were randomized into three groups of equal size (n=35): group I – ST + 1 capsule and 1 rectal suppository per day with plant extracts (PE), group II – ST + 1 rectal suppository with PE per day, ІІІ group – ST + 1 rectal suppository with animal extract (AE). Composition of 1 capsule with PE: dwarf palm berry extract – 160 mg; stinging nettle extract – 100 mg; ginkgo biloba extract – 20 mg; Japanese knotweed extract – 20 mg; selenium methionine – 15 mg. Composition of 1 suppository with PE: extract of dwarf palm berries – 150 mg, extract of lovage roots – 50 mg, extract of calendula flowers – 50 mg. Composition of 1 suppository with AE: prostate extract of sexually mature bulls – 30 mg. The therapy lasted 30 days. At the end of therapy, the groups were compared with each other in terms of changes in pain syndrome (NIH CPSI), results of digital rectal examination, intensiveness of lower urinary tract symptoms (IPSS/QoL), sexual function (IIEF), activity of the inflammatory reaction of metabolism in the prostate (leukocyte count, lecithin grains in the field of view during light microscopy of prostatic secretion), the size of the prostate, the frequency of detection of sonographic artifacts (ultrasound examination), the maximum flow rate – Qmax, urination time – Tu (uroflowmetry), the frequency and nature of undesirable phenomena. To assess the significance of differences, the Student and Fisher tests were used. Significance level – 0.05. Results. Initially, the following disorders were recorded in groups I, II and III: pain syndrome – in 45.7%, 37.1% and 40% of patients, respectively, dysuria – in 62.9%, 51.4% and 54.3%, premature ejaculation (PEj) – in 31.9%, 34.3%, 40%, erectile dysfunction (ED) – in 20%, 14.3%, 20%, calcifications in the prostate – in 45.7%, 40%, 34.3%, diffuse changes in the pancreas. The most common pathogen in all groups was Escherichia coli: it was identified in 42.9%, 54.3% and 60% of patients, respectively. The second and third places in the frequency of detection were taken by Streptococcus faecalis (38.1%) and Staphylococcus aureus (16.2%). At the end of therapy, a decrease in the intensity of pain sensations was recorded in all groups, but the most pronounced – in group I. Thus, in group I, the rate of decrease in the indicator was 15.8 times, in contrast to 4.3 times in group II, and 2.9 times in group III (p<0.001). Pain on palpation of the pancreas was arrested in 100% of patients in group I, in 91.4% in group II, in 88.6% in group III (p<0.001). The decrease in the intensity of dysuria was also more significant in group I. The addition of a combination of PE in the form of capsules and suppositories to ST was associated with a more pronounced decrease in the proportion of patients with PEj and ED. In group I, their share decreased by 3.7 and 3.5 times, respectively, while in group II – by 2 and 2.5 times, and in group III – by 2 and 2.3 times (p<0.001). All three modes of therapy effectively reduced the activity of the inflammatory reaction (a decrease in the number of leukocytes in the pancreas secretion in the field of view), but did not differ in the severity of this effect (p>0.05). Only in group I statistically significant changes in the frequency of daytime and nighttime urination were recorded, which decreased by 21% and 50%, respectively. Although IPSS and QoL improved in all groups, the groups, where PE were used, did not differ in the magnitude of changes in these parameters (p>0.05). The frequency of detecting diffuse and focal changes in the echostructure of the prostate also decreased in all three groups. All three treatment regimens significantly increased Qmax (on average by 1.7 times) and reduced Tu (on average by 1.66 times), but these effects did not differ statistically significantly. Also, there were no significant intergroup differences in the change in the integral indicator of the NIH CPSI scale and the effectiveness of pathogen eradication. In particular, in group I it decreased from 39.3±2.2 to 18.3±1.8 points (p<0.01); in group II – from 37.4±2.7 to 21.3±0.19 points (p<0.01); in group III – from 37.9±2.4 to 22.3±1.9 points (p<0.01). Eradication of the pathogen was achieved in 97.1%, 91.4% and 85.7%, respectively. All three therapeutic regimens were characterized by a satisfactory safety profile: adverse events in the form of a transient skin rash occurred in 1 (2.9%) patient from group I, in 2 (5.7%) patients from group II, and in 2 (5, 7%) of patients from group III. When comparing the groups in accordance with the integral assessment of treatment results, it was found that the proportion of patients assessing the effect as “high” was significantly higher in group I – 57.1% in contrast to 48.6% and 37.1% in II and III groups, respectively. Conclusion. The multisyndromic nature of CBP makes it possible to include in the therapy program extracts of plant and animal origin, which have a wide range of biological effects. Adding of the PE in the form of capsules and rectal suppositories to standard treatment of CBP is scientifically approved, since it is statistically significantly more effective. than PE in the form of capsules and AE in the form of suppositories in correction of pain syndrome, sexual disorders, dysuria, day and night pollakiuria, and is characterized by a higher integral assessment of the effect. The effect of ST with the inclusion of PE in the form of capsules and rectal suppositories on the activity of inflammation, urination parameters, and pathogen eradication can be compared with that of ST + PE in the form of capsules and ST + AE in the form of suppositories. The addition of the plant and animal extracts to ST is safe. Long-term studies are required to evaluate the possibility of ST + PE in the form of capsules and rectal suppositories to influence the size of the prostate.

MАR-test and Spermiological Research Indices

Antisperm antibodies are detected in 3% to 25% of cases in men and women diagnosed with infertility. They can also be diagnosed in 1–10% of healthy fertile men. The presence of a high titer of AST is one of the factors of male infertility, which can be «hidden», i. e. not cause symptoms and deterioration of the overall spermogram. The objective: to analyze the results of sperm testing in men with antisperm antibodies, which were detected by MAR-test. Material and methods. A retrospective analysis of the examination results of 555 men was conducted on the basis of the Medical Center for Infertility Treatment in Chernivtsi. Spermograms were examined according to WHO recommendations in 2000, using an inverted microscope Olympus CKX41 in a Broker chamber. Determination of the percentage of sperm coated with antisperm antibodies was performed using the MAR-test (MAR-test, MAR-mixed antiglobulin reaction). Results. If we calculate the percentage of patients in whom we assume the connection between the presence of antisperm antibodies and undertaken surgery, genital infections and allergy history, we get only 48.3% of cases. It has been found that most changes in sperm counts correlate with the percentage of sperm that are coated with IgG. These data indicate that increased IgG levels play an important role in the development of pathospermia. A negative medium-strength correlation was found between the percentage of Category A sperm and the percentage of IgG-coated sperm. Persistence of IgG in semen is accompanied by a probable decrease in the morphological quality of sperm. Conclusion. In 52% of patients it was not possible to establish the etiological factor for the presence of Ig in the ejaculate. It has been found that most changes in sperm counts correlate with the percentage of sperm that are coated with IgG. It has been determined that an increase in the level of IgA and IgG leads to a probable increase in the percentage of pathological sperm forms and decrease in sperm motility. In the presence of 30% of sperm that are coated with IgG, with a probability of 95%, the ejaculate of patients will have 100% of pathologicoalr mf s of sperm.

Features of the Course of Lower Urinary Tract Symptoms in Men with Benign Prostate Hyperplasia and COVID-19

Nowadays men’s health remains in priority. It is given no less attention than to the cardiovascular disorders and cancer. Low urinary tract symptoms (LUTS) accompany most urological diseases and thus are among the most significant syndromes in urology. The medico-social significance of the syndrome puts the development of protocols for its effective detection and drug treatment with long-term efficacy in a number of priority tasks, stimulating the pharmaceutical industry to search for promising candidates.. Restrictions of COVID-19 Pandemic prevent routine procedures by urologists, prompting them to provide online counseling. Under these circumstances, recommendations were made on the strategy and tactics of treatment of urological diseases during a pandemic, as well as strategic directions in the urology of the future were identified. There is a worldwide consensus among experts on minimizing invasive treatments for benign prostatic hyperplasia (BPH) to maximize the protection of medical personnel from the potential risk of COVID-19 infection, while direct contact with patients is not always possible to avoid. It is known from scientific sources that, in contrast to 2019, in 2020 there was a tendency of increase the share of hospitalizations for emergency urological conditions as well as the share of critical conditions, requiring the strengthening of anti-epidemic measures. Over the past year the ability of the SARS-CoV-2 virus to increase the severity of LUTS in men with urological pathology was reported. Furthermore the development of severe urogenital symptoms (COVID-19-associated cystitis) with a high content of proinflammatory cytokines not only in blood plasma but also in urine was registered. This allows to include LUTS «de novo» in the complex of symptoms of COVID-19. Physicians should be aware of urogenital manifestations COVID-19 and include verification of bladder dysfunction to diagnostic program. Strict adherence to WHO and EAU anti-epidemic recommendations and algorithms is extremely important, so we provide online counseling to patients with symptomatic BPH, ensuring the continuity of the specialized treatment process and minimizing direct contact. The proposed method of treatment of moderate to severe BPH associated LUTS involves tamsulosin monotherapy or in combination with finasteride. The results of the use of tamsulosin hydrochloride in cases of LUTS in BPH indicate that the percentage of acute urinary retention in patients receiving monotherapy is almost similar to that when using combination therapy (tamsulosin + finasteride) and is about 7.0% per year. The obtained data suggest that the observation of patients at a distance can be justified only temporarily, but requires strict adherence to an individually designed treatment plan, which should be based on the guidelines of the Ministry of Health of Ukraine and WHO standards. The problem of BPH is a very important issue in modern medicine and requires clear treatment algorithms, with different contexts of modern realities, such as the latest data on certain links in the pathogenesis of urinary tract obstruction caused by BPH on the background of COVID-19.

Peculiarities of Sexual Health of Women of Reproductive Age Depending on the Types of Localization of Paraurethral Glands

Sexual health is a state of physical, emotional, mental and social well-being associated with sexuality. The complexity of the female sexual reaction lies in its dependence on many physiological, psychological and sociocultural factors. The objective: a comprehensive analysis of erogenous zones in women of reproductive age, taking into account the types of localization of the paraurethral glands, assessment of their sexual function and the causes of its disorders. Materials and methods. A comprehensive study to confirm the existence of female paraurethral glands and their functional activity, performed at the Institute of Urology of the National Academy of Medical Sciences of Ukraine (Department of Reconstructive Urology and Advanced Technologies), took 94 relatively healthy women of reproductive age, who as a result of a comprehensive examination paraurethral glands of different types of localization (anterior, posterior, diffuse). Analytical-synthetic, comparative analyzes were used. Average values with their standard error were calculated; in cases of comparison of statistical values, Student’s test was used. Results. The relationship between the localization of the paraurethral glands in women of reproductive age and the peculiarity of the manifestation of sexual relations has been traced. Differences in the number and severity of the reaction of erogenous zones among this category were revealed. Sexual dysfunctions in 24 (25.5%) of 94 women were predominantly in the posterior type of localization of the glands (50% versus 37.5% and 12.5% in the anterior and diffuse types, respectively). Among the reasons for dissatisfaction with sexual relations, women most often indicated satisfaction (36.2%), then – reaching orgasm (22.4%) every fifth noted the absence (decrease) of sexual arousal and 13.7% – a decrease in desire; dyspareunia was observed in 8.6% of cases, was inconsistent and manifested itself with individual partners. These features were mostly manifested in cases with the posterior type of localization of the paraurethral glands of different reproductive ages. Conclusion. The results obtained made it possible to reveal the features of the sexual life in women, depending on the type of localization of their paraurethral glands.

Modern Methods of Treatment for Proximal Ureterolithiasis

Urolithiasis is a disease characterized by the formation of stones in the urinary tract. According to statistics, SCC causes about 30% of hospitalizations in the urology department. Treatment of SCC is divided into conservative and operative. The choice of method depends on age, clinical course of the disease, general condition of the patient, anatomical and functional condition of the kidneys and the size of the localization of the calculus. Methods of treatment of SC have changed significantly in recent years. Due to the technical achievements of the method of open ureterolithotomy, which was once the standard method of treatment of so-called «complicated» concretions of the ureter, evolved into a laparoscopic ureterolithotomy, and with the advent of ultrasonic and laser lithotriptors – began the newest era of minimally invasive urology– extracorporeal shock-wave lithotripsy and endourology: antegrade percutaneous ureterolithotripsy, retrograde ureteroscopic lithotripsy and flexible retrograde uretherolithotripsy (FURS). The purpose of the work – on the basis of scientific literature to assess the effectiveness, safety and profitability of modern methods of surgical treatment for proximal ureterolithiasis. During the scientific research, attention was paid to the following parameters: stone free rate (SFR), postoperative pain level, need for painkillers, number of postoperative bed-days, presence of postoperative fever, hemoglobin level, need for blood transfusion, and on the economic component during the implementation of a technique. The principles of treatment of patients with large proximal ureterolithiasis are described in the clinical guidelines of the European and American Associations of Urologists. However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community. Percutaneous antegrade ureterolithotripsy is the preferred method of choice in patients with large proximal ureteral stones that cannot be removed by contact or extracorporeal ureterolithotripsy, characterized by a high level of absence of stones and minimal complications, optimal post operative and high indicators of economic attractiveness of this technique.

Hypersexuality as a Manifestation of Various Disorders

The article deals with hypersexuality, which can be a manifestation of a wide variety of disorders. These include: consequences of a psychotrauma; premature psychosexual development; borderline personality disorder; submaniac and maniac states in bipolar affective disorder and schizoaffective type of the course of schizophrenia; disinhibition of libido, rough and naked eroticism in the initial stage of schizophrenia; consequence of advanced emotional volitional disorders in simple-type schizophrenia; temporal lobe epilepsy; dementia; mental retardation (oligophrenias); various organic brain lesions (resulting from neuroinfections, injuries, vascular damages, neoplasms) [the temporal and frontal lobes of the brain are indicated as regulators of libido]; consequence of disorders in the hypothalamic area and limbic system. It is reported that a correlation exists between development of hypersexuality and damages in certain cerebral areas in patients with non-traumatic brain damage. It is pointed out that hypersexuality may result from maldevelopment of the right hippocampus, anti-NMDA receptor encephalitis, in patients with disseminated sclerosis, Huntington’s disease, Kluver-Bucy syndrome as well as be caused by various hormonal disorders and consequences of premenstrual changes and effect of virilizing hormones during the childhood or intrauterine period. Numerous clinical illustrations of cases with hypersexuality, caused by various disorders, are given. The author holds the opinion that it is necessary to divide hypersexuality at least into two categories: true hypersexuality and sexual disinhibition, when with the normal or even reduced level of libido manifestation the hypersexual behaviour results from absence or insufficiency of inhibitory mechanisms (for example, in dementia).