Study of the constrictor properties of the neobladder under the influence of new chemical compounds in vivo experiment

The orthotopic ileocystoplasty is the most preferred urine derivation method for patients after removal of the bladder. The best quality of life, self-esteem, cosmetic appearance of one’s own body, and the possibility of physiological urination characterize the artificial bladder as the “gold standard” of urine derivation. There are a greater number of postoperative complications associated with the functionality of the neobladder, considering the complexity of orthotopic derivation of urine. The autocaturation is required in some patients day or night urinary incontinence, and in the other group, periodic urinary retention. Urinary retention is more common in women up to 43 % compared with 20 % in men, who need intermittent catheterization. The aim of investigation was to evaluate the possibility of pharmacological correction of contractile activity of mini-pigs neobladder in vivo, under the influence of new chemical compounds and the anticholinesterase drug nivalin. Materials and methods Experimental studies were performed on 21 female mini-pigs, with an average age of 6 to 14 months. The duration of the experiment was 12 months. Performing of enterocystometry in experimental animals is possible only under anesthesia and, accordingly, only part of the urodynamic parameters can be obtained. Results. The obtained results of in vivo experimental studies demonstrated the constrictor activity of the studied new chemical compounds. Compound I in comparison with the control group statistically significantly increased basal tone by 62.09 %, the amplitude of contractions by 37.34 %, and the duration of contractions by 35.71 %. The new chemical compound II, in comparison with the control group, showed less pronounced results of constrictor activity, so the basal tone statistically significantly increased by 38.86 %, and the amplitude of contractions by 15.0 %. Conclusion. Thus, under the influence of new chemical compounds in the conditions of an experimental artificial bladder, constrictor properties are proved, which require further research and study. In turn, cholinomimetic nivalin has prospects for use in urology, in particular in patients with hypoactive forms of artificial and neurogenic bladder.

Nonobstructive azoospermia, when we can find spermatozoa, is FSH as a marker of succes?

Azoospermia is the absence of spermatozoa in ejaculate even after semen centrifugation at least two times. Azoospermia due to spermatogenic failure – non-obstructive azoospermia (NOA) observed in 1% of population and in 10–15% of infertile men. Predictive factors for the presence of spermatozoa in testis are still under debate. The development of ICSI revolutionized management of azoospermia. In our practice we advised TESA as a first step and FSH can predict the success. According serum FSH levels we divided our men in three groups: FSH < 10 mU/ml, 10–15 mU/ml and > 15 mU/ml. We tried to evaluated SRR in accordance serum FSH level and find significant difference. In 117 men with FSH < 10 mU/ml SRR was 66% (in 77 cases), in 89 men which FSH was 10–15 mU/ml SRR was 27 % and finally SRR was 35% when FSH was > 15 mU/ml (45 cases from 131). At the same time, we make embryologist personal assessment (EPA) and try to show embryologist crucial role in tissue assessment after TESA. Another crucial point of discussion – histomorphology within the testis in NOA and indications for re – TESA after 3–6 months.

Diagnostics of anatomical obstruction of the lower urinary tract using uroflowmetry with a pharmacourodynamic test

Uroflowmetry is an effective, non-invasive method for detecting lower urinary tract obstruction. However, by the nature of the uroflowgram, it is impossible to distinguish between the anatomical and functional obstruction of the urethra. The aim of the study was to develop a screening non-invasive method for the diagnosis of anatomical urethral obstruction using uroflowmetry with a pharmacourodynamic test with selective alpha-1-blocker silodosin. The study involved 235 patients aged 66.2±1.8 years (from 30 to 76 years) with symptoms of the lower urinary tract (LUTS). Uroflowmetry was performed using a “Flow-K” uroflowmeter. Ultrasound examinations of the kidneys, prostate and bladder with determination of residual urine were performed using a HONDA HS-2000 ultrasound machine. All patients underwent a pharmacourodynamic test: repeated uroflowmetry 2.5-3 hours after a single dose of 8 mg of silodosin, taking into account the pharmacodynamics of the drug. During the pharmacourodynamic test, 15 patients with obstructive or obstructive-interrupted uroflowgram had no reaction to silodosin, which was considered a positive test for anatomical (mechanical) urethral obstruction. Аn increase the maximum and average volumetric flow rate of urine during urination by 25-30%, respectively from 9.02±0.24 ml/s up to 11.69±0.32 ml/s and from 5.64±0.21 ml/s to 7.03±0.25 ml/s, were noted in 220 patients with obstructive, obstructive-interrupted obstructive-intermittent or intermittent type of uroflowgram when conducting a pharmacaurodynamic test. Such results were considered negative for anatomical (mechanical) urethral obstruction. They testified to functional obstruction of the urethra, which was subsequently successfully corrected with prescribing selective alpha-1-blockers. Patients with a positive pharmacourodynamic test were prescribed further examination using such methods as ureteroscopy, urethrocystoscopy, retrograde urethrography, to confirm the violation of the patency of the urethra or bladder neck. Urethral stricture was diagnosed in 10 patients, a calculus of the posterior urethra in 2 patients, a median lobe of the prostate gland in 3 patients with BPH. In the presence of obstructive or obstructive-interrupted uroflowgram in patients with LUTS, the pharmacourodynamic test with silodosin can be used as a screening non-invasive test to detect anatomical obstruction of the lower urinary tract.

Research of indicators of pro- and antioxidant system in spermoplasm in violation of fertility in men

The article presents the study results of marker indicators of pro- and antioxidant spermoplasm systems among men of reproductive age with various types of infertility. It is shown that patients who were diagnosed with “secretory male infertility”, had the level of MDA content that was exceeding control indicators in 1.2 times (aЈ0,05) with simultaneous activation of SOD (in 132.2%, aЈ0,05) against the background of slight CAT activity decreasing. The SOD/CAT ratio increased in 1.44 times compared to the control, and the activity of GAOS enzymes was not significantly different from the control group. The condition of pro- and antioxidant protection system can be classified as “activated” due to “SOD + CAT” link with imbalance in the system, which can lead to progression of cytotoxic effects. The patients’ segmentation who were diagnosed with “excretory-toxic male infertility” into three subgroups by MDA content in spermoplasm made it possible to establish that the first subgroup was characterized by “compensatory activation” mainly of GAOS against the background of decreasing MDA content, in the second subgroup - indicators of the pro- and anti-radical protection system did not have reliable differences comparing with control results. The third subgroup showed increase of MDA content (66.1%, aЈ0,01) and activity decrease of all anti-radical protection systems. The state of pro- and antioxidant protection system in this subgroup can be classified as “oxidative stress.” The indicators study of pro-antioxidant systems in spermoplasm among patients with various types of male infertility will allow to carry out pathogenetically justified prevention and correction of conditions, which are accompanied by development of oxidative stress.

Epidemiological features of chronic cystitis in the capital megapolis

The paper presents the results of the analysis for 2008–2017 of the prevalence and incidence of chronic cystitis in the adult population of Kiev based on the data of state, sectoral statistical reports (F.F. No. 12, 20). Two five-year periods are highlighted, the justification for which was the well-known territorial changes in the country; the corresponding indicators served as a comparison, which made it possible to identify the features of the dynamics of the studied processes. As a result of 10 years of observation, it was revealed that for the city of Kiev, which ranks second in the structure of the prevalence and incidence of chronic cystitis in Ukraine, a decrease in the number of registered patients (by 7.3%) with a simultaneous increase in newly diagnosed patients (by 15.6%; by 25.6% of men and 13.2% of women), in contrast to their overall growth in the country as a whole (by 0.4% and 2.8%, respectively). Prevalence rates (per 100 thousand) after an increase in the first five years are replaced by a decrease in the next period (621.2 to 687.9 versus 627.8 to 533.4). Among women, they were 3.5-4.8 times large; in 2017 – 862.8 versus 176.6 among men. The peculiarity of the incidence was manifested by its increase among women and men in 2013–2017 against the background of a decrease in the previous years; in 2017, the indicators per 100 thousand reached 88.5; among women – 127.2, men – 41.5. The observed situation of an increase in the incidence of chronic cystitis among the adult population of the capital with a simultaneous decrease in the prevalence allows us to evaluate it as a result of the provided adequate specialized care and, at the same time, indicates the need to study the causes, negative factors, as the basis for the improvement and implementation of disease prevention.

Emotional burnout syndrome in primary specialization doctors

We conducted an anonymous survey of 140 medical interns at the end of the 2nd year of study in specialties leading in emotional burnout. The results obtained indicate the beginning of the syndrome formation even at the undergraduate level of education, with significant deterioration during the course of primary specialization. Prevention of burnout syndrome should begin with its diagnosis, as well as assessment of the presence of depression, situational and personal anxiety at the early stages of medical education.

New antibiotics in the treatment of urinary tract infections

Antibiotics are very often prescribed for the indication urinary tract infections (UTIs). Therefore, UTIs are an important field for the development of antibiotic resistance. A number of new antibiotics have been tested for the indication complicated UTI / pyelonephritis. These are cephalosporins and carbapenems, in combination with new beta-lactamase inhibitors, cefiderocol as a new type of cephalosporin, plazomicin a new aminoglycoside, eravacycline a new tetracycline, and intravenous fosfomycin. Not all antibiotics are approved in Europe. Although the development of these new substances is promising, these new antibiotics should be used very carefully to avoid the development of new antibiotic resistance against these new substances.

Modern approaches to local treatment of metastatic prostate cancer (literature review)

The potential oncological benefit of modern technological, laboratorial and imaging studies significantly improved disease-free survival rates in patients suffering from prostate cancer (PCa). Systematic reviews carried out in men with metastatic prostate cancer (mPCa) identify plenty of studies, especially dedicated to local treatment options. Unfortunately, young and fit patients with mPCa at diagnosis present unexpected resistance towards proposed treatment. Oncological outcomes demonstrate high rate of cancer-specific and overall mortality with precursory invasion of adjacent structures and impaired quality of life in patients. Current literature review was carried out using mainly PubMed and SciELO database to identify and analyze advances of local treatment of mPCa. The most relevant articles included studies performed from March 2005 to November 2020. According to the last brief reviews, main indication for providing primary treatment of PCa includes nonmetastatic PCa. Additionaly, it may be performed as palliative treatment for mPCa to minimize local invasion, prevent arising of new metastasis and provide better biological answer of chemotherapy and hormonal treatment. Recent data suggests that local treatment and overall survival turned out to be more effective in patients under 70 years. Thus, independent negative prognostic factors mentioned in patients with mPCa are age above 70 years, cT4 stage or high-grade disease, PSA і 20 ng/ml, and pelvic lymphadenopathies. While comparing patients who underwent local treatment with those one who did not, the presence of these 3 or more CSS and OS factors conditions remains the same. Metastasis degree and location number can also influence outcome. Furthermore, visceral metastases lead to worse prognosis. Exploring new treatment options for mPCa awoke interest in scientists in recent years. Radical prostatectomy and target radiation therapy remain the most effective in achieving local disease control and, thus, control of systemic disease. There is growing evidence supporting local treatment in cases of metastatic prostate cancer at diagnosis in the context of a multimodal approach. However, its oncological effect requires prospective studies with well-defined patient selection criteria. Prospective multicentric studies might sustain the existing data and define the main indications for primary treatment in mPCa.