Трансуретральная лазерная простатолитотрипсия: клинический случай

PREVALENCE AND CORRELATES OF PROSTATITIS IN THE HEALTH PROFESSIONALS FOLLOW-UP STUDY COHORT

The objective: effectiveness of the drug PHARMAPROST manufactured by SYSTEM PHARM (Ukraine) in patients with benign prostatic hyperplasia (BPH) I degree in combination with chronic abacterial prostatitis, (NIH USA, category IIIa CP/CPPS – chronic prostatitis and chronic chronic syndrome) pain with signs of inflammation), assessment of the quality of treatment by patients, the study of intolerance and possible side effects of the study drug.Materials and methods. The Ukrainian Institute of Sexology and Andrology studied the clinical efficacy of PHARMAPROST manufactured by SYSTEM PHARM (Ukraine) in patients with grade I BPH in combination with chronic abacterial prostatitis.Study design: examined and treated 60 men with BPH I degree in combination with chronic abacterial prostatitis, aged 48 to 66 years and disease duration from 6 months to 12 years. The treatment program consisted of two courses of rectal suppositories PHARMAPROST for 10 days a night, the interval between courses was 20 days. All 60 patients completed the full course of treatment.Evaluation of effectiveness: the study included two visits (before and after treatment), during which a history was collected, physical examination, laboratory examination of ejaculate (clinical analysis and bacteriological examination), questionnaire, uroflowmetry, ultrasound. The effectiveness of treatment was evaluated 30 days after the end of the course.Results. The obtained data confirm the clinical efficacy of PHARMAPROST presented inUkraine by SYSTEM PHARM (Ukraine) in 60 patients with a combination of grade I BPH and chronic abacterial prostatitis (NIHUSA, category IIIa CP/CPPS – chronic prostatitis/chronic pelvic syndrome) signs of inflammation). High clinical (89.6–91.7 %) efficacy of this drug has been proven. Treatment was accompanied by good tolerability and minimal side effects.Conclusions. The use of the drug PHARMAPROST in the treatment of patients with chronic abacterial prostatitis and BPH I degree is clinically justified and effective (89.6–91.7 %). The use of the drug PHARMAPROST is accompanied by good tolerability and a small number of side effects (8.3 %). The obtained results allow to recommend the use of the drug PHARMAPROST as monotherapy of patients with a combination of BPH I degree and chronic abacterial prostatitis.

The etiology of chronic prostatitis remains unclear; consequently, this disease is associated with recurrence and ineffective clinical therapy. Therefore, there is an urgent need to investigate the underlying pathogenesis of chronic prostatitis in order to develop more efficacious treatments. The previous study found that knocking out of PEBP4 leads to chronic prostatitis in the male mice. This research aimed to identify the role of PEBP4 in prostatitis, determine the molecular pathogenic mechanisms associated with chronic prostatitis, and provide guidelines for the development of new treatment strategies for chronic prostatitis. A PEBP4 exon knockout strain (PEBP4-/-) was established in C57BL/6 mice via the Cre-loxP system. Hematoxylin-eosin (H&E) staining was used to investigate histological changes. RNA-sequencing was used to investigate the gene expression signature of the prostate and the levels of inflammatory cytokines were determined by real-time polymerase chain reaction (RT-PCR). The expression of PEBP4 protein in prostate tissue was determined by immunohistochemistry in specimens from patients with BPH and BPH combined with chronic prostatitis. Finally, we used a CRISPR-Cas9 plasmid to knockout PEBP4 in RWPE-1 cells; western blotting was subsequently used to measure the level of activation in the NF-κB signaling pathway after activating with TNF-α. Hemorrhage and inflammatory cell infiltration were incidentally observed in the seminal vesicles and prostate glands of PEBP4-/- mice after being fed with a normal diet for 1 year. In addition, we found significantly lower (p<0.001) expression levels of PEBP4 protein in prostate tissues from patients with benign prostate hyperplasia (BPH) and chronic and non-bacterial prostatitis (CNP)when compared to those with BPH only. The reduced expression of PEBP4 led to a higher risk of prostatitis recurrence in patients after 2 years of follow-up. Increased levels of NF-κB and IκB phosphorylation were observed in PEBP4-knockout RWPE-1 cells and prostate glands from PEBP4-/- mice. The knockout of PEBP4 in experimental mice led to chronic prostatitis and the reduced expression of PEBP4 in patients with higher risk of chronic and non-bacterial prostatitis suggested that PEBP4 might act as a protective factor against chronic prostatitis. The knockout of PEBP4 in RWPE-1 cells led to the increased activation of NF-κB and IκB, thus indicating that inhibition of PEBP4 faciliated the NF-κB signaling cascade. Our findings provide a new etiology and therapeutic target for chronic prostatitis.

Objective To explore the effect transurethral holmium laser lithotripsy for bladder lithiasis complicated with benign prostatic hyperplasia. Methods 78 patients with bladder stones complicated with benign prostatic hyperplasia treated in our hospital from January, 2011 to October, 2016 were retrospectively analyzed. Complicated with bladder outlet obstruction or not, they were treated by transuretharal holmium laser lithotripsy; the prostatic hyperplasia was observed or treated with drungs. The treatment efficacy was evaluated. Whether it needed transurethral resection for prostatic hyperplasia was evaluated. The postoperative complications were observed. Results The stone cleared rate in the 78 patients was 100%. The average follow-up time was 15 months. The TURP was not performed after transurethral laser lithotripsy for prostatic hyperplasia. Conclusions Single transurethral holmium laser lithotripsy for bladder stones as well as benign prostatic hyperplasia observation or drug treatment is feasible; and the absolute indications of bladder stones for prostatic hyperplasia surgery is challenged. Prostatic hyperplasia is recommended for conservative treatment in the following cases: mild lower urinary tract symptoms (IPSS≤ 7), no bladder outlet obstruction, no effect on the quality of life (observation or drug treatment); moderate-to-severe symptoms (IPSS >7), when the quality of life is affected, drug combination therapy is recommended; when BPH-related complications occur, transurethral resection of the prostate is the choice. Key words: Bladder stones; Benign prostatic hyperplasia; Holmium laser; Non-surgical treatment

EVALUATION OF THE BACTERIAL FLORA OF THE PROSTATE USING A 16S rRNA GENE BASED POLYMERASE CHAIN REACTION

Multidisciplinary approach to prostatitis.

Introduction. Chronic prostatitis (CP) is one of the most common urological diseases; CP often accompanies benign prostatic hyperplasia (BPH). Quite often in patients with CP, obstructive, irritative and urethral symptoms are detected. However, there is simply no effective therapy for CP. Despite the lack of data on the proven effectiveness of herbal medicine in international clinical trials, this treatment for CP and BPH remains popular. Aim. To study clinical efficacy and safety of CHINCH herbal drug in treatment of patients with CP and BPH. Materials and methods. 820 men from 13 clinical centers of the Russian Federation with lower urinary tract symptoms associated with CP and BPH were included in the study. The patients were divided into 2 groups. Group I included 423 patients who were administered a complex therapy with Tamsulosin (0.4 mg, 1 capsule once a day for 2 months) and CHINCH (2 capsules 2 times a day for 2 months). Group II consisted of 397 patients who had only Tamsulosin (0.4 mg, 1 capsule once a day for 2 months). Results. According to uroflowmetry, the patients from the group with combined therapy showed significantly better average values of the maximum urine flow rate (Qmax) at the end of 2 months of the therapy, than the initial values in the group, as well as the values of the monotherapy group (p&lt;0.05). All patients noted an increase in the urine flow rate after a month of taking drugs with an increase in the effect by the end of the program. All patients who were included in the observational program, marked an improvement in the quality of life (QoL). The QоL value in the group I became significantly higher (p &lt;0.05) compared with the initial and intermediate values, as well as with the same values in the monotherapy group. All patients noted that the prescribed therapy was well tolerated. Discussion. The study showed, that both subjective and objective criteria for assessing the disease course improved in patients using our approach of complex therapy for lower urinary tract symptoms, associated with CP and BPH (CHINCH in combination with Tamsulosin). These results indicate that the use of herbal therapy in combination with basic therapy with Tamsulosin is an effective and safe treatment method for lower urinary tract symptoms, caused by CP and BPH. Our results are consistent with the data of other researchers. Conclusions. Combined therapy with an alpha-adrenergic blocker in combination with CHINCH, compared with monotherapy, can help to achieve a faster and more significant result in the relief of lower urinary tract symptoms caused by CP and BPH. The combined therapy allows to achieve a higher level of Qmax, IPSS and QOL values within a month, and by the end of the second month - to enhance this effect. The use of CHINCH is not accompanied by adverse effects and can be administered for a long time to relieve lower urinary tract symptoms in patients with CP and BPH.

V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS

Prostatic calculi (PC) are frequently detected at computed tomography or ultrasound in men attending the health center or the urology outpatient department. PC have attracted more attention from urologists, but the clinical significance of PC is unknown. To review the available literature on the effects of PC on prostatic diseases and sexual function in men. Relevant clinical trials were identified by searching the PubMed, Embase, and Cochrane Library databases. Results were classified, summarized, and analyzed. Transabdominal and rectal ultrasonography; urodynamics analysis; International Prostate Symptom Score; pathologic examination of prostatic tissue; prostate-specific antigen; and expressed prostatic secretion. PC can not only prolong the duration of bothersome symptoms but also decrease the cure rate of antibacterial therapy in patients with chronic prostatitis. Patients with PC usually have more severe lower urinary tract symptoms (LUTS), and some studies reported that moderate to marked PC are a predisposing factor for moderate to severe LUTS. Studies also reported that the serum level prostate-specific antigen is not influenced by PC. In addition, the presence of PC is not associated with an increased risk of prostate cancer. However, the correlation between PC in the peripheral zone and prostate cancer is statistically significant. In addition, the association between PC and Gleason scores is controversial. Some novel studies suggested that PC might play an important role in sexual impairment in middle-age men or men with chronic pelvic pain syndrome or chronic prostatitis. Recently, PC were found to increase the incidence of severe LUTS, urinary retention, and hematospermia after transrectal ultrasound-guided prostate biopsy. PC can aggravate LUTS, chronic prostatitis, and sexual dysfunction in men, but the association between PC and prostate cancer is still controversial. Cao J-J, Huang W, Wu H-S, etal. Prostatic Calculi: DoThey Matter? Sex Med Rev 2018;6:482-491.

PREVALENCE OF PROSTATITIS-LIKE SYMPTOMS IN A POPULATION BASED STUDY USING THE NATIONAL INSTITUTES OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX

Introduction. According to specialized literature, prostatic calculi are found in up to 80% of men over the age of 50. Prostatic calculi associated with chronic prostatitis may be closely related to lower urinary tract symptoms (LUTS) and may cause nonspecific symptoms of LUTS. The treatment approaches of prostatic calculi in chronic prostatitis include drug therapy, minimally invasive as well as open surgeries, the number of which is actually decreasing worldwide. This phenomenon is mostly related to the emergence of both new diagnostic technologies and endourological treatment. Material and methods. The study included 40 patients with bladder outlet obstruction caused by prostatic calculi due to CNBP, who were diagnosed via a series of clinical and paraclinical investigations. The treatment methods to remove the bladder outlet obstruction included surgical approaches like transurethral resection (TUR) (n = 10 patients) and laser surgery (Ho: YAG) (n = 30 patients). Subsequently, the patients were monitored and monitored at 1 and 3 months. Results. All included patients in the study complained of difficulty urinating (bladder outlet obstruction and residual urine) underwent endoscopic surgical treatment. 30 patients underwent transurethral resection of the prostate with Ho:YAG laser operating at pulse energy of 2.3 J and a frequency of 18 Hz, with a peak power of 18.4 W. Laser incisions were made at 5 and 7 points of a standard quadrant by local tissue resection and removal of prostate stones. During 3 months of follow-up, the mean IPSS value improved from 23.2 ± 2.57 points to 12.6 ± 0.54 points; QoL also changed from 4.83 ± 0.51 points to 2.23 ± 0.1 points; Qmax shifted from 9.08 ± 1.8 ml/s before surgery to 14.07 ± 1.7 ml/s after surgery; the mean value of residual urine decreased to 94.8 ± 47.4 ml and 34.23 ± 9.82 ml. The other 10 patients with prostate stones due to CNBP underwent another endoscopic method: incision (ITUP) or transurethral resection (TURP). The dynamics of the test findings during the follow-up period: IPSS improved from 22.9 ± 2.42 to 10.7 ± 0.5 points; QoL improved from 5.0 ± 0.66 to 2.1 ± 0.31 points; Qmax changed from 9.34 ± 1.29 ml/s to 15.82 + 0.44 ml/s after the surgery. The average value of residual urine decreased from 92.9 ± 17.95 ml to 38.9 ± 5.97 ml. A decrease in prostate volume of 15.2 cm3 was also observed, possibly due to partial removal of sclerotic tissue and lithiasis. Conclusion. Improvement in urodynamic parameters showed that endoscopic surgical treatment of prostate stones is an effective method for eliminating bladder obstruction and helps to restore urination, as well as improving the quality of life.

To investigate the relationship between interleukin-8 levels in expressed prostatic secretion and expressions of basic fibroblast growth factor (bFGF) and Bcl-2 in benign prostatic hyperplasia (BPH). A series of 50 consecutive patients diagnosed with BPH and scheduled for transurethral resection of the prostate (TURP) were included. Patients were divided into two groups, simple BPH and BPH with chronic prostatitis (CP). The grade of inflammatory changes in the prostate was then determined blindly by two experienced pathologists, according to the classification system. Expressed prostatic secretion (EPS) was collected right before TURP for IL-8 detection using ELISA kits. The resected prostatic tissue was harvested for immunohistochemistry to measure the expression of Bcl-2 and bFGF. A total of 30 (60%) patients were confirmed to have prostatic histologic inflammation. The volume of the prostate in BPH with CP was obviously larger than that in simple BPH (P=0.022). The NIH chronic prostatitis symptom index (NIH-CPSI) and international prostate symptom score (IPSS) of BPH with CP were both higher than those of simple BPH (P<0.05). Significantly increased levels of IL-8 were observed in EPS obtained from BPH patients with CP (mean level, 43.29 ng/L), compared with patients with simple BPH (mean level, 36.90 ng/L) (P=0.003). The expression of Bcl-2 in BPH with CP (mean level, 6.17) increased significantly, compared with those in simple BPH (mean level, 2.45) (P=0.013). The expression of bFGF in BPH with CP (mean level, 7.57) also obviously elevated, compared with those in simple BPH (mean level, 5.05) (P=0.008). Correlation coefficients of IL-8 levels in EPS and expression of Bcl-2 or bFGF indicated that IL-8 had strong correlation with Bcl-2 and bFGF respectively both in simple BPH and BPH with CP (0<R<1, P<0.05). IL-8, Bcl-2 and bFGF are significantly up-regulated in BPH with CP patients, compared with simple BPH patients. Inflammation might play an important role in the outcome and development of benign prostatic hyperplasia and makes it more severe.

The reported prevalence of prostatic calculi / stones ranges from 7% to 99% and depends on patient age. Prostatic calculi are found in 9% of men aged 18 – 29 years, in 32.3% of those aged 50 – 59 years, and in 66.7% of those aged 70 – 79 years. Prostatic calculi associated with benign prostatic hyperplasia (BPH) are often asymptomatic and are usually detected incidentally during surgical treatment of BPH. Large or multiple calculi, as well as stones associated with chronic prostatic inflammation, may cause nonspecific lower urinary tract symptoms (LUTS). In addition, patients with prostatic calculi may present with hematuria, post‑micturition dribbling, urinary incontinence, and chronic pelvic pain syndrome. Prostatic calculi occurring in the setting of chronic inflammation of the gland can serve as a nidus for bacterial colonization and may promote the selection of microorganisms resistant to antimicrobial therapy. Asymptomatic calculi generally do not require specific treatment and are most often removed incidentally during surgery for prostate cancer. In symptomatic cases, the efficacy of conservative treatment, particularly antibiotic therapy, is limited because the stones themselves represent a persistent source of infection. Therefore, in such patients, the preferred management option, in combination with antibacterial therapy, is endoscopic removal. In this paper, we present our clinical cases in patients with multiple symptomatic and asymptomatic prostatic calculi and provide a review of the relevant literature.

PREDICTORS OF PATIENT RESPONSE TO ANTIBIOTIC THERAPY FOR THE CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: A PROSPECTIVE MULTICENTER CLINICAL TRIAL

Evaluation of Interleukin-8 in Expressed Prostatic Secretion as a Reliable Biomarker of Inflammation in Benign Prostatic Hyperplasia