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The article presents a review of Russian and international literature dedicated to the problem of painful ejaculation. Mentions of this type of disorders are quite rare. Its real incidence remains unknown. Connections between painful ejaculation and infectious and inflammatory diseases (orchitis, epididymitis, prostatitis, vesiculitis, urethritis), previous surgeries (in particular, transurethral resection of the prostate), administration of certain drugs (for example, antidepressants), rare congenital developmental anomalies are considered. Data on the effectiveness of conservative and surgical treatment are presented.

We have assessed the implication of analysis of amydolitic activity of hepsin, which is a trans-membrane serine protease of II type, in the detection of prostate cancer diagnosis. According to literature review over-expression of hepsin is characteristic for prostate cancer whereas prostatic cells do not express this protease in normal states and benign tumors of prostate. Our results have demonstrated the value of screening for hepsin activity in the diagnosis of prostatic pathologies which possibly is an adequate substitution for widely used test of prostate specific antigen determination.

To determine features of the bone metabolism, 65 patients with prostate cancer (PC) were examined. Locally advanced process is determined in 41 patients, disseminated counterpart – in 24 patients. To specify the level of bone metabolism, the level of the osteoporosis markers – osteocalcin and â-cross-laps was measured. The markers level determines activity of the bone metabolism: osteocalcin shows the level of synthesis, â-cross-laps – resorbtion intensity. In locally advanced PC, a significant positive correlation between resorbtion marker and the patients age is observed. An increase in the value of the marker of bone synthesis and time of treatment after surgical castration in patients with locally advanced process is observed. Thus, increase of the bone metabolism is revealed, reliably associated with the age changes and the treatment features in patients with locally advanced PC. The same changes accompany metastatic cancer progression. Based on these observations, the one can conclude, that the bone metabolism alterations in patients with locally advanced and disseminated PC are pathologic and can be measured fairly. Bisphosphonates use, especially those of the last generation (zoledronic acid) is not only justified but is indicated in the locally advanced cancer to prevent progression of the pathologic bone metabolism caused by age and intense hormonal therapy. It will redice a probability of the expansion of the tumor process into the bones and disease progression. In disseminated PC, decrease in the pathologic bone metabolism will also allow to hamper disease progession and reduce the probability of the pathologic manifestations of the skeleton lesion.

Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy.Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching.Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises.Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1–2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill.Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

The efficacy of Zometa has been evaluated in the treatment of patients with disseminated prostate cancer. The use of Zometa as an inhibitor of bone resorption in the presence moderate changes in the activity of bone resorptive processes has shown the highest survival rates.

The impact of prostatoliths (PL) on the level of prostate-specific antigen (PSA) was evaluated and their association with prostate cancer (PC) was studied in 145 patients with benign hyperplasia and cancer of the prostate. No statistically significant increase in PSA levels in the presence of PL was found. A chronic inflammatory process in the prostate was more common in PC concurrent with PL, which is an indirect signof a possible correlation between PL and PC. Final conclusions about the oncourological aspects of PL can be made only after further investigations in this area.

Objective: to define a possible correlation between Mycoplasma infection persistence and prostate cancer (PC). Subjects and methods. Two hundred and fifty males aged 45 to 83 years (mean age 65.50.71 years) with suspected PC were examined. In all the patients, polyfocal prostate biopsy from 12 points was carried out, by additionally taking 2 tissue columns from the peripheral area of both lobes. The basic material was referred for morphological study; the two additional columns were tested for Mycoplasma DNA by a polymerase chain reaction (PCR) and real-time PCR. The study was blind. According to the morphological findings, the patients were divided into 2 groups: 1) those with chronic prostatitis, prostate adenoma, low-grade prostatic interstitial neoplasia (PIN); 2) those with high-grade PIN (HG-PIN), PC. There were no age differences between the groups (p = 0.05). Results. The standard procedure for PCR was applied to 127 subjects. Twenty-six (20.5%) of the 127 subjects with suspected PC were found to have Mycoplasma infection, Mycoplasma being detected in 21 (26.2%) of the 81 patients with verified HG-PIN and PC. Mycoplasma hominis was encountered in 19 (15%) patients of the 127 subjects with suspected PC and this infection was present in 16 (20%) of the 81 patients with verified HG-PIN and PC. Comparison of the frequency of HG-PIN and PC in the patients of general group (60%) and in those with Mycoplasma infection (80.8%) revealed significant differences (p = 0.031). HG-PIN and PC were also significantly more frequently seen in the patients with Mycoplasma hominis (84.2%) that in the general patient group (60%) (p = 0.033). There were no significant differences in the frequency of HG-PIN and PC between the patients from the general group (60%) and those with Mycoplasma genitalium (71.4%) (p = 0.05). The patients with verified PC and HG-PIN were more frequently found to have Mycoplasma hominis (20%) than Mycoplasma genitalium (6.2%), which further drew our closer attention to just this pathogen. The real-time PCR was used in 123 subjects to detect Mycoplasma. HG-PIN and prostate adenocarcinoma were revealed in 63 of the 123 patients with suspected PC, Mycoplasma hominis was seen in 46 (37%). The frequency (n=46) was 73.9%. The frequency of HG-PIN and PC was significantly higher in the patients with isolated Mycoplasma hominis DNA that in those without this pathogen (p < 0.001). Conclusion. Thus, the investigation showed a significantly higher correlation in the frequency of HG-PIN and PC in the patients with Mycoplasma infection that in the general study patients with suspected PC. This was supported by the use of both the standard procedure for Mycoplasma DNA determination and real-time PCR diagnosis.

Показано, что у большинства женщин недержание мочи начинается одновременно с последним менструальным периодом. Многие женщины, страдая от симптомов нарушения мочеиспускания, с большей неохотой обращаются за помощью к профессионалам по сравнению с другими заболеваниями. Стеснительность и отношение женщин к проблеме как к неотъемлемому признаку старения приводят к тому, что полученные цифры о распространенности заболевания не отражают истинного положения вещей. В последние годы исследование распространенности недержания мочи проведено Д.Ю.Пушкарем (1996). Однако в этой работе, как и в большинстве работ других авторов, частота недержания мочи не была сопоставлена с климактерическим периодом. К сожалению, в силу социально-экономических причин в России практически отсутствуют выполненные на больших свободных популяциях эпидемиологические исследования, посвященные частоте урогенитальных расстройств вообще и расстройств мочеиспускания в частности. Данных о распространенности нарушений мочеиспускания у женщин в постменопаузе в нашей стране нет.Цель нашего исследования - усовершенствование существующих схем медикаментозного лечения пациенток со стрессовым недержанием мочи в климактерическом периоде. В результате проведенного нами исследования установлено, что наиболее эффективной является комбинированная терапия стрессового недержания мочи у женщин в климактерическом периоде с использованием препаратов для ЗГТ и селективных модуляторов негормональных рецепторов нижних мочевых путей. По нашему мнению, возможностью повышения эффективности лечения стрессового недержания мочи у женщин в климактерическом периоде является: 1) первоначальное, не менее чем на 3-6 мес назначение ЗГТ (в комбинации с селективными модуляторами негормональных рецепторов нижних мочевых путей); 2) решение вопроса о необходимости и варианте оперативного лечения; 3) дальнейшее пожизненное применение ЗГТ.

Рак предстательной железы (РПЖ) - одно из наиболее распространенных заболеваний у мужчин пожилого возраста. При наличии костных метастазов, а также при развитии резистентности к гормональной терапии, вероятность осложнений со стороны скелета возрастает.В связи с актуальностью проблемы в 2002 г. было решено провести Российское многоцентровое исследование по оценке эффективности зометы у больных РПЖ с костными метастазами.В исследовании участвовало 9 исследовательских центров. Урологи, онкологи в настоящее время имеют в своем арсенале эффективный препарат "Зомета", который позволяет длительное время стабилизировать состояние костной системы и снижать число патологических осложнений со стороны скелета. Зомета одобрена Фармкомитетом МЗ РФ для лечения больных с литическими, бластическими и смешанными метастазами в кости. Все указанное подтверждает необходимость широкого использования зометы в лечении больных РПЖ.