The combined ultrasound/pneumatic lithotripsy device is safe and highly effective. It reduces treatment time and enhances surgeon's comfort.
73 patients with chronic bacterial prostatitis were undergone several methods of investigations, such as pelvic rheography, rheoprostatography, laser doppler flowmetry and ultrasonic dopplerography for studying its hemodynamics.The results obtained indicate a violation of the blood supply to the prostate, which depends not only of the severity of the inflammatory process, but on the degree of hemodynamic disturbances in the small pelvis too and caused by a violation of the tone of the vessels of the prostate as well. (For citation: Krupin VN, Krupin AV, Nashivochnikova NA. Evaluation of blood flow in prostate in patients with chronic bacterial prostatitis. Urologicheskie vedomosti. 2017;7(3):38-43. doi: 10.17816/uroved7338-43).
Введение. СЭффективность методов лечения хронического простатита, направленных на улучшение гемодинамики тазовых органов, доказана множеством исследований проведенных на протяжении более тридцати лет. В то же время, к нарушениям гемодинамики в малом тазу может приводить тазовый миофасциальный синдром (МФС). Цель исследования. Оценить влияние миофасциальных синдромов у больных хроническим бактериальным простатитом (ХБП) на кровообращение в предстательной железе и проследить динамику изменений кровотока в ней в ответ на лечение сопутствующего миофасциального синдрома. Материалы и методы. С целью оценки динамики кровообращения в предстательной железе обследованы 59 мужчин 34-52 лет с различными клиническими проявлениями миофасциального синдрома (пациенты неврологической клиники). Кроме того, влияние лечения сопутствующего миофасциального синдрома у больных ХБП на состояние гемодинамики в предстательной железе оценили у 127 мужчин в возрасте 28-52 года (средний возраст 38 лет) с типичными клиническими проявлениями хронического простатита, неоднократно и безуспешно получавшими лечение по поводу этого заболевания. Результаты. Получены результаты, свидетельствующие о нарушении микроциркуляции в предстательной железе у больных хронической тазовой болью (ХТБ) с миофасциальным синдромом. При этом нарушение гемодинамики в предстательной железе напрямую связано с нарушением тазовой гемодинамики в целом. Выявлена зависимость состояния микроциркуляции в предстательной железе от выраженности болевой симптоматики при неспецифической ХТБ, а лечение неспецифической ХТБ привело к снижению основного симптома заболевания (боль) и к нормализации микроциркуляции в предстательной железе. Лечение сопутствующего МФС у больных ХБП позволило добиться исчезновения клинических проявлений заболевания, нормализации гемодинамики в предстательной железе и исчезновению лабораторных признаков воспаления простаты. Выводы. Сопутствующий миофасциальный синдром у больных ХБП является причиной нарушений гемодинамики малого таза и, как следствие, развития воспалительного процесса. Выраженность нарушений гемодинамики напрямую зависит от интенсивности болевых проявлений МФС. Лечение миофасциального синдрома у пациентов ХБП сопровождается исчезновением клинических симптомов заболевания, восстановлением кровообращения в предстательнй железе и уменьшению или исчезновению признаков воспаления. Ключевые слова: тазовая гемодинамика; миофасциальный синдром; хронический бактериальный простатит; лечение Раскрытие информации: Исследование не имело спонсорской поддержки. Авторы заявляют об отсутствии конфликта интересов.
The aim of this study was to evaluate the state of blood flow in prostate in 59 men with chronic pelvic pain due to myofascial syndrome in the absence of clinical manifestations of chronic prostatitis and its dynamics against the background of the treatment. The results of the study revealed a reliable relationship between the severity of blood flow disorders in the prostate and the intensity of pain symptoms caused by myofascial syndrome. It was concluded that the hemodynamic disorders of the prostate caused by myofascial syndrome are important in the possible formation of clinical symptoms of chronic pelvic pain in men. (For citation: Krupin VN, Krupin AV, Belova AN, Nashivochnikova NA. The state of prostate hemodynamics in patients with myophascial pain syndrome. Urologicheskie vedomosti. 2017;7(4):39-43. doi: 10.17816/uroved7439-43).
In this study were analyzed the results of examination and treatment of patients with chronic prostatitis and vertebral neurogenic prostatopathy. Inclusion in the complex treatment of methods of correction of neurogenic disorders (segmental therapy, therapeutic gymnastics, psychotherapy, pharmacotherapy) showed high efficiency. Correction of the revealed neurological pathology and vertebral pathology as well, in most patients led to the elimination of not only neurological manifestations, but also symptoms of chronic prostatitis. (For citation: Krupin VN, Makhmudov IYa, Makhmudova LA, et al. Neurological aspects of diagnosis and treatment of chronic prostatitis. Urologicheskie vedomosti. 2017;7(3):22-27. doi: 10.17816/uroved7322-27).
The purpose of the study was to evaluate the blood flow in the left renal vein after ligation of the internal spermatic vein with varicocele and to study the changing of the level of biological markers of acute kidney damage in these patients. Materials and methods. Under observation were 64 men in age 1823 years with the first hemodynamic type of varicocele. In 3 patients clinically significant compression of the left renal vein was revealed and the remaining 61 patients underwent surgery by Ivanissevich approach. Before the operation, on the 2nd, 10th, 30th and 90th days after the operation patients underwent Doppler blood flow rate by ultrasound with color mapping of the left renal vein with measurement of venous blood flow velocity. During these periods all patients underwent laboratory tests, including the study of the content of cystatin C and interleukin 18 in the blood and urine. Results. On the first day after ligation of the internal spermatic vein an increase in the concentration of biological markers of acute kidney damage in the blood and urine was noted. After surgery all patients showed an increase in the diameter of the left renal vein by 1.52 mm and a decrease in the linear blood flow velocity in the region of the renal vien by 56 cm/s. On the 10th day after the operation the diameter of the left renal vein was increasesd by 34 mm more and the linear blood flow velocity slows down by 22.5 cm/s. The restoration of blood flow velocity and the diameter of the left renal vein occurred within three months and in most cases returned to baseline and in 22.9% of patients recovery did not occur by the 90th day of observation. Conclusion. Ligation of the internal spermatic vein with varicocele is accompanied by impaired blood flow in the left renal vein and an increase in the concentration of biological markers of acute kidney damage, which is a manifestation of venous hypertension and renal hypoxia. In most patients these indicators normalize to the 90th day of observation after surgery.
Purpose of the research. To assess the incidence of arterial hypertension in men with varicocele and to identify the relationship between increased blood pressure and surgical treatment of varicocele. Material and methods. A survey of 412 men receiving treatment for arterial hypertension, 482 men previously operated on for varicocele and 68 patients with varicocele who had no surgical treatment was conducted. Results. Varicose veins of the spermatic cord in patients with arterial hypertension were detected in 44.6% of cases, which exceeds the incidence of varicocele occurrence in men of a comparable age category by 1.52 times. Surgical treatment of the left spermatic cord varicocele is combined with the development of arterial hypertension in 51.2% of patients, which is three times higher than the incidence of hypertension in men who didnt undergo surgical treatment for varicocele and twice the frequency of hypertension in the general population of men of comparable age. The more frequent occurrence of renal arterial hypertension in patients who underwent surgical treatment for varicocele may indicate an adverse effect of occlusion of the internal spermatic vein on the state of renal venous hemodynamics. Conclusion. Varicocele should be considered as a compensatory process for renal venous hypertension due to obstruction of blood flow through the renal vein, and elimination of compensatory blood flow can lead to renal venous hypertension, hypoxia and the development of arterial hypertension.
A total of 127 patients (mean age 38.1 ± 7.8 years) with chronic bacterial prostatitis who had concomitant neurologic diseases were treated. The patients were divided into 3 groups: group 1 (n = 47) included those with pain of the upper lumbar spine and myofascial syndrome; group 2 (n= 41), those with disorders of general and peripheral autonomic tone with vascular disorders in the pelvis; and group 3 (n = 39), those with disorders of the joints of the pelvic girdle, ligaments, and muscles of the pelvic floor. Treatment was given for the specific neurologic and hemodynamic disorders identified. No antibiotic therapy was prescribed. Patients in group 1 were prescribed pathogenetic therapy, including manual and regional therapy (for effects on the sclerotome and myotome), as well as medical correction of hemodynamics, physiothe rapy, psychotherapy, and hyperbaric oxygenation. Group 2 received treatment aimed at correcting autonomic innervation, including medications and magnetic therapy. Patients in group 3 were prescribed specific therapy aimed at eliminating pain-provoking factors, medications, massage, physiotherapy, manual therapy, therapeutic exercises, and reflex therapy. Treatment was associated with a decrease in the severity of pain and improvement of pelvic hemodynamics in patients in all 3 groups. Thus, the results indicate the potential efficacy of pathogenetic therapy for patients with chronic bacterial prostatitis with concomitant neurologic pathology.
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