Evaluation of testosterone replacement therapy in the rehabilitation of men with urinary disorders after BPH surgical treatment.
Authors:   department of faculty surgery of the Federal State Educational Institution of Higher Education Chita State Medical Academy of the Ministry of Health, Dudarev V.A. ,   Chita, Russia, Startsev V.Yu. ,   Department of Oncology, Pediatric Oncology and Radiation Therapy, St. Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation, scientific consultant and urologist LLC «Multidisciplinary Medical Clinic MEDSI; St. Petersburg, Russia, Kushnirenko N.P. ,   Department of Urology in the S.M. Kirov Military Medical Academy of the Ministry of Defence of the Russian Federation; Saint-Petersburg, Russia
Published: April 2023

Introduction. Symptoms of lower urinary tract dysfunction (LUTS) in older men are most often associated with benign prostatic hyperplasia (BPH). A low level of testosterone leads to various changes in the organs and systems of the body, including causing structural changes in the tissues of the genitourinary system, which negatively affects their function. The aim of this work was to study the effect of testosterone replacement therapy on LUTS with androgen deficiency in patients after surgical treatment of BPH. Materials and methods. The analysis of observation and treatment of LUTS in 101 patients operated on for BPH was performed. The patients are divided into three groups. Group A (n=48) included patients with normal testosterone levels receiving conservative therapy for moderate LUTS. Groups B (n=38) and C (n=21) included patients with SNIP and low testosterone levels. In order to correct the level of testosterone in patients in group C, after surgical treatment, androgen replacement therapy was prescribed. For primary diagnosis and evaluation of the effectiveness of the treatment vinitial and during periods of 1, 3, 6 and 12 months, general clinical examination methods, the International Pancreatic Symptom Scale (IPSS) questionnaire, urination diaries (DM), uroflowmetry, and ultrasound examination of the pancreas and bladder were used. Results. According to the IPSS questionnaire, patients in group B had more pronounced manifestations of LUTS compared with patients in groups A and C due to accumulation symptoms. At the same time, by prescribing androgen replacement therapy, it was possible to achieve an increase in the level of total testosterone in patients of group C to «physiological values», corresponding to patients in group A. According to the results of the analysis of DM data, it was found that in patients in all observation groups, the number of urination per day decreased (p<0.001) with an increase in the functional capacity of the bladder. The highest values of the maximum micturition volume, at the end of the observation period, were recorded in patients in group A, the minimum micturition volume and the most pronounced decrease in episodes of nocturia and nocturia index – in patients in group C. Temporal values of the accumulative bladder function also indicate a more pronounced decrease LUTS in group C. Conclusions. The use of androgen replacement therapy increases the effectiveness of LUTS treatment in patients with androgen deficiency after surgical treatment of BPH.