Highlights. The article discusses the features of general anesthesia in patients with cerebrovascular diseases using the relaxant binding agent sugammadex.Aim. To evaluate the effectiveness of sugammadex in endovascular management of cerebrovascular diseases.Methods. The study included 57 patients who underwent endovascular treatment of cerebrovascular disease under general anesthesia. The experimental group included 29 patients who were injected with sugammadex - a selective relaxant binding agent for reversal of neuromuscular block induced by rocuronium. The comparison group included 28 patients who did not undergo decurarization (n = 13), or it was performed with neostigmine (n = 15). Acceleromyography was used to monitor the state of neuromuscular function.Result. Onset of action and duration of action of rocuronium at a dose of 0.9 mg/kg did not differ between the groups. The neuromuscular recovery time was 2.14 [1.67; 2.59] minutes after administration of sugammadex, compared with spontaneous 35.8 [31.5; 40.4] minutes and neostigmine-induced 22.1 [16.8; 27.3] minutes (p<0.001). No adverse or allergic reactions were noted after administration of the relaxant binding agent.Conclusion. Using a specific antidote sugammadex to eliminate the effect of rocuronium helps to restore neuromuscular function within 2–3 minutes and assess the neurological status of patients immediately after the endovascular treatment of cerebrovascular disease.

The results of surgical treatment of 59 patients with veno-occlusive erectile dysfunction and follow-up of 8 years are presented. The age of patients is 18-48 years old (average age is 29.3 ± 7.6). Five of them had hemodynamic and clinical signs of arteriovenous erectile dysfunction in the stage of subcompensation, 16 patients underwent simultaneous treatment in the form of sclerotherapy of testicular veins in connection with the secretory type of male infertility, 5 underwent simultaneous surgical treatment to eliminate veno-occlusive and arterial insufficiency of the cavernous bodies of the penis by stenting of the internal iliac or pudendal arteries, 2 patients underwent delayed stenting of the iliac veins due to May-Turner syndrome, the remaining patients underwent surgical treatment aimed at eliminating venous erectile dysfunction. The diagnosis was established on the basis of a clinical and urological examination, including physical examination and questioning according to the IIEF-5 (International Index of Erectile Function), ultrasound Doppler examination of the cavernous bodies of the penis with intracavernous pharmacotest, dynamic computer pharmacocavernosography with 3D reconstruction, with veno-occlusive arteries with suspected arteries, or computer tomography arterial insufficiency of the cavernous bodies of the penis. All types of endovascular and hybrid operations on the venous collectors of the penis were analyzed. Priority surgical techniques for the treatment of pathological venous drainage have been identified, which are 75 % effective in the long-term postoperative period. Based on the presented experience of the authors and analysis of foreign literature, the expediency of revising the European and Russian recommendations for venous surgery of the penis towards the priority use at the first stage of minimally invasive X-ray surgical treatment in a category of young patients has been proved.

The article presents the results of endovascular diagnosis and treatment of 76 women suffering from migraine cefalgia, which as a result of the survey also identified signs of a congenital disease. The failure of the ovarian vein valve apparatus and reversed blood flow on them with the formation of pelvic full-volume was detected in 100 % of cases. The results of the endovascular correction of pelvic venous blood flow make it possible to approve about the connection of the congenital syndrome with migraine cefalgia with a high propriety.

Introduction. Modern studies indicate a close relationship between the deterioration of the quality of the ejaculate and the increase in the symptoms of the lower urinary tract (LUTS) with the increase in the age of the man. Taking into account the common pathogenesis of reproductive dysfunction, LUTS and the development of possible preventive measures, we conducted an independent study.The study objective was to evaluate the effectiveness of the combined dietary supplement Rotaprost to improve the functional state of the male genitourinary system.Materials and methods. The study included 30 patients with clinical and laboratory signs of infertility and LUTS aged 23–65 years (mean age 44.91 ± 4.5). Patients were divided into two groups of 15 patients. Group 1 with chronic pelvic pain syndrome (CPPS) of IIIb category (US National Institutes of Health, 1995) with secretory type of infertility and LUTS, group 2 of 15 patients with stage 1 benign prostatic hyperplasia (BPH), pathozoospermia and LUTS. During the study, clinical and laboratory parameters were registered, NIH-CPSI, IPSS-QoL, IIEF-5, NRS questionnaires were used, spermogram data, MAR test, oxidative stress, DNA fragmentation, and electron microscopy of spermatozoa were evaluated. All patients before and after treatment underwent triplex ultrasound of the scrotum and transrectal ultrasound of the prostate. Expert-class devices E-CUBE 15 (Alpinion) were used. Patients included in the design of the study took Rotaprost capsules No. 30, 1–2 times a day for 30 days at the place with meals, drinking a small amount of water. After the course of treatment, patients were examined again.Results. The results of the study showed a more significant effect on the parameter of progressive mobility after treatment in the group with CPPS IIIb (group 1) by 23.5 % compared to the BPH group, where the total increase was 10.7 %. Also, an interesting finding was the trend towards a decrease in the number of leukocytes in the semen while taking Rotaprost in patients with CPPS IIIb (from 1.22 million/ml to 0.43 million/ml) compared with the BPH group, where changes are less significant (from 0.68 million/ml to 0.36 million/ml). Comparing the level of reactive oxygen species in the ejaculate and assessing the DNA fragmentation of spermatozoa revealed a statistically significant decrease during treatment in both groups, reducing the amount of residual urine. The drug had a significant effect on the level of pain, assessed by the NRS scale and improved the quality of life, including IPSS-QoL and NIH-CPSI data. Conclusions. Rotaprost mineral-herbal complex allows to correct moderate pathozoospermia and indicators of impaired urination in the vast majority of patients with CPPS IIIb and men with stage 1 BPH.The use of the Rotaprost mineral-herbal complex for a month leads to an improvement in the quality of life of patients with CPPS IIIb, reducing their pain by 25 %, restoring the quality of urination, and reduce the prostate volume of men with stage 1 BPH.High safety and adherence to therapy in the studied groups of patients is explained by the general pathogenetic mechanisms of the development of these diseases in men over 40 years of age and the possibility of a complex effect on the key pathophysiological cellular mechanisms of age-related changes in the genitourinary system of men by multifactorial components of modern dietary supplements.