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Вестник РУДН. Серия: МЕДИЦИНА
RUDN Journal of MEDICINE
2018 Vol. 22 No. 3 272-278
http://journais.rudn.ru/medjcine
DOI: 10.22363/2313-0245-2018-22-3-272-278
EPIDEMIOLOGY OF AGE-RELATED ANDROGEN DEFICIENCY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA
P.I. Chumakov, L.A. Marchenko, I.V. Kravchenko
Stavropol' State Medical University, Stavropol, Russia
Abstract. Every fourth patient at the age of 50 years, every third patient at the age of 60 years, every second man at the age of 70 years and almost everyone (90%) older than 80 years have Benign prostatic hyperplasia (BPH). Lower urinary tract symptoms developing against the background of BPH are often connected both with manifestations of the hyperplasia of a prostate, and with the age androgenic deficiency (AAD). Aim: To determine the frequency of emergence of age androgenic deficiency of patients with Benign prostatic hyperplasia (BPH). Materials and Methods: 180 patients with clinical signs of Benign prostatic hyperplasia have been examined. All patients were conducted with standard clinical examination: survey, measurement of International prostate symptom score (IPSS), assessment of quality of life (QOL). The research of the androgenic status of patients included clinical assessment of deficiency of androgens with the use of the standard international questionnaire: "The questionnaire of Aging Males' Symptoms" (AMS) and hormonal blood test with determination of level of the general testosterone, follicle-stimulating and luteinizing hormones. Results: There were 118 patients with the low level of the general testosterone (Tgen) (67,7%) of all people. An average level of Tgen was 8,74 ± 0,9 nmol/l. In group of patients with low testosterone the GPA (grade point average) on a scale of AMS was 47,3 ± 9,1. Patients with BPH and AAD frequently have the accompanying pathology which is generally presented in such diseases as arterial hypertension, a metabolic syndrome, coronary heart disease, diabetes of the II type, anurolithic disease. Conclusions: Monitoring of the Tgen level is necessary for patients with BPH. Considering the high risk of a combination of BPH with the deficiency of testosterone it is necessary to include in the standard scheme of inspection the hormonal blood test with determination of the Tgen level.
Key words: benign prostatic hyperplasia, testosterone, age, androgen deficiency, metabolic syndrome
Correspondence Author:
P.I. Chumakov — MD, Professor of the Department of Polyclinic Surgery with the Course of Urology of Stavropol State Medical University, ul. Mira, 310, Stavropol, 355017, Russia; E-mail: [email protected] SPIN: 1274-7096, ORCID: 0000-0002-6566-6087
For citation: Chumakov P.I., Marchenko L.A., Kravchenko I.V. (2018). Epidemiology of Age-Related Androgen Deficiency in Patients with Benign Prostatic Hyperplasia. RUDN Journal of Medicine, 22 (3), 272—278. DOI: 10.22363/2313-02452018-22-3-272-278.
Для цитирования: Чумаков П.И., Марченко Л.А., Кравченко И.В. Эпидемиология возрастного андрогенного дефицита у пациентов с доброкачественной гиперплазией предстательной железы // Вестник Российского университета дружбы народов. Серия: Медицина. 2018. Т. 22. № 3. С. 272—278. DOI: 10.22363/2313-0245-2018-22-3-272-278.
Benign prostatic hyperplasia (BPH) is the most widespread urological disease of men of the advanced age [1—3]. According to modern writers every fourth patient at the age of 50 years, every third patient at the age of 60 years, every second man at the age of 70 years and almost everyone (90%) older than 80 years have BPH [2, 4—6]. BPH isn't a threat of life of the patient, but its clinical manifestations considerably reduce quality of life
[4, 6—8]. As a rule, BPH is clinically shown in the form of disorder of quality of urination [1, 2, 9]. Despite the medical importance of BPH, pathogenesis of this disease up to the end remains not clear [1, 4—6, 10]. Many urologists specify in the researches that BPH is a multiple-factor disease: violation of balance of estrogen and androgens, chronic inflammation, metabolic syndrome, oxidative stress, etc. [7, 11—14].
Lower urinary tract symptoms developing against the background of BPH are often connected both with manifestations of the hyperplasia of a prostate, and with an age androgen deficiency (AAD), being at the same time compensatory reaction which is directed to increase the production of 5a-DHT, against the background of the reduced level of testosterone [15—17]. According to H.Y. Ngai et al. AAD meets in 26.5% of cases of men with clinical manifestations of lower urinary tract symptoms (LUTS) during BPH [18].
Not always drug treatment of patients with BPH yields satisfactory results [1, 6, 13, 19, 20]. Influence of age decrease of androgens on a clinical process of BPH is not well- studied now.
The aim of the study wasto determine the frequency of emergence of age androgenic deficiency of patients with benign prostatic hyperplasia (BPH).
MATERIALS AND METHODS
180 patients with clinical symptoms of benign prostatic hyperplasia (BPH) have been examined. The protocol of the real research has been approved by the decision of local ethical committee and also corresponds to the Helsinki declaration [21]. Consent of Patients to a Research has been received.
All patients were conducted with standard clinical examination: survey, measurement of International prostate symptom score on a 35-ball scale (IPSS), assessment of quality of life on a 6-ball scale (QOL), a manual rectal research. We carried out laboratory methods of research: the general blood test with a haemo syndrome, the general analysis of urine, the biochemical blood test including determination of level of glucose of blood, electrolytes, urea, creatinine, the general protein, choles-
terol, triglycerides, determination of level of the prostates of specific antigen (PSA).
The research of the androgenic status of patients included clinical assessment of deficiency of andro-gens with the use of the standard international questionnaire: "The questionnaire of Aging Males' Symptoms" (AMS) and hormonal blood test. Hormonal blood test included determination of level of the general testosterone (Tgen), an estradiol, Prolac-tinum and the level of gonadotropic hormones of a hypophysis: follicle-stimulating (FSG) and luteinizing (LG) hormones and for differential diagnostics of character of the available gipogonadizm.
Ultrasound investigation of nephros, prostate gland, urinary bladder, with evaluation of amount of residual urine was carried out by a standard technique on the device "VolusonE 8" GE with the convex sensor with a frequency of 3,5 MHz [22, 23].
Results of the research have been subjected to statistical processing (Statistics program 6,0) with respect for criterion Mann-Whitney. The reliable difference was 95% (p < 0,05).
RESULTS AND DISCUSSION
All examined patients were older than 50 years. Average age of patients was 64 ± 8 years. Distribution of patients on age is presented in Table 1.
For the purpose of AAD identification biochemical blood test with definition of a hormonal profile was made to patients. Thus, there were 118 patients with the low level of the general testosterone (67,7%) that we have regarded as AAD. Other patients with BPH — 62 (32,3%) have been estimated as normogonadotropic and became group of control. Results of hormonal blood test of patients with BPH And AAD are presented in Table 2.
Table 1 / Таблица 1
Distribution of the examined patients on age (N = 180) / Распределение обследуемых пациентов по возрасту (N = 180)
Number Age
50—54 years 55—59 years 60—64 years 65—69 years 70—74 years 75—80 years
n 7 24 35 39 46 29
% 3,8 13,3 19,4 21,6 25,5 16,1
Table 2/ Таблица 2
Results of hormonal blood test / Результаты гормонального исследования крови
T LG FSG estradiol Prolactinum
nmol/l nmol/l ME/ml ME/ml pg/ml
Normal indicators 19,2 ± 1,1 8,6 ± 1,2 6,3 ± 0, 7 58,9 ± 17 5,0 ± 1,2
BPH + AAD 8,74 ± 0,9 9,3 ± 1,8 7,0 ± 0,4 51,4 ± 12 4,8 ± 0,7
Р р < 0,05 р > 0,05 р > 0,05 р > 0,05 р > 0,05
120
sluggish complicated tension nocturia urgent frequent
stream urination during desires desires
of urine urination to urinate to urinate
Fig. 1. Clinical manifestations of BPH against the background of age androgenic deficiency (Irritant symptoms of abnormality of urination of patients with BPH in combination with AAD prevailed over obstructive (р < 0,05)) /
Рис. 1. Клинические проявления ДГПЖ на фоне возрастного андрогенного дефицита (у пациентов с ДГПЖ в сочетании в ВАД преобладали ирритативные симптомы нарушения мочеиспускания над обструктивными (р < 0,05))
The GPA of group of patients with BPH and normal level of testosterone according to the questionnaire of AMS was 28,0 ± 6,3. In the group of patients with low testosterone the GPA on a scale of AMSwas 47,3 ± 9,1 (р < 0,05).
Further we represent results of clinical trial of group of patients with BPH against the background of age androgenic deficiency. The average level of PSA was 2,8 ± 0,6 ng/ml. The GPA on a scale of IPSS was 17,4 ± 4,2. All men estimated the quality of life, on Qol scale as unsatisfactory, an average value — 4,2 ± 0,6 points. Clinical manifestations of BPH against the background of age androgenic deficiency are presented in the figure 1.
Irritant symptoms of abnormality of urination of patients with BPH in combination with AAD prevailed over obstructive.
According to ultrasonography the Volume of prostate gland was 62,7 ± 12,6 cm3, the size of adenomatous knots — 14,9 ± 2,1 cm3, the volume of residual urine — 48,6 ± 23,4 cm3.
In group of patients with BPH and deficiency of testosterone 109(92,3%) violations of an erection have been revealed. The GPA on a scale of MIEF-5 was 12 ± 5 points.
Among patients with BPH and low level of testosterone the following associated diseases occurred more often: the arterial hypertension (AH) — 59 people (43,7%) diabetes of the II type (SD) — 19 (14%) men, the metabolic syndrome (MS) is revealed at 75 (5%). Frequency of associated diseases of patients with BPH and ADD is presented in table 3.
Table 3 / Таблица 3
Frequency of associated diseases of patients with AAD / Частота заболеваний, ассоциированных с возрастным андрогенным дефицитом (ВАД)
Number of patients Diseases
CHD AH Diabetes of the II type MS Chronic prostatitis USD Chronic bronchitis
n 17 64 32 96 45 28 5
% 14,4 54,2 27,1 81,3 38,1 23,7 4,2
Influence of low level of testosterone on progressing of BPH can be explained with the fact that AAD leads to violation of mechanisms of regulation in the system of a gonad — a hypophysis — a hypothalamus.
It is known that besides age decrease in level of testosterone in blood, men with BPH have a decreasing number of androgen receptors. The last, in turn, strengthens the clinical manifestations of AAD and the related processes in an organism.
Multifactorial effect of testosterone is characterized by the range of the metabolic violations developing owing to its deficiency. A variety of a clinical picture of age androgenic deficiency is explained by structurally functional changes in many bodies and systems (a reproductive system, the central nervous system, bones and muscles). Therefore decrease of testosterone leads not only to sexual, but also to other somatic violations which potentially impact on quality of life of patients.
The most of modern writers agrees in opinion that progression of BPH is a consequence of an imbalance of the circulating sex hormones in the course of aging of a male body.
CONCLUSION
Men with Benign prostatic hyperplasia and age androgenic deficiency meet in 67,7% of cases. Therefore, monitoring of the level of testosterone is necessary for patients with BPH. Considering the high risk of a combination of BPH with deficiency of testosterone it is necessary to include in the standard scheme of inspection hormonal blood test with determination of level of the general testosterone. Patients with BPH and AAD have the accom-
panying pathology which is generally presented by such diseases as arterial hypertension, metabolic syndrome, coronary heart disease, diabetes of the II type, urinary stone disease more often.
REFERENCES
1. Gratzke C., Bachmann A., Descazeaud A., Drake M.J., Madersbacher S., Mamoulakis C. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015;67:1099—109.
2. Wang X., Lin W.J., Izumi K. Increased infiltrated macrophages in benign prostatic hyperplasia (BPH): role of stromal androgen receptor in macrophage-induced prostate stromal cell proliferation. J Biol Chem. 2012;287:18376.
3. Kaprin A.D., Kostin A.A., Kulchenko N.G. The relationship of ultrasonic and morphological changes of the prostate tissue in patients with benign prostatic hyper-plasia on a background of conservative therapy. Andro-logiya i genitalnaya hirurgiya. 2012;3:47—51. (In Russian).
4. Vuichoud C., Loughlin K.R. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22(1):1—6.
5. Gandhi J., Weissbart S.J., Smith N.L., Kaplan S.A., Dagur G., Zumbo A., Joshi G., Khan S.A. The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia. Transl. Androl Urol. 2017;6:295—304.
6. Kaprin A.D., Kostin A.A., Kulchenko N.G. Optimization of drug therapy for benign hyperplasia. Voprosy urologii i andrologii. 2013;1(2):5—9. (In Russian).
7. Patel N.D., Parsons J.K. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014;30:170—176.
8. Kulchenko N.G., Bicherova K.I., Strachuk A.G., Gud-kova I.E. Clinical and morphological characteristics of the pancreas on the background of treatment with an inhibitor of 5-alphareductase for BPH. Zemskij vrach. 2012;5:55—56. (In Russian).
9. Bostancia Y., Kazzazia A., Momtahenb S., Lazea J., Djavana B. Correlation between benign prostatic hyperplasia and inflammation. Curr. Opin Urol. 2013;23:5—10.
10. Egan K.B. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am. 2016; 43:289—97.
11. ZHukov O.B., Zubarev A.R., Kul'chenko N.G. Vliyanie androgenozamestitel'noj terapii na gemodinamicheskie parametry vnutri organnogo krovotoka organov-mishenej testosterona. Andrologiya i genital'naya hirurgiya. 2008; 1:31—35. (In Russian).
12. Eom C.S., Park J.H., Cho B.L., Choi H.C., Oh M.J., Kwon H.T. Metabolic syndrome and accompanying hyperinsulinemia have favorable effects on lower urinary tract symptoms in a generally healthy screened population. J Urol. 2011;186:175—179.
13. Efremov E.A., Shekhovtsov S.Yu., Merinov D.S., Bu-tov A.O., Kastrikin Yu.V., Garaev T.I. Change in testosterone levels in endoscopic operations on the prostate gland. Research 'n Practical Medicine Journal (Issled. prakt. med.). 2018; 5(2): 48—55. (In Russian).
14. Kasyan G.R., Konovalov I.V. Sovremennye vozmozhnosti kombinirovannoj terapii simptomov nizhnih mochevyvo-dyashchih putej na fone dobrokachestvennoj giperplazii predstatel'noj zhelezy u muzhchin. Issledovaniya i praktika v medicine. 2016; 3(2): 37—44. (In Russian).
15. Nicholson T.M., Ricke W.A. Androgens and estrogens in benign prostatic hyperplasia: past, present and future. Differentiation. 2011;82:184.
16. Kulchenko N.G. Optimizaciya podhodov konservativnoj terapii dobrokachestvennoj giperplazii predstatelnoj
zhelezy inibitorami 5-al'fareduktazy. Kliniko-morfo-logicheskoe issledovanie. Kurskij nauchno-prakticheskij vestnik CHelovek i ego zdorov'e. 2012; 1: 101—106. (In Russian).
17. Hirshburg J.M., Kelsey P.A., Therrien C.A., Gavino A.C., Reichenberg J.S. Adverse effects and safety of 5-alpha reductase inhibitors (finasteride, dutasteride): a systematic review. J Clin Aesthet Dermatol. 2016; 9: 56—62.
18. Ngai H.Y., Yuen K.S., Ng C.M., Cheng C.H., Chu S.P. Metabolic syndrome and benign prostatic hyperplasia: An update. Asian J Urol. 2017; 4(3):164—173.
19. Jarvis T.R., Chughtai B., Kaplan S.A. Testosterone and benign prostatic hyperplasia. Asian J Androl. 2015; 17:212—216.
20. Giorgio I.R., Cimino S., Morgia G. Benign prostatic hyperplasia and metabolic syndrome: the expanding evidences of a new disease of aging male. Aging Male. 2015;18:133—134.
21. World Medical Association. Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013; 310 (20): 2191—2194.
22. Gromov A.I., Builov V.M. Luchevaya diagnostika i tera-piya v urologii [Radiation diagnostics and therapy in urology]. Moscow: "GEOTAR-Media" Publ., 2011, 544 p. (In Russian).
23. Bolockov A.S., Volkov A.A., Petrichko M.I. Ehlasto-grafiya sdvigovoj volny v diagnostike zabolevanij pred-statel'noj zhelezy. Medical news of the North Caucasus. 2013;8(3):73—75. (In Russian).
Received 04.07.2018 Accepted 29.08.2018
DOI: 10.22363/2313-0245-2018-22-3-272-278
ЭПИДЕМИОЛОГИЯ ВОЗРАСТНОГО АНДРОГЕННОГО ДЕФИЦИТА У ПАЦИЕНТОВ С ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИЕЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ
П.И. Чумаков, Л.А. Марченко, И.В. Кравченко
Федеральное государственное бюджетное образовательное учреждение высшего образования «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской федерации, Ставрополь, Россия
Доброкачественная гиперплазия предстательной железы (ДГПЖ) встречается у каждого четвертого пациента в возрасте 50 лет, у каждого третьего пациента в возрасте 60 лет, у каждого второго мужчины в возрасте 70 лет и почти у каждого (90%) старше 80 лет. Симптомы заболеваний нижних мочевыводящих путей, развивающиеся на фоне ДГПЖ, зачастую связаны как с проявлениями самой гиперплазии простаты, так и с возрастным андрогенным дефицитом (ВАД). Цель. Определить частоту возникновения возрастного андрогенного дефицита у пациентов с доброкачественной гиперплазией предстательной железы. Материалы и методы. Были обследованы 180 пациентов с клиническими
признаками доброкачественной гиперплазии предстательной железы. Всем пациентам проводилось стандартное клиническое обследование: осмотр, измерение суммарного балла по международной системе суммарной оценки симптомов при заболеваниях предстательной железы (IPSS), оценка качества жизни Исследование андрогенного
статуса пациентов включало клиническую оценку дефицита андрогенов с использованием стандартной международной анкеты: «Опросник возрастных симптомов мужчины» (AMS — AgingMales' Symptoms) и гормональное исследование крови с определением уровня общего тестостерона, фолликулостимулирующего и лютеинизирующего гормонов. Результаты. Пациентов с низким уровнем общего тестостерона (Тобщ) было 118 (67,7%) человек. Средний уровень Тобщ у них был 8,74 ± 0,9 нмоль/л. В группе пациентов с низким тестостероном средний балл по шкале AMS составил 47,3 ± 9,1. У пациентов с ДГПЖ и ВАД чаще встречается сопутствующая патология, в основном представленная такими заболеваниями, как артериальная гипертензия, метаболический синдром, ишемическая болезнь сердца, сахарный диабет II типа, мочекаменная болезнь. Заключение. Для пациентов с ДГПЖ необходим мониторинг уровня Тобщ. Учитывая высокий риск сочетания ДГПЖ с дефицитом тестостерона необходимо в общепринятую схему обследования включать гормональное исследование крови с определением уровня Тобщ.
Ключевые слова: доброкачественная гиперплазия предстательной железы, тестостерон, возраст, андрогенный дефицит, метаболический синдром
Ответственный за переписку:
Чумаков Петр Ильич, д.м.н., профессор кафедры поликлинической хирургии с курсом урологии ФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской федерации, ул. Мира, 310, г. Ставрополь, 355017, Россия. E-mail: [email protected]; SPIN-код: 1274-7096, ORCID: 0000-0002-6566-6087
БИБЛИОГРАФИЧЕСКИЙ СПИСОК
1. Gratzke C., Bachmann A., Descazeaud A., Drake M.J., Madersbacher S., Mamoulakis C. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015;67:1099—109.
2. WangX., Lin W.J., Izumi K. Increased infiltrated macrophages in benign prostatic hyperplasia (BPH): role of stromal androgen receptor in macrophage-induced prostate stromal cell proliferation. J Biol Chem. 2012; 287:18376.
3. Каприн А.Д., Костин А.А., Кульченко Н.Г. Взаимосвязь ультразвуковых и морфологических изменений ткани предстательной железы у пациентов с доброкачественной гиперплазией на фоне консервативной терапии. Андрология и генитальная хирургия. 2012;3:47—51.
4. Vuichoud C., Loughlin K.R. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22(1):1—6.
5. Gandhi J., Weissbart S.J., Smith N.L., Kaplan S.A., Dagur G., Zumbo A., Joshi G., Khan S.A. The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia. TranslAndrol Urol. 2017;6:295—304.
6. Каприн А.Д., Костин А.А., Кульченко Н.Г. Оптимизация медикаментозной терапии доброкачественной гиперплазии предстательной железы. Вопросы урологии и андрологии. 2013;1(2):5—9.
7. Patel N.D., Parsons J.K. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014;30:170—176.
8. Кульченко Н.Г., Бичерова К.И., Страчук А.Г., Гуд-кова И.Е. Клинико-морфологическая характеристика ПЖ на фоне лечения ингибиторами 5-альфаредуктазы при ДГПЖ. Земский врач. 2012;5:55—56.
9. Bostancia Y., Kazzazia A., Momtahenb S., Lazea J., Djavana B. Correlation between benign prostatic hyper-plasia and inflammation. Curr. Opin Urol. 2013;23:5—10.
10. Egan K.B. The epidemiology of benign prostatic hyper-plasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am. 2016; 43:289—97.
11. Жуков О.Б., Зубарев А.Р., Кульченко Н.Г. Влияние андрогенозаместительной терапии на гемодинамиче-ские параметры внутриорганного кровотока органов-мишеней тестостерона. Андрология и генитальная хирургия. 2008;1:31—35.
12. Eom C.S., Park J.H., Cho B.L., Choi H.C., Oh M.J., Kwon H.T. Metabolic syndrome and accompanying hyperinsulinemia have favorable effects on lower urinary tract symptoms in a generally healthy screened population. J Urol. 2011;186:175—179.
13. Ефремов Е.А., Шеховцов С.Ю., Меринов Д.С., Бутов А.О., Кастрикин Ю.В., Гараев Т.И. Изменение уровня тестостерона при эндоскопических операциях на предстательной железе. Исследования и практика в медицине. 2018; 5(2):48—55.
14. Касян Г.Р., Коновалов И.В. Современные возможности комбинированной терапии симптомов нижних мочевыводящих путей на фоне доброкачественной гиперплазии предстательной железы у мужчин. Исследования и практика в медицине. 2016; 3(2):37—44.
15. Nicholson T.M., Ricke W.A. Androgens and estrogens in benign prostatic hyperplasia: past, present and future. Differentiation. 2011;82:184.
16. Кульченко Н.Г. Оптимизация подходов консервативной терапии доброкачественной гиперплазии предстательной железы ингибиторами 5-альфаредуктазы. Клинико-морфологическое исследование. Курский научно-практический вестник «Человек и его здоровье». 2012;1:101—106.
17. Hirshburg J.M., Kelsey P.A., Therrien C.A., Gavino A.C., Reichenberg J.S. Adverse effects and safety of 5-alpha reductase inhibitors (finasteride, dutasteride): a systematic review. J Clin. Aesthet. Dermatol. 2016; 9: 56—62.
18. Ngai H.Y., Yuen K.S., Ng C.M., Cheng C.H., Chu S.P. Metabolic syndrome and benign prostatic hyperplasia: An update. Asian J Urol. 2017; 4(3):164—173.
19. Jarvis T.R., Chughtai B., Kaplan S.A. Testosterone and benign prostatic hyperplasia. Asian J Androl. 2015;17: 212—216.
20. Giorgio I.R., Cimino S., Morgia G. Benign prostatic hyperplasia and metabolic syndrome: the expanding evidences of a new disease of aging male. Aging Male. 2015;18:133—134.
21. World Medical Association. Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013; 310 (20): 2191—2194.
22. Громов А.И., Буйлов В.М. Лучевая диагностика и терапия в урологии: национальное руководство. М.: ГОЭТАР-Медиа, 2011. 544 с.
23. Болоцков А.С., Волков А.А., Петричко М.И. Эласто-графия сдвиговой волны в диагностике заболеваний предстательной железы. Медицинский вестник Северного Кавказа. 2013;8(3):73—75.
Поступила 04.07.2018 Принята 29.08.2018
