Aspects of improving clinical protocols for the profile «Adult urology»

Aim of the study. To evaluate the availability of pharmacological treatment and the relevance of recommendations presented in clinical protocols in the field of «Adult Urology» through a comparative analysis of international experience and to identify aspects for improving protocols in this field.
Materials and methods. The materials used were current clinical protocols for diagnosis and treatment in the field of «Adult Urology» available on the official website of the National Scientific Center for Healthcare Development, international recommendations of the constantly updated database of guidelines for decision support in clinical practice British Medical Journal Best Practice, guidelines of the European Association of Urologists, guidelines, reviews of the UpToDate resource, providing medical professionals with relevant and evidence-based information.
Results and discussion. Urological diseases are often complex, multifactorial conditions; it is impossible to encompass all treatment regimens for every clinical scenario. Nonetheless, it is necessary to broaden the scope of this profile by developing clinical protocols depending on the etiological factor, extent of involvement, and stage of medical intervention. Upon reviewing clinical protocols in the field of «Adult Urology» the following common deviations were identified regarding pharmacotherapy: irrational selection of antibacterial agents, routine use of antifungal prophylaxis, use of medications with low levels of evidence, dosing regimen errors, and the use of trade names in the protocol text, which constitutes a blatant violation of the ethical promotion policy of pharmaceuticals. Antibiotic therapy is recommended only for confirmed bacteriuria with broadspectrum antibiotics. Antifungal prophylaxis is recommended only for patients at risk (secondary or primary immunodeficiency).
Conclusions. Currently, 100% of clinical protocols in the field of «Adult Urology» are outdated and require revision. The rapid advancement of science, development, and improvement of pharmaceuticals necessitates ongoing professional development on the part of healthcare personnel, which can be facilitated by regular updating of clinical protocols. The availability of pharmacological therapy for urological patients is quite high: 97.35% medications presented in clinical protocols are available to patients in the Kazakhstani market (registered and included in the Kazakhstani National Drug Formulary), 94.7% medications are reimbursed within the framework of outpatient care, and 90.9% medications are available for procurement by medical organizations through the Single Distributor.

1. Arafa M. Jeffektivnost' snizhenija antioksidantov pri obychnyh i rasshirennyh testah funkcii spermy u pacientov s idiopaticheskim muzhskim besplodiem /A. Agarval, A. Madzhub // Antioksidanty (Bazel'). – 2020. – V. 9 (3). – P. 219.

2. Del' D. F. Sistematicheskij obzor i metaanaliz klinicheskih issledovanij primenenija ingibitorov aromatazy dlja lechenija muzhskogo besplodija // Aziatskij zhurnal andrologii. – 2020. – № 22 (4). – S. 360-367.

3. Kannarella R. Jeffekty selektivnyh moduljatorov receptorov jestrogena pri lechenii muzhskogo besplodija: sistematicheskij obzor i metaanaliz //Jekspertnoe mnenie o farmakoterapii. – 2019. – №20. – S. 15-17.

4. Mezhdunarodnye rekomendacii postojanno obnovljaemoj bazy rukovodstv dlja podderzhki prinjatija reshenij v klinicheskoj praktike British Medical Journal Best Practice //https://bestpractice.bmj.com/info/ (data obrashhenija: 16.03.2024).

5. Metodicheskie rekomendacii Evropejskoj associacii urologov //https://uroweb.org/guidelines(data obrashhenija: 16.03.2024)

6. Ministerstvo zdravoohranenija Respubliki Kazahstan «Press-reliz sistemnyh mer po obespecheniju finansovoj ustojchivosti» //https:// www.gov.kz/memleket/entities/dsm/press/news/ details/711242?lang=ru (data obrashhenija: 16.03.2024).

7. Nacional'nyj centr jekspertizy lekarstvennyh sredstv i medicinskih izdelij. Gosudarstvennyj reestr LS i MI //http://register.ndda.kz/category/search_prep (data obrashhenija: 16.03.2024)

8. Patan S. A. Sistematicheskij obzor i metaanaliz, sravnivajushhij jeffektivnost' nesteroidnyh protivovospalitel'nyh preparatov, opioidov i paracetamola pri pojavlenii ostroj pochechnoj koliki //S. A. Patan, B. Mitra, P. A. Kjemeron //Evropejskaja urologija. – 2018. – №73 (4). – S. 583-595.

9. Prikaz Ministra zdravoohranenija Respubliki Kazahstan ot 12 nojabrja 2020 goda № ҚR DSM - 188/2020 «Ob utverzhdenii pravil razrabotki i peresmotra klinicheskih protokolov» Zaregistrirovan v Ministerstve justicii Respubliki Kazahstan 16 nojabrja 2020 goda № 21637 //https://adilet.zan.kz/rus/docs/V2000021637 (data obrashhenija: 16.03.2024).

10. Prikaz Ministra zdravoohranenija Respubliki Kazahstan ot 20 avgusta 2021 goda № ҚR DSM-88 «Ob opredelenii perechnja lekarstvennyh sredstv i medicinskih izdelij, zakupaemyh u edinogo distrib'jutora» Zaregistrirovan v Ministerstve justicii Respubliki Kazahstan 24 avgusta 2021 goda № 24078 //https://adilet.zan.kz/rus/docs/V2100024078 (data obrashhenija: 16.03.2024).

11. Prikaz Ministra zdravoohranenija Respubliki Kazahstan ot 5 avgusta 2021 goda № ҚR DSM – 75 «Ob utverzhdenii Perechnja lekarstvennyh sredstv i medicinskih izdelij dlja besplatnogo i (ili) l'gotnogo ambulatornogo obespechenija otdel'nyh kategorij grazhdan Respubliki Kazahstan s opredelennymi zabolevanijami (sostojanijami)» Zaregistrirovan v Ministerstve justicii Respubliki Kazahstan 6 avgusta 2021 goda № 23885 //https://adilet.zan.kz/rus/docs/V2100023885 (data obrashhenija: 16.03.2024)

12. Prikaz Ministra zdravoohranenija Respubliki Kazahstan ot 6 ijunja 2023 goda № 103. «O vnesenii izmenenij v prikaz Ministra zdravoohranenija Respubliki Kazahstan ot 18 maja 2021 goda №ҚR DSM- 41 «Ob utverzhdenii Kazahstanskogo nacional'nogo lekarstvennogo formuljara». Zaregistrirovan v Ministerstve justicii Respubliki Kazahstan 7 ijunja 2023 goda №32721 //https://adilet.zan.kz/rus/docs/V2300032721 (data obrashhenija: 16.03.2024).

13. RGP na PHV «Nacional'nyj nauchnyj centr razvitija zdravoohranenija imeni Salidat Kairbekovoj» MZ RK. Klinicheskie protokoly //https://nrchd.kz/ru/2017-03-12-10-51-13/klinicheskie-protokoly (data obrashhenija: 16.03.2024).

14. Rekomendacii UpToDate //https://www.uptodate.com (data obrashhenija: 16.03.2024).

15. Salonija A. Muzhskoj gipogonadizm u detej i vzroslyh //Nat. Rev. Dis. Primers. – 2019. – №5. – C. 38.

16. Safarinezhad M. R. Issledovanie pentoksifillina po parametram spermy, reproduktivnyh gormonov i antioksidantnoj sposobnosti semennoj kletki u muzhchin s idiopaticheskim besplodiem: randomizirovannoe dvojnoe slepoe placebokontroliruemoe issledovanie //Int. Urol. Nefrol. – 2011. – №43 (2). – S. 315-328.

17. Centry po kontrolju i profilaktike zabolevanij. Rekomendacii po zabolevanijam, peredajushhimsja polovym putem //https://www.cdc.gov/std/treatmentguidelines/default.htm (data obrashhenija: 16.03.2024).

18. Shtajner A. Z. Vlijanie antioksidantov na muzhskoj faktor besplodija: randomizirovannoe klinicheskoe issledovanie «Muzhchiny, antioksidanty i besplodie» (MOXI) //Fertil. Steril. – 2020. – №113. – S. 552.

19. Chris H. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial //https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8905684 (data obrashhenija: 16.03.2024).

20. Maria A. C. Economic considerations of antifungal prophylaxis in patients undergoing surgical procedures /A. C. Maria, N. Petrosillo //https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039009/ (data obrashhenija: 16.03.2024).

21. Weidner W. Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis /W. Weidner, W. Krause, M. Ludwig //Hum. Reprod. – 1999. – V. 5. – P. 421.

22. WHO: European Health Information Gateway. SDR, disease of genitourinary system, all ages, per 100 000 //https://gateway.euro.who.int/en/indicators/hfa_269-1910-sdr-disease-of-genitourinary-systemall-ages-per-100-000/#id=19845 (data obrashhenija: 16.03.2024).