Object of study: reproductive health in men with chronic inflammation of the urogenital tract (CIUT). Purpose: to improve medical care for men with chronic inflammation of the urogenital tract in the practice of a family doctor by developing a pathogenetically proved observation algorithm and a differentiated scheme of immunocorrective therapy, taking into account medical, biological and social risk factors, morphometric and immunological features. Research methods: bibliosemantic, sociological, conventional clinical, laboratory and instrumental methods, morphological, immunological, biochemical; statisticalє, mathematical modeling. Scientific data on determining the most important risk factors for the development of CIUT in men: age 30 years and older; presence of a history of prostatitis and / or sexually transmitted diseases; body mass index higher than 29.5; sexual problems: erectile dysfunction, orgasm disorders; verified infertility. For the first time, the assessment of micromorphometric parameters of sperm in men with CIUT in the practice of a family doctor, an increase in the development of infertility in the number of persons with a pathological variant of spermograms with a predominance of microsomatic and hypercapitated morphotypes. On the basis of the conducted researches new data on features of disturbances from systemic and local immunity in blood and in an ejaculate of men with CIUT against chronic course of inflammatory process are received. For the first time, the features of dysregulation and inhibition of apoptosis at the local level were determined: significant growth in the ejaculate of cells ready for apoptosis (CD95 +, CD25 + and CD4 + HLA-DR4) as modulators of infertility formation in men with CIUT. For the first time the profile and ratio of cytokines of the main classes (pro- and anti-inflammatory cytokines, chemokines) in semen were analyzed and the peculiarities of their imbalance in men with CIUT depending on the state of fertility were established. For the first time, a comprehensive assessment of changes in the system of matrix metalloproteinases and their tissue inhibitors in seminal plasma as factors of the microenvironment in the formation of infertility in men with CIUT. For the first time, correlations between morphological, immunological and metabolic parameters of ejaculate were established, which formed the basis for the development of an original algorithm for monitoring patients with CIUT at the stage of primary care. Pathogenetically substantiated a new approach to the differentiated use of immunoactive drugs: "Polyoxidonium" (azoximer bromide), "Glutoxime" (glutamyl-cysteinyl-glycine disodium) and "Nuclex" (ribonucleic acid) in addition to the micrological data ejaculate in men with CIUT in the practice of a family doctor. For the first time, an original method of complex rehabilitation of men with CIUT at the stage of primary care using the immunoactive drug "Uro-Waxom" containing a lysate of Escherichia coli bacteria was proposed. For the first time, the prognostic model of reproductive health of men with CIUT taking into account medical, biological and social risk factors has been scientifically substantiated and tested. A new original patient-oriented algorithm of outpatient observation (diagnosis, treatment, rehabilitation, prevention) of men with CIUT by a family doctor has been developed and its clinical effectiveness has been proved.
