Urology reports (St. - Petersburg)

BACKGROUND: Renal cell carcinoma is predominantly observed in elderly patients. Many of them have multiple comorbidities, which can limit the feasibility of surgical treatment. The search for an optimal approach of radical treatment for comorbid and frail patients remains a current challenge.

AIM: To evaluate the perioperative outcomes of robot-assisted partial nephrectomy and radical nephrectomy in comorbid and frail patients with renal cell carcinoma.

MATERIALS AND METHODS: At the Almazov National Medical Research Centre we retrospectively studied the results of 118 comorbid and frail patients who underwent robot-assisted surgeries for localized renal cell carcinoma from 2012 to 2022. Mean age of men was 65.7 ± 11.4 years, and women was 61.3 ± 13.1 years. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Frailty was determined using a modified Frailty index (mFI-11). Robot-assisted partial nephrectomy and radical nephrectomy were perfomed by single experienced robotic surgeon. Perioperative functional outcomes were assessed. Renal function was evaluated based on glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula before surgery and at 1.3, and 6 months after surgery.

RESULTS: Among 118 patients, 71 (60.2%) underwent robot-assisted partial nephrectomy, while 47 (39.8%) underwent radical nephrectomy. Postoperative complications occurred in 15 (12.7%) of patients for robot-assisted surgeries. There were no positive surgical margins. Mortality in the early postoperative period amounted to 1.7% and was associated with the development of acute cardiovascular failure.

CONCLUSIONS: Robot-assisted partial nephrectomy and radical nephrectomy for renal cell carcinoma in comorbid and “fragile” patients — the safest and optimal method of treatment, accompanied by minimal perioperative complications and mortality.

BACKGROUND: Satisfaction with the results is a complex and poorly studied aspect of testicular prosthetics, which currently has no comprehensive consecration in the literature. There are no works that are based on a comprehensive view of the problem, from a subjective analysis of the local physical characteristics of the implant itself and the aesthetic perception of one’s body to assessing the impact of prosthetics on the patient’s sex life and socialization.

AIM: The aim of this study is to evaluate the results of testicular prosthetics using an original questionnaire reflecting satisfaction with the physical characteristics of the implant, sexual behavior characteristics and the socio-psychological status of the patient.

MATERIALS AND METHODS: Questionnaires of 236 patients were analyzed — 112 adults 1 year after prosthetics and 124 adolescents after reaching 18 years of age with a period after surgery from 1 to 8 years. The survey was carried out using an original questionnaire that included 15 questions reflecting various aspects of the patient’s attitude to the results of prosthetics.

RESULTS: Overall satisfaction with prosthetics was more than 90% in both groups, prevailing in patients operated on in adolescence. The greatest satisfaction with prosthetics was noted in patients after testicular torsion and trauma, less satisfaction in patients with cryptorchidism, testicular hypoplasia, and monorchidism. When analyzing the patient’s interest in this procedure depending on the period before prosthetics, it was noted that satisfaction does not tend to decrease over time, up to a 10-year interval between the loss of the gonad and prosthetics. Requirements for the final result of prosthetics tend to increase in more educated patients. The results of the survey demonstrate the greatest demands for prosthetics in patients in the age group of 21–30 years as the most sexually active age category.

CONCLUSIONS: Patient satisfaction with modern implant prosthetics is quite high — at least 90%. However, these values are not maximum and leave room for further optimization of this method, which follows from the lack of a maximum assessment of satisfaction with the results of prosthetics — for all criteria the indicators do not exceed 95%.

BACKGROUND: The cause of ejaculatory dysfunction in patients with benign prostatic hyperplasia can be either the disease itself or its surgical or drug treatment, including the use of alpha1-blockers.

AIM: To study the effect of alpha1-blockers on the ejaculatory function of patients with benign prostatic hyperplasia.

MATERIALS AND METHODS: Under observation were 90 patients with benign prostatic hyperplasia aged from 56 to 79 years, who were distributed into 3 groups of 30 people. Patients of the group 1 were prescribed tamsulosin at a dose of 0.4 mg once a day, patients of the group 2 were prescribed silodosin at a dose of 8 mg once a day, and patients of the group 3 were prescribed alfuzosin 10 mg once a day. Duration of treatment is 4 weeks. To assess the effectiveness of treatment and its impact on copulatory function before and after treatment, patients filled out the IPSS, IIEF-5, ICF and MSHQ questionnaires.

RESULTS: The reduction in the severity of clinical manifestations of benign prostatic hyperplasia and the improvement in quality of life in patients of the three groups were the same. The effect of alpha1-blockers on erectile function has not been noted. A significant decrease in ejaculatory function was revealed in patients of the groups 1 and 2, while in patients of the group 3 no changes in ejaculatory function were observed.

CONCLUSIONS: When planning drug therapy for patients with benign prostatic hyperplasia, it is necessary to take into account the specific effects of different alpha1-blockers on ejaculatory function.

A systematic review and meta-analysis of research data on the effectiveness of the drug Wobenzym in the treatment of chronic bacterial prostatitis was performed. The aim of this study to evaluate the effectiveness of Wobenzym in the complex therapy of chronic bacterial prostatitis. The analysis included randomized and non-randomized controlled studies of the effectiveness of Wobenzim in the complex therapy of chronic bacterial prostatitis. The search was carried out in the databases CENTRAL, PubMed, ICTRP, eLibrary, ClinicalTrials.gov., Google Scholar, CyberLeninka, search engines. The meta-analysis was conducted using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Statistical heterogeneity was assessed using the Cochran test and visually when constructing forest plots. A random effects model and a fixed effect model were used. Works published over the entire period were analyzed, 712 publications were identified, of which 9 fully met the stated criteria, all studies were non-randomized controlled. The final analysis included the results of 1292 patients. According to the meta-analysis, it was possible to establish the superiority of complex therapy including Wobenzym compared to therapy without Wobenzym in all studied parameters: eradication of the pathogen, decrease in the number of points on the Quality of Life (QoL) scale, an increase in the linear speed of blood flow in the veins and peak systolic blood flow velocity in the arteries of the prostate gland, maximum urine flow rate, reduction in the number of points of the NIH-CPSI “Pain” subscale (difference 5 points) and NIH-CPSI “Quality of Life” subscale. The use of therapy including Wobenzym in patients with chronic prostatitis leads to a greater increase in the number of CD4+, CD8+ lymphocytes, phagocytic activity of lymphocytes, the level of complement CH-100 and immunoglobulins M, G, A. A systematic review/meta-analysis revealed an objective, statistically significant, positive effect of the drug Wobenzym in the complex therapy of patients with chronic bacterial prostatitis, which is associated with its pathogenetic orientation in relation to this group of patients.

The prevalence of bladder stones is quite high, which represents a significant medical and social problem. Despite significant progress in the field of medicine, there are currently no generally accepted standards for the treatment of patients with cystolithiasis. This review presents an analysis of literature sources using the PubMed, Google Scholar, Scopus, eLibrary, Cyberleninka databases, dedicated to modern aspects of the treatment of patients with bladder stones and bladder outlet obstruction. The features, advantages and disadvantages of various surgical methods for treating such patients are described in detail. It has been shown that despite the fact that transurethral cystolithotripsy with litholapaxy is the most common surgical option, modern medicine offers alternative methods of surgical treatment. It is emphasized that to achieve the greatest effectiveness of treatment, the correct choice of surgical method is necessary, based on the individual characteristics of the patient. It was noted that there is a need to optimize the treatment algorithm for patients with bladder stones and bladder outlet obstruction.

Prostate cancer is the most diagnosed malignant neoplasm among males worldwide. Over the past few years, there has been a need to find alternative methods for early diagnosis of prostate cancer. There is evidence that metabolic dysfunction is a characteristic feature of the carcinogenesis of prostate cancer, with various metabolites acting as biomarkers of tumor growth. Metabolomics is a young science that arose at the junction of molecular biology, biochemistry and genetics. The complete set of substrates and metabolic products is a metabolic profile, or metabolome. The metabolome of prostate cancer is formed by substances formed as a result of metabolic changes in response to the occurrence of a malignant process in the prostate. Unique data on metabolic changes have already been obtained, allowing us to rethink the carcinogenesis of prostate cancer. The study of the metabolome opens up new opportunities for early diagnosis, prognosis and treatment of prostate cancer.

Ureteral atresia is a rare pathology, the diagnosis of which is difficult, and a unified approach to the method of surgical correction has not been formed. The aim of this study is to demonstrate a rare clinical case of a patient with distal ureteral atresia of a non-functioning lower pole of a duplicated kidney, and also to present the method of surgical treatment. A 12-year-old female patient was diagnosed with a cystic formation of the retroperitoneal space. During the operation, it was determined that this cyst was an atretic, dilated ureter of a lower pole of the duplacated kidney. Lower heminefrureterectomy was chosen as the method of surgical correction. Ureteral atresia is rarely combined with any other anomalies of the upper urinary tract, and the presented clinical case has not previously been described in the available foreign and Russian literature. The methods of surgical correction of ureteral atresia include nephrureterectomy, ureteroureterostomy, intestinal ureteroplasty, and Boari procedure. In the presented case, heminefrureterectomy was chosen because of severe hypoplasia of the lower pole of the duplicated kidney and the almost complete absence of its parenchyma. When examining patients with cystic formations of the retroperitoneal space, it is necessary to remember about the ureteral atresia, which may be accompanied by other anomalies of the upper urinary tract.