Urologiia

Objectives of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events. Materials and methods. 129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently. Main outcome measures: Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed. Results. Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability ofAUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) - within 2 days, and in 13 (50%) - within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patient’s age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I. Conclusion. Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patient’s social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.

Introduction. The current armamentarium of drugs for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is diverse and includes both monotherapy and combination therapy. Indirect and limited direct comparisons have demonstrated that all alpha-1-blockers (a1-ABs) have similar efficacy when used at appropriate doses. Differences in tropism to the prostate of modern a1-ABs are largely responsible for the severity of their side effects, mainly negative influence on sexual function and cardiovascular system. Aim. To evaluate the influence of Alfuprost® MR 10 mg once daily on sexual function in patients with LUTS due to BPH during 3-months therapy in real clinical practice. The secondary endpoint was an effect on systolic, diastolic blood pressure (BP) and heart rate. Materials and methods. A total of 537 men with LUTS/BPH were included in the study by urologists from 21 outpatient departments of the Russian Federation. The follow-up included 3 visits: visit of inclusion in the program of patients with a previously prescribed drug of Alfuprost® MR in a dosage of 10 mg once a day (visit "0"), visit 1 at 30 days (±5 days) later, and visit 2 at 90 days (±5 days) after inclusion in the study. At each visit, evaluation of complaints and physical examination was performed. In addition, patients completed questionnaires: International prostate symptom score (IPSS) and quality of life (QoL) index; the full version of the International Index of Erectile Function (IIEF) questionnaire; the Likert scale for the patient and for the physician. Also, laboratory and instrumental studies used in routine clinical practice were recorded: total prostate specific antigen (PSA) in serum; ultrasound examination (US) of the bladder; transrectal ultrasound examination (TRUS) of the prostate; uroflowmetry (maximum urine flow rate (Qmax)); measurement of systolic and diastolic BP; measurement of heart rate. Results: after 3 months of therapy with Alfuprost® MR in a dosage of 10 mg once a day, significant (p<0.05) improvement of all urodynamic parameters was documented, including a decrease in the average IPSS score by 55% and improvement of quality of life by 2.46 points (on the QoL index); increase of Qmax by 53%; reduction of the average postvoid residual to normal values. In addition to a significant improvement in the quality of urination, changes in sexual function were also positive. Thus, the average total IIEF score increased significantly (p<0,05) from 45.35 to 53.18 points. When considering specific domains of male sexual function, positive dynamics in all domains was noted: overall improvement of orgasm function, sexual desire, sexual satisfaction and overall sexual functioning was 11.98%, 15.14%, 19.7% and 18.46%, respectively. Hemodynamic indices remained stable during the 3-month follow-up; only clinically insignificant decrease in systolic BP by no more than 2 mm Hg during the entire follow-up period was observed. At the same time there was no influence on diastolic BP. Changes in heart rate were also clinically insignificant, averaging no more than 1 beat per minute. Conclusions: The results of observational study allow to recommend Alfuprost® MR as a first-line therapy for BPH, including for sexually active men and patients with various types of sexual dysfunction. Considering minimal and clinically insignificant vasodilatory effects observed during 3 months of therapy, it is possible to prescribe Alfuprost® MR in a dosage of 10 mg once daily, including comorbid patients.

Introduction. According to domestic and foreign publications, benign prostatic hyperplasia (BPH) is one of the most common urological diseases among older men, which prevalence reaches 50% by the age of 60. Aim. To analyze the efficiency of the use of the alpha1-blocker silodosin at a dose of 8 mg a day in comorbid patients with lower urinary tract symptoms (LUTS), associated with BPH. Materials and methods. A total of 197 comorbid patients with LUTS/BPH were included in the study. All men underwent a standard examination. They were divided into 2 groups without differences in baseline parameters. In the main group (n=100) patients received silodosin at a dose of 8 mg, while in the control group 97 men did not receive any drug therapy for LUTS. Discussion. There were significant differences between groups in the total IPSS score, postvoid residual (ml), maximum urine flow rate (ml/s), patient satisfaction with treatment efficacy based on the TS-VAS visual analogue scale (total score). However, we didn’t find significant differences in rate of cardiovascular side effects between the groups. Conclusions. Treatment of comorbid patients with LUTS/BPH with silodosin at a dose of 8 mg results in significant improvement and is not associated with cardiovascular adverse events.

Introduction. Urinary tract infections (UTIs) remain an important problem in urology due to their high prevalence and tendency to relapse. The improvement of the treatment outcomes in chronic cystitis is still relevant. Material and methods. A total of 91 patients were included in prospective, multicenter, randomized, comparative, controlled study. They were randomized into three groups: in the comparison group 1 (n=32) basic therapy was administered for 5 days. In the comparison group 2 (n=28) basic therapy was combined with rectal suppositories Superlymph® 25 IU once a day for 10 days. In the main group (n=31) basic therapy in combination with rectal suppositories Superlymph® 10 IU once a day for 20 days were prescribed. The basic therapy included a combination of two antimicrobial drugs: fosfomycin trometamol 3.0 g at night once on the first day of therapy, and furazidin 100 mg three times a day after meals for 5 days. Pathogenetic treatment was not prescribed in comparison group 1, but administered for 10 days and 20 days in comparison group 2 and main group, respectively. Results. After the completion of etiotropic therapy, a significant effect in all groups was shown. At the same time, at the 2nd visit, there was a significantly better results in patients who received Superlymph® rectal suppositories, both at a dose of 10 U and at a dose of 25 U, without any differences between two schemes. The frequency and severity of cystitis symptoms at the end of etiopathogenetic therapy in the main group was less pronounced than in the comparison groups (p=0.0001), and a significant difference was found between comparison groups 1 and 2 (p=0.0001). The use of Superlymph® significantly improved the parameters of microcirculation in the urethra, however, there was no difference between comparison group 2 and main group. Conclusion. Etiopathogenetic therapy, including Superlymph® rectal suppositories at a dose of 10 IU and 25 IU in patients with chronic cystitis, can significantly improve the results of combination therapy. Analysis of the symptoms score of acute cystitis showed the superiority of longer-term use of Superlymph® rectal suppositories at a reduced dosage (10 units). Peptide-cytokine therapy led to a significant improvement in local microcirculation in comparison group 2 and the main group.

Aim. To analyze some effects of plasma acid in vitro on the bladder tissue obtained from laboratory animals and to evaluate the possibility of its application for in vitro modeling of IC/BPS. Materials and methods. The tissue samples of the bladder wall were obtained from female Wistar rats aged 3 months (n=16, weighing 180-200 g). The tissues were processed for 1 hour in the plasma acid prepared by spark discharge of water for injection in air. The immunohistochemical study of obtained samples was performed. Results. The changes in the expression profile of bladder epithelial cells under the action of plasma acid in vitro were found indicating the development of oxidative, nitrosative and dicarbonyl stress, impaired expression of NADPH oxidase DUOX2 and VEGF, and a decrease in cell proliferative activity, which, in general, corresponds to the main mechanisms of urothelial alterations specific for the IC/BPS. Conclusion. The revealed effects of plasma acid on bladder epithelial cells confirm the possibility of using it as an inducer of urothelial cell damage typical for IC/BPS in the in vitro models.

Aim. To evaluate the efficiency of long-term use of trospium chloride (Spazmex) for the treatment of patients with neurogenic overactive bladder due to Parkinson's disease (PD) and to determine the influence of therapy on the cognitive status of patients. Materials and methods: 60 patients with PD and neurogenic overactive bladder with stages 2.5, 3 and 4 according to Hoehn-Yahr scale were included in the main group. The mean age was 58.2±5.7 years. All patients were prescribed trospium chloride at entry into the study, with doses titrated gradually according to clinical efficacy (30 to 90 mg). The comparison group included 15 patients with PD and neurogenic overactive bladder at stages 2,5 and 3, who received tibial neuromodulation according to the standard technique with skin electrodes. The mean age of patients was 56.4±4.6 years. At baseline, both groups were comparable in terms ofgender, age and cognitive status (p=0.801). All patients received treatment for 52 weeks. The efficiency of therapy was assessed according to bladder diaries, while safety outcomes included postvoid residual, side effects, cognitive status according to the MoCA scale and quality of life according to the SF-Qualiveen questionnaire. Results: clinical efficacy and satisfaction were achieved in all patients who completed the study (47 patients in the main group and 15 patients in the comparison group). Good clinical efficacy was demonstrated in both groups, since there was a decrease in the number of urinations, episodes of urgency and urinary incontinence. In addition, there was an improvement in the quality of life according to the SF-Qualiveen scale. The cognitive status during the entire follow-up period remained without significant changes in both groups. Conclusion. Trospium chloride is an effective drug in patients with PD. It does not affect cognitive functions during long-term use. Trospium chloride should be considered as first-line drug in those with urologic manifestations of PD.

Background. Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients. Objective. To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients Materials and methods. From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula. Results. Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients front 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4- 66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months. Conclusion. Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.

Introduction. Treatment of pyelonephritis in children should be combined, long-term and individual-based. The success of the therapy in children largely depends on the prompt appointment and the correct choice of antimicrobial therapy. Aim. To evaluate the efficiency of the dietary supplement «Cystenium II» in a group of children aged 7 to 14 years with a diagnosis of acute and chronic recurrent pyelonephritis in the acute phase. Materials and methods. A total of 60 children aged 7 to 14 years with a diagnosis of acute or chronic recurrent pyelonephritis in the acute stage were included in the study. The clinical group consisted of 30 patients (mean age 12.1+1.8 years), while the control group included 30 patients of mean age 11.2+1.7 years. In the control group patients received only standard antibiotic therapy, while in the clinical group it was combined with a dietary supplement «Cystenium II» 1 tablet 2 times a day with meals for 14 days. After the course of antibacterial treatment, the children in the clinical group continued to take the studied dietary supplement for another 14 days in order to prevent the recurrence of pyelonephritis. The results of treatment (patient's condition, presence of pain, dysuria, fever) were assessed on the 3rd, 7th, 14th day, 1 and 6 months after the start of treatment. A urinalysis was performed at the baseline, on the 7th and 14th days, as well as after 1 and 6 months. Urine culture was performed before and after antibiotic therapy at the baseline, on the 14th day, 1 and 6 months after the start of treatment. Results. The main indicators of urinalysis (leukocytes, red blood cells, protein) returned to normal values in 26 (86.7%) patients of the clinical group and in 23 (76.7%) patients of the control group on the 7th day after the start of treatment. At the completion of the basic therapy (after 14 days) normal clinical parameters (absence of leukocyturia, microhematuria, proteinuria) were observed in all patients of the clinical group and in 28 (93.3%) patients of the control group. After a month of follow-up, the disturbances in urinalysis (leukocytes, red blood cells, protein) in the control group were again seen in 3 (10%) patients, as well as after 6 months. However, in the clinical group all patients had normal urinalysis (absence of leukocyturia, microhematuria, proteinuria) after 1 month and only in 1 (3.3%) case leukocyturia, as well as an increase in the number of red blood cells and protein was detected by 6 months. Discussion. According to our results, the use of dietary supplements «Cystenium II» (manufactured by Akvion, Russia), due to the constituents of D-mannose (450 mg), cranberry fruit extract with a standardized activity of 500 mg (36 mg of proanthocyanidins) and vitamin C (60 mg), may cause anti-inflammatory and anti-adhesive effects (resolving of leukocyturia and bacteriuria). This allows to use the dietary supplement Cystenium II in children from 7 years of age in the combination therapy of acute pyelonephritis, as well as exacerbation of chronic pyelonephritis. The obtained results showed a high overall therapeutic efficacy of combination therapy using Cystenium II after 6 months from the start of treatment (relapse in 1 patient), in contrast to the control group (relapse in 6 patients). Conclusions: the use of dietary supplement «Cystenium II» allowed to reduce the number of repeated courses of antibiotic therapy in children during 6 months of follow-up and, most likely, reduced the frequency of development of chronic pyelonephritis after an acute inflammation. Therefore, the wide clinical use of dietary supplements «Cystenium II» for the combined treatment of acute and exacerbation of chronic pyelonephritis in children older than 7 years seems to be very reasonable.

The clinical examples of the use of modern endoscopic minimally invasive technologies in patients with urinary tract anomalies and in complex clinical cases are presented in the article. The techniques and features of percutaneous nephrolithotomy, retrograde intrarenal surgery (RIRS), antegrade ureteroscopy using flexible scope in this category of patients are discussed. The paper confirms the efficiency and necessity of further development of endourological methods for the treatment of urolithiasis.

Individual differences in efficacy and safety of drugs between patients are a significant problem in modern pharmacotherapy. The body’s pharmacological response to the administration of a particular drug is determined by multiple factors, where up to 50% of the variability of the pharmacological response may be determined by the genetic variability of the body. The article presents an up-to-date review of the data on genetic polymorphisms influencing the efficacy and safety of tamsulosin therapy in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.