Urologiia

Aim. To compare the functional outcomes of various surgical procedures, to assess the rate of complications and urination disorders after surgery, and to identify possible risk factors and predictors of unsatisfactory treatment outcomes.

Materials and methods. The functional outcomes of surgical treatment were evaluated in 398 patients with benign prostatic hyperplasia (BPH). Patients were divided into 3 groups depending on the surgical method: bipolar transurethral resection of the prostate, laser enucleation of the prostate, and laparoscopic simple prostatectomy. The groups were comparable in age, comorbidities, and maximum urinary flow rate (Qmax). Prostate volume, total PSA level, and IPSS score differed between groups. They were higher in the group of simple prostatectomy.

Results. Before surgical treatment, 192 (48.2%) patients underwent urodynamic studies including "filling cystometry" and "pressure-flow", to determine the bladder outlet obstruction index (BOOI) and detrusor overactivity (DO), which was confirmed in 82.8% of cases. The mean BOOI value was 72.1.

Functional outcomes did not statistically differ between groups at all follow-up points during the first year. After 12 months, the mean Qmax across all groups was 22.3±6.4 ml/s, the median IPSS value after the transurethral resection and simple prostatectomy was 3.0 points, while in the enucleation group it was 4.0 points.

Transient urinary incontinence after catheter removal was recorded in 46 (11.6%) patients. By 3 months of follow-up, 10 (2.5%) patients had urge urinary incontinence on urodynamic study, requiring conservative therapy with M-anticholinergics or β3-adrenomimetics. De novo stress urinary incontinence was confirmed in 1 (0.3%) patient after transurethral enucleation.

Infectious complications (prostatitis, orchiepididymitis) requiring antibiotic therapy occurred in 61 (15.3%) patients. The risk of infectious complications was higher in those with longer operative time (p=0.004), diabetes mellitus (p=0.006), and bacteriuria (p=0.019).

All strictures were identified after transurethral procedures, including transurethral resection (1.1%) and transurethral enucleation (6.8%). Patients with urethral strictures more often developed postoperative infectious complications (p=0.008). It was noted that patients with cystostomy tube had a lower frequency of strictures (p=0.076).

A stricture of fossa navicularis is a significant challenge due to the complexity of surgical reconstruction which should provide good aesthetic and functional outcomes.

Aim. To evaluate the efficiency and safety of transurethral ventral augmentation urethroplasty in men with stricture of fossa navicularis.

Materials and methods. A prospective study of treatment outcomes of 9 patients with stricture of fossa navicularis who were admitted at V.M. Buyanov City Clinical Hospital from 2021 to 2024, was carried out. The inclusion criterion was the presence of an isolated urethral narrowing in the fossa navicularis, which was urodynamically significant. All patients underwent transurethral ventral urethrotomy of the narrowed segment using a lance scalpel with optical control of the depth of incision. Subsequently, a triangular oral mucosa graft was harvested and fixed using the “inlay” technique with 4 deep sutures (monocryl 4-0) in and 5 sutures along the ventral semicircle of the meatus. The urethral catheter was removed on days 12-14 in order to restore spontaneous voiding.

Results. The mean age of patients was 63.4 years. The follow-up period ranged from 6 to 38 months. The etiology was balanitis xerotica obliterans (BXO) in 5 cases, unknown in 2, and iatrogenic stricture in 2 patients. Labial mucosa was used as a graft in 6 men, and buccal mucosa in 3 cases. No intra- or postoperative complications were observed. Preoperatively, average maximum urine flow rate was 5.8 ml/sec, IPSS score 20.5 points. After surgical treatment, the average Qmax was 15 ml/sec, and the IPSS score was 13. No patient reported urine splashing.

Discussion. All patients experienced the satisfaction with both functional and aesthetic outcomes. The surgeon's subjective assessment of the convenience and the cosmetic result of using labial and buccal grafts favored labial mucosa. It seems to be preferable both due to the lesser thickness of the graft, which facilitates the technical manipulations, and in terms of preserving the buccal mucosa in patients with BXO for possible subsequent reconstructions.

Conclusions. The transurethral augmentation repair using oral mucosa is an effective and safe method for treatment of stricture of fossa navicularis.

Introduction. According to international studies, the prevalence of uric acid stones in 2023 was 8-10% worldwide. Uric acid stones are considered high-risk for symptomatic recurrence. Uric acid constitutes a frequent component of urinary calculi and may promote calcium oxalate stone formation.

Aim. To assess the prevalence of “pure” and mixed uric acid and urate salt stones among urinary calculi in the Novosibirsk Region.

Materials and methods. We evaluated 987 urinary stones from patients with urolithiasis in the Novosibirsk Region. Data for the period 2020–2023 were provided in anonymized form by INVITRO laboratory. We determined the prevalence of single-component and mixed urinary stones containing uric acid and its salts, alone or in combination with other minerals, stratified by sex and age.

Results. Uric acid stones were identified in 119 cases (80 men, 39 women), accounting for 12.06% of all analyzed stones. Pure uric acid stones presented as anhydrous uric acid in 1 case and as uric acid dihydrate in 4 cases. The majority (n=114) were mixed stones of anhydrous uric acid and uric acid dihydrate. Uric acid stones occurred nearly twice as often in men as in women (80 vs. 39). The prevalence of uric acid stones was highest in men aged 31–70 years and in women aged 41–70 years, declining thereafter in both sexes.

Mixed uric acid/urate stones (ammonium urate, sodium urate) were found in 15 patients (10 men, 5 women), representing 1.5% of all urinary stones. In women, these types were found at ages 51–70. In men, the most common type was anhydrous uric acid + sodium urate (8 cases), occurring equally in all age groups above 31 years. One stone comprised anhydrous uric acid + ammonium urate (age 41–50). Calcium oxalate combined with uric acid and urate salts in two- and multi-component stones was observed in 99 cases, predominantly in men (58 cases). Overall, calcium oxalate with uric acid and its salts in various combinations accounted for 10.03%.

Conclusion. A study of regional stone-forming patterns is essential for planning healthcare at both national and regional level. The prevalence of uric acid stones underscores the need for widespread implementation of oral dissolution therapy and effective metaphylaxis for uric acid urolithiasis. The frequent co-occurrence of calcium oxalate with uric acid warrants comprehensive metabolic evaluation of patients with pure uric acid stones and mixed uric acid/urate stones. Identifying concomitant metabolic disorders in patients with predominately uric acid stones requires tailored urinary pH targets during oral dissolution therapy to minimize conditions favoring precipitation of uric acid salts and phosphate crystallization.

Aim. To evaluate the effect of a drug based on bovine testicular polypeptides (Testiwell) on sperm parameters and sperm DNA fragmentation index in patients with idiopathic male infertility.

Materials and methods. A total of 100 men with a diagnosis of infertility were included in the study. They received Testiwell intramuscularly once a week for 10 weeks. Before and after treatment, basic sperm parameters according to WHO criteria and sperm DNA fragmentation index using the TUNEL method were assessed. Statistical analysis included Shapiro-Wilk, Wilcoxon, paired Student's t-test, and McNemar's test.

Results. The median age of patients was 32 years. Significant improvement was noted in the proportion of morphologically normal sperm (p<0.001), concentration of morphologically normal sperm (from 1.16 to 1.55 million/ml, p=0.048). A decrease in sperm DNA fragmentation index was observed (from 20.8% to 17.8%, p<0.001), a reduction in the frequency of oligozoospermia from 34% to 22% (p=0.0047), and a decrease in the proportion of patients with increased DNA fragmentation index from 79% to 67% (p=0.0013). In patients with oligozoospermia at baseline, the median increase in concentration was 142%, while in those with asthenozoospermia an increase in motility by 77% was seen, and in men with high levels of DNA fragmentation, a decrease in DNA fragmentation index by 15.5% was found.

Discussion. Testiwell demonstrated the ability to positively influence not only quantitative but also qualitative sperm parameters, including morphology and sperm DNA fragmentation. Proposed mechanisms of action include regulation of protamination, reduction of apoptosis, and immunologically mediated effects on sperm maturation. The obtained data are consistent with previously described effects of polypeptide drugs in preclinical models and expand the possibilities of using the Testiwell for various forms of male infertility, including assisted reproduction techniques failures.

Conclusion. Testiwell significantly improves morphological and molecular parameters of spermatogenesis in patients with male infertility. It can be used both in the basic therapy of idiopathic infertility and, possibly, in cases of miscarriage and inefficiency of assisted reproduction techniques.


Introduction. Currently, benign prostatic hyperplasia is a highly relevant problem. The main treatment methods are transurethral bipolar resection of the prostate (TURis) or transurethral bipolar enucleation (TUEB). One of the most serious complications during these procedures is bladder explosion.

Aim. To investigate the clinical conditions that create the risk of bladder explosion, to develop a surgical strategy for managing this complication, and to analyze the composition of the gas mixture formed intraoperatively in the bladder during transurethral procedures on the prostate.

Materials and methods. Procedures were performed under spinal anesthesia. The PLASMA system was used for transurethral plasma enucleation and transurethral plasma resection, including a 26 Fr plasma resectoscope (Olympus), and a high-frequency generator ESG-400. Plasma electrodes were used as following: Plasma-Needle for incision, Plasma-TUEB Loop for enucleation, and Plasma-Large Loop for resection. Normal saline was used as the irrigation fluid. TUEB and TURis were performed by standard technique.

At the end of the procedure, the gas sample was aspirated through the inflow channel of the resectoscope using a Jané syringe. Gas composition analysis was carried out by gas chromatography on a GC-2014 chromatograph (Shimadzu, Japan) in a physico-chemical analysis laboratory.

Results. In addition to carbon monoxide and carbon dioxide, methane was detected in the gas sample; this formed an explosive mixture that ignited upon contact with the hot loop of the resectoscope.

Conclusions. Bladder explosion occurs during TUR in patients with large prostates and is independent of equipment settings. Management strategy depends on the size of the bladder rupture. To prevent bladder rupture, continuous evacuation of intravesical gases is required by advancing the resectoscope to the gas pocket and allowing fluid drainage, as well as careful monitoring of electrode activation when working at the bladder neck at the 12 o’clock position, and use of a morcellator to evacuate adenomatous tissue after enucleation.

The association of congenital cysts of seminal vesicles with unilateral renal agenesis and obstruction of the vas deferens was first described by A.Zinner in 1914. Later, the combination of these anomalies was called Zinner’s syndrome. Zinner’s syndrome occurs in just over 200 cases out of 100,000 patients and includes a triad of symptoms: cystic formation of the seminal vesicle, obstruction of the vas deferens and ipsilateral renal agenesis. Zinner’s syndrome is most often asymptomatic until the third or fourth decade of life, and symptoms usually appear with the onset of sexual activity. Patients usually have non-specific symptoms such as problems urinating, pain in the perineum, possible hematuria, recurrent urinary tract infections, and painful ejaculation. Infertility caused by obstruction of the vas deferens is also common. The severity of the symptoms is associated with an increase in cyst size. Minimally invasive interventions such as traditional laparoscopy or robot-assisted surgery are safe and effective and should currently be considered the gold standard of treatment. In the framework of this work, we present a clinical case of treatment of a patient with Zinner’s syndrome.

Autonomous dysreflexia (AD) is a life-threatening condition that occurs in patients with spinal cord injury at the Th6 level and above. As a result of AD, dysregulation of the autonomic nervous system occurs, which leads to an uncoordinated sympathetic reaction, and can result in a potentially life-threatening increase in blood pressure, a hypertensive crisis, and even death. In about 85% of cases of AD, the cause is bladder overdistension. Urologists need to understand the clinical features of this condition and how to help patients with AD.

Tuberculosis remains a significant public health issue worldwide. In 2022, over 45 000 new tuberculosis cases were registered in Russia, corresponding to an incidence rate of 31.0 per 100 000 population. Among genitourinary tuberculosis, bladder involvement accounts for 10.6-52.3%. The clinical presentation of tuberculous cystitis mimics that of typical cystitis. Lack of specific symptoms, combined with insufficient clinical suspicion among phthisiatrists, often leads to delayed diagnosis and treatment, so that irreversible morphological changes have occurred in the bladder wall. This process manifests as persistent impairments of both the storage and voiding phases and significantly diminishes quality of life. The so-called small contracted bladder represents the end-stage of bladder involvement and is universally considered an indication for surgical intervention.

A literature search was carried out in Elibrary.ru, PubMed, and Google Scholar to compile data on tuberculous bladder involvement leading to the development of a small, contracted bladder. This review covers the etiology, pathogenesis, and classification of bladder tuberculosis, and summarizes current diagnostic approaches.

Aggressive disease course, recurrences, and deterioration of patients’ quality of life remain significant challenges in the treatment of bladder cancer. Determining the indications for systemic therapy or radical treatment, the early detection, and the optimal timing for initiating adjuvant therapy are all crucial aspects in the management of urothelial carcinoma. The analysis of the literature on changes in diagnostics and therapeutic approaches to urothelial bladder cancer according to disease stage is presented in the article.