Urologiia

Aim: to explore the development of a computer-aided diagnosis (CAD) system based on deep learning (DL) neural networks aimed at minimizing human error in PI-RADS grading and supporting medical decision-making.

Materials and Methods. This retrospective multicenter study included a cohort of 136 patients, comprising 108 cases of PCa (PI-RADS score 4–5) and 28 cases of benign conditions (PI-RADS score 1–2). The 3D U-Net architecture was applied to process T2-weighted images (T2W), diffusion-weighted images (DWI), and dynamic contrast-enhanced images (DCE). Statistical analysis was conducted using Python libraries to assess diagnostic performance, including sensitivity, specificity, Dice similarity coefficients, and the area under the receiver operating characteristic curve (AUC).

Results. The DL-CAD system achieved an average accuracy of 78%, sensitivity of 60%, and specificity of 84% for detecting lesions in the prostate. The Dice similarity coefficient for prostate segmentation was 0.71, and the AUC was 81.16%. The system demonstrated high specificity in reducing false-positive results, which, after further optimization, could help minimize unnecessary biopsies and overtreatment.

Conclusion. The DL-CAD system shows potential in supporting clinical decision-making for patients with clinically significant PCa by improving diagnostic accuracy, particularly in minimizing intra- and inter-observer variability. Despite its high specificity, improvements in sensitivity and segmentation accuracy are needed, which could be achieved by using larger datasets and advanced deep learning techniques. Further multicenter validation is required for accelerated integration of this system into clinical practice.

Staghorn nephrolithiasis represents one of the most complex forms of urolithiasis, with treatment approaches remaining a subject of ongoing debate among specialists. This study aims to assess the effectiveness and safety of oral chemolysis using citrate mixtures in treating staghorn urate nephrolithiasis. A prospective, multicenter cohort study was conducted from January 2023 to October 2024 among patients with CT-diagnosed staghorn stones of presumed urate composition (average urine pH ≤ 5.8, average stone density ≤ 650 HU, radiolucent on urogram or topogram) who received oral chemolysis with a citrate mixture containing citric acid, potassium bicarbonate, and sodium citrate («Blemaren»). Patients were recruited from outpatient clinics and hospitals in Moscow.

Results: Of the 49 patients included in the study, 2 were excluded within the first 2 months. Complete stone dissolution was achieved in 30 patients (63.8%), while 17 patients (36.2%) eventually required surgical intervention. Among these, 4 patients (8.5%) achieved complete stone dissolution within 1 month of therapy, 18 patients (38%) within 3 months, and 8 patients (17%) within 6 months. Of the stones removed surgically, 12 (70.6%) were calcium oxalate, and 5 (29.4%) were uric acid stones. Consequently, the proportion of patients with non-calcium oxalate stones who did not achieve complete stone dissolution was 14.3%. Stone density was the only parameter that significantly influenced the likelihood of stone dissolution and the risk of surgical intervention (p<0.05). According to regression analysis, the likelihood of stone dissolution decreased by a factor of 1.012 with each unit increase in stone density, while the risk of surgery increased by a factor of 1.008 under the same conditions.

Conclusions: The results of this study demonstrate that oral chemolysis for staghorn uric acid nephrolithiasis is an effective method and may serve as a viable alternative to surgical treatment, potentially reducing the associated risks of anesthesia and surgery for this patient group.

Introduction. The most complex stage of retrograde intrarenal surgery (RIRS) is intrarenal navigation in the collecting system. The existing simulators for training have drawbacks or are unavailable, so a non-biological simulator was developed to teach the technique of this procedure.

Aim. To provide the characteristics of the developed non-biological simulator for teaching the RIRS technique and the results of its testing.

Materials and methods. We have developed a non-biological simulator for teaching the RIRS technique, the main part of which is a quadrangular box of 60 × 30 cm, having special internal recesses for models of the bladder, ureters and 3D-collecting system, as well as transparent and dark covers. The simulator has three or more pairs of 3D-models of the collecting system. After the insertion of the ureteral access sheath and instructions from an expert urologist at the RIRS, a training session with 15 urologists (10 without experience and 5 with experience in endourology, except for the RIRS) was carried out. Intrarenal navigation with inspection of all groups of calyces was initially performed with the simulator closed with a transparent top, while the trainee looked at the 3D model of the kidney itself. Then the training continued with an opaque top and the physician looked only at the video monitor. Ten navigations were performed on each side. The navigation time from the moment of insertion of the flexible ureteroscope into the renal pelvis was determined.

Results. A total of 268 intrarenal navigations were performed (134 on each side). Thirty-two (10.7%) tests were not completed, since 6 and 4 urologists stopped the training on the 8th and 9th tests, showing the minimum navigation time. For all trials, the average navigation time was 155.8±92.4 s, and it significantly decreased from 252.6±107.0 in the first to 94.5±34.0 s in the last attempt (p<0.001). In experienced physicians, the navigation time decreased from 185.0±52.4 to 85.6±26.8 s (p=0.045), while in inexperienced urologists from 290.5±109.6 to 96.7±35.4 s (p<0.0001). The experienced urologists demonstrated better results in the initial test compared to the inexperienced group (185.0±52.4 s vs. 290.5±109.6 s, p=0.037), but after training, the navigation time in the final test did not differ (85.6±26.8 s vs. 96.7±35.4 s, p=0.984).

Conclusions. Our non-biological simulator allows to improve surgical skills in RIRS. The obtained results show that both experienced and inexperienced urologists significantly improve their skills in the navigation in the collecting system.

Introduction. Sildenafil citrate (Viagra) is widely used to treat erectile dysfunction (ED). However, this drug is associated with high frequency of adverse events such as headaches and cardiovascular disorders. «Vildegra» is a sildenafil encapsulated in hypromellose, which provides a slow release of the substance and a longer duration of action (13 hours vs. 4 hours). This may reduce the incidence of such effects.

Aim. To prove that Vildegra 50 mg has non-inferior efficiency compared to Viagra 50 mg, but is associated with better tolerability and greater safety.

Materials and methods. A triple-arm crossover open placebo-controlled randomized clinical trial was carried out in accordance with the protocol and all ethical principles. Patients were men aged 19–60 years with a diagnosis of ED. Patients received Vildegra as monotherapy within 4 weeks, followed by a week of a “washout” period, 4 weeks of placebo, another week of a «washout» period, then 4 weeks of Viagra. In the control group, the sequence of drugs was as following: Viagra – placebo – Vildegra.

Results. «Vildegra» increased sexual activity 1.6 times more than «Viagra» and 2.4 times more than placebo. At the same time, there were no significant changes in the IIEF-5 score between «Vildegra» and «Viagra». The initial IIEF-5 score was 14±3.8 and 13.9±3.5, respectively, while after 1 month of therapy it improved to 20.9±3 and 20±3.4, respectively (p=0.678). The frequency of adverse events of «Vildegra» was 1.6 times lower compared to «Viagra». At the end of therapy, no negative impact on laboratory and clinical parameters was documented.

Conclusion. «Vildegra» is not inferior to «Viagra» in efficiency and has better tolerability, which resulted in the higher frequency of on-demand use of «Vildegra».

Introduction. The widespread prevalence of BPH among men leads to an increase in urination disorders, a decrease in the quality of life, and an increased risk of surgical intervention. The introduction of long-term conservative therapy into clinical practice can improve the quality of life and reduce the number of prostate procedures.

Aim. To obtain additional data on the efficiency of Afalaza during long-term use in patients with BPH.

Materials and methods. A retrospective analysis of 99 patients with a diagnosis of BPH, aged over 40 years, who received Afalaza monotherapy for more than a year, was performed. The IPSS questionnaire was used to assess LUTS, while the transabdominal US, transrectal US and MRI were performed to measure the prostate volume. Statistical analysis was done using ANCOVA analysis. Covariates included age, duration of therapy in months, and duration of therapy by category (IPSS, prostate volume).

Results. An average age of patients was 50.8±6.9 years. The average duration of therapy was 26 months (11 to 41 months). The average IPSS score decreased from 13.3±3.6 (13, 6, 19) to 9.4±3.1 points (9, 6, 18). The average change in the IPSS score was 3.8±2.7 points (4, -6, 9) (F1/99=203.8, p<0.0001). The duration of therapy influenced on the reduction in the severity of lower urinary tract symptoms (F1/99=8.75, p=0.0039). Treatment results did not depend on the age of the patients (F1/99=0.01, p=0.9172). The average prostate volume decreased from 39.9±6.1 cc (40, 30, 60) to 38.0±6.1 cc (38, 28, 58). Delta was 1.9±1.0 cc (F1/99=364.85, p<0.0001). There were neither acute urinary retention nor the need for surgical treatment. According to outpatient records, there were no adverse events when taking Afalaza.

Conclusion. Long-term use of Afalaza is effective in improving the quality of life of patients with BPH and can be recommended for long-term therapy to prevent progression and surgical intervention. The drug requires further study in various groups of patients with BPH.

Introduction. Prostatitis is considered to be the most common disease in men. A wide range of drugs used for the treatment of patients with chronic prostatitis (CP) does not always result in the cure. Since the role of free radicals in the pathogenesis of chronic inflammation has been studied extensively, antioxidant therapy in CP is very promising.

Aim. To evaluate the efficiency of the dietary supplement «Querceprost» in the combined treatment of patients with CP of II and IIIA categories.

Materials and methods. A total of 120 patients with average age of 35.6 years and a verified diagnosis of «CP of II or IIIA categories» were included in the study. All patients were divided into two main groups, depending on the presence of chronic bacterial (n=30) or chronic abacterial prostatitis (n=30) and two control groups with a similar diagnosis (30 men in each). In the main groups, standard therapy was accompanied by taking the dietary supplement "Querceprost" 2 capsules per day during meals for 1 month. In the control groups, patients received only standard therapy depending on the category of CP. The results were assessed after 1 and 3 months from the start of treatment. During the study, medical history was taken and physical examination was performed. In addition, IPSS (International Prostate Symptom Score), Lower Urinary Tract Symptoms (LUTS), IIEF-15 (International Index of Erectile Function), and NIH-CPSI scales were filled out. Clinical and biochemical laboratory tests of blood and urine, measurement of serum prostate-specific antigen (PSA) level, as well as microscopic examination of the expressed prostatic secretions were done. All patients underwent uroflowmetry, ultrasound examination (US) of the bladder with determination of the postvoid residual and transrectal US of the prostate.

Results. The use of antioxidant complex «Querceprost» in the combination therapy of CP (category II and IIIA) in men of resulted in the decrease in the pain severity score and improvement of the patient's impression of his condition according to the NIH-CPSI. The total IPSS score significantly decreased compared to baseline values, and it was between mild and moderate symptoms, while the positive dynamics persisted even after 3 months from the start of therapy. The resolution of the inflammatory process was proved by a decrease in the number of leukocytes in the expressed prostatic secretions after the use of antioxidants. Also, in those patients, who took antioxidant as part of the combined therapy, an improvement in the erectile function according to the IIEF-15 scale and an increase in the urine flow rate on uroflowmetry were noted.

Conclusions. The use of antioxidants from the dietary supplement «Querceprost» in the combined therapy of CP (category II and IIIA) is not only accompanied by a significant reduction or resolution of symptoms, but also allows to achieve consistent effect.

Introduction. Urinary incontinence after radical treatment of prostate cancer causes a significant negative impact on the quality of life. Patients with severe urinary incontinence are most commonly treated with artificial urinary sphincter (AUS) placement.

Aim. To evaluate the functional results of AUS implantation in patients with severe urinary incontinence at long-term follow-up.

Materials and methods. Between 2004 and 2023, the AUS was implanted in 62 patients with severe stress urinary incontinence. Urinary losses were assessed using a bladder diary. No need to use pads or use of no more than 1 safety pad per day ("social continence") was considered a success, while use of no more than 2 pads, or a reduction in urine loss of more than 50% was regarded as an improvement.

Results. The mean patient age at the time of AUS implantation was 67.4±8 years. Urinary incontinence was most often a complication of radical prostatectomy (61.3%). A history of radiation therapy, previous treatment of urethral stricture, and surgical procedures for urinary incontinence were noted in 14.5%, 48.4%, and 19.4% of patients, respectively. The median follow-up was 73.5 months (IQR 14.8–118.3 months). There was a significant decrease in median urine loss from 900 mL (IQR 700–1100 mL) to 7 mL (IQR 0-35 mL; p<0.05), and a decrease in the number of pads used per day from 7 (IQR 6–8) to 1 (IQR 0-2; p<0.05). The criterion for successful implantation was met in 69.4% of patients, while 43.5% of patients did not use pads. According to the correlation analysis, concomitant diabetes mellitus, history of radiation therapy, surgical treatment of the urethral stricture or urinary incontinence did not have any significant effect on functional results. In addition, there were no cases of AUS revision.

Conclusions. AUS placement in patients with severe stress urinary incontinence allows to achieve satisfactory functional results during long-term follow-up.

Introduction. One of the most promising minimally invasive methods for preventing the recurrence bladder neck sclerosis (BNS) is balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone.

Aim. To evaluate the efficiency and safety of serial balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone for the prevention of recurrence BNS after endoscopic procedures on the prostate.

Materials and methods. The study involved 30 patients with recurrent BNS who were included in the protocol of serial balloon dilation of the bladder neck. Recurrence of BNS was confirmed in each case by the flexible urethroscopy in the outpatient settings, after which the patient was included in the protocol of serial balloon dilation of the bladder neck. Incision of the bladder neck was performed using a thulium Fiber laser U3 (IRE-Polus) with power settings of 1 J, 30 Hz, 30 W or bipolar energy with the PlasmaNeedle electrode (Olympus). Serial balloon dilation was performed three weeks after repeated incision of the bladder neck. Before each session of balloon dilation, the following parameters were assessed in all patients: the total International Prostate Symptom Score (IPSS) and quality of life (QoL) score, Qmax and postvoid residual.

Results. Contracture stabilization at a urodynamically acceptable level (Qmax is higher than 12 ml/s and QoL is less than 3) was observed in 73.3% (n=22) of patients with a median follow-up of 10 months. Effective treatment required a median of 6 sessions of balloon dilatation. 4 out of 8 patients with recurrent BNS refused further participation in the study, while the remaining 4 underwent re-incision of the bladder neck followed by inclusion in the repeat balloon dilatation program, which was successful, thereby increasing the primary efficiency to 86.7%. Based on the Kaplan-Meier survival analysis, it was found that the longer the time since the start of serial balloon dilation, the lower the chance of recurrence of BNS. In terms of safety, no patient experienced complications associated with serial balloon dilation.

Conclusion. Serial balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone is an effective and safe technique that can be offered to patients to prevent recurrent BNS.

Aim. To develop surgical technique for definite treatment of recurrent rectourethral fistula in children.

Materials and methods. From 2010 to 2022, 6 children with anal atresia and recurrent rectourethral fistula after sphincteroplasty were treated. In all patients an isolation and ligation of fistula with bringing down and resection of rectum above the level of fistula using transanal access in prone position was done.

Results. The procedure was successful in all cases. Follow-up duration ranged from 4 months to 5 years. There were no complications. Sphincter function was totally preserved.

Conclusion. Novel proposed method is an effective, reliable and safe procedure to treat recurrent recto-urethral fistulas. This technique provides good view of intestine and urethra without damaging the sphincter and levator structures, and also respects the principle of separating the fistulous tract with total resection of altered segment of the intestine, which eliminates all pathogenetic mechanisms of fistula recurrence.

Melanoma is the most aggressive malignant skin neoplasm with a high potential for metastasis and molecular genetic diversity.

A clinical case of a 35-year-old patient who admitted to the clinic with a diagnosis of melanoma of the skin on the back of pT2aN2M1b, Clarke invasion stage 3, BRAF (+), metastases to the brain, spine (Th8), who had previously undergone to complete excision of melanoma in 2023, is presented in the article. During examination, bladder tumor was detected. Histological study confirmed the presence of metastatic melanoma of the bladder.

Metastatic bladder tumor in patients with melanoma is a rare entity. Surgical treatment can be carried out to improve dysuria and the oncological outcomes, including those patients with synchronous metastases.

The protection of men’s health as a concept is currently only beginning to emerge in most countries, but the belief about the need to develop this area is being discussed more and more often by leading representatives of the medical community. Interest in the issues of men’s health protection and gender approaches to health assessment in the health system has increased significantly, primarily due to the higher mortality rate of the male population, as well as lower life expectancy at birth (LEB). Compared to women, men are more vulnerable to many diseases that affect the quality and duration of life, but they are poorly motivated to maintain health, rarely turn to doctors for prevention. Many important steps have already been taken in this direction: pilot projects are being created all over the world, interdisciplinary platforms are being developed, specialists are being trained and legislative regulation is changing. The joint work of doctors in the field, as well as the development of national programs, will help to overcome the gender gap in life expectancy between men and women by promoting a holistic and orderly approach to men’s health.

The review is devoted to assessing the state of the problem of infectious and inflammatory diseases of the bladder of viral etiology, their pathogenesis, differential diagnosis, and treatment features. The search was conducted using Medline, PubMed, and EMBASE databases. Data from a literature search indicate that the problem of chronic recurrent cystitis (CRC) of viral etiology is widely represented in the press and in search databases. Such attention is due to the difficulties of diagnostics, differential diagnostics, lack of treatment standards, and the recurrent course of the process. In most cases, with a clinical picture of recurrent urinary tract infection, even in the absence of leukocyturia and bacteriuria, antibacterial therapy (AB) is prescribed, which not only does not lead to an improvement in the condition if there is a viral infection of the bladder, but in some cases only worsens the clinical symptoms.

Objective: to identify the characteristics of the course of chronic recurrent cystitis of viral etiology, to determine differential diagnostic criteria for the development of the infectious process caused by various viral agents, taking into account their pathogenic properties.

Transrectal prostate biopsy remains the standard method for prostate cancer diagnosis, but it is associated with a high risk of infectious complications. In recent years, fosfomycin has been increasingly used as an alternative for antibiotic prophylaxis due to the increasing resistance of pathogens to fluoroquinolones, its good safety profile and ease of use. Results of several studies dedicated to the efficiency of fosfomycin are highlighted in this review. Fosfomycin demonstrates significant advantages as a drug for the prevention of infectious and inflammatory complications in patients after prostate biopsy, especially in case of increasing resistance to fluoroquinolones. Its efficacy, safety and ease of use make it an attractive choice and a reliable alternative in the context of increasing antibiotic resistance. Combination regimens with fluoroquinolones may be preferable for high-risk group.

Ureteral stricture is a common urological problem, which has a high recurrence rate. The efficiency of treatment is affected not only by the etiology of the stricture, its length, the technique of the surgical procedure (open, endoscopic, laparoscopic, robot-assisted), but also the method and duration of ureteral drainage in the postoperative period. Classical approach using one internal stent does not provide optimal ureteral lumen at the site of intervention, while special stents for endopyelotomy (with larger segment at the area of stricture) can lead to ischemia and prevent adequate urodynamics. The insertion of two internal stents (tandem stenting) allows to achieve adequate urine passage due to the so-called "useful" space between the stents and the natural ureteral lumen, a low probability of ischemia due to the absence of circular pressure on the stricture area, as well as a sufficient diameter to maintain the internal lumen. In this article, publications devoted to tandem ureteral stenting are reviewed and our own results are presented.

Tandem ureteral stenting is an effective and safe method and, in the future, can expand the possibilities of minimally invasive treatment of patients with ureteral strictures.