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No 6 (2023)

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ORIGINAL ARTICLES

Study of allelic variants of the CYP2D6 and CYP3A genes on the effectiveness and safety of tamsulosin therapy in patients with BPH: results of a pilot study

Abdullaev S.P., Shatokhin M.N., Tuchkova S.N., Abdullaev S.P., Teodorovich O.V., Loran O.B., Sychev D.А.

Abstract

Introduction. Tamsulosin is a member of the group of selective α1-adrenoblockers. Tamsulosin monotherapy is the most common first-line option in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and can be used regardless on severity of LUTS. The CYP2D6, CYP3A4, and CYP3A5 enzymes are involved in the metabolism of tamsulosin. Carriage of different allelic variants of CYP2D6, CYP3A4 and CYP3A5, involved in its metabolism, may potentially affect the variability of efficacy and safety of the drug.

Aim. To evaluate the effect of carriage of allelic variants of cytochrome P450 superfamily enzyme genes (CYP2D6*3, CYP2D6*4, CYP2D6*9, CYP2D6*10, CYP2D6*41, CYP3A4*3, CYP3A4*22 and CYP3A5*3) on the efficiency and safety of tamsulosin in patients with LUTS associated with BPH.

Materials and Methods. All phases of the study were completed by 106 patients with LUTS/BPH (N40 according to ICD 10). All patients received monotherapy with tamsulosin 0.4 mg/day for a minimum of 8 weeks. Based on the severity of symptoms, they were divided into two groups using the International Prostate Symptom Score (IPSS). In Group 1, there were patients with moderate symptoms (IPSS score of 8-19) (n=57), while Group 2 consisted of those with severe symptoms (IPSS score >20) (n=49). Treatment outcomes were assessed using the IPSS score with determination of quality of life (QoL), transrectal ultrasound with evaluation of prostate volume and residual urine, and uroflowmetry. Follow-up visits were at 2, 4, and 8 weeks after the start of therapy. Genotyping of all patients was performed using polymerase chain reaction to determine the CYP2D6 (*3, *4, *9, *10, and *41), CYP3A4 (*3, *22), and CYP3A5*3 markers.

Results. In the group of patients with moderate symptoms, carriers of the CYP2D6*10 and CYP2D6*41 polymorphisms showed a significantly greater reduction in symptoms according to the overall IPSS score at 8 weeks (p=0.046) and in the micturition symptom subscale starting from 4 weeks of treatment (p<0.05). Carriers of the CYP2D6*10 polymorphism in both groups were associated with a decrease in residual urine volume at 8 weeks (p<0.05). The presence of the CYP3A5*3 variant in those with severe symptoms significantly improved quality of life during therapy. Allelic variants of the CYP2D6 and CYP3A genes did not affect the frequency of adverse events.

Conclusion. The results obtained by calculating the prognostic significance of individual polymorphic markers pointed to the contribution of CYP2D6*10 and CYP2D6*41. Tamsulosin therapy is more effective in patients with LUTS who are carriers of these allele variants. The safety parameters of tamsulosin were not influenced by the studied polymorphic variants. It was found that CYP3A5*3 was associated with an increase in the subjective assessment of the patient's quality of life, but it is too early to draw final conclusions. The issue of the contribution of genetic factors to the efficiency and safety of treatment of LUTS in BPH requires further study with a larger sample size and analyzed parameters.

Urologiia. 2023;(6):5-13
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Evaluation of the effect of Alfuprost® MR on detrusor thickness and bladder mass in patients with detrusor hypertrophy caused by benign prostatic hyperplasia

Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A.

Abstract

Introduction. Benign prostatic hyperplasia (BPH) can lead to the detrusor hypertrophy and deterioration of the bladder function with a decrease in its contractile activity. A number of publications are presented in the literature, the results of which indicate the possibility of reducing bladder hypertrophy with alpha-blockers.

Aim. To carry out the retrospective analysis to study the effect of Alfuprost® MR on urodynamic parameters, as well as the influence of the therapy on detrusor thickness and bladder mass in patients with detrusor hypertrophy and bladder outlet obstruction caused by BPH.

Materials and methods. Outpatient records of 30 patients with lower urinary tract symptoms (LUTS) caused by BPH who received Alfuprost® MR as monotherapy for 24 weeks were reviewed. Based on the diaries, the following parameters were assessed: total IPSS score, IPSS voiding (questions No. 1, 3, 5 and 6) and storage subscale scores (questions No. 2, 4 and 7), maximum flow rate (Qmax) according to uroflowmetry, the volume of the prostate and the postvoid residual (assessed by ultrasound), satisfaction with treatment on the quality-of-life score (QoL), as well as the changes in detrusor thickness and bladder mass index.

Results. An improvement in LUTS severity, starting from the 4th week of treatment, followed by a positive trend that persists until the 24th week of therapy with Alfuprost® MR, was found. The overall average IPSS score improved by 39.0% by the 24th week of therapy. At the same time, voiding symptoms improved by 46.8%, and storage symptoms improved by 30.9% by 24 weeks of therapy. The average Qmax increased significantly (p<0.05) by 22.1% after 24 weeks of therapy. The average detrusor thickness decreased by 40,2%. Bladder mass index decreased significantly by an average of 34,3% (p<0.05). QoL score improved significantly (p<0.05) by 2.2 points after 24 weeks of therapy.

Conclusion. During the 24-week treatment of patients with BPH, Alfuprost® MR demonstrated clinical efficacy not only in reducing voiding symptoms and in improving the QoL, but also a positive effect on detrusor hypertrophy, as evidenced by changes in detrusor thickness and bladder mass index. The absence of any adverse events, including decrease in blood pressure and heart rate, allows us to recommend Alfuprost® MR as an effective treatment for LUTS associated with BPH, which reduces detrusor hypertrophy and has a high safety profile and minimal vasodilating effects.

Urologiia. 2023;(6):14-21
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The possibility of correcting oxidative stress in patients with inflammatory type of chronic abacterial prostatitis (chronic pelvic pain syndrome category IIIA)

Shevchenko S.Y., Kulchavenya E.V., Baranchukova А.А.

Abstract

Introduction. The term «chronic prostatitis» includes many different symptomatic patterns, many aspects of which still remain a mystery. The role of oxidative stress in the pathophysiology of many diseases, including prostatitis, is undisputable.

Aim. To evaluate the capabilities of a mineral-vitamin antioxidant complex for the treatment of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Material and methods. A total of 47 patients with inflammatory type of chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) were included in the study. The examination, along with standard tests, included evaluation of the antioxidant status. Patients were randomized into the main group (n=26), and the control group (n=21). All men received standard therapy. However, in the main group, Selzinc-plus was additionally prescribed, 2 tablets per day for 2 months. The results were assessed after 2 months of therapy.

Results. Standard therapy had a significant effect in patients of both groups, which lasted for two months. However, additional antioxidant therapy practically doubled this effect on the symptom scale, although it had no influence on the number of leukocytes in the expressed prostate secretions. At baseline, all patients in both groups had a decrease in antioxidant protection. Two months of taking Selzinc-plus led to normalization of the overall antioxidant status. In the control group, there was also a positive trend in antioxidant status, but significant differences were obtained only in the activity of erythrocyte superoxide dismutase.

Conclusion. CP/CPPS is accompanied by oxidative stress. Taking Selzinc-plus for two months allows to restore the activity of the antioxidant system.

Urologiia. 2023;(6):22-29
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Onto-phylogenetic prerequisites for development of chronic cystitis in women

Kulchavenya E.V., Treyvish L.S., Telina Е.V., Tsukanov А.Y., Neymark А.I., Neymark A.B., Kholtobin D.P., Razdorskaya M.V.

Abstract

Introduction. Urinary tract infections (UTIs) are among the most common bacterial infections. At the request “cystitis”, there are 12,067 publications in the RSCI system (e.library) as of 10/08/2023 and 16,332 articles were screened in the Pubmed. This is evidence that the problem of cystitis is far from being resolved.

Material and methods. A total of 425 patients with bacterial vaginosis and 77 women with chronic recurrent cystitis were included in the study. In all patients, the vaginal biocenosis was assessed through molecular genetic testing. The examination included filling out the Russian version of the Acute Cystitis Symptom Score (ACSS), urinalysis, and urine culture. In addition, local microcirculation was measured using laser Doppler flowmetry (LDF). After examination, patients were prescribed basic therapy and randomly assigned to one of three groups. In a control group (n=17), only basic therapy, consisting of fosfomycin 3.0 once at night + furagin 100 mg after meals 3 times a day for 5 days was prescribed. In the main group 1, 29 women received basic therapy plus Superlymph® suppositories 10 units 2 times a day vaginally for 10 days. In the main group 2, 31 patients received basic therapy plus suppositories Superlymph® 10 units (rectally in the morning) and Acylact Duo (vaginally in the evening) for 10 days.

Results. Among 425 patients with bacterial vaginosis, 78 (18.3%) complained of various urinary disorders, but only 21 women (4.9% of those with vaginal dysbiosis and 26.9% with dysuria) had a diagnosis of cystitis. In all cases, it was an exacerbation of a chronic disease. Among 77 patients with chronic cystitis, normal vaginal flora was initially present in 32 patients (41.6%), and bacterial vaginosis was found in 45 (58.4%) cases.

After therapy, positive results were noted in patients of all groups. Complete eradication of the pathogen occurred in 15 women (88.2%) who received only basic therapy; in the main groups 1 and 2, uropathogens were not detected in 27 (93.1%) and 28 (90.3%) cases, respectively. In the control group, the proportion of patients with normal vaginal flora remained virtually unchanged (41.2% [n=7] vs. 47.1% [n=8]). In the main group 1, the proportion of patients with normal vaginal flora almost doubled: from 41.4% (n=12) to 79.3% (n=23). In main group 2, restoration of vaginal flora was noted in 87.1% of cases.

Conclusion. According to our data, only 4.9% of patients with bacterial vaginosis were diagnosed with chronic cystitis, however, 58.4% of patients with chronic cystitis had vaginal dysbiosis. The use of a complex of antimicrobial peptides and cytokines has significantly increased the bidirectional effect of therapy. Suppositories Superlymph in a combination with vaginal use of Acylact Duo allow to obtain the best results.

Urologiia. 2023;(6):30-37
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Safety and efficiency of retrograde intrarenal surgery without X-ray guidance

Guliev B.G., Talyshinsky A.E., Agagyulov M.U., Andrianov А.А.

Abstract

Introduction. The main stages of flexible ureteroscopy in patients with renal stones are usually performed under X-ray guidance. Long-term exposure of ionizing radiation can have negative effects on the patients with nephrolithiasis and the operating team.

Aim. To study the results of retrograde intrarenal surgery (RIRS) without fluoroscopic guidance.

Materials and methods. The results of flexible ureteroscopy (fURS) without X-ray-guidance in 76 patients were analyzed. There were 46 (53.3%) men and 30 (46.7%) women. The average age was 50.4±14.6 years. All patients underwent laboratory tests and non-contrast-enhanced computed tomography to determine the size and density of the stone. In all cases, preoperative ureteral stenting was performed. The average stone size was 10.5±4.2 mm. First, ureteroscopy with a rigid endoscope was done to assess the ureter and determine the depth of the introducing ureteral access sheath. After removing the ureteroscope along the guidewire, a ureteral access sheath was put at this distance. An inspection of the collecting system and laser fragmentation of kidney stones were performed using a flexible ureteroscope. In 64 (84.2%) patients, a 4.7 Ch stent was put at the end of the procedure, while in the remaining 12 (15.8%) patients, a ureteral catheter was left for 1–2 days. The operation time, stone-free rate, and the number of intra- and postoperative complications were studied.

Results. All fURS were successful and performed without X-ray guidance. The average operation time was 42.5±8.0 minutes. After the first session, stone-free rate was 92.1% (70/76). In 6 (7.9%) cases, residual stones were found, which were completely removed after the second session. Intraoperative complications, namely perforation of the upper calyx by the distal end of the ureteral access sheath, were observed in 2 (2.6%) patients, which did not require any additional interventions. Postoperative complications occurred in 10 (13.2%) patients, including fever in 6 (7.9%) and hematuria in 4 (5.3%) cases. There were no serious complications, such as ureteral perforation or sepsis, and no blood transfusion was performed.

Conclusion. Flexible ureteroscopy with laser lithotripsy can be performed safely and effectively without X-ray guidance.

Urologiia. 2023;(6):38-43
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Development of purulent-destructive forms of acute pyelonephritis in patients with a history of new coronavirus infection COVID-19

Pulbere S.А., Kotov S.V., Magomedov М.А., Zheltikova Е.А.

Abstract

Introduction. Since 2019, more than 600 million cases of the new coronavirus infection COVID-19 have been reported worldwide. According to various studies, the development of a systemic inflammatory response and «cytokine storm» play an important role in the pathogenesis of kidney damage, which leads to impaired microcirculation, increased thrombus formation and the development of ischemic areas in the parenchyma.

Aim. To study the frequency and possible causes of purulent forms of pyelonephritis in patients who have had a new coronavirus infection COVID-19.

Materials and methods. The prospective and retrospective study included the results of 403 patients with acute non-obstructive pyelonephritis in the pre-COVID period and those with a history of a new coronavirus infection.

Results. In patients with acute non-obstructive pyelonephritis without past urological history who had a new coronavirus infection, an increase in purulent-destructive forms from 5.0 to 17.0% was noted. One of the reasons is increased antibiotic resistance and the emergence of pan-resistant uropathogens due to irrational use of antibacterial drugs.

Conclusion. The use of reserve antibacterial drugs in patients with acute pyelonephritis as empirical therapy and anticoagulants in order to improve microcirculation and prevent thrombosis is pathogenetically justified.

Urologiia. 2023;(6):44-50
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Taxonomic characteristics and antibiotic susceptibility of microorganisms verified in the expressed prostate secretion in post-COVID-19 patients with recurrent chronic bacterial prostatitis

Ibishev K.S., Naboka Y.L., Ismailov R.S., Gudima I.А., Prokop Y.O., Vlasenko V.A., Kogan M.I.

Abstract

Introduction. Recurrent chronic bacterial prostatitis (rCBP) is a hard-to diagnosis-and-treat disease which there is no consensus. A particularly difficult cohort is represented by patients who had COVID-19. The study aimed to evaluate the taxonomic structure and sensitivity to antibacterial drugs of microorganisms verified in expressed prostate secretion (EPS) in rCBP-patients who had COVID-19.

Materials and methods. A multicenter, prospective, randomized study was conducted with the inclusion of 52 rCBP patients who had COVID 19, in which the taxonomic structure and susceptibility were studied to antibacterial drugs of microorganisms that were verified and dominated in the EPS. Bacteriological study was carried out using an extended set of selective nutrient media and special cultivation conditions. Antibiotic susceptibility was determined in the taxa of microbiota dominating in the EPS.

Results. The mean age of the patients was 34.8±5.2 years, the duration of rCBP was 5.7±2.3 years. In all patients, various variants of aerobic-anaerobic compositions of microorganisms were recorded in the life cycle. A total of 27 microbiota taxa were isolated. The aerobic cluster was represented by 16 genera and/or species, the anaerobic cluster by 11. When studying antibiotic susceptibility to antibacterial drugs, an increase in antibiotic resistance of the most microorganisms isolated was revealed.

Conclusions. The taxonomic structure of microorganisms in rCBP-patients who had COVID-19 in all cases was characterized by complex and new variants of aerobic-anaerobic associations of microorganisms. When studying the antibiotic susceptibility, multi-resistant and pan-resistant bacteria were identified that is a real threat to this category of patients.

Urologiia. 2023;(6):51-57
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Obstructive uropathia in pregnant women: results of treatment depending on the etiopatogenetic factor of development

Perov R.A., Nemenov А.А., Nizin P.Y., Sokolov N.M., Kotov S.V.

Abstract

Actuality. The development of renal colic in pregnant women is one of the most common reasons for visiting a hospital that is not associated with obstetric pathology. Given the pharmacological and diagnostic limitations during gestation, the problem of expanding the renal cavitary system in pregnant women, as well as the choice of treatment tactics, remains a difficult clinical task.

Materials and methods. The study group included 537 patients with obstructive uropathy with a gestation period of 5 to 36 weeks, who were hospitalized from January 2018 to January 2022 at the GBUZ GKB named after. S.S. Yudina DZM. Depending on the etiopathogenetic obstructive uropathy, the patients were divided into 3 groups: group I – 201 (37.4%) patients with gestational pyelonephritis (the presence of a systemic inflammatory response syndrome) and expansion of the renal cavitary system without confirming the diagnosis of urolithiasis; group II – 216 (40.2%) patients with renal colic (presence of pain without signs of a systemic inflammatory reaction) and enlargement of the renal cavitary system not associated with urolithiasis; group III – 120 (22.4%) pregnant women with an expansion of the cavitary system of the kidney caused by urolithiasis, both with and without signs of a systemic inflammatory reaction. Age, body mass index and previous number of pregnancies in all groups did not differ. The mean age of the patients in the three groups was 26.1 years, with a mean gestational age of 20.8 weeks. In 433 (80.6%) patients, pain was observed in the lumbar region on the right, in 83 (15.5%) – on the left, the bilateral nature of the process – in 21 (3.9%) patients.

Results. In group I, despite ongoing conservative therapy, 129 (64.2%) pregnant women received an internal ureteral stent. After 2–4 weeks of follow-up, the ureteral stent was removed in all patients. As a result, a short-term drainage method (up to 4 weeks) was effective in 90.1% of pregnant women, and in 13 (9.9%) patients, it was necessary to re-insert the stent, followed by a routine replacement of the drain every month. Considering the pain syndrome among patients of group II, drainage was performed in 80 (37%) pregnant women. Routine stent replacement was required in 2 (2.3%) patients. In group III, the location of the calculus in the pyelocaliceal system was in 28 (23.3%) patients, in the ureter - in 92 (76.7%) patients. Independent passage of the calculus was noted in 8 (6.7%) pregnant women, ureteroscopy without prior stenting was performed in 31 (25.8%) pregnant women with ureteral calculus. The remaining 81 (67.5%) pregnant women underwent stent placement at the first stage. When the stone was localized in the ureter, 32 (22.7%) patients underwent contact laser ureterolithotripsy and 21 (17.5%) patients underwent ureterolithoextraction. When a stone was located in the kidney, 28 (23.3%) pregnant women underwent pyelocalicolithotripsy. Achievement of the stone-free status was observed in 92.8%.

Conclusion. Obstructive uropathy in pregnant women requires identification of the cause and a multidisciplinary approach. Long-term drainage of the urinary tract should be avoided and short-term drainage should be preferred. Surgical treatment of urolithiasis, regardless of gestational age, is an effective and safe method.

Urologiia. 2023;(6):58-63
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The efficiency of pre-administration of a peptide mimicking the spatial structure of erythropoietin α-chain B in modeling experimental post-contrast acute kidney injury

Bratchikov O.I., Kondrashov М.М., Kostina D.A., Shcheblykina O.V.

Abstract

Aim. To study the efficiency of pre-administration of a peptide mimicking the spatial structure of erythropoietin α-chain B in modeling experimental post-contrast acute kidney injury.

Materials and methods. In this study, an experimental model of post-contrast acute kidney injury was created using a non-steroidal anti-inflammatory drug, a nitric oxide synthase inhibitor, and injection of iopromide to mature male mice. After 48 hours, a comprehensive assessment of the concentration of creatinine, urea, glomerular filtration rate, the ratio of urea/albumin in the serum, as well as the level of proteinuria and interleukin 6 in the urine was carried out.

Results. A peptide mimicking the spatial structure of erythropoietin α-chain B, administered at a dose of 100 μg/kg 30 minutes before modeling of pathologic process, contributes to a significant decrease in creatinine and urea concentrations by 2.5 and 1.8 times, respectively, with an increase in glomerular filtration rate 4.4 times. In addition, in the group with pharmacological correction, there was a significant decrease in the ratio of urea/albumin by 2.2 times, a decrease in the level of proteinuria by 61.9% and a decrease in the concentration of pro-inflammatory interleukin-6 in the urine by 2.1 times.

Conclusion. Thus, the preliminary administration of a peptide that mimics the spatial structure of the erythropoietin α-chain B helps to reduce the severity of post-contrast acute kidney injury in the experiment, due to anti-inflammatory properties.

Urologiia. 2023;(6):64-67
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The efficiency of totally tubeless percutaneous nephrolithotomy: analysis of 40 cases

Berezhnoy A.G., Dunaevskaya S.S., Ershov А.V.

Abstract

Introduction. Previously, the placement of a nephrostomy tube was considered standard practice during percutaneous nephrolithotomy (PCNL) to ensure repeat access and kidney assessment. However, some publications have shown that in certain cases, a totally tubeless approach may be a viable alternative, provided that PCNL is performed properly and safely.

Aim. To analyze the results and complications of totally tubeless PCNL.

Materials and methods. A retrospective analysis of 40 patients with renal stones who underwent totally tubeless PCNL using a single percutaneous access of 16 Ch or 26 Ch at the urology department of NUZ KB “RJD-Medicine”, Krasnoyarsk, Russia, from September 2021 to March 2023, was carried out. Factors that could affect the efficiency and safety of PCNL were analyzed.

Results. The mean duration of the procedure was 39.6 ± 14.4 minutes. The average decrease in hemoglobin level was 5.9 ± 5.5. Narcotic analgesics were used postoperatively in 17.5% (7) of patients. The mean length of stay was 4.7 ± 1.1 days. Transient fever was observed in 4 (10%) cases. In one case, an exacerbation of chronic pyelonephritis developed. There were no cases of significant bleeding during the PCNL, and no patients required blood transfusion.

Conclusions. Our results confirm that totally tubeless PNL is a safe alternative to standard procedure and is not associated with an increased risk of early postoperative complications. This technique is efficient and safe for kidney stones and may be recommended for a select group of patients.

Urologiia. 2023;(6):68-71
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Andrology

Evaluation of long-term results of using the drug Fertiwell: impact on the likelihood of conception and pregnancy outcome

Spivak L.G., Gamidov S.I., Al-Shukri S.H., Morozov A.O., Androsov А.А., Popova А.Y., Kupriyanov Y.A., Pushkar D.Y.

Abstract

Introduction. Current methods of treating male infertility have limited efficiency, since they are aimed to individual stages of the pathogenesis. Preparations based on testicular regulatory polypeptides are the most physiological and universal, owing to a complex effect on the self-regulation of testicular tissue.

Aim. To study the delayed efficiency and safety of therapy with Fertiwell in patients with pathospermia and to assess the frequency of conception and pregnancy outcome in their partners based on the collection, analysis and interpretation of medical data.

Materials and methods. A telephone survey of patients participating in the phase III clinical trial was carried out. The fact of conception in a couple was assessed over a period of 1 to 9 months after completion of therapy, as well as time from completion of the course to conception, pregnancy outcomes, newborn health outcomes.

Results. In the period from 1 to 9 months after completion of therapy, pregnancy occurred in 17 out of 34 couples (50%) in the Fertiwell group and in 13 out of 42 couples (30.95%) in the placebo group. This difference was statistically and clinically significant (p<0.05). All pregnancies resulted in a live birth. The median time from completion of the course to conception was 4 months in Fertiwell group and 6 months in the placebo group. There were no significant differences in anthropometric parameters of newborns between the two groups (p>0.05).

Conclusion. When using the drug Fertiwell, pregnancy and live birth rate was significantly higher (2.23 times) compared to the control group. There was a trend toward earlier pregnancies in partners of men receiving Fertiwell. Thus, this drug can be recommended for the treatment of men with idiopathic infertility as monotherapy, as well as in combination with assisted reproductive technologies.

Urologiia. 2023;(6):72-79
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Comparative analysis of antibiotic therapy and cytokine therapy (the drug “superlymph”) for male infertility associated with male accessory gland infections

Gamidov S.I., Popova A.Y., Shatylko T.V., Li K.I.

Abstract

Aim. To compare the effects of cytokine and antibacterial therapy on semen parameters and additional functional tests in patients with infertility due to male accessory gland infections (MAGI) who are preparing for assisted reproductive technologies (ART).

Materials and methods. A randomized, prospective, controlled clinical trial without blinding was carried out. A total of 60 men from infertile couples with MAGI who were preparing to ART was included in the study. In the main group (n=30) patients received Superlymph, 1 suppository of 25 units, 2 times a day for 20 days. In the control group (n=30), the antibacterial drug Doxycycline 100 mg 2 times a day for 28 days was given. After the end of therapy on day 33±3, a repeated sperm analysis, MAR test, a test for reactive oxygen species in the ejaculate and sperm DNA fragmentation, and bacteriological examination of sperm was performed. In addition, a survey for adverse events was carried out. The significance of differences in initial and final parameters and differences between groups was assessed using the Student’s t-test, Wilcoxon test and Mann-Whitney U-test depending on the data distribution. The Shapiro-Wilk test was done to investigate the normality of data distribution. Fisher's exact test was used to compare categorical variables.

Results. The final analysis included data from 53 patients (n=28 in the main group and n=25 in the control group). In both groups, a significant decrease in the level of free oxygen radicals in the ejaculate was noted (p=0.031), which was more pronounced in the main group. There were no differences in other semen parameters. Eradication of the microorganism according to bacteriological examination occurred in 57.1% of patients in the main group and in 88% of those in the control group (p=0.016). In patients receiving monotherapy with Superlymph, there was a significant decrease in the sperm DNA fragmentation index and the concentration of leukocytes in the ejaculate. In patients receiving antibacterial therapy, there was a significant increase in ejaculate volume, a decrease in the proportion of IgG-associated sperm and leukocyte concentration.

Conclusion. Many issues of diagnosis and treatment of MAGI have not been thoroughly studied and are poorly standardized. Considering the problems of increasing antibiotic resistance, alternative treatment options are needed. Cytokine therapy (the drug Superlymph) is an effective alternative method of monotherapy for male infertility due to MAGI and is optimal for quickly preparing a couple for ART protocol, given its positive effect on oxidative stress and the index of sperm DNA fragmentation. The prospect of combination therapy with antibiotics and Superlymph seems promising.

Urologiia. 2023;(6):80-86
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Use of the antioxidant complex Androdoz in infertile men

Nashivochnikova N.A., Krupin V.N.

Abstract

Introduction. Infertility is a global problem, affecting more than 15% of sexually active couples worldwide. The frequency of the male factor reaches 40–50% and continues to increase. Fertility problems with unknown causes are referred as idiopathic.

Aim. To evaluate the possibility of using the Androdoz antioxidant complex in men with infertility.

Materials and methods. A retrospective analysis of the medical records of 32 infertile men aged 21 to 45 years (average of 27.8 ± 6.7 years) with pathospermia was carried out. Antioxidant complex Androdoz was prescribed 2 capsules bid with meals according to the package insert for up to 3 months. The results were assessed after 3 and 12 months (follow-up period) from the start of therapy. In addition to ejaculate analysis, all patients underwent digital rectal examination, transrectal ultrasound of the prostate and ultrasound of the scrotum, microscopic examination of ejaculate and expressed prostate secretions, and PCR-based assay of urethral swab (Androflor). The zinc concentration in seminal plasma, as well as the total antioxidant capacity of sperm, was also evaluated. Damage to sperm chromosomes was characterized by DNA fragmentation using an assessment of sperm chromatin dispersion.

Results. Based on the results of a comparative analysis of ejaculate, it was revealed that taking Androdoz complex not only had a positive effect on sperm motility and viability, but also led to a decrease in the percentage of sperm with DNA fragmentation to a level of less than 15%, and significantly increased the total antioxidant capacity of the ejaculate.

Conclusions. The use of Androdoz antioxidant complex in men with reproductive disorders improves the qualitative and quantitative markers of the sperm analysis and the morphological state of the male reproductive system, and allows to replenish the lack of vitamins. The most important effect of Androdoz complex appears after 3 months.

Urologiia. 2023;(6):88-94
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ONCOUROLOGY

Herpes viruses and human papillomavirus in prostate cancer: first results

Mikhaleva L.M., Kamalov А.А., Karpov V.K., Okhobotov D.A., Akopyan E.P., Shakhpazyan N.K., Shaparov B.M., Nesterova O.Y., Martirosyan L.K., Ekhoyan М.М., Osmanov О.А.

Abstract

Introduction. Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are among the most common urological diseases in men. It has been repeatedly suggested that viral infection plays an important role in prostate carcinogenesis.

Aim. To assess the relationship between viral infection and PCa, as well as the clinical and morphological features of BPH and PCa.

Materials and methods. A total of 98 patients undergoing treatment for BPH (n=48) or PCa (n=50) between 2019 and 2021 were included in the study. Real-time PCR on the surgical specimens for human papillomaviruses (HPV), herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes virus type 6 (HSV-6) was performed.

Results. In patients with PCa, viruses in prostate tissue were found more often compared to those with BPH (50.0 vs. 31.3%, respectively, p=0.046.) The most common virus in both PCa and BPH was EBV (22.0 vs. 16.7%, respectively). The second most common virus in patients with PCa was HSV-6 (20.0%), which was not detected in any men with BPH (p=0.003). There was a trend toward higher prevalence of CMV among patients with PCa (16.0% vs. 4.2%), but the difference was not significant (p=0.09). There was no association of viral infection with clinical and morphological features.

Conclusions. The resulting trend toward a higher prevalence of HSV-6 and CMV in patients with PCa compared to those with BPH creates the prerequisites for further study of viruses in prostate diseases involving a larger cohort, which will provide an idea of the multi-stage process of malignant transformation and, possibly, open new therapeutic options for prevention and treatment.

Urologiia. 2023;(6):95-101
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Minimizing the number of trocars during laparoscopic partial nephrectomy. Surgical technique

Kurbanov А.А., Chernov Y.N., Chinenov D.V., Tsukkiev Z.K., Votyakov А.Y., Lerner Y.V., Sutugin K.E., Shpot E.V.

Abstract

Introduction. During last 20 years in urology there has been a number of significant advancements, which were due to the introduction into practice and improvement of minimally invasive techniques. Development of laparoscopic surgery allowed to actively introduce these procedures in various kidney disorders, including renal tumors. Laparoscopic partial nephrectomy is also undergoing changes in order to improve the technique. Standard technique requires four or more trocars, where fourth (additional) trocar is put for the assistant. However, there is an opinion that in most cases it is possible to perform partial nephrectomy without an assistant trocar, while maintaining the safety and efficiency of the procedure and improving some perioperative outcomes. The aim of our study was to compare the safety and efficiency of the three-trocar and four-trocar techniques during transperitoneal partial nephrectomy. This article also presents the technical features of laparoscopic partial nephrectomy.

Materials and methods. Between 2021 and 2023, a total of 200 patients were included in the study comparing three- and four-trocar partial nephrectomy.

Results. There was no difference in the rate of achieving renal trifecta between the two groups. In the three-trocar group, 94 cases of renal trifecta were found, while in the four-trocar group, there were 95 patients with renal trifecta.

Conclusions. The three-trocar technique is not inferior in safety and efficiency to the standard four-trocar technique. The main advantages of the three-trocar technique are less pain, cost and post-operative scarring.

Urologiia. 2023;(6):102-107
pages 102-107 views

Pediatric urology

Evaluation of the efficiency and safety of pain relief in the postoperative period in children after urological interventions

Fayziev O.Y., Satvaldiyeva E.A., Yusupov A.S., Agzamova S.A., Abzalova M.Y.

Abstract

Introduction. Urinary tract disorders are one of the most common pathologies in children, regardless of age, and every year their prevalence is growing. Our study is dedicated to improvement of postoperative pain management after pediatric urologic procedures and to implementation of modern approaches for enhanced recovery.

Aim. To develop optimal methods of postoperative pain relief for moderate and severe intensity of pain syndrome in children undergoing urological procedures.

Materials and methods. The study involved 34 patients who were undergone to urological procedures. For an objective assessment of the quality of anesthesia, the following research methods were used: clinical study with the determination of the pain intensity on a visual analogue scale (VAS) and the determination of systolic and diastolic blood pressure, pulse oximetry and echocardiographic study.

Results. The analysis of the postoperative period with monitoring of blood pressure, oxygen saturation, pulse oximetry, subjective assessment of the pain intensity on the VAS and the echocardiographic study showed that the relative stability of the condition was associated with an adequate pain relief. The use of a combination of infulgan, which caused an early analgesic effect, with tramadol realizing its action later, provides a prolongation of analgesia. A combination of tramadol with infulgan was several times more efficient than ketorolac.

Conclusions. The use of a combined analgesia after urological procedures, including ketorolac, provides a hemodynamically stability in the entire postoperative period.

Urologiia. 2023;(6):108-112
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Clinical case

The efficiency of complex phytotherapy for the treatment of lower urinary tract infection in women

Gyaurgiev T.A., Kuzmenko A.V.

Abstract

Lower urinary tract infections (LUTI) are one of the most common urological diseases. Prevention of recurrences and development of chronic cystitis are among the key tasks in the treatment of women with LUTI. It consists of choosing adequate antibacterial therapy and preventive measures. Phytotherapy using various herbal preparations is considered to be one of the most common and effective preventive measure. Three clinical cases of effective treatment of patients with recurrent LUTI with Phytolysin® paste and Phytolysin capsules as part of complex therapy are presented in the article, demonstrating the high efficiency of long-term courses of phytotherapy.

Urologiia. 2023;(6):113-116
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Literature reviews

The actual concept of salvage therapy for local recurrence prostate cancer after radical prostatectomy

Pavlov A.Y., Dzidzaria A.G., Tsibulskii A.D., Mirzakhanov R.I.

Abstract

Despite highly effective radical methods of treatment of prostate cancer (PC), 30% of patients will have a biochemical recurrence. The evolution in the diagnosis of recurrent prostate cancer after prostatectomy (RP) contributes to the search and development of such methods of treatment of relapses that consider not only the effectiveness, but also the quality of life of patients. This review demonstrates the actual concept of treatment of recurrent PC after RP, starting with salvage androgen-deprivation therapy with or without EBRT, and ending with minimally invasive methods such as salvage high-dose brachytherapy.

Urologiia. 2023;(6):117-121
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Predictors of therapy efficacy of immune response checkpoint inhibitors in clear cell renal cell carcinoma

Gilyazova I.R., Izmailov А.А., Asadullina D.D., Ivanova E.A., Pavlov V.N., Khusnutdinova E.K.

Abstract

Immunotherapy in oncologic diseases involves the use of drugs which stimulate the immune system and indirectly suppress tumor cells growth. These agents have expanded the treatment options for cancer patients. Despite the impressive success achieved in the development of immune checkpoint inhibitors (ICIs) and subsequent approval in a broader spectrum of malignant tumors, most patients are not responded the therapy. Currently available predictive markers of efficacy are nonspecific. However, microRNAs are of particular interest, which regulate gene expression and are involved in the carcinogenesis and therapy resistance. Therefore, it is clear that for the most efficient and cost-effective use of ICIs, it is important to have validated biomarkers that will accurately predict the therapeutic response. The published results on molecular genetic changes in patients with renal cell carcinoma (RCC) were analyzed and summarized in order to determine possible prognostic biomarkers when prescribing ICI therapy.

Urologiia. 2023;(6):122-126
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Optimization of prevention of infectious complications during prostate biopsy

Kolontarev K.B., Stroganov R.V., Pushkar D.Y.

Abstract

Prostate cancer (PCa) is one of the most common malignant neoplasms in middle-aged and elderly men. Transrectal ultrasound guided prostate biopsy is the standard method for diagnosing prostate cancer but is associated with a high incidence of infectious compli-cations.

A review of the literature on optimizing the prevention of infectious complications when performing transrectal prostate biopsy is presented. The main risk factors and the common measures to prevent the development of complications are discussed, including a study of using fosfomycin trometamol as the preferred drug for antibacterial prophylaxis. Fosfomycin meets the requirements for empirical prophylaxis, but further clinical studies are needed.

Urologiia. 2023;(6):128-132
pages 128-132 views

Robot-assisted prostatectomy for pT3. Oncological and functional outcomes

Medvedev R.М., Kolontarev K.B., Govorov А.А., Skrupskii К.S., Vasiliev А.О., Dyakov V.V., Kotelnikova А.А., Vitoslavsky А.А., Pushkar D.Y.

Abstract

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

Urologiia. 2023;(6):133-137
pages 133-137 views

Regnerative technologies in reconstructive operations on the urethra: a review. Part 2

Pavlov V.N., Kazikhinurov R.А., Kazikhinurov А.А., Guspanov R.I., Shamsov B.I., Vardikian А.G., Kazikhinurov R.R.

Abstract

Recent advances in the treatment of urethral strictures are associated with regenerative medicine and tissue engineering. Urethral reconstruction in some cases is a difficult task for urologists due to the insufficient amount of autologous tissue and relapses, which encourages clinicians to search for alternatives. The purpose of this work is to review the latest achievements in the use of regenerative technologies, biomaterials and cell therapy in urethroplasty. The second part of the literature review presents the prospects of using the stromal vascular fraction (SVF) of autologous adipose tissue during reconstructive operations on the urethra, especially considering the availability of these cells through lipoaspiration. Tissue engineering technologies are reflected, which offer their own solutions to problems and limitations of their use. The article also provides examples of experimental studies in which cell-free and cellular biomaterials were used for urethral reconstruction.

We believe that the approach of using SVF and biomatrix can become a potentially safe and effective method of therapy associated with the acceleration of regeneration processes, and can be of great benefit to patients with urethral diseases in the future.

Urologiia. 2023;(6):138-144
pages 138-144 views

Lectures

The use of a urethral catheter with an ultrasound-induced biopolymer drug coating for the prevention of recurrent bladder neck sclerosis in patients after endoscopic treatment of benign prostate hyperplasia

Kamalov А.А., Sorokin N.I., Kadrev А.V., Shaparov B.М., Afanasevskaya Е.V., Sindeeva О.А., Sukhorukov G.B., Kritsky А.А., Pyataev N.А., Abdurashitov А.S., Kulikov О.А., Proshin P.I.

Abstract

Recurrent bladder neck sclerosis is one of the common complications of endoscopic treatment of benign prostate hyperplasia, which often leads to multiple re-operations, including complex open and laparoscopic reconstructive procedures. One of the most promising minimally invasive methods for preventing recurrence of bladder neck sclerosis is balloon dilatation under transrectal ultrasound guidance. To improve the results of using this technique, a urethral catheter with a biopolymer coating, capable of depositing a drug and eluting it under the influence of diagnostic ultrasound, was proposed.

Urologiia. 2023;(6):145-150
pages 145-150 views

Balanoposthitis in the clinical practice of a urologist and dermatovenereologist: an interdisciplinary problem

Khryanin А.А., Sokolovskaya А.V., Bocharova V.К.

Abstract

Balanoposthitis is a common inflammatory disease of the male genitals, which occurs more often in uncircumcised men. The cause of balanoposthitis can be an infectious, inflammatory or autoimmune process, as well as traumatization. In most cases, after proper intimate hygiene and the use of neutral moisturizers, the symptoms of balanoposthitis are completely stopped. In the case of torpid course of balanoposthitis and in the absence of improvement after drug therapy, it is necessary to exclude the malignant process. In the review article, the authors present the data of modern scientific research on the qualitative and quantitative composition of the microbiome in balanoposthitis. Differences in the composition of the microbiome were revealed in patients with balanoposthitis and healthy patients from the control group with excess foreskin. It was found that in patients with balanoposthitis, a impaired in hydration of the skin of the glans penis was revealed. Staphylococcus warneri and Prevotella bivia are the most common species associated with balanoposthitis and positively correlate with the severity of the disease. Candida infection, as an etiological factor of balanoposthitis, often occurs in children and may be associated with diaper rash. The prevalence of Gardnerella vaginalis as a pathogen in the male urogenital tract has not been fully studied. Currently, there are no reliable scientific studies that make it possible to attribute G. vaginalis to the etiological factor of balanoposthitis in men. However, it should be borne in mind that balanoposthitis may have a polymicrobial and synergistic etiology with the participation of G. vaginalis and anaerobic bacteria in the lower genital tract of men. The review article is clearly illustrated with clinical examples of the disease from the personal practice of the authors.

Urologiia. 2023;(6):152-157
pages 152-157 views

Anniversaries

pages 158-158 views

Commemorative and jubilee dates

pages 159-160 views

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