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No 6 (2022)


Asymptomatic bacteriuria in pregnant women - the normal condition of healthy women urine

Kogan M.I., Naboka Y.L., Gudima I.A., Vorob’yeva N.V.


Objective: to study the dynamics of the microbiota of a freshly excreted middle portion of urine in primigravida at different times of all three trimesters of pregnancy. Materials and methods. A single-center prospective observational cohort study was conducted with a consecutive enrollment of 30 women at different gestational ages: I - 8-12 weeks, II - 22-24 weeks, III -30 -32 weeks. A midstream specimen of morning vesical urine was taken for the study, then it was cultivated using nutrient media for aerobic and anaerobic microorganisms under appropriate conditions. Statistical analysis was performed using SPSS ver.26 (IBM SPSS Inc., Chicago, IL, USA). Results. The freshly released middle portion of urine in all 30 observations in the I-III trimesters contains aerobic-anaerobic associations of microorganisms. Coagulase-negative staphylococci, Enterococcus spp., Corynebacterium spp., Lactobacillus spp., Eubacterium spp. prevail in the urine during pregnancy. The E. coli, Candida spp. detection frequency decreases by the third trimester, but Lactobacillus spp. detection frequency rises. Significant differences in the detection frequency were found only in Propionibacterium spp. and Lactobacillus spp. The average level of bacteriuria in most cases is 102-103 CFU/ml with significant differences only in E. faecium, Lactobacillus, Propionibacterium spp. in the III trimester. Discussion. The study of urine at different times of all three trimesters of pregnancy refutes the previous ideas about asymptomatic bacteriuria. The urine microbiota in primigravida during pregnancy has wide spectrum and quite stable until delivery. Such bacteriuria can be considered asymptomatic, but it is a consequence of a healthy state and it is not a disease or its predictor. Conclusion. The term asymptomatic bacteriuria is not correct in the context of risk factor of urinary tract infection in pregnant women.
Urologiia. 2022;(6):5-8
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Efficacy and safety of intermittent catheterization for acute urinary retention: a prospective comparative randomized study

Malkhasyan V.A., Kotov S.V., Mamaev I.E., Belomytcev S.V., Perov R.A., Pulbere S.A., Volnukhin A.I., Pushkar D.U.


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.
Urologiia. 2022;(6):9-15
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Antibiotic resistance of strains of gram-positive cocci isolated from prostate secretion in men with chronic bacterial prostatitis

Kartashova O.L., Pashinina O.A., Morozova N.V., Pashkova T.M., Kuzmin M.D.


Objective: to characterize the antibiotic resistance of gram-positive cocci strains isolated from the prostate secretion in men with chronic bacterial prostatitis at the level of phenotype and genotype. Materials and methods. Bacteria were isolated from the prostate secretion of men of reproductive age (20-45 years) with chronic bacterial prostatitis by conventional bacteriological method. The type of microorganisms was determined by MALDI-TOF mass spectrometry. Resistance to 16 antibiotics of 31 strains of E. faecalis and 91 cultures of coagulase-negative staphylococci (CoNS) was determined by the disk diffusion method. Antibiotic resistance genes (mecA; blaZ; aac(6’)-aph (2’’); ant (4’)-Ia; aph (3’)-IIIa; gyrA, grlA) were detected using polymerase chain reaction (PCR ) using selected primers. Results. A high resistance of enterococci to antibacterial drugs was revealed: fluoroquinolones, carbapenens, cephalosporins (with the exception of cefoperazone), gentamicin and oxacillin. It has been established that CoNS are characterized by variable antibiotic resistance, while: isolates of S. epidermidis and S. haemolyticus are resistant to all studied fluoroquinolones and carbapenems; S. warneri to carbapenems and the vast majority of studied cephalosporins; S. saprophyticus - to aminoglycosides. Amoxiclav and cefoperazone are characterized by the highest activity against clinical isolates. Using PCR, the presence of genetic determinants of resistance to aminoglycosides and ß-lactams was established in the isolates, with a predominance of the studied genes in CoNS. Conclusion. For effective antibiotic therapy in chronic bacterial prostatitis, it is necessary to conduct regional monitoring of the resistance of microorganisms to antibacterial drugs.
Urologiia. 2022;(6):16-20
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The influence of alfuzosin monotherapy on the sexual function of patients with benign prostatic hyperplasia in real clinical practice (results of a Russian multicenter study)

Pushkar D.Y., Loran O.B., Bernikov A.N.


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.
Urologiia. 2022;(6):21-29
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Evaluation of long-term results of the use of entomological drug in the combination therapy of patients with benign prostatic hyperplasia and chronic prostatitis

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


Introduction. Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are among the most important urological diseases. The right choice of treatment for patients with BPH and CP continues to be contradictory. Recently, a new group of entomological drugs has been increasingly used, one of which is Adenoprosin®. Aim. To study the efficiency of Adenoprosin® as part of combination therapy, as well as to evaluate the long-term outcomes in patients with BPH and CP. Materials and methods. A total of 60 patients with BPH and CP were included in the study. They were randomized into two groups of 30 each. In the comparison group, traditional therapy with a1-blockers and fluoroquinolones was administered. In the main group, similar therapy was prescribed in combination with Adenoprosin for 6 months. The follow-up period was 12 months. Results. At baseline, the groups were homogeneous. After three and six months, the results in the control group did not significantly improve, but negative dynamics was revealed at visit 4. The results obtained in the main group at visits 3 and 4 were also significantly better (p<0.05) compared to the control group. During 12 months of follow-up, 7 (23.3%) cases of recurrent CP in the comparison group and 1 (3.3%) case in the main group were seen. Conclusion. According to our results, the use of Adenoprosin® for 6 months allowed more effectively to reduce the lower urinary tract symptoms. The obtained effect persisted for the next 6 months, as evidenced by the dynamics of the studied indicators and the relapse rate of CP.
Urologiia. 2022;(6):30-35
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Evaluation of the efficacy of silodosin 8 mg in comorbid patients with LUTS/BPH

Zimichev A.A., Gusev D.O., Lukyanova D.Y.


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.
Urologiia. 2022;(6):36-40
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The use of prostate extract preparations in patients after transurethral resection of prostate for its benign hyperplasia

Pavlov V.N., Kazikhinurov A.A., Kazikhinurov R.A., Sabirzyanov S.S., Saleeva Y.D., Kazikhinurova K.A.


The purpose of the study is to study the efficacy and safety of the prostate extract (GEROFARM LLC, Russia) in the postoperative period in patients after transurethral bipolar resection of the prostate. Materials and methods. The clinical study included 127 men aged 50 to 78 years with grade II benign prostatic hyperplasia (adenoma) who underwent a typical bipolar transurethral resection of the prostate. Patients of the main (n=60) group received tamsulosin 0.4 mg/day for 30 days in the postoperative period in combination with prostate extract 10 mg rectally for 21 days. In the control group (n=67) - tamsulosin 0.4 mg/day for 30 days as monotherapy. To assess the results of treatment, the questionnaire of the international system of total assessment of symptoms in prostate diseases (IPSS) with the definition of quality of life (QoL), the international index of erectile function (IIEF-5) and uroflowmetry were used. The control was carried out in terms of 1 and 3 months after the operation. Results. In the main group, in the observation period of 1 and 3 months after the operation, a decrease in the average IPSS score by 40.2% and 52.9% was revealed, and an improvement in the quality of life by 45% and 64.7%, respectively, was noted. In the control group, at the same time of observation, a decrease in the average IPSS score by 34% and 44.7%, respectively, was revealed, and the quality of life improved by 25.5% and 37.3%, respectively. The increase in the average rate of urination in the main group by the end of 1 and 3 months of treatment was 59.2% and 85.7%, respectively, and in the control group, these figures were 40.5% and 50%. The positive effect of the proposed combination therapy on erectile function in the main group by the end of 1 and 3 months of treatment was 5.2% and 9.2%, respectively, and in the control group, these figures were 2.9% and 5.2%. Discussion. There is a significant decrease in the symptoms of the lower urinary tract in the group of patients who received the drug Prostateks (GEROFARM LLC, Russia). Conclusions. The efficacy results of Prostatex (GEROFARM LLC, Russia) (reduced symptom severity on IPSS (11.7 1.2 ) and QoL (2.3 0.3)) scales are comparable to those of Vitprost® Plus which allows you to evaluate the effectiveness of two drugs equally.
Urologiia. 2022;(6):42-46
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Combined therapy of patients with recurrent cystitis using a complex of natural antimicrobial peptides and cytokines: first results

Kulchavenya E.V., Neymark A.I., Tcukanov A.Y., Plugin P.S., Neymark A.B., Razdorskaya M.V.


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.
Urologiia. 2022;(6):47-55
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Dissolution of uric acid stones in the ureter

Frolova E.A., Tsarichenko D.G., Saenko V.S., Rapoport L.M., Glybochko P.V.


Introduction. Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures. Materials and methods. The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses). Results. In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.
Urologiia. 2022;(6):56-60
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Plasma acid reproduces oxidative and nitrosative stress in bladder tissue in vitro: experimental study

Alekseeva E.A., Firsov M.A., Malinovskaya N.A., Salmina A.B., Salmin V.V.


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.
Urologiia. 2022;(6):61-65
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Pilot study of the manifestations of synchrony of the anatomical-metabolic and functional state of the brain, kidneys and bladder

Berdichevsky V.B., Berdichevsky B.A., Kolpakov V.V., Sapozhenkova E.V., Pavlova I.V., Gonyaev A.R., Korabelnikov M.A.


Aim. The results of clinical observations and scientific studies of recent years indicate that abstinence from urination before the introduction of radiopharmaceuticals for PET / CT procedures is accompanied by a significantly lower flow of it into the bladder than after preliminary urination. Purpose of the study. Comparative analysis of PET/CT metabolism of 18F-fluorodeoxyglucose at the level of the cingulate gyrus of the brain, different regions of the kidney parenchyma and in the bladder wall in individuals without nephrourological history, depending on the phase of the functional state of the bladder. Materials and methods. The results of PET/CT of the whole body of 30 patients of the radiological center of the Tyumen Regional Oncological Dispensary, including 16 men and 14 women (median age 52.5 (38; 63) years), were analyzed, distributed randomly in three equal study groups: after urination, in the intermictory period and immediately after the appearance of the first urge to urinate. Results. Signs of synchrony were revealed in the anatomical and metabolic activity of the cortical vegetative centers, certain regions of the renal parenchyma and the wall of the bladder in the process of urination, the movement of urine along the urinary tract, the stage of its accumulation in the bladder and preparation for urination. Conclusion. The data obtained allow us to assume that the analyzed regions are equivalent areas of the general regulatory system that provides physiological processes in the organs of the urinary system. However, this fact requires further research and clarification.
Urologiia. 2022;(6):66-70
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Long-term safety and efficacy of trospium chloride for the treatment of neurogenic overactive bladder due to Parkinson's disease - is there an effect on cognitive status?

Korshunova E.S., Andreev M.N., Korshunov M.N., Pyatnitskaya T.M., Korshunov D.M., Darenkov S.P., Suponeva N.A.


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.
Urologiia. 2022;(6):71-77
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Tuberculosis of the male genital organs

Kulchavenya E.V., Shevchenko S.Y.


Introduction. Tuberculosis of the genitourinary system is still of importance. The observed decrease in the incidence of urogenital tuberculosis is largely due to the inaccuracies of registering this disease. Materials and methods. A retrospective cohort comparative noninterventional study of the structure of urogenital tuberculosis in the Siberian and Far Eastern federal districts was carried out. We analyzed statistical reports from 2003 to 2015, which included data for a total of 456 patients, as well as extended questionnaires compiled specifically for this study. In addition, outpatient records of 95 patients with urogenital tuberculosis who were registered at the Novosibirsk Regional Tuberculosis Dispensary by 01/01/2022 were evaluated. Results. An analysis of the structure of urogenital tuberculosis from 2003 to 2015 showed that urinary system was affected in the most of cases (n=314, 68.8%). Tuberculosis of male and female genital organs took the second place (n=101, 22.2%) patients. Generalized urogenital tuberculosis was diagnosed in 41 (9%) patients. From 2003 to 2008, the proportion of renal tuberculosis increased by 12.6%, but then a significant decrease in its proportion was found (82.2% in 2008 vs. 48.6% in 2015 [χ2=12.71; p=0.0004]). On the contrary, in 2003 the proportion of genital tuberculosis was 18% (n=18) compared to 29.1% (n=3) in 2015 (χ2=3.46; p=0.06). In 2015, generalized forms of urogenital tuberculosis were diagnosed in 23 (22.3%) patients, which is approximately 2.5 times more than in 2003 (n=9; 9%) and 2008 (n=7; 6.6%) (χ2> 6.46; p<0.01). The proportion of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013. In 2003, tuberculosis of the scrotum was diagnosed in 100% of men with genital tuberculosis, while in 2013 and 2015 its proportion was 25%. In total, scrotal tuberculosis during whole follow-up was diagnosed in 26 patients, which accounted for 41.9% of all male genital tuberculosis. The combination of tuberculosis of the scrotum and prostate also varied significantly from 17.3 to 35.7%. Generalized urogenital tuberculosis was diagnosed with a minimum proportion (1.4%) in 2008, then there was an upward trend with a maximum rate in 2015 (22.3%, x2=29.38; p<0.0001). Among 95 patients with tuberculosis of the urinary and male reproductive system, who were followed by the phthisiourologist of Novosibirsk Regional Tuberculosis Dispensary, 34 (35.8%) had a diagnosis of kidney tuberculosis, 42 (44.2%) had isolated tuberculosis of the male genital organs, and the remaining 19 (20.0%) men had generalized urogenital tuberculosis. In total, HIV infection was detected in 23 (24.2%) patients with urogenital tuberculosis, and among patients with kidney tuberculosis, it was diagnosed in 7 (20.6%) cases compared to 9 (21.4%) cases in those with male sexual tuberculosis. In patients with generalized urogenital tuberculosis, HIV infection was detected almost 2 times more often, namely in 7 (36.8%) cases. Conclusion. Patients with urogenital tuberculosis are under follow-up of urologists for a long time with erroneous diagnoses, and only when the disease becomes irreversible and requires surgical intervention, the pathomorphological study of the surgical material will allow to make a proper diagnosis.
Urologiia. 2022;(6):78-83
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Mean features of the nephronsparing surgery in older patients with localized renal cell carcinoma

Kotov S.V., Nemenov A.A., Yusufov A.G., Guspanov R.I., Pulbere S.A., Nemenova D.M.


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.
Urologiia. 2022;(6):84-88
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Safety and efficacy of a new method of percutaneous nephrolithotripsy performed under ultrasound and endovisual control without the use of intraoperative x-ray examination

Abramov D.V., Dyrdik M.B., Atduev V.A., Sevryukov F.A., Ledyaev D.S., Gasrataliev V.E., Stroganov A.B.


Purpose of the study. to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control. Materials and methods. A comparative analysis of the results of percutaneous nephrolithotripsy performed under ultrasound and endovisual control in 515 (84.1%) patients (main group) and percutaneous nephrolithotripsy performed under fluoroscopic control in 97 (15.8%) patients (control group) was carried out. The groups did not differ in age, gender, body mass index, the number and location of stones, and the duration of the disease. In the main group, there were more patients with large, staghorn and X-ray negative stones, and there were also more patients with kidney block. To analyze and stratify the complications of percutaneous nephrolithotripsy, we used a modified classification of surgical complications according to the Clavien-Dindo system. Statistical analysis of the material was carried out using the licensed package IBM SPSS Statistics Version 14.0.1. Results. The average duration and number of stages of operations in the main and control groups was the same. Almost all operations in groups (93,8% и 91,8%) were performed in one step (p=0,55). In the main group, in the vast majority of cases95,1%; p<0,001), percutaneous nephrolithotripsy was performed through one puncture access, with the degree of complete elimination of stones statistically the same as in the control group (80.6% in the main group and 70.1% in the control group, p=0.158). The degree of decrease in hemoglobin in the postoperative period in the groups did not differ (p=0,271). The frequency of postoperative complications in both groups did not differ statistically: in the control - 33.0%; in the main group - 29.3% (p=0.469). The severity of complications according to Clavien-Dindo did not differ in the groups either (p=0.17). Conclusion. Percutaneous nephrolithotripsy under ultrasound and endovisual control is a safe and effective operation. The results of the operation and the frequency of early complications are comparable with the traditional X-ray control technique.
Urologiia. 2022;(6):90-96
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Clinical and pathogenetic aspects of the treatment and prevention of pyelonephritis in children

Nashivochnikova N.A., Leanovich V.E.


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.
Urologiia. 2022;(6):97-104
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A clinical case of severe vascular complication during implantation of three-piece inflatable penile prosthesis

Kotov S.V., Pavlov I.S., Denschikov M.B., Osadchinskiy A.E.


Injury of iliac vessels is one of the most disastrous complications of penile prosthesis implantation. There are no detailed descriptions of such cases in world literature. In this article, we present the clinical case of injury to the external iliac vein during the implantation of a three-piece penile prosthesis with particular emphasis on the consequences of such complication in the postoperative period. The article comprises a brief review of the literature on the methods of ectopic placement of the penile prosthesis reservoir.
Urologiia. 2022;(6):106-110
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Modern endourological technologies - new opportunities in the treatment of patients with urinary tract anomalies and in complex clinical cases

Kochetov A.G., Esipov A.V., Sidorov O.V., Gvasalia B.R., Alekhnovich A.V., Baikov N.A., Gritskevich A.A., Kasaikin A.V., Martov A.G.


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.
Urologiia. 2022;(6):111-116
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A rare case of bladder leiomyoma in pregnancy: a case report

Aizat Sabri B.I., Yusof M.R., Jagwani A.V., Fahmy O., Lee C.K., MG-Khairul Asri -., Wan Muhamad Mokhzani W.M., Dharmendra G., Ahmad Zhariff H.


We present a rare case of leiomyoma of the urinary bladder that was diagnosed during pregnancy. The case of a 29-year-old woman primigravida at 13 weeks of pregnancy who presented with 6 months history of abdominal swelling which was gradually increasing in size. Computed tomography done revealed a large heterogenous mass(enhancing) with an area of non-enhancing (necrosis) suggestive of malignant ovarian tumor. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings, and management of this relatively rare benign tumor are discussed in this case report.
Urologiia. 2022;(6):118-121
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Molecular genetic predictors of the efficacy and safety of tamsulosin therapy

Abdullaev S.P., Shatokhin M.N., Teodorovich O.V., Sychev D.A.


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.
Urologiia. 2022;(6):122-126
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Ureteral obstruction and segmental ureteral stents

Gadzhiev N.K., Gorelov D.S., Obidnyak V.M., Malikiev I.E., Gadzhieva Z.K., Mantsaev A.B., Petrov S.B., Martov A.G.


Currently, various types of stents are widely used in urological practice. One of the indications is the presence of upper urinary tract strictures. The factors leading to the development of strictures can be endogenous and exogenous, iatrogenic and non-iatrogenic, benign and malignant. After open, laparoscopic and X-ray-endoscopic procedures a double-J stent is usually placed or, less often, nephrostomy tube. It should be noted that both methods have certain side effects and may affect the patient's quality of life. To reduce the stent-related symptoms and increase their tolerability, various modifications of ureteral stents have been developed. In this article, we analyze the publications devoted to the most commonly used segmental stents without renal and bladder coils, such as Memokath, Uventa, Allium, Memotherm and nitinol stents manufactured by MIT LLC.
Urologiia. 2022;(6):128-133
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