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No 5 (2022)


Long-term inflammatory and neoplastic reaction of prostate tissues during its transurethral infection with uropathogens: evaluation of the results of animal model study

Kogan M.I., Ismailov R.S., Todorov S.S., Naboka Y.L., Gudima I.A.


Introduction. There is no convincing evidence of the persistence of acute or the development of chronic bacterial-induced prostatic inflammation in the long term when infected with various titers of the uropathogen. Along with this, controversial data are presented on the relationship between post-infectious chronic inflammation and neoplastic changes in prostate tissues. Objective. To carry out, based on the experimental data: 1) assessment of the degree ofbacterial contamination and the severity ofhistological changes in prostate tissues on the 60th follow-up day in case of transurethral infection with various uropathogens in titers of 102,3,5 CFU/ml; 2) fundamental comparative analysis between the indicators of the inoculated test-titer and microbial load with the severity of histological changes in prostate tissues; 3) verification of neoplastic transformations in the prostate tissues during a long-term persistent bacterial-induced inflammatory process. Materials and methods. Animal studies were conducted using FELASA protocols. Laboratory animals: 14 New Zealand rabbits. Tested uropathogens: aerobes - E. coli, S. haemolyticus, anaerobes - P. niger. Titers: 102,3,5 CFU/ml. Uropathogen inoculation technique: topical transurethral. Randomization: all laboratory animals were divided into 5 groups according to the uropathogen (4 experimental, 1 control). Follow-up period: 60 days. Sacrification and autopsy of the animals were performed on day 60. Biopsies were taken from various parts of the prostate, as well as from the bladder neck and the edge of the membranous urethra. Cultural, histological and immunohistochemical (expression of p53 and Ki-67) studies of prostate tissues were conducted. Statistical data processing was performed using the GraphPad Prism 9.0 program (GraphPad Software Inc., Graphpad Holdings LLC, San Diego, CA, USA) applying descriptive and non-parametric statistics. Results. Two individuals infected with S. haemolyticus + P. niger had a lethal outcome. The contamination of prostate tissue was determined in all cases of infection. In 88.9% of the cases, an increase in tissue microbial load was determined compared to the initial titer. Multivariate analysis of culture study values revealed the presence of intragroup differences in prostate contamination only between infection with E. coli 103 CFU/ml and E. coli 105 CFU/ml (p=0.006), as well as intergroup differences between infection with E. coli 105 CFU/ml and P. niger 105 CFU/ml (p=0.013). The histological study revealed moderate proliferative inflammation after inoculation with 102,3,5 CFU/ml in the E. coli and S. haemolyticus groups. In the case of S. haemolyticus, it was more pronounced due to the presence of persistent alterative lesion foci; in the P. niger group, mild proliferative transformations were observed in prostate tissues in all cases. The immunohistochemical study of changes determined p53 expression (=10.0%) in some areas ofthe glandular epithelium of prostate glands (but without a positive internal control) only in case of infection with E. coli 105 CFU/ml. Areas of glandular epithelium with Ki-67 expression (625.0%) were visualized in all tested groups, mainly at titers of 103 and 105 CFU/ml, but the severity of proliferative activity was not high (1+). There were no foci of prostate tissue with simultaneous nuclear activity of p53 and Ki-67. Conclusion. Proliferative inflammation of different intensity in prostate tissues was observed after sixty days. Its severity was mainly determined by the type of infecting agent (S. haemolyticus > E. coli > P. niger) and was not dependent on the inoculated titer and the subsequent microbial load of prostate tissues. No areas of neoplastic transformation of prostate tissues were reliably identified in the case of a bacterial-induced inflammatory process in the estimated follow-up period.
Urologiia. 2022;(5):5-14
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Protective potential of 5-alpha-reductase inhibitors on Covid-19 incidence and severity: results from retrospective cohort study FOUNDER (features of a new coronavirus infection course and options therapy depending on the androgenic status)

Kamalov A.A., Nesterova O.Y., Orlova Y.A., Mareev V.Y., Mareev Y.V., Pavlova Z.S., Okhobotov D.A., Strigunov A.A., Vasilevsky R.P., Nesuk O.M., Demkin V.V.


Materials and methods. In our study, electronic medical records of 1678 patients with prostatic hyperplasia were analyzed. 1490 men aged 71 (64-76) years were selected for final analysis. Vaccination against COVID-19 was carried out in 730 patients (49%). Treatment with 5-ARI inhibitors was carried out in 269 (18.1%) patients. Results. Among 1490 included patients 790 (53%) had COVID-19 while 360 (45.7%) of them required hospitalization. During the multivariate analysis, only two factors were associated with the risk of COVID-19 in the cohort studied: vaccination (odds ratio (OR) =0.095; 95% confidence interval (CI) 0.074-0.122), i.e. a 90.5% chance reduction, p<0.001) and the fact of taking 5-ARI (OR=0.235; 95%CI=0.165-0.335; p<0.001), i.e. a 76.5% chance reduction. The duration of 5-ARI therapy was not associated with the incidence of new coronavirus infection. The severe course of COVID-19 which required hospitalization was positively associated with age (p=0.025) and the presence of coronary artery disease (p=0.004); and negatively associated with the frequency of vaccination (p<0.001) and treatment of 5-ARI (3.1% vs. 11.6%, p<0.001). In a multivariate analysis of outpatient patients with prostatic hyperplasia who had COVID-19, 5-ARI intake (OR=0.240; 95% CI 0.122-0.473; p<0.001) and vaccination (OR = 0.570; 95% CI 0.401-0.808; p=0.002). The factors associated with increased chances of hospitalization due to the severe course of COVID-19 were coronary heart disease (+43.8%, p=0.019) and older age (+1.7% by one year, p=0.046). Conclusion. Taking 5-ARI, along with vaccination in patients with prostatic hyperplasia is a protective factor for morbidity and the severity of COVID-19.
Urologiia. 2022;(5):15-22
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The influence of pyelovenous reflux on the development of acute pyelonephritis in an experimental model

Akhmedov O.R., Magomedov D.M., Akhmedov S.R., Sargsyan S.M., Pulbere S.A., Kotov S.V.


Introduction: currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux. The purpose of the study: to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora. Materials and methods: 32 mature female rabbits of the “White Giant” breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3. Results: Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3. Conclusions: pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.
Urologiia. 2022;(5):23-28
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Risk factors and mechanisms of acute pyelonephritis development after contact ureterolithotripsy

Barinov E.F., Malinin Y.Y., Grigoryan K.V.


Aim of the study is to identify risk factors for the development of acute pyelonephritis after contact urethrolithotripsy (URLLT) and to establish the mechanisms for maintaining inflammation after the withdrawal of NSAIDs. Material and methods. The study included 21 patients who underwent contact ureterolithotripsy (URLT). The severity of leukocyturia was assessed 1 day after URLT, 2 days (the last appointment of NSAIDs, the total duration of the drug was 9 days) and 3 days (24 hours after NSAID discontinuation). The number of circulating platelet-leukocyte aggregates (PLA) was calculated by microscopy of stained blood smears. Analysis of the functional activity of platelet receptors involved in the modulation of the acute inflammatory response was performed by the turbidimetric method on a ChronoLog analyzer (USA).Statistical analysis was performed using the MedCalc package. Results. After URSL, when NSAIDs were prescribed to patients, the level of leukocyturia decreased (p<0.05) compared to that at the time of hospitalization. A similar dynamics was found by analyzing the amount of TLA in the blood. Similar dynamics was found in the analysis of the amount of TLA in the blood. After 24 hours of NSAIDs cancellation, an increase in the severity of leukocyturia was detected (p<0.001). At the same time, normoreactivity of the a2-adrenergic receptor, GPVI receptor, AT1 receptor, PAT receptor, P2X1 receptor and A2A receptor, as well as hyporeactivity of the p2-adrenergic receptor and P2Y receptors, were revealed. An analysis of correlations made it possible to establish that the a2-adrenoreceptor, AT1 receptor, and GPVI receptor play a key role in the formation of TPA. Incubation of blood cells in vitro with agonists made it possible to establish that the maximum effect of TLA formation was reproduced during the interaction of the a2-adrenergic receptor and the AT1 receptor. Conclusion. With the abolition of NSAIDs, activation of the sympathetic-adrenal and renin-angiotensin systems, as well as remodeling of the basement membrane of the vascular wall are risk factors for the development of acute pyelonephritis after URLS.
Urologiia. 2022;(5):29-33
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Blebbing of plasma membrane of lymphocytes in infectious complications of urolithiasis

Berezhnoi A.G., Dunaevskaya S.S.


Introduction. About 200 thousand operations for urolithiasis are performed annually in Russia, but the frequency of postoperative complications reaches 30%. Infectious complications occur with a frequency of up to 40% in the form of various forms of pyelonephritis, urosepsis is recorded in 3% of patients. The aim of the study determine the intensity of blebbing of the plasma membrane of lymphocytes in infectious complications of urolithiasis. Materials and methods. A prospective study examined 1,240 patients with urolithiasis. Inflammatory complications were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. Complications ofinfectious nature were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. During the study, complications of an infectious nature were detected in 148 patients, which amounted to 11,93% of cases. The control group consisted of - 25 persons with urolithiasis and a favorable course of the postoperative period. Lymphocyte membrane condition was evaluated by phase contrast microscopy. Results. Changes in plasma membrane structure were more frequently reported in patients with postoperative purulent pyelonephritis and urosepsis. When assessing the presence of circulating microparticles, the highest number was recorded in patients with urolithiasis complicated by purulent pyelonephritis or urosepsis - 1318 [982; 2007] and 1531 [1028; 1963], respectively. A relationship was established between the degree of severity of terminal blebbing of the plasma membrane of lymphocytes and the nature of inflammatory complications in urolithiasis.
Urologiia. 2022;(5):34-38
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Normative parameters for monitoring of nocturnal penile tumescences: results of own observations and approbation of the developed normative criteria

Chaliy M.E., Ohobotov D.A., Strigunov A.A., Kadrev A.V., Dyachuk L.I., Nesterova O.Y., Mikhalchenko A.V., Bogachev R.K., Tivtikyan A.S., Tsigura D.A., Kamalov A.A.


Objective. Clinical approbation of previously obtained normative criteria for evaluating erectograms using the Androscan MIT hardware complex, as well as comparing the monitoring indicators of nocturnal penile tumescence (NPT) with the results of the standard questionnaire International Index of Erectile Function-15 (IIEF-15). Materials and methods. The study included 120 patients aged 19 to 72 years. Erectile function was assessed using the IIEF-15 questionnaire and the Androscan MIT hardware complex. To assess erectile function, previously developed normative criteria for the relative increase in the diameter of the penis (OP) and the duration of NTP were used. Statistical data processing was carried out using the STATISTICA 12 software. A systematic literature search on the normative criteria for monitoring NTP was carried out in the Medline database. Results. After performing and roscanning, patients were divided according to the degree of ED: there were 12 patients without ED, 58 patients with grade 1 ED, 27 patients with grade 2 ED, and 23 patients with grade 3 ED. According to the results obtained, a positive correlation was found between the OD value and the results of the IIEF-15 questionnaire. Conclusion. The obtained data on the correlation between the results of the IIEF -15 questionnaire and the NTP monitoring parameters are consistent with most of the currently available foreign data.
Urologiia. 2022;(5):39-45
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Current state of metaphylaxis of urinary stones in Russian Federation

Malkhasyan V.A., Gazimiev M.A., Martov A.G., Gadzhiev N.K., Sukhikh S.O., Pushkar D.Y.


Introduction. Urolithiasis is one of the most common urological diseases in adults. Increased life expectancy of the population in developed countries, make urolithiasis topical issue and requires close attention. Due to the high risk of recurrent stone formation causing repeated surgical interventions, the issue of effective urinary stone metaphylaxis is very important today. Materials and methods. To study the current state of the problem of urolithiasis metaphylaxis among Russian urologists, an anonymous questionnaire was applied. A 25-question questionnaire was sent to e-mail to more than 4,000 Russian urologists. A total of 1,238 specialists completed the questionnaire. The database compiled from the received responses was processed and presented with descriptive statistics in the form of tables and charts. Results. According to the survey, more than half of the 831 (67.1%) specialists specialized in the treatment of urolithiasis. It was noted that 626 (86%) inpatient urologists and 205 (40%) outpatient urologists specialized in the treatment of urolithiasis. Only 521 (69.6%) urologists specializing in surgical treatment of urolithiasis give a patient a stone fragment to analyze its chemical composition. At the same time, half of the respondents reported that less than 10% of patients come to them for further metaphylaxis. One of the main reasons for not analyzing the chemical composition of the stone was the fact that 877 (70,84%) specialists indicated the inaccessibility of analysis under the state guarantee program, 503 (40,63%) specialists indicated the patient’s satisfaction with the results of minimally invasive surgical treatment and lack of sufficient motivation for further examinations. At the same time, less than 3% of specialists can perform stone analysis within the framework of the state guaranty program. 1180 (96,8%) respondents practiced the prophylaxis of recurrent calculi formation, but only 336 (28,47%) performed comprehensive metabolic examination of all patients followed by prescription of drug therapy and appropriate diet. Conclusions. Our survey revealed low involvement of urologists at the outpatient level in the process of conservative treatment and metaphylaxis of urolithiasis, low activity of urologists in performing complex metabolic study and comprehensive prevention of recurrent stone formation, low percentage of performing chemical composition analysis of stone and low activity of urologists in performing primary litholytic therapy of urate stones. Based on this analysis of the responses of most Russian urologists, it is possible to formulate recommendations to remove the obstacles to providing patients with urolithiasis with quality medical care in terms of conservative therapy and metaphylaxis of urolithiasis.
Urologiia. 2022;(5):46-53
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Functional phimosis: prevalence, diagnosis and treatment in outpatient practice

Akhvlediani N.D., Sadchenko A.V., Prilepskaya E.A., Smernitsky A.M., Pushkar D.Y.


Aim. To study the prevalence of functional phimosis determined during erection in patients over 18 years of age, as well as the features of its diagnosis and treatment in outpatient practice. Materials and methods. A retrospective study that included 201 patients who underwent circumcision at a mean age of 42.7 years, was carried out. Complaints, history, initial examination and autophotography of the penis during erection were evaluated. The subjects were divided into 2 groups. The group I (n=38) included patients complaining of the inability to reveal the glans penis during erection, while in group II (n=163) men with similar complaints in a flaccid state of the penis were included. All patients underwent circumcision under local anesthesia. Results. The proportion of functional phimosis was 18.9%. The mean age in groups I and II was significantly different (29.47+8.82 and 45.6+19.4 years, respectively, p<0.01). In 14 (36.8%) patients of group I, a short frenulum was also diagnosed. Primary phimosis was detected in 26.3% and 14.1% of patients in groups I and II (p<0.05), respectively. The acquired phimosis was diagnosed in 73.7% and 85.9% (p<0.05) of cases, respectively. There were no concomitant diseases in patients with “functional” phimosis, while in men with “pathological” phimosis, 22.7% of patients had various comorbidities, such as diabetes mellitus, coronary heart disease, hypertension, etc. Conclusions. Among patients who visit a urologist with a diagnosis of phimosis, almost every fifth man has functional form (18.9%). For the diagnosis of the phimosis, the history taking and autophotography of the penis during erection have an important role. In this category of patients, surgical treatment can be performed on an outpatient basis.
Urologiia. 2022;(5):54-58
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Investigation of the role of polymorphic loci RS2299941, RS1903858, RS10490920, RS2735343 of the PTEN gene in patients with prostate cancer

Pavlov V.N., Loginova M.V., Ivanova E.A., Mustafin A.T., Gilyazova I.R.


Prostate cancer is a clinically heterogeneous disease, and accurate risk stratification of patients is becoming a key clinical task. This is the most common malignant neoplasm and the leading cause of cancer death in men worldwide. Genomic markers include tools and technologies that can predict the probability of an initial positive biopsy, reduce the number of unnecessary repeated biopsies, identify tumors with low, medium and high risk, classify the degree of disease, as well as predict and monitor the clinical response to intervention. Variants of the PTEN gene are of great interest as genetic markers of the risk of developing prostate malignancies.
Urologiia. 2022;(5):59-63
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The role of expression of monocarboxylates of the first and fourth types (MCT1, MCT4) by tumor and stromal cells of prostate cancer in determining the prognosis and the efficiency of definitive treatment

Vovdenko S.V., Morozov A.O., Avraamova S.T., Aleksandrov N.S., Zharkov N.V., Saenko V.S., Kogan E.A., Bezrukov E.A.


Aim. A search for new methods for diagnosing clinically significant prostate cancer is of importance due to the insufficient accuracy of modern methods in detecting aggressive tumors. One of the promising opportunities for the early diagnosis of clinically significant prostate cancer is the assessment of the glycolytic profile of the tumor by determining the expression of monocarboxylates (MCT) types 1 and 4 in tumor cells, as well as in adjacent stromal cells. Materials and methods. An analysis of patients of who underwent radical prostatectomy at the Institute ofUrology and Reproductive Health of Sechenov University from 2015 to 2017 was carried out. The patients with histologically confirmed prostate adenocarcinoma were included in the study. Among them, the presence or absence of biochemical recurrence during the first year was studied. An immunohistochemical (IHC) study of postoperative specimen was performed to determine the expression of MCT1 and MCT4 by tumor and stromal cells. The correlation between the intensity of their expression and the risk of biochemical recurrence and the tumor characteristics was evaluated. Results. High membrane expression of MCT1 directly correlated with high stromal expression of MCT4 (r=0.314, p<0.003). A significant direct correlation was found between the predominance of stromal expression of MCT4 over membrane expression and biochemical recurrence (r=0.403, p<0.001), as well as a high ISUP group (4 and 5) (r=0.294, p=0.005). Conclusions. Determination of the level of expression of type 1 and 4 monocarboxylate transporters in adenocarcinoma cells and tumor stromal cells can become an effective tool for risk stratification, and may also predict the biological behaviors of the prostate cancer and the efficiency of definitive treatment.
Urologiia. 2022;(5):64-70
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Functional state of a solitary kidney after nephrectomy for renal cancer

Tityaev I.I., Andreev S.S., Neymark B.A., Vasilenko A.A.


Introduction. The outcome of surgical treatment of renal cancer depends not only on cancer-specific survival, but also on the degree of loss of renal function, which often develops after surgery, especially radical nephrectomy. Aim. To study the features of functional changes in a solitary kidney as a compensation mechanism after radical nephrectomy for renal cancer. Materials and methods. The functional state of a solitary kidney in 36 patients with renal cancer who undergone to radical nephrectomy was evaluated. There were 20 and 16 women. The mean age was 59.0+10.8 years (from 39 to 76 years). The size of the tumor was in the range of 7.0-12.0 cm. All patients with a solitary kidney underwent a follow-up examination 3 months after surgery, including measurement of peripheral blood pressure with calculation of mean dynamic pressure, renal ultrasound, calculation of glomerular filtration rate (GFR), renal doppler ultrasound, determination of serum fibrinogen and fibrin monomers, and microscopy of the bulbar conjunctiva. Patients who had pathological abnormalities during the examination were prescribed reno-cardioprotective drugs, including perindopril in a titrated dose, apixaban 5 mg a day as thromboprophylaxis and for improvement of the flow properties of blood for a period of 3 months with re-evaluation of the above parameters. Results. In 61.1% of patients after radical nephrectomy, on 2-4 postoperative days, there was a tendency to increase blood pressure compared to baseline values (p<0.05). By the seventh day after the procedure, the volume of the contralateral kidney increased on average by 16% (from 110.4+11.2 cm3 to 132.4+4.8 cm3, p<0.05). After radical nephrectomy, a decrease in GFR was detected in 33 cases (91.7%; p<0.05). Renal doppler ultrasound showed a moderate increase in linear blood flow, the resistance index in the main renal artery, and a decrease in the pulse index in the segmental and arcuate arteries. The microscopy of the bulbar conjunctiva in 83.3% of patients revealed changes in the microcirculatory bed, including narrowing of arterioles, dilation of venules, a decrease in venular and capillary blood flow. After 3 months of reno-cardioprotective therapy, it was revealed that the target values of blood pressure (<130/85 mm Hg) were achieved with an average dynamic blood pressure of 93.4+2.6 mm Hg. In addition, a decrease in creatinine to an average of 106.2+6.4, fibrinogen and fibrin monomers to subnormal values of 3.2+0.2 g/l and up to 8.1+0.5x10-2 g/l, respectively were seen. Renal hypertrophy according to ultrasound examination was preserved with a mean kidney volume 119.7+3.6 cm3. Disturbances in peripheral microcirculation according to the microscopy of the bulbar conjunctiva was assessed as moderate. Conclusion. The development of CKD in patients with a solitary kidney is accompanied by a structural reorganization of the organ with an increase in blood pressure, an increase in its volume, a decrease in function, microcirculatory disorders and hypertensive nephropathy. Considering the prognostic significance of changes in the solitary kidney, it is important not only to control the functional parameters, but also to include renocardioprotective therapy as a standard, since it contributes to the preservation of the renal function and prevents the rapid progression of CKD. Thus, medical and social rehabilitation of patients with a solitary kidney is required. However, it is currently cannot be considered comprehensive.
Urologiia. 2022;(5):71-76
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Roadmap of ultrasound-guided percutaneous access to the renal collecting system

Mamaev I.E., Akhmedov K.K., Dolomanov K.A., Saypulaev G.S., Bolotov A.D., Yusufov A.G., Kotov S.V.


Introduction. The key point of successful PCNL is getting access to the renal collecting system. Ureteral catheterization and injection of contrast material provide an important advantage of visualizing and dilating the collecting system. However, catheterization increases the operation time, exposure to anesthesia, and requires additional reusable and disposable medical supplies. The purpose ofthe study was to develop a surgical algorithm for accessing the renal collecting system for mini-PCNL without catheterization. Materials and methods. We analyzed the treatment results of 82 patients with a single kidney stone, who underwent mini-PCNL without prior catheterization of the ureter. The percutaneous access was obtained according to the roadmap we had developed. The puncture was performed under X-ray control and US guidance. For a calyx stone, the puncture was performed “to the stone”. For a pelvis stone, the targeted calyx was accessed using the following algorithm where each next step was performed if the puncture had been impossible at the previous one: 1. 30 min before the operation: infusion load of normal saline, 1000 ml. 2. Intraoperatively: intravenous furosemide, 60 mg. 3. Puncture “to the pelvic stone”, injecting contrast material into the collecting system and correcting the access puncture through the required calyx. Results. In all 82 cases, puncture access was performed without ureteral catheterization. In 20 patients with calyceal stones, puncture onto a stone was successfully performed in 100% of the cases. Of 62 patients with pelvic stones, preliminary infusion was enough to allow a successful puncture in 49 (79%), access after intravenous administration of furosemide was obtained in 13 (21%), and a primary puncture onto a pelvic stone had to be done in 6 (10%) patients. Conclusions. Our proposed algorithm for accessing the PCS of the kidney was successfully used in 100% of the cases. It makes possible to avoid routine ureteral catheterization and thus reduce the overall operation time and the risk of complications, as well as save medical supplies. Clearly, such results require that the surgeon should have significant experience with puncture interventions under ultrasound control.
Urologiia. 2022;(5):77-83
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Retrograde intrarenal surgery for kidney diseases

Guliyev B.G., Komyakov B.K., Agagyulov M.U., Yagubov K.K., Korol E.I., Talyshinsky A.E.


Introduction. Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures. Aim. To study the results of RIRS in patients with nephrolithiasis and various renal disorders. Materials and methods. A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done. Results. RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (я=7) and repeated RIRS (я=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 + 20.5 minutes) and there were no complications. Conclusion. RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.
Urologiia. 2022;(5):84-89
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Calico-venous fistulae: an intrarenal complication of percutaneous nephrolithotomy

Kalinin N.E., Ali S.H., Bezrukov E.A., Gazimiev M.A.


Bleeding is a serious complication of percutaneous nephrolithotomy (PCNL). A rare cause of gross hematuria is a calico-venous fistula. A clinical case of successful intraoperative diagnosis and treatment of calico-venous fistula during PCNL is presented in the article. Description of a clinical case. A patient J., 53 years old, underwent examination and treatment at the Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University with a diagnosis of staghorn stone of the right kidney, a stone of the left kidney, chronic right-side pyelonephritis. On June 15, 2021, mini-PCNL was performed for the staghorn stone of the right kidney. The procedure seemed to be unremarkable, but during intraoperative antegrade pyelography, the inflow of contrast agent from the lower calyxes into the posterior segmental vein of the right kidney was detected, which was managed by creating sufficient traction of the nephrostomy drainage. Communication of the collecting and venous systems of the kidney is associated with a risk of both severe gross hematuria and urine flow into the venous bed. The urine flow into the bloodstream may result in hemodynamic disturbances, up to collapse followed by cardiac arrest. In order to prevent complications of PCNL it is necessary to analyze the kidney anatomy based on three-dimensional modeling of contrast-enhanced computed tomography. A calicovenous fistula can be a source of risk of bleeding and severe complications. To minimize intraoperative damage to parenchymal structures, an analysis of three-dimensional modeling of a kidney in patients with staghorn calculus based on computed tomography is required, which allows rational planning of surgical tactics.
Urologiia. 2022;(5):90-95
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Complications of retrograde intrarenal sugery in patients with low pole kidney stones

Goncharuk V.S., Dutov V.V., Dutov S.V., Buymistr S.Y., Dadashov M.T.


A lot of patients with nephrolithiasis have calculi at low pole calyces. One of the best and safety operative options of such category is retrograde intrarenal surgery (RIRS). RIRS is wide spread in current clinical practice. But not rarely it corresponded with different grade complications. Current literature review is dedicated to predictors of complications due to RIRS in patients with low pole calculi.
Urologiia. 2022;(5):96-101
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Mechanical kidney injury - what urologists miss in medical records

Chiglintsev K.A., Zyryanov A.V., Chiglintsev A.Y.


The article provides a brief description of the main terms and concepts of kidney damage used in forensic medicine and urology, with a list of requirements for the description and formation of a clinical diagnosis when maintaining primary medical documentation. The importance of a unified approach in objective interpretation in the expert assessment of kidney injuries is substantiated.
Urologiia. 2022;(5):102-107
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Urological problems related to coloproctology. Part 2

Khryanin A.A., Feofilov I.V., Markaryan D.R., Bocharova V.K.


The second part of the review article is devoted to current urological and proctological issues: rectal injuries during urological procedures, rectal complications associated with prostate cancer, as well as violations of the genitourinary function during interventions on the pelvic and rectal organs. Ignoring the symptoms from the adjacent pelvic organs can lead to diagnostic errors and the choice of wrong treatment, which ultimately adversely affects the outcomes. The interaction of specialists «working in the small pelvis» is required to exchange experience and improve the quality of care for this category of patients.
Urologiia. 2022;(5):108-111
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Fournier's gangrene: evolution of representations about pathogenesis, current state diagnosis and treatment

Aliyev S.A., Aliev E.S.


The article is devoted to one of the rare forms of necrotizing fasciitis - Fournier’s gangrene (FG). In chronological order, key aspects related to epidemiology, etiology, pathogenesis, classification, clinic, diagnosis and treatment are highlighted, according to extensive literature. It is postulated that according to modern scientific provisions, Fournier gangrene is a private clinical model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesion and putrefactive decay of soft tissue and fascial structures and is accompanied by phenomena of systemic endotoxicosis (sepsis) and high mortality, varying from 35 to 76-86%. It is declared that the trigger pathogenetic mechanism of the development of FG is disseminated thrombosis of the microcirculatory bed of the superficial fascia of the scrotum due to intravascular invasion of various strains of causative microbes. The methods of clinical, laboratory and instrumental diagnostics and methods of treatment are described, taking into account modern achievements of evidence-based medicine. Based on a multifactorial analysis of literature data and their own experience, the authors stated that the cornerstone that completely affects the outcome of treatment and prognosis of the disease is a multidisciplinary approach to solving diagnostic and therapeutic and tactical tasks with the participation of doctors of related specialties (surgeon, resuscitator, radiologist, cardiologist, coloproctologist, urologist, microbiologist). It is shown that the unshakable priority of treating patients with FG is still urgent surgical intervention in the format of «aggressive surgery», which provides for extremely wide excision of necrotic and non-viable tissues, followed by programmed (stage-by-stage) rehabilitation necrectomy. The issues of laser irradiation and hydropressive wound treatment with ozonated saline solution are touched upon. Adjuvant wound treatment using vacuum therapy and hyperbaric oxygenation are given.
Urologiia. 2022;(5):112-116
pages 112-116 views

Role of the lower urinary tract viral infections in the development of female micturition disorders

Barsegian V.A., Kosova I.V.


Currently, an increase in the incidence and reactivation of the lower urinary tract viral infections is seen in women that often manifest as various micturition disorders. The most common viral agents are herpes simplex virus types 1 and 2, Varicella-Zoster virus, Epstein-Barr virus, cytomegalovirus, and human papillomavirus. Since micturition disorders in bacterial cystitis and viral infections of the lower urinary tract are identical, urologists often prescribe antimicrobial drugs. This, in turn, not only has no effect in the treatment of micturition disorders, but also leads to the imbalances in the microflora of vagina and lower urinary tract, and, as a result, to the development of a chronic infectious process. This review presents the main characteristics, as well as features of the pathogenesis, diagnosis and treatment of the most common lower urinary tract viral infections.
Urologiia. 2022;(5):117-122
pages 117-122 views

Modern aspects of the etiological structure of chronic recurrent cystitis

Mamedov V.K., Shabanova K.A., Ilyasov K.K., Kazilov B.M.


The review is devoted to the study of modern aspects of the etiological structure of chronic recurrent cystitis. The search was carried out using the databases Medline, PubMed, EMBASE. The data of the literature search indicate that chronic recurrent cystitis in women is one of the most common and urgent problems in modern urology, which affects all age categories and has a polyetiological structure. Issues of the pathogenesis of chronic recurrent cystitis, as well as methods of diagnosis and treatment, are closely related to the etiological factors of the disease. The success of chronic recurrent cystitis treatment mainly depends on the accurate identification of the pathogen.
Urologiia. 2022;(5):123-126
pages 123-126 views

The main aspects of the impact of the new coronavirus infection SARS-CoV-2 on the development of infertility in men

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


Since the end of 2019, the world has been overwhelmed by a pandemic of a new coronavirus infection (COVID-19), a disease that damages various organs and systems. Because of the extensive coverage of the population by the infection, the long-term effects of the disease are not well understood, which is of considerable scientific and practical interest. We performed an in-depth analysis and systematization of data from foreign and domestic publications in the Scopus, Web of Science, eLIBRARY, PubMed, Wiley Online Library, and Google Scholar databases were performed. Information searches included original articles, reviews, guidelines, manual comments, and editorials related to the effects of SARS-CoV-2 virus on the male reproductive system. Accumulated clinical evidence suggests that the SARS-CoV-2 virus and the COVID-19 disease it causes have a negative impact on male reproductive health.. Drugs with a negative effect on spermatogenesis are used in the therapy of patients with COVID-19. These include lopinavir, chloroquine and its derivatives, and widely used glucocorticosteroids. Lopinavir and chloroquine have subsequently been excluded from potential COVID-19 therapy. Although available data on the fertility of men with COVID-19 are scarce and the results of published studies are from a limited sample, it is clear that maintaining male reproductive health during the COVID-19 pandemic is a pressing issue in modern medicine and requires further in-depth study. Preconceptional screening should be recommended for men who have undergone COVID-19.
Urologiia. 2022;(5):127-134
pages 127-134 views

Evolution of views on the etiology and pathogenesis of lower urinary tract symptoms for men

Tyuzikov I.A., Tishova Y.A.


The review article in the format of a «Lecture for Doctors» examines the evolution of terminology reflecting various disorders of urination and understanding their etiology and pathogenesis from a methodological and historical point of view. Symptoms of the lower urinary tract (LUTS) is a new term that replaced the term «Dysuria» that previously existed in the literature and suggests the allocation of various groups of symptoms depending on the violation of key functions of the bladder, which greatly facilitates obtaining reliable information about the state of urination in a particular patient. However, for a long time, LUTS were identified exclusively with urological pathology. Thanks to the fundamental research of recent decades, it has become obvious that LUTS is an interdisciplinary problem involving various specialists in the process of diagnosis and correction. One of the current trends in the study of the urination pathophysiology is the influence of systemic hormonal and metabolic disorders in men, which are considered as independent factors of the LUTS. The role of testosterone deficiency in the pathogenesis of LUTS is highlighted and the safety and effectiveness of testosterone replacement therapy (TRT) in hypogonadal men with LUTS is shown
Urologiia. 2022;(5):135-141
pages 135-141 views

Challenges in the clinical diagnosis and treatment of encrusted cystitis

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


Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.
Urologiia. 2022;(5):142-146
pages 142-146 views


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Urologiia. 2022;(5):147-148
pages 147-148 views

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