No 4 (2022)

Background. Robot-assisted radicaI prostatectomy (RARP) is a wideIy used treatment method for patients with cIinicaIIy IocaIized prostate cancer. Posterior reconstruction of urethrovesicaI anastomosis (UVA) is one of the techniques that provides earIy recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functionaI resuIts. Aim. To evaIuate the functionaI resuIts of earIy removaI of the urethraI catheter (after 3 days) after RARP using a modified surgicaI technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery). MateriaIs and methods. Patients who underwent RARP were randomIy assigned to earIy catheter removaI (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, controI group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removaI. Secondary endpoints were the incidence of urine Ieakage into the paravesicaI tissue during retrograde cystography, as weII as compIications according to the CIavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removaI was assessed using the InternationaI ConsuItation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). ResuIts. There were no significant differences between groups in terms of baseIine and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. AIso, there were no cases of urine Ieakage into the paravesicaI tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery. ConcIusions. The method of modified posterior reconstruction aIIows to remove the urethraI catheter 3 days after RARP. EarIy removaI of the urethraI catheter did not adverseIy affect the earIy recovery of urinary continence, the quaIity of UVA, and did not increase the incidence of acute urinary retention. Further studies with Ionger foIIow-up periods are needed.

Introduction. Robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder creation is a complex surgical procedure, which is gradually becoming an alternative to open surgery. Aim. To compare the perioperative, functional and oncological outcomes of open radical cystectomy (ORC) and RARC. Materials and methods. RARC with ileocystoplasty was performed in 25 patients, including 24 men. The average age was 65.5 years. ORC was done in 30 patients (28 men; control group) with the mean age of 67.2 years. In RARC, the ureters were isolated at the level of lower thirds, the bladder was dissected from the rectum on both sides, then the bladder vessels were divided using clips, and the urethra was cut off. After pelvic lymph node dissection, 50 cm of the ileum was resected. Then two distal segments were folded in a U-shape, a 1.5 cm incision was made in the lower part, and an anastomosis with the urethra was carried out. Further, these segments were detubularized and a modified Studer reservoir was created. The ureters were implanted into the tubular part. In ORC, urine diversion was also done using Studer technique. In both groups, the operation time, the volume of blood loss, the number of complications, the duration of hospitalization, the proportion of daytime and nighttime continence were evaluated. Results. The mean time for RARC and ORC was 380 (320-580) and 260 (220-320) min, respectively (p<0.05). In the group of RARC, the volume of blood loss was 85 (50-250) ml and no blood transfusion was performed, while in ORC, the volume of blood loss was 520 (350-1400) ml, an average of 480 (0-840) ml of blood was transfused (p<0.05). After RARC, 30- and 90- complications rate was 32.0% (n=8) and 24.0% (n=6), respectively, compared to 40.0% (n=12) and 30.0% (n=9) in ORC. One patient died due to myocardial infarction during the 90-day follow-up period after RARC (grade V complication according to Clavien). The average number of removed lymph nodes in the RARC group was 15 (10-18). One patient had lymph node metastases. There were no cases of local recurrence. In ORC, the average number of lymph nodes was 16 (11-20), metastases were detected in 2 patients. One of them was subsequently diagnosed with local recurrence. There was no significant difference in the number of lymph nodes removed between two groups. After RARC, 20 (80.0%) patients had complete urinary continence, while 5 patients (20.0%) used 1-2 pads per day. Night continence was preserved in 15 cases (60.0%). After ORC, complete urinary continence was seen in 23 cases (76.7%). Five patients (20.0%) used 1-2 pads per day and two patients (6.7%) used 2-3 pads per day. Night continence after ORC was preserved in 17 cases (56.7%). Conclusion. RARC is a minimally invasive method of surgical treatment of patients with muscle-invasive bladder cancer. Compared with ORC, a significantly lower rate of complications and blood transfusions is documented, but RARC requires a longer operation time. Both interventions provide the equivalent oncological and functional outcomes, which are in line with published data.

Objective. The aim of the investigation was to determine the influence of such parametric characteristics of the stone such as size and volume on the duration of tulium laser disintegration of the urinary stone and to determine which of these parameters is more effective to use like prognostic criterion for the duration of the planned surgical intervention in the percutaneous nephrolithotripsy. Materials and methods. Overall 52 patients (27 females and 25 males) with an average age of 56,9 (25-79) years participated in the present study. All patients underwent percutaneous nephrolithotripsy with disintegration of the kidney stone by thulium energy. Inclusion criteria were: stone size >2 cm, stone density >1100 HU. Exclusion criteria were: patients with a single kidney, urinary tract divertions, coagulopathy. The average operation time was 30 (15-100) minutes, with an average puncture time of 3.15 (1-10) minutes and lithotripsy time of 28 (14-98) minutes. To determine the volume we used the method of automatic lithometry according to CT data using the software: Vitrea ver. 4.1.52. The size of the stone was determined by the longest length in one of the plane. During the study it was found that the average size of the stone was 28.25 (20-58) mm and the average volume was 2579.4 (250-9990) mm3. To confirm our assumption, we decided to determine the dependence of the time of disintegration of the stone on the size and volume of the stone. For this purpose, we graphically presented the correlation of these parameters. Results. We have drawn 2 graphs reflecting the dependence of lithotripsy time parameters on the size and volume characteristics of the stone. As a result of comparing these parameters we found that size is a prognostically less reliable predictor of lithotripsy time, and is not characterized by a linear distribution, in contrast to the stone volume. Conclusions. Thereby, the main stereoscopic characteristic of a stone is a volume, which should be the primary guide in selecting the preferred method of treatment as well as in predicting the operative time and associated risks.

Introduction. According to the recommendations of the European Association of Urology the presence of a suspicious lesion on MRI is an indication for both primary and secondary MR-targeted biopsies. At the same time, the Russian Society of Urologists recommends to perform mpMR/US fusion biopsy only in patients with a prior negative biopsy. In clinical practice, mpMR/US fusion and cognitive biopsies are the most frequently performed. However, when comparing them, contradictory data on detection of clinically significant prostate cancer is obtained. Objective to compare the detection rate of clinically significant prostate cancer performing cognitive and mpMR/US fusion biopsies. Materials and Methods. Inclusion criteria: PSA >2 ng/mL and/or a positive DRE, and/or a suspicious lesion on TRUS, and PI-RADSv2.1 lesion >3. At first, «unblinded» urologist performed a transperineal mpMR/ultrasound fusion and saturation biopsy. Then “blinded” urologist obtained transrectal cognitive biopsy Clinically significant cancer was defined as ISUP >2. Results. We enrolled 96 patients. Median age was 63 years, prostate volume - 47 cm3 and PSA - 6.82 ng/mL. MpMR/US fusion and cognitive biopsies were comparable in regard to the detection rate of clinically significant (32.3% vs 25.0%; p=0.264), clinically insignificant cancer (25.0% and 26.0%; p=0.869) and overall detection rate (57.3% and 51%; p=0.385). Both biopsies missed clinically significant cancer with equal frequency (5.2%; p=0.839). Histological efficacy also was comparable. The number of positive cores between mpMR/US fusion and cognitive biopsy was equal (34.1% and 31.1% respectively; p= 0.415). At the same time, no statistically significant difference was found with respect to maximum cancer core length (53.1% vs 47.7%, respectively; p=0.293). Conclusion. The results suggest that both cognitive and mpMR/US fusion biopsies are equally accurate diagnostic methods for clinically significant prostate cancer detection, thus their wider introduction into cIinicaI practice is necessary.

Background. Current trends in the anesthesiology require a change in the perioperative management of patients, with a consideration of new approaches to anesthesia and the introduction of methods that reduce the stress response to surgery. Aim. To introduce the "fast-track" concept with the analysis of systemic hemodynamics and stress markers at the perioperative stage in children with urological diseases. Materials and methods. A prospective and retrospective analysis of the results of 42 children with urological disorders treated from 09.2016 to 04.2021 under spinal anesthesia (SA) was carried out. In each case, perioperative parameters were evaluated, including central hemodynamics and biochemical markers of stress response. Results. Hemodynamic stability under SA in young children has an evidence base and a physiological explanation. Changes in stress response markers in various anesthesia methods revealed a more pronounced stress-protective effect in SA than in general anesthesia. Conclusions. Our data have shown that combined SA for urological procedures in children allows to more effectively and reliably prevent and block the manifestations of stress-induced reactions of hemodynamics and metabolism than general anesthesia. The introduction of fast-track approach in pediatric urology resulted in the faster postoperative recovery and shorter length of stay.

Zinner’s syndrome (SC) is a rare congenital disease characterized by ejaculatory duct obstruction, seminal vesicle cyst in combination with ipsilateral renal agenesis. This syndrome is due to development arrest of the Wolffian duct (mesonephros). Before the onset of sexual activity, the disease is asymptomatic. The main symptoms are nonspecific, including dysuria, urinary frequency, perineal and scrotal pain after ejaculation. A clinical case with the presentation of our own experience of surgical robot-assisted treatment of a patient with Zinner’s syndrome is presented in the article.

Lower urinary tract infection (LUTI) is one of the most common causes for a large number of females of different ages to visit a urologist and other physicians. LUTI is often a chronic condition, and its symptoms can sometimes persist throughout live, leading to a serious deterioration in the quality of life. Three clinical cases of the effective treatment of women with recurrent UTI with Phytolysin® paste* and Phytolysin capsules as part of combined therapy are presented in the article.

The most common sites of prostate cancer metastases are lymph nodes, bones, lungs. The bladder is in 4th place in terms of the frequency of metastasis. We present a case of a rare single metastasis of prostate cancer to the bladder 8 years after the first diagnosis of prostate cancer T3N0M0. Patient A., 83 years old, complained of blood in the urine, frequent urination, nocturia. PSA level 5.4 ng / ml. During cystoscopy, a villous tumor on a broad base was totally resected. On histological examination, poorly differentiated adenocarcinoma 10 points according to Gleason (5 + 5).

The treatment of ureteral strictures is one of the most difficult problems of current urology. In recent years, an increase in postradiation patients who have an iatrogenic ureteral damage during surgical procedures on the pelvic and abdominal organs is seen. We describe two cases in which a long ureteral stricture was diagnosed. The etiology of the strictures was associated with urolithiasis. After the removal of ureteral stones, long ureteral stricture developed in both patients. A nephrostomy tube was initially put. Considering the prolonged length of the stricture with a formation of obliteration, several treatment options were discussed, including nephrectomy. Nevertheless, due to the young age and the good functional state of the renal parenchyma, the decision was made about renal autotransplant, which was associated with a lower surgical risk. However, this procedure requires a high degree of training of the surgical team with appropriate experience.

The review article is devoted to the possibilities of using targeted therapy for urothelial diseases, namely painful bladder syndrome (BPS). The protective structural components of the bladder mucosa, as well as their chemical features, are described in detail. Pentosanpolysulfate (PPS), being an oral heparinoid, can be used as part of pathogenetic therapy to restore the mucous membrane of the bladder. The efficacy and safety of this drug has been proven by us in a multicenter, randomized, double-blind, placebo-controlled trial. An additional assessment of the effectiveness and safety of the use of PPS in BPS was confirmed as part of our systematic review and meta-analysis. Thus, PPS is a pathogenetically sound tool in the treatment of patients with painful bladder syndrome

The aim of this review was to characterize the possible urological manifestations of rectal disorders in case of the involvement of the genitourinary system, as well as the symptoms of urological diseases involving the distal part of the large bowel. In urological and coloproctological practice, the anatomical and physiological proximity of the distal part of the intestine and the urogenital organs is of importance (for example, the common innervation of the pelvic organs, the synergy of the pelvic floor muscles, etc.), since it results in similar clinical manifestations, making it difficult to make a diagnosis. The most relevant and common urological and proctological diseases, including prostatitis, intestinovesical and rectourethral fistulas, damage to the ureter and bladder during colorectal surgery are discussed in the article. Particular attention is paid to the interdisciplinary cooperation of urologists and proctologists and the frequent need for their joint participation in the diagnosis and treatment of the pelvic organs’ disorders.

This review provides up-to-date information on the molecular basis of the pathogenesis of male infertility at the cellular and subcellular levels. The emphasis is on the importance of new next-generation sequencing technologies as a high-performance tool for studying the genome and epigenomic mechanisms, transcriptome, proteome and metabolome of ejaculate, and organs of the reproductive system. This methodology made it possible to identify differentially expressed metabolic and signaling pathways in fertile and infertile men that combine the genotype and phenotype of a particular individual into a single whole. The current ideas about the relationship between oxidative stress and imbalance of redox systems with DNA damage in spermatozoa as the leading mechanism for the development of idiopathic infertility are summarized. The role of miRNAs, methyloma aberrations, deficiency of phospholipase C zeta in spermatozoa in the pathology of fertility is given. Deciphering the molecular profile and molecular phenotypes of infertility as a result of the interaction of genetic and environmental factors is a necessary condition for screening the most informative biomarkers, assessing their stratification potential, and validating new molecules as potential targets for targeted therapy.