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No 4 (2022)


Early urethral catheter removal after robot-assisted radical prostatectomy

Kodzokov M.A., Shpot E.V., Akopyan G.N., Proskura A.V., Gasanov E.N., Gazimiev M.A.


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.
Urologiia. 2022;(4):5-9
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Comparative analysis of patients with spongy urethral strictures undergoing multistage urethroplasty or permanent urethrostomy

Glukhov V.P., Kogan M.I., Ilyash A.V., Bugaenko V.A.


Introduction. Deciding on the optimal surgical method for treating complex spongy urethral strictures is a challenging clinical task. Purpose of the study. To determine the clinical differences between patients undergoing multistage urethroplasty and permanent urethrostomy. Materials and methods. Two groups of patients were formed for the analysis: group I - 73 patients who underwent multistage urethroplasty; group II - 48 patients underwent permanent urethrostomy. The differences between groups were studied according to the following clinical parameters: age, body mass index, duration of the disease, previous treatment, etiology, length and localization of strictures, complications of stricture disease, concomitant diseases, urine flow parameters, the presence of early postoperative complications, and recurrence of strictures. Results. Patients of group I compared to group II are significantly younger (43.0 vs 59.6 years; p<0.0001). They have fewer idiopathic strictures (8.2 vs 31.3%; p=0.001), undergo cystostomy less often (26.0 vs 54.2%; p=0.002), have less pronounced lower urinary tract symptoms (I-PSS - 18.6 vs 23.8 points; p<0.0001, QoL - 4.3 vs 5, 1 point; p<0.0001) and impaired urination parameters (Qmax - 8.1 vs 6.5 ml/s; p=0.09, Qave - 5.5 vs 4.1 ml/s; p=0.015, PVR - 62.4 vs 126.0 ml; p=0.03). The incidence of concomitant diseases (69.9 vs 87.5%; p<0.025) and their number (1.8 vs 3.1; p<0.002) are significantly higher in group II. Among the comorbidities, cardiovascular diseases (31.5 vs 58.3%; p=0.015), diabetes mellitus (5.5 vs 16.7%; p=0.045) and prostatic hyperplasia (8.2 vs 27.1%; p=0.005) predominate. Early surgical complications in group I were detected in 28,8% of patients, in group II - in 2.1% (p<0,0001) of cases. The primary treatment success among patients with permanent urethrostomy is higher than with multistage urethroplasty (85.4 vs 65,8%; p=0,017). Conclusions. It is advisable to perform multistage surgery of extended spongy urethral strictures in young and middle-aged men without serious comorbidities in cases of conscious choice and sufficient awareness. Urethrostomy should initially be discussed with the patient as the operation of choice, considering age, cardiovascular comorbidity, diabetes mellitus and prostatic hyperplasia.
Urologiia. 2022;(4):10-14
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Comparative analysis of robot-assisted and open radical cystectomy with orthotopic urinary diversion

Guliev B.G., Komyakov B.K., Bolokotov R.R.


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.
Urologiia. 2022;(4):15-22
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Features of surgical treatment of renal cysts depending on the risk of malignancy

Simonov P.A., Firsov M.A., Laletin D.I., Alekseeva E.A., Junker A.I.


Background. According to national and foreign publications, renal cyst is one of the most common urological diseases with a prevalence up to 20-50%. Aim. To determine the results of surgical treatment of patients with renal cysts, depending on the risk of malignancy. Materials and methods. The analysis of124 patients with symptomatic renal cysts who were treated in the Department of Urology of Regional Clinical Ho spital was carried out. All patients underwent a comprehensive clinical and instrumental evaluation, including contrast-enhanced CT scan of the kidneys. To assess the risk of harboring malignant tumor, the classification of renal cysts of Bosniak (2019) was used. Results. The average age of patients was 56.6+12 years. According to CT, Bosniak I, II, IIF and III cysts were diagnosed in 96 (77.4%), 11 (8.9%), 11 (8.9%) and 6 (4.8%) patients, respectively. The morphologic study revealed renal cell cancer in 8 patients (6.4%), four of whom had Bosniak III cysts and other four had Bosniak IIF cysts. Discussion. The prediction of the harboring of malignancy is a fundamental criterion for selection of patients with renal cysts for surgical treatment. Conclusion. Surgical treatment of symptomatic renal cysts is a justified treatment method, and in patients with Bosniak class II or higher cysts, it is necessary to exclude the malignant lesion. Based on our data, category IIF and III cysts have a high risk of harboring malignant cells, which is 36.4% and 66.7%, respectively. In our opinion, laparoscopic partial nephrectomy is the most rational treatment method in these categories.
Urologiia. 2022;(4):23-26
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Comparative study of the influense of stone size and volume on the duration of thulium laser percutaneous nephrolithotripsy

Popov S.V., Orlov I.N., Suleymanov M.M., Gorelik M.L., Perfil’ev M.A.


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.
Urologiia. 2022;(4):27-31
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Prognostic ability of seminal plasma lipidomic analysis in predicting the success of microTESE in men with azoospermia

Gamidov S.I., Shatylko T.V., Tambiev A.K., Tokareva A.O., Chagovets V.V., Bitsoev T.B., Starodubtseva N.L., Popova A.Y., Frankevich V.E.


Introduction: The aim of this work is to assess the possibility of metabolomic (specifically lipidomic) analysis of seminal plasma to identify patients with preserved focal spermatogenesis in the testes who may have a reasonable chance of sperm retrieval during the microTESE procedure. Materials and methods: lipid composition of semen plasma samples from 64 men with azoospermia and 24 fertile control men was analyzed. Lipids were isolated from semen by a modified Folch extraction method. Lipid extracts were analyzed by reverse phase liquid chromatography coupled to mass spectrometry. Lipidomic data were compared with the results of the microTESE procedure. Results: Comparison of two groups revealed a statistically significant difference in concentration for 23 lipids detected in positive ion mode and 37 lipids detected in negative ion mode. Those lipids mainly belong to hexosylceramides, sphingomyelins and phosphatidylcholines, phosphatidylethanolamines and their ethers. In multivariate analysis content of SM d16: 1/18:0 lipid (beta coefficient: -7.23; 95% confidence interval [95% CI]: -11.93 to - 2.53; odds ratio: 7.23e-04; CI for odds ratio: 6.59e-06 to 7.93e-02; Wald’s test: -3.02; p=0.003), content of TG 14: 1_16 : 0_18: 3 lipid (beta 2.95; 95% CI 0.98 to 4.93; odds ratio: 1.92e + 01; CI for odds ratio: 2.66e + 00 to 1.39e + 02 ; Wald’s test: 2.93; p=0.003) and testicular volume (beta: 0.14; 95% CI: 0.04 to 2.45; odds ratio: 1.15e + 00; CI odds ratio: from 1.04e + 00 to 1.27e + 00; Wald’s test: 2.65; p=0.008) were significantly associated with positive MicroTESE outcome. The sensitivity of this regression model was 61%, the specificity was 83%, and the AUC was 0.75. Conclusions: seminal plasma serves as a rich source of biological markers for identifying patients with preserved focal spermatogenesis in the testes. Seminal plasma lipidomic profile of the of patients in the control group with normal spermatogenesis clearly differs from the profile of patients with azoospermia, also there was a significant difference in content of a difference in lipids between patients with positive and negative microTESE outcomes. These are preliminary results and further research is needed to confirm the validity of the resulting lipid panel.
Urologiia. 2022;(4):32-37
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Prospective comparison of cognitive and mpMR/US fusion biopsy for prostate cancer detection

Petov V.S., Bazarkin A.K., Morozov A.O., Taratkin M.S., Ganzha T.M., Danilov S.P., Chernov Y.N., Chinenov D.V., Amosov A.V., Enikeev D.V., Krupinov G.E.


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.
Urologiia. 2022;(4):38-43
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X-ray endoscopic treatment in patients with ureteral anastomotic obliteration after orthotopic neobladder formation

Martov A.G., Dutov S.V., Andronov A.S., Mishugin S.V., Mantcaev A.B.


Introduction. Strictures and obliterations of ureteral anastomosis after radical cystectomy with orthotopic neobladder reconstruction occur in 8-13% of cases, mainly in the first 2 years after surgery. According to the European Association of Urology guidelines, open reconstruction is considered the "gold standard" for the treatment of those patients. At the same time, according to various publications, X-ray endoscopic treatment of ureteral anastomotic strictures can be performed, especially in patients who have undergone orthotopic neobladder reconstruction. Materials and methods. Three clinical cases of endoscopic treatment of ureteral anastomotic obliteration after orthotopic neobladder formation are presented. In all patients, nephrostomy tube was initially put due to acute pyelonephritis. Obliteration of the ureteral anastomosis was diagnosed by contrast-enhanced multispiral computed tomography and antegrade pyelography. The length of obliteration in all patients did not exceed 1.0 cm. The recurrence of the bladder cancer was excluded. After percutaneous opacification of the pelvicalyceal system and advancement of two guidewires (“working” and “safety”) to the level of ureteral obliteration, a catheter with a built-in fiber optic light source was put in antegrade fashion along the “working” guidewire to the area of obliteration. During transurethral inspection of the reservoir, the distal end of the light source was visualized and the reservoir wall was cut “to the light” using electrosurgery (n=2) and a thulium fiber laser (one case). For adequate kidney drainage, two internal stents of 6 Fr were put for a period of 6 months in two patients and for 2 months in another case. Results. All patients had an adequate diameter of the ureteral anastomosis after removal of the stents. In two cases, an adequate passage of the contrast agent through both ureters was maintained for 42 and 37 months after procedure (according to the follow-up computed tomography and excretory urography). One patient had an attack of acute pyelonephritis 2 months after the removal of internal stents due to recurrent stricture. After repeated endoscopic ureteral recanalization with putting of two internal stents for a period of 6 months, no recurrence of the stricture was observed during 28 months of follow-up. Conclusion. Endoscopic treatment of both primary and recurrent short ureteral anastomotic obliterations in patients with orthotopic neobladder allows for adequate ureteral patency, provided that two internal stents are left in place for 6 months.
Urologiia. 2022;(4):44-51
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The use of "Fast-Track" in pediatric urology

Satvaldieva E.A., Shakarova M.U., Mamatkulov I.B., Ismailova M.U., Khotamov K.N.


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.
Urologiia. 2022;(4):52-55
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Primary melanoma of renal pelvis

Abdullin I.I., Grigoriev N.A., Gaydamaka N.V., Drozdova Y.Y.


A rare case of primary renal pelvis melanoma in 47-year-old man is presented in the article. Before surgery a patient was considered to have metastatic urothelial carcinoma. A diagnosis of malignant melanoma was based on immunophenotyping and detection of intracellular melanin pigment both in pelvis tumor and lung metastasis. The primary localization in the pelvis was proven by the presence of scattered melanocytes within urothelium. The patient had no previous history of skin or mucosa melanoma. This is the sixth case of renal pelvis melanoma published in PubMed.
Urologiia. 2022;(4):56-59
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Surgical treatment of Zinner syndrome

Kamalov A.A., Karpov V.K., Pshihachev A.M., Andreytsev I.L., Takhirzade T.B., Ekhoyan M.M., Gevorkyan Z.A.


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.
Urologiia. 2022;(4):60-62
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Transurethral resection and buccal mucosal graft for the treatment of refractory bladder neck contracture

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


Bladder neck contracture after prostate surgery is a rare but feared complication. The treatment of choice is endoscopic incision or resection of fibrotic tissue. In case of ineffective transurethral correction, bladder neck reconstruction has to be done. In this report, we present a complicated case treated with combined transurethral and laparoscopic bladder neck reconstruction with buccal mucosal graft inlay. Using retrograde endoscopy fibrotic tissue in the bladder neck was resected to achieve a smooth and wide prostate cavity. After that the laparoscopy performed. The retropubic space is created and prostatic urethra opened via longitudinal prostatic-vesical incision. Buccal mucosal graft was fixed in place. Bladder and prostatic urethra were closed with resorbable suture. Two weeks after surgery the urethral catheter was removed and adequate voiding reestablished. After eleven months patient had no urination complaints and any sings of recurrence. Thus, the combined surgical approach for bladder neck reconstruction using buccal mucosa inlay may be a durable option for treatment of recalcitrant bladder neck contracture.
Urologiia. 2022;(4):63-67
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Combined therapy of acute and recurrent cystitis in women

Alexandrov I.V., Terentyev A.V., Klymovich O.A.


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.
Urologiia. 2022;(4):68-70
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Bilateral laparoscopic nephrectomy for polycystic kidney disease

Biktimirov T.R., Martov A.G., Biktimirov R.G., Baranov A.V., Miloserdov I.A., Kaputovskiy A.A., Khitrikh A.M., Amosov N.A.


A clinical case of surgical treatment of a patient with autosomal dominant type of polycystic kidney disease, stage 5 of chronic kidney disease and secondary arterial hypertension is presented in the article. The technique of single-stage bilateral laparoscopic nephrectomy, patented by the authors, is described. The practicability and safety of a simultaneous bilateral procedures was demonstrated, as well as the advantage of laparoscopic access for this type of surgical interventions. The successful and prompt procedure allowed the patient to undergone to allotransplantation of a cadaveric kidney as soon as possible.
Urologiia. 2022;(4):71-74
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Rare localization of prostate cancer single metastasis. Clinical case and literature review

Selivanov S.P., Barysheva E.V., Shikunova Y.V.


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).
Urologiia. 2022;(4):75-77
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Transvesical correction of recalcitrant vesicourethral anastamotic stenosis with buccal graft fixed by automated V-LOC suture

Loran O.B., Seregin A.A.


We present a clinical case of a patient with a post radical robot-assisted prostatectomy recurrent vesicourethral anastamotic stenosis. Successful simplified transvesical correction with buccal mucosa graft fixed by self-anchoring automated V-Loc suture through the needle for epidural anestesia without knot formation was the unique feature of case presented.
Urologiia. 2022;(4):78-81
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Renal autotransplant as a treatment method in a patient with ureteral stricture

Kurmanov T., Zhanbyrbekuly U., Zhexen Y.


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.
Urologiia. 2022;(4):82-85
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Infiltrative endometriosis with ureteral lesion - a clinical case of interaction between gynecologist and a urologist in diagnostics, surgical treatment and follow-up

Ishenko A.I., Bryunin D.V., Shpot E.V., Chushkov Y.V., Khokhlova I.D., Tevlina E.V.


The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patient’s treatment should be carried out in a specialized hospital using modern surgical technologies.
Urologiia. 2022;(4):86-90
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Protective properties of urothelium and possibilities of targeted pathogenetic therapy of chronic pelvic pain: sodium pentosan polysulfate

Kasyan G.R., Zaitsev A.V., Baibarin K.A., Karasev A.E., Pushkar D.Y.


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
Urologiia. 2022;(4):91-95
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Current approach to management of staghorn nephrolithiasis. Literature review. Part 2

Dutov V.V., Buymistr S.Y., Dutov S.V.


Data on predictors and methods for resolving the complications of surgical treatment of staghorn nephrolithiasis are presented. New information on the features of the morphological and functional state and individual platelet reactivity in patients undergoing surgical treatment is described. Thrombotic and hemorrhagic complications, intra- and postoperative bleeding, as well as prediction of PNL results in patients with staghorn stones are also discussed.
Urologiia. 2022;(4):96-102
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Urological problems related to coloproctology. Part 1

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


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.
Urologiia. 2022;(4):103-108
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Use of urethral stents for urethral strictures

Kyzlasov P.S., Martov A.G., Mustafayev A.T., Kazantsev D.V., Ostrovsky D.V.


Urethral stents have been popular in urology since the early 1980s and are used in the treatment of urethral stricture. The literature review presents data on the introduction into urological practice and the use of urethral stents in urethral strictures.
Urologiia. 2022;(4):109-113
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Molecular mechanisms of male infertility: main directions of scientific research

Galimov S.N., Gromenko Y.Y., Galimov K.S., Galimova E.F., Bodrova E.S., Bulygin K.V., Litvitsky P.F.


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.
Urologiia. 2022;(4):114-117
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