No 3 (2022)

Introduction. Urinary incontinence is one of the common complications of laparoscopic radical prostatectomy performed in patients with prostate cancer. Conservative measures for postprostatectomy urinary incontinence (PPUI) after radical prostatectomy include lifestyle changes and pelvic floor muscle training. Providing the patient with information about the functioning of the pelvic muscles during exercise (biofeedback) helps to control the activity and strength of the muscles and increases the efficiency of exercises. Materials and methods. A total of 44 patients who underwent laparoscopic radical prostatectomy performed pelvic floor muscle training plus biofeedback. A questionnaire on the ICIQ-SF scale to objectify complaints was used. Education, pelvic floor muscle training and control of the efficiency of exercises were provided using biofeedback with electromyogram. Results. The skill of isolated contraction of perineal muscles with minimal participation of the anterior abdominal wall muscles was acquired in 37 (84.1%) patients during 2-4 sessions. The rest 7 men (15.9%) required regular support using biofeedback with two channel electromyography. This group of patients performed training once a week. The duration of urinary incontinence in patients who learnt the isolated contraction was 3.7 (1.1-39) months compared to 7 (1.5-11) months in men who required additional biofeedback (p=0.13). Conclusions. Pelvic floor muscle training is an effective way to improve urinary continence after radical prostatectomy, including laparoscopic one. The use of biofeedback using electromyogram, especially with two channels, allows the patient to receive visually accessible information about the functioning of the pelvic muscles and their antagonists (abdominal muscles). This method improves the efficiency of teaching patients with urinary incontinence and pelvic floor muscle training.

The aim of the study to analyze the effectiveness of endoscopic intravesical methods of treatment of women with primary bladder pain syndrome (PBPS). Materials and methods. 145 women in the age 19 to 79 years (mean age 43.9 + 3.1 years) with confirmed diagnosis of PBPS were treated. The treatment stages were divided into 4 consecutive lines. The first line of treatment included behavioral and pharmacotherapy, the second was hydrodistension of the bladder, the third was intravesical botulinum therapy (intravesical injections of botulinum toxin type A at 20 points of the bladder wall, 5 U each, total dose 100 U), the fourth was laser ablation of Hunner’s lesions. Evaluation of the effectiveness was carried out one month after the start of treatment measures for each stage of treatment. Improvement of the patient’s quality of life by at least 1 point according to the QoL questionnaire was used as a criterion for the effectiveness of treatment. Results. Conservative treatment was effective only in 21 (14.4%) out of 145 treated patients. The remaining 124 patients underwent bladder hydrodistension, the positive results were recognized in 46 (37.1%) patients. Botulinum therapy was effective in 41 (52.5%) of 78 treated patients with PBPS refractory to the previous lines of treatment. Laser ablation of Hunner’s lesions of the bladder was performed in the remaining 37 patients, that procedure was effective in 28 (75.1%) patients. Conclusion. The results of the study showed high efficiency and good tolerance of endoscopic intravesical methods of treatment of women with PBPS.

Aim. To evaluate the efficiency and safety of Vesusten® (5 mg lyophilized powder for intramuscular injection in vial) compared to placebo in patients with overactive bladder (OAB). Materials and methods: a multicenter, double-blind, randomized, placebo-controlled III phase clinical trial was carried out in accordance with GCP guidelines (Good Clinical Practice). The study consisted of three stages: a screening period (lasting 14 days, after which Visit 1 was carried out), a period for evaluating the efficiency of therapy (duration 42±5 days; Visit 2 was at 21±5 days with an assessment of the patient's health status, as well as Visit 3 at the end of period for evaluating efficiency), the observation period (lasting 28±2 days and ending with Visit 4 to monitor the patient’s condition and assess the safety of therapy using a telephone survey by the researcher). Results: Vesusten® (5 mg) given 3 times a week intramuscularly resulted in pronounced effects: the average decrease in total of TUFS (Total Urgency and Frequency Score) was 1.97 times higher than in placebo group (p=0.0007), while the margin of superiority was 2.36 points (p=0.022). The daily number of urinary incontinence episodes decreased by 50% or more in 65.33% of patients compared to the baseline level (the difference with the placebo group was 24% by point estimates). The average number of urinary incontinence episodes in the group of Vesusten® decreased by 2.15 times compared to Placebo group. Vesusten® effects were more pronounced at Visit 3 (3 weeks after stopping therapy) compared to Visit 2 (3-weeks of therapy), which may indicate that Vesusten® (product containing bioactive peptides derived from the bladder) triggers a cascade interfering with OAB pathogenetic pathways followed by the bladder function restoration. Vesusten® has a favorable safety profile. There were no serious adverse events (SAE), and there were no significant differences between the Vesusten® and placebo groups in other safety parameters evaluated in this study. Conclusion. Our results suggest the favorable safety profile and the superiority of Vesusten® over placebo in terms of reducing OAB symptoms by TUFS (Total Urgency and Frequency Score) and reducing the number of incontinence episodes. A positive effect on patient’s quality of life was seen. Vesusten® is a promising effective and safe drug for the OAB treatment.

Aim. To evaluate the effect of intravesical prostatic protrusion on the functional results of bipolar transurethral resection of the prostate and retropubic adenomectomy. Materials and methods. From September 2019 to December 2021 in the clinic of urology on the basis of the GKB. S.P. Botkin, 210 patients underwent surgical treatment ofprostatic hyperplasia, 101 ofthem-bipolar transurethral resection of the prostate (group I), 109 patients - retropubic adenomectomy (group II). Depending on the size of intravesical prostatic protrusion - more than 5 mm and less than 5 mm, the corresponding subgroups «a» and «b» are distinguished. Functional results were assessed 6 months after the operation: IPSS scores, including filling and emptying IPSS, QoL, maximum urination rate, residual urine volume. Results. Comparing the functional results of the quality of urination 6 months after surgical treatment by the method of bipolar TURP in patients with PPI, a significantly significant decrease in IPSS scores, including both emptying and filling, a decrease in QoL scores, and improvements in maximum urination rate in patients (p<0.05). There were no significant differences in the reduction in residual urine volume (p=0.89). Similar functional results were demonstrated in the group of patients who underwent retropubic adenomectomy. Six months after surgery, in patients with PPI >5 mm, a significantly significant decrease in IPSS scores was found, including emptying and filling, a decrease in QoL scores, and an improvement in maximum urination rate (p<0.05). There were no significant differences in the volume of residual urine (p=0.49). Conclusion. A significantly more significant decrease in the results of the IPSS scale was revealed, especially in emptying symptoms, QoL and an increase in the maximum urination rate after 6 months in patients with intravesical prostatic protrusion over 5 mm. Comparing bipolar transurethral resection of the prostate and retropubic adenomectomy, the latter showed a significantly more significant decrease in the above indicators in the group with intravesical prostatic protrusion over 5 mm, while in the group with intravesical prostatic protrusion less than 5 mm, there were no significant differences between the quality of urination.

Introduction. The effect of retropneumoperitoneum on the cardiovascular system, peripheral blood flow and the potential risk of thrombotic complications has not been adequately studied. Aim. To assess changes in systemic hemodynamics during minimally invasive retroperitoneal procedures, carried out with use of retropneumoperitoneum. Materials and methods. A total of 120 males and females, aged from 40 to 60 years, were undergone to a retroperitoneoscopic procedures for renal cysts. The parameters of systemic hemodynamics and the presence of edema of the lower extremities under various modes of retropneumoperitoneum were studied. Results. There was an increase in lateral arterial pressure by 10%, a decrease in cardiac output by 20%, a cardiac index by 24% and a stroke volume by 11%, a decrease in the linear blood flow velocity by 17%, an increase in total peripheral vascular resistance by 12% in patients who underwent the longest procedure using the highest gas pressure in the retroperitoneal space. There was a significant increase in the circumference of the right leg, more than 1.5 cm. On the 7th day after the surgery, the edema on the lower extremities was completely absent. Conclusion. Retroperitoneoscopic procedures have a significant effect on the cardiovascular system, and can lead to the development of thromboembolic complications.

Aim. Adaptation of the Clavien-Dindo classification to the assessment of postoperative complications of surgical treatment of benign prostatic hyperplasia (BPH) and assessment of the efficacy and safety of various surgical methods for treating BPH by systematizing postoperative complications. Materials and methods. Patients with BPH were divided into three groups depending on the method of surgical treatment. In group I (n=40; 26.7%) HoLEP was performed, while in group II (n=50; 33.3%) and III (n=60; 40%) TURP and open transvesical simple prostatectomy (SP) were done. The Clavien-Dindo classification system was used to adapt to the assessment of postoperative complications of surgical treatment of BPH. Results. To determine the normal and complicated postoperative period, the respective were developed. According to the adapted Clavien-Dindo classification, postoperative complications were systematized. In group I, there were 28 (70%) complications, including 8 of I grade (28.6%), 16 of II grade (57.1%), 3 of IIIa grade (10.7%) and 1 of IIIb grade (3.6%). There were no complications of IVa, IVb and V grade. In group II, a total of 41 (82.0%) complications were observed, including 16 (39%), 17 (41.5%), 1 (2.4%) and 7 (17.1%) of grade I, II, IIIa and IIIb, respectively. There were also no complications of IVa, IVb and V grade. In group III there were 154 complications in total and 89 (57.8%), 48 (31.2%), 9 (5.8%), 3 (1.96%), 3 (1.96%), 0 and 2 (1.3%) of grade I, II, IIIa, IIIb, IV and V, respectively. Conclusions. To objectively assess the quality of surgical procedures and systematize complications using the Clavien-Dindo classification, it needs to be adapted, taking into account the specifics of the methods and the postoperative period. OP is characterized as an effective method of eliminating bladder outlet obstruction, but it is associated with significantly longer lengths of stay compared to TURP and HoLEP, more severe complications, and significantly more often requires additional interventions. In terms of morbidity, blood transfusion rate and the length of hospital stay, the results of TURP are comparable to HoLEP, but TURP is inferior in terms of the frequency of long-term complications.

Objective: To determine the prognostic factors of satisfaction with erectile function in Peyronie’s disease. Materials and methods: 342 patients with Peyronie’s disease who underwent corporoplasty were analyzed. Mean age of patients at time of surgery was 42.4±15.6 years (range: 28-72 years). Median follow-up was 9.5 years (range: 0.5-20 years). Average preoperative penile curvature was 68±28, and mean stretched penile length was 12.4±3.1 cm. A logistic regression model was built to identify predictors of complete satisfaction with erectile function (EF). The analysis includes factors related to the patient, Peyronie’s disease, and the surgical method. The results are presented as the odds ratio (OR) and 95% confidence interval (95% CI). A factor was considered to be a significant independent predictor of an outcome if p value < 0.05. Results: Among patients who were included in final analysis, only 285 (83.3%) were sexually active at long term. Among 285 sexually active patients, 139 (40.6%) were completely satisfied with EF, 84 (24.6%) were relatively satisfied, and 62 (18.1%) were dissatisfied. Median IIEF-EF score (+interquartile range) was 24+5. Seven patients (2%) only had rare sexual encounters and 50 patients (14.6%) had no sexual activity due to treatment for prostate cancer, severe refractory erectile dysfunction, or non-medical reasons. Preoperative IIEF score, tunica albuginea plication, and substitution corporoplasty with venous autograft or cadaveric pericardium allograft were significant predictors of complete satisfaction with EF outcome on regression analysis. No negative predictors were found according to the regression model. Conclusion: A high preoperative IIEF-EF score is a positive predictor of satisfaction with erectile function. Despite the high satisfaction rate after substitution corporoplasty and tunica albuginea plication, it is necessary to inform patients about the possible negative influence of concomitant factors and the risk of erectile dysfunction, regardless of the method of treatment.

Introduction. Ureteral stents are widely used as drainage for the upper urinary tract. Incrustation and biofilm formation are the most dangerous complications of this type of drainage, leading to its failure. None of the existing methods completely solve the problem of preventing these complications. Purpose of the study: to assess the effectiveness and safety of the usage of extracorporeal acoustic exposure by ultrasonic amplitude-modulated signal for the prevention of incrustation of ureteral stents in a chronic experiment. Materials and methods. A team of authors calculated, designed and manufactured an ultrasonic generator, the main principle of which is the generation of an amplitude-modulated ultrasonic signal. 10 somatically healthy mongrel dogs without urinary tract infections were included in the experiment. Bilateral ureteral stenting was performed on the animals. Standard polyurethane stents 5CH were used. Starting from the 7th day of the postoperative period, ureteral stents were extracorporeally affected by the amplitude-modulated ultrasonic signal in their projection, leaving the contralateral stents intact. On the 28th day of the experiment, the stents were removed, the weight of each of them was measured, and their surface was examined by scanning electron and atomic force microscopy. Morphological examinations of the ureters and descending part of the colon on the side of the acoustic impact were carried out. Results. No complications in the postoperative period were observed. After extraction, the average weight of the sonicated stent was 0.5711±0.0264 g, the intact one - 0.6218±0.0296 g (p - 0.0022497). The surface of the new stent has thin rows of small technological defects revealed by scanning electron and atomic force microscopy. On the surface of the sonicated stent, salt deposits are noted, but this array is loose, fragmentarily repeating the technological shading of the new stent. On an intact one stent, striation is lost, formations of a rough monolithic structure with massive relief defects are visible. Atomic force microscopy: the height of technological irregularities on the surface of the new stent was 0.15±0.02 qm; on the sonicated stent, the average height of salt deposits was 0.2382±0.0988 μm, with an average maximum of peaks - 0.8564±0.5013 μm. On an intact stent, the average height reached 1.2470±0.6559 μm, and the average maximum of peaks was 3.1021±1.3844 μm. Histological examination: the severe of damage to the urothelium in both groups was comparable. The revealed changes did not worsen by exposure of amplitude-modulated ultrasonic signal. The hypertrophy of muscle fibers was noted in the sonicated ureteral wall. These findings are explained by the reflex increasing of peristalsis during vibration of a foreign body in the lumen of the ureter by the exposure of ultrasound. Morphological manifestations of traumatic damage to the colon were not revealed. Conclusions. Extracorporeal ultrasound exposure by amplitude-modulated signal is an effective and safe way to prevent incrustation of ureteral stents, which requires further study and adaptation to clinical practice.

Sacral agenesis is a rare anomaly with a frequency of up to 1:100 thousand newborns. This malformation can be either unique or combined with abnormalities of other organs and systems. With agenesis of the sacrum of types 1-3 according to T. Renshaw, a sufficiently satisfactory connection of the spine with the pelvis is revealed, which allows the patient to verticalize and move. In addition to the orthopedic component of the anomaly, in patients, violations of the function of the pelvic organs - the bladder and the evacuation function of the colon-come to the fore. The authors of the article describe a clinical observation - a 4-year-old patient, the results of a urodynamic examination against the background of therapy with a combination of M-holinoblokator and alpha-adrenoblokator. The possibilities of correcting the function of the bladder-restoration of capacity and reduction of detrusor hypertension against the background of the therapy are shown.

In urinary stone disease, several nephrolithotomy scores have been used, which allow predicting the efficiency and rate of complications of percutaneous nephrolithotomy (PCNL). However, the most optimal score is still under debate. The aim of our work was to perform a review of the existing nephrolithotomy scores for PCNL. A search for articles on nephrolithotomy systems to evaluate PCNL results was done. After reviewing the literature over the past 10 years, 110 publications were initially selected. Subsequently, 68 of them were excluded, and 42 English-language articles and 2 domestic publications were included in the non-systematic literature review. Currently, a total of 4 nephrolithotomy scores for PCNL are used. Each of them is based on certain factors, for which, depending on the characteristics of the stone and kidney anatomy, specific points are assigned. The final score allows to predict the results of PCNL. Among the nephrolithotomy scales, Guy’s, S.T.O.N.E. and CROES are most commonly described, while S-ReSC is used less often. Among the surveyed urologists, S.T.O.N.E. was used by 29% ofrespondents, compared to 10.3%, 8.3% and 2.1% for Guy’s scoring system, CROES nomogram and S-ReSC, respectively. Various authors have evaluated the efficacy and complications of PCNL using two or three nephrolithotomy scores, which established a correlation between pre- and postoperative results. Nephrolithotomy scores allows to establish the complexity of each clinical case and predict the results of PCNL.

Prostate cancer is the most common urological malignancy and the leading cause of cancer death in men worldwide. It is a heterogeneous disease with wide variability. Genomic markers, combined with clinical and pathological variables, are useful tools for reducing unnecessary biopsies, stratifying low-risk tumors from high-risk tumors, and guiding personalized treatment decisions. Variants of the TEP1 gene are of great interest as a genetic marker of the risk of developing prostate malignancies.

Provided data according prevalence of disease and its etiology, as well as about using of different methods of operative treatment at patients with coral stones, predictors and prophylaxis of complications and prognosis of PCNL-results.

Highlights the main milestones of scientific and practical activity of Professor Alexander Petrovich Tsulukidze (1888-1967) - Soviet urologist-surgeon, academician of the Georgian SSR Academy of Sciences (1955) and corresponding member of the AMN (1945) of the USSR. It is noted that during the first world war, Alexander Petrovich was a surgeon of an ambulance train on the Western front in 1915-1916. It is shown that from 1916 to 1922, he worked as a surgeon under the guidance of the outstanding Soviet surgeon Professor G.M. Mukhadze. In 1922-1924 and in 1926, A.P. Tsulukidze specialized in urology in Austria, Germany and France. It is emphasized that since 1927 Alexander Petrovich was a private assistant Professor of urology at the Department of hospital surgery of the medical faculty of Tbilisi University. It is also noted that since 1933 A.P. Tsulukidze headed the Department of surgery, and since 1953-the Department of urology of the Tbilisi state medical University. At the same time, in 1949-1953, A.P. Tsulukidze was the Director of the Tbilisi giduv. During the great Patriotic war, A.P. Tsulukidze was the chief surgeon of the evacuation hospitals of the people’s Commissariat of health of the Georgian SSR. Since 1959, Alexander Petrovich was the first Director of the research Institute of urology founded with his direct participation (now the National Center of urology named after A. Tsulukidze in Georgia), which he headed until 1965. It is noted that A.P. Tsulukidze is the author of more than 120 scientific works, including 16 monographs and manuals devoted mainly to the clinic and treatment of urolithiasis, bladder and prostate tumors, the use of bacteriophage in surgery, urology. Scientists have proposed a number of modifications of surgical interventions on the bladder and ureters. A.P. Tsulukidze was an honorary member of the aII-Union society of urologists, editor of the editorial Department «Urology» of the 2nd edition of the BME and a member of the editorial Board of the journal «Urologiia».