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No 5 (2013)


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Comparative clinical and morphological characteristics of incidental and symptomatic renal cell carcinoma

Trapeznikova M.F., Kazantseva I.A., Tyan P.A., Dutov V.V.


Over the last two decades, marked increase in detection of incidental or asymptomatic renal cell carcinoma (RCC) in developed countries was observed. The study included 268 patients aged from 25 to 92 years with RCC, which underwent evaluation and treatment in urology clinic MRSRCI for the past 5 years. There were no significant differences in the frequency of histological types of RCC between incidental and symptomatic tumors. Among incidental neoplasms with clear- cell structure, tumor with small size — up to 4 cm (T1a stage) and moderate to high degree of differentiation (G 1-2 according Fuhrman) were predominant. Papillary variant of RCC was detected at a higher stage of the disease and characterized by a high degree of nuclear atypia, which indicates its high malignant potential. Chromophobe RCC was usually diagnosed at T3 stage. The average age of men and women with chromophobe RCC was 46,5±6,8 years; there were no age difference in patients with symptomatic and incidental RCC. Among the benign tumors of the kidneys, angiomyolipoma was most commonly diagnosed — in 13 (53,8 %) cases. Thus, incidental tumors have a better prognosis than symptomatic tumors.
Urologiia. 2013;(5):6-11
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Extravaginal transposition of the urethra in the treatment of post-coital cystitis

Komyakov B.K.


From 2005 to 2013, 106 patients with post-coital cystitis underwent surgery. Of these, vaginal ectopia of urethral meatus was diagnosed in 19 (17,9%), and hypermobility of the distal urethra in 87 (82,1%). 28 (26,4 %) women underwent the traditional plasty of distal urethra by O'Donnell method (group 1) and 78 (73,6 %) patients underwent surgery using new method of extravaginal transposition of the urethra developed in our clinic (group 2). In group 1, satisfactory results were obtained in 23 (82,1 %) patients, poor results - in 5 (17,9%) patients; in group 2, in 77 (98,7 %) and 1 (1,3% ) patients, respectively (p < 0,05). The disappointing results were attributable to the divergence of seams, reverse bias of urethra and recurrence of the disease. The use of method of extravaginal transposition of the urethra compared with a standard method allows to reduce the trauma of surgery, improve reliability of fixing the urethra, reducing the risk of its restriction and disease recurrence.
Urologiia. 2013;(5):12-15
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Automated decision making support system for urologists in the prediction and the prevention of stone formation. in urolithiasis

Kotsar A.G., Seregin S.P., Novikov A.V.


This article describes a decision making support system for urologists on the prediction and management of preventive interventions for urolithiasis using fuzzy logic decision-making device. Dictionary of informative signs and alphabet of classes are formed. The formulas for calculating the membership functions according to the known features are developed; these formulas allow to calculate the certainty factors for pertaining of inspected object to the desired class by means of iterative rules of rule of logical inference. Based on comparison of the values obtained with the threshold certainty factors, dephasification of conclusion is produced. In accordance with the obtained decision rules, control algorithm for the prevention measures in urolithiasis is developed. To test the effectiveness of «operation» of the synthesized decision rules, the certainty factors were calculated for 200 patients with urolithiasis, which were divided into two groups according to the results of observation during the year depending on the presence of recurrence. The analysis of the intersection of histograms of distribution of coefficient values showed high diagnostic efficiency (0,94) of synthesized decision rules.
Urologiia. 2013;(5):16-20
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Laboratory diagnosis of urinary tract injuries

Zubareva N.A., Sosnin D.Y.


In 238 patients with various surgical diseases of the abdominal cavity, concentration of creatinine in serum and peritoneal cavity exudate was evaluated. In the most cases, no significant differences in creatinine levels were found in these biological fluids, that allowed to recommend to use creatinine level in the exudate, flowing along drainages, as a parameter for dynamic control of nitrogen-excretion renal function. Significant difference in the serum creatinine level and exudate creatinine level was found in cases of injury of organs of urinary system and the penetration of urine into the peritoneal cavity. In these cases (n=16), creatinine level in the abdominal exudates exceeded the serum level (p <0,01), that allowed to provide a new method for diagnosis of lesions of the urinary tract.
Urologiia. 2013;(5):21-23
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The efficacy and safety of cefixime and amoxicillin/ clavulanate in the treatment of asymptomatic bacteriuria in pregnant women: a randomized, prospective, multicenter study

Rafalsky V.V., Dovgan E.V., Kozyrev Y.V., Gustovarova T.A., Khlybova S.V., Novoselova A.V., Filippenko N.G., Likhikh D.G.


The study was aimed to the evaluation of efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women. A prospective, multicenter, randomized study that included 112 pregnant women with asymptomatic bacteriuria was performed. 58 women were randomized in group 1 (cefixime [suprax solutab®] 400 mg 1 time a day, 7 days), 54 women were included in group 2 (amoxicillin/clavulanate [amoksiklav®] 625 mg 3 times a day, 7 days). The average age of the patients in group 1 was 25,2±6,6; in group 2 - 26,6±5,8 years. Physical examination, evaluation of complaints, collection of data on adverse reactions, and bacteriological analysis of urine were performed after enrollment in the study at visit 2 (day 10±1) and 3 (day 35±2). Comparable effectiveness of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women was found. Eradication of the pathogen and sustained bacteriological response were observed in 94,8 and 92,7% of women treated with cefixime, and in 98,2 and 92,5 % of women treated with amoxicillin/clavulanate, respectively (P> 0,05). At the same time, the use of amoxicillin/clavulanate compared with cefixime significantly higher was followed by the development of adverse reactions (13% and 1,7; respectively; P = 0,02). Seven-day courses of cefixime at a dose 400 mg 1 time a day and amoxicillin/clavulanate at a dose of 625 mg 3 times a day are high-effective treatment regimens for asymptomatic bacteriuria in pregnant women in Russia. The use of amoxicillin/ clavulanate is significantly more often accompanied by the development of adverse reactions compared with cefixime.
Urologiia. 2013;(5):24-29
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Assessment of equivalence of the original tamsulosin and its generics

Zyryanov S.K., Belousov Y.B., Kamaev A.V., Krivoborodov G.G.


Generics constitute a significant part of the modern pharmaceutical market. The use of generics in the case of their equivalence to the original drug allows to reduce the burden of health care costs. Often, however, the quality of generics does not match that of the original drug. The results of study suggest that the investigated generics of tamsulosin may not be fully recognized as pharmaceutically equivalent to the original drug.
Urologiia. 2013;(5):30-34
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The effectiveness of use of prolit in patients with ureteral stone

Tkachuk V.N., Al-Shukri A.S., Tkachuk I.N.


The study was aimed to the evaluation of the efficacy of prolit in patients with urolithiasis and localization of stone in the ureter. 225 patients with various localization of solitary ureteral calculi ranged from 0,4 to 0,7 cm were under observation. Depending on the treatment, the patients were divided into two groups. The study group (n = 175) has received prolit for 30-40 days, control group (n = 50) has received standard therapy. As a result of treatment, spontaneous discharge of ureteral stone was registered in 158 (90.3%) patients of study group and only in 21 (42%) patients of control group. Renal colics during treatment were recorded four times more often among patients of control group. The intensity of pain in patients receiving prolit was less pronounced.
Urologiia. 2013;(5):35-36
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Therapy of rapid ejaculation using drug NeyroDoz: results of a multicenter non-randomized. clinical study

Kamalov A.A., Aboyan I.A., Sitdykova M.E., Tsukanov A.Y., Teodorovich O.V., Medvedev V.L., Komyakov B.K., Zhuravlev V.N., Novikov A.I., Yerkovich A.A., Okhobotov D.A., Karpov V.K., Zubkov A.Y.


The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.
Urologiia. 2013;(5):37-42
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Potentials for the correction of endothelial and erectile dysfunction in patients after coronary artery bypass. surgery

Pomeshkin E.V., Neymark A.I., Pomeshkina S.A., Barbarash O.L.


The study was aimed to the evaluation the effect of NO- synthase inducer impaza on endothelial function and erectile function in patients undergoing coronary artery bypass grafting (CABG). The study involved 127 men with stable coronary artery disease (CAD), aged 55,8±5,3 years, which were planned on CABG. The survey included assessment of IIEF score and blood lipid levels, registration of nocturnal penile tumescences, postcompression tests on the shoulder and cavernous arteries. Endothelial function was assessed as the plasma levels of nitric oxide (NO) and endothelin-1 (ET-1). The comparison group of patients (n=67) were treated with standard rehabilitation program, and the study group (n=67) additionally has received impaza 1 tablet a day for 24 weeks. It is shown that in patients with erectile dysfunction (ED) undergoing CABG, the use of impaza for 24 weeks facilitates optimal dynamic expression of the ED. But a year after the operation, there were marked deterioration in erectile function, indicating a short-term effect of action of impaza that may require its longer use. In addition, 6 months after CABG, patients receiving impaza had better indicators of functional activity of the endothelium in shoulder and cavernous arteries compared with patients who received conventional rehabilitation; one year after surgery, however, there were no significant differences in these parameters. Restorative treatment using impaza in CAD patients after myocardial revascularization operations has positive influence on the NO, ET-1 levels, which is reflected in the functional state of the endothelium and characterized by an increase in vasodilator properties and decrease in vasoconstrictor properties.
Urologiia. 2013;(5):43-49
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Correction of erectile dysfunction in patients with BPH using daily administration of tadalafil 5 mg against the background of combined drug. therapy

Volkov A.A., Petrichko M.I., Budnik N.V.


The study included 59 patients with benign prostate hyperplasia (BPH) and erectile dysfunction (ED), inhibited inflammation in the prostate gland and with normal or medically normalized levels of total testosterone. All the patients underwent conservative therapy using dutasteride and tamsulosin, 21 of them (group 2) additionally received tadalafil 5 mg daily. Efficacy of treatment was assessed by self-assessment questionnaire of patients before treatment and 12 weeks after therapy. In group 1 of patients, the dynamics of the erectile function, sexual satisfaction and quality of life for patients was not revealed. In the group 2, improvement in erectile function in an average of 19 points was shown (IIEF-5 questionnaire). According to the AMS questionnaire, improvement in sexual function was demonstrated; in patients with compensated androgen deficiency, however, response to the treatment with tadalafil was less pronounced. According to BSFI score after 3 months of therapy with tadalafil, indicator of overall satisfaction of sexual life improved to 2.4 points (p<0,002). According to the Hospital Anxiety and Depression Scale, anxiety in patients was reduced to the permissible values (p<0,0002), the level of depression was decreased by almost 2-fold (p <0,0002). The total IPSS score decreased from 13 to 9 points in average. The inclusion of tadalafil in complex of combined conservative therapy of patients with BPH not only improves sexual function but has a positive effect on symptoms of the disease and the psychological state of the patient.
Urologiia. 2013;(5):50-54
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Clinical and urodynamic evaluation of efficacy of conservative treatment of urination disorders in patients with benign prostate. hyperplasia

Danilov V.V., Danilova T.I., Danilov V.V., Danilov V.V.


17 patients (mean age, 61±1,7 years) with an benign prostate hyperplasia (BPH) and urination disorders were under observation. After examination by ultrasound, urodynamic and laboratory studies, patients received conservative combined therapy, including α1-adrenoblocker silodosin, L-carnitine, B vitamins and picamilon. As a result of the 4,5-month treatment, most of the symptoms were eliminated as evidenced by the decrease in IPSS score from 17 to 3; urodynamic parameters have improved that was recorded by the home uroflowmetry. It was concluded that the use of proposed combined therapy in patients with BPH as the first stage of treatment, followed by the administration of 5α-reductase inhibitors or performing surgical correction in case of formation of bladder outlet obstruction is justified.
Urologiia. 2013;(5):55-58
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Clinical, laboratory and uretroscopic evaluation of the effectiveness of safocid in treatment of urethritis associated with sexually transmitted infections by using endoscopic. techniques

Abdrakhmanov R.M., Khalilov B.V., Abdrakhmanov A.R.


The study included 110 men suffering from sexually transmitted infections. Clinical diagnosis was made using modern hardware and instrumental methods of examination. It is shown that the combined preparation «Safocid» is a high-effective drug for the etiotropic treatment of specific and non-specific urethritis, with elimination of causative microorganisms of sexually transmitted infections in 96,4% of cases.
Urologiia. 2013;(5):59-63
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Combined treatment of patients with lower urinary tract symptoms and erectile. dysfunction

Tomilov A.A., Golubtsova E.N.


In men of middle and older age group, urination disorders and erectile dysfunction are often combined. The role of phosphodiesterase type 5 inhibitors in the treatment of these patients remains uninvestigated. Prospective study included 38 patients with urination disorders and erectile dysfunction. The average age of the patients was 63,6±5,3 years. During first three months of observation, all patients have received alpha-adrenoblocker doxazosin at a dose of 4 mg once daily per os, the next three months - phosphodiesterase type 5 inhibitor udenafil at a dose of 50 mg once daily per os was added to doxazosin. 3 months after treatment, majority of patients reported improvement of urination. The statistically significant changes in BP and heart rate were not recorded, indicating a satisfactory tolerability and safety of doxazosin. Against the background of combined treatment during next 3 months, progressive improvement of erectile function (IIEF score 12,8±3,4 vs 18,4±3,7; p<0,05), and regression of urination disorders, according to IPSS score (13,4±1,2 vs 11,2±1,7; p<0,05) were observed. Uroflowmetric indicators were not significantly changed. Based on experimental and clinical studies, it was suggested that the dysregulation of NO - cGMP system, pathological activation of Rho-kinase pathways, hyperactivity of autonomic innervation, atherosclerosis and impaired blood flow in the pelvic organs are the common pathophysiological mechanisms for LUTS and erectile dysfunction. The clinical efficacy of phosphodiesterase type 5 inhibitors in the treatment of patients with these diseases is explained by its effects on these mechanisms.
Urologiia. 2013;(5):64-69
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Modern tactics of management of patients with bilateral staghorn nephrolithiasis

Theodorovich O.V., Shatokhin M.N., Borisenko G.G., Naryshkin S.A., Dalgatov S.Y., Syrkin A.S.


A comparative analysis of the effectiveness of open and percutaneous operations in the treatment of bilateral staghorn nephrolithiasis (SN) was performed. Of the 38 patients with bilateral SN, stage operation (without discharge) was performed in 26 (68,5%) patients, and single-step operation — in 12 (31,5%) patients. For the 47 patients with bilateral SN, who underwent open surgery, the interventions were following: pelviolithotomy (64 operations), nephrolithotomy (21 operations), nephrectomy (9 operations). Surgery was performed in stages on each side, but unlike percutaneous operations, with discharge from the hospital. When using open surgery, only in 27 of the 47 patients complete discharge of kidney stones was achieved. A comparative analysis of single-step and stage surgery for bilateral SN revealed no significant difference in the duration of surgery and intraoperative blood loss (p>0,1); endoscopic surgery compared with open surgery is characterized by significantly lower intraoperative blood loss and postoperative in-hospital stay (p<0,001).
Urologiia. 2013;(5):70-73
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Experimental validation of the use of ND:YAG-interstitial laser coagulation of the kidney

Rasshchupkina E.V., Teodorovich O.V., Kochiev D.G., Andreeva Y.Y., Shatokhin M.N., Borisenko G.G., Naryshkin S.A.


Interstitial laser coagulation (ILC) is one of the effective methods of minimally invasive destruction of small renal tumors. For the safe use of ILC in clinical practice, it is necessary to select the optimal mode of action of laser radiation on the tissue of target organ and techniques for the procedure. The effects of ILC on kidney tissue in 6 rabbits weighing less than 3 kg and 5 mongrel dogs weighing up to 20 kg were investigated in vivo. The impact of ILC was made intraoperatively. Organ retrieval in experimental animals for the macro- and microscopic examination was performed immediately after the impact of ILC and at various times thereafter during the month in rabbits and 35 days in dogs. Morphological study in different periods after exposure allowed to establish phasing and volumes of changes in the tissues of the kidney, confirming the safety and efficacy of ND:YAG laser irradiation on kidney tissues. The results indicate the possibility of effective application of ILC of kidney tissues for destruction of small size tumors, without impairment of functions of the organ.
Urologiia. 2013;(5):74-79
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Laparoscopic transperitoneal and extraperitoneal reconstructive plastic surgery on the ureter

Baranov A.V., Biktimirov R.G., Parkhonin D.I.


The results of laparoscopic reconstructive operations on ureter distal of ureteropelvic junction are analyzed. The study included 19 patients with different obstructive lesions of the ureter who underwent surgery in the period from 2003 to 2012. According to the method of surgical treatment, the patients were divided into three groups. Ureteroureteroanastomosis was formed in 6 patients, ureterocystoanastomosis - in 5 patients, and ureterolysis was performed in 8 patients. Mean duration of operations ranged from 113 to 210 minutes. There were no requirements of conversion to open surgery in any case. Significant blood loss and other intraoperative complications were not observed. It is concluded that laparoscopic reconstructive plastic surgery in these patients can be performed with good effect equal to open surgery.
Urologiia. 2013;(5):80-83
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Retroperitoneoscopic surgeries for pyoinflammatory diseases of the kidney with varying severity of endotoxemia

Zhumagaliev A.A., Usupbaev A.C.


The medical histories of 98 patients with pyoinflammatory diseases of the kidney, who underwent surgery by retroperitoneoscopic access, and 75 patients, who underwent traditional open surgery were analyzed. The degrees of multiple organ dysfunction and endotoxemia were determined in all patients. The groups were comparable in terms of clinical manifestations and severity of intoxication. The advantages of minimally invasive retroperitoneoscopic interventions are demonstrated; they allow to reduce the surgical morbidity, pain after surgery, the frequency and severity of intraoperative complications, length of in-hospital stay, the period of disability, the cost of treatment, and the need for medications
Urologiia. 2013;(5):84-88
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Comparison of the results of correction of medium and proximal hypospadias using Onlay Island Flap and Tubularized Incised Plate methods in children

Kagantsov I.M.


Results of treatment of 35 children with primary medium and proximal hypospadias, including 15 boys undergoing Onlay Island Flap (OIF) and 20 boys undergoing Tubularized Incised Plate (TIP) were analyzed. At the time of OIF surgery the average age of children was 50,7 (14-130) months, TIP - 26 (9-74) months. Long-term outcomes (at least one year after surgery) were registered in all children. After OIF, complications were observed in 9 (60%) children; after TIP - in 5 (25%). Statistically significant differences in the number of postoperative complications were not identified, but re-operation was statistically significantly less required in children undergoing TIP (p=0,016).
Urologiia. 2013;(5):89-91
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Flexible approach to the appointment of solifenacin: for whom and when?

Kasyan G.R.


Solifenacin at a dose of 5 mg per day has demonstrated the high efficacy in the treatment of patients with overactive bladder. However, for patients who remained dissatisfied with the outcome of treatment, the dose may be increased to 10 mg per day, which leads to the improvement of patient's condition. However, there is an opinion that treatment should be started with the use of high doses of the drug. Efficiency of solifenacin at a dose of 10 mg was accompanied by favorable safety and tolerability profile. Despite the fact that numerous studies have shown that the clinical efficacy of different anticholinergics is not very different from one another, it is known that patients may prefer some other drugs. Application of solifenacin in these patients leads to significant improvement in quality of life. Thus, flexible approach to the use of solifenacin allows to achieve the best results in the treatment of patients, including those cases where the initial treatment is not effective or is interrupted due to pronounced side effects.
Urologiia. 2013;(5):92-95
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Potentials for the combined therapy of urination disorders in men: the choice of optimal scheme of treatment

Golubtsova E.N., Tomilov A.A., Veliev E.I.


Moderate to severe urination disorders occur in 13-29% of men, and their frequency increases progressively with age. The key for successful use of the capabilities of modern drug therapy is the understanding of the pathophysiological bases of urination disorders. Despite some successes of monotherapy with а- adrenoblockers and 5
Urologiia. 2013;(5):96-101
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Contact ureterolithotripsy: updating and traditions

Kogan M.I., Belousov I.I., Khvan V.K.
Urologiia. 2013;(5):102-107
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Urological complications in oncogynecological patients

Loran O.B., Sinyakova L.A., Tekeev M.A.
Urologiia. 2013;(5):108-111
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Conservative and surgical treatment of patients with tuberculosis of the bladder

Kholtobin D.P., Kulchavenya E.V.
Urologiia. 2013;(5):112-115
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Hypogonadism and chronic obstructive pulmonary disease

Vertkin A.L., Morgunov L.Y., Shakhmanaev K.A.


Chronic obstructive pulmonary disease (COPD) is a systemic disease that affects not only the respiratory system. Sex hormones deficiency in men can be correlated with the COPD stages and make a negative contribution during its progression. Up to date, there are no long-term trials evaluating the effects of androgens on the parameters of respiratory function in patients with COPD. Changes of testosterone levels in patients with COPD correlate with forced expiratory volume, and hypoxemia and hypercapnia levels. Glucocorticosteroids exacerbate androgen deficiency in patients with COPD, and the use of hormone replacement therapy with testosterone in these patients is justified. Androgens, in particular drug nebido, testosterone depot, can be effectively used in treatment and rehabilitation of patients with COPD.
Urologiia. 2013;(5):116-123
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