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No 6 (2013)


Journal "Urology"is 90 years

Alyaev Y.G., Borisov V.V., Voskanyan G.A.
Urologiia. 2013;(6):5-8
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Konstantinova O.V., Dutov V.V., Katibov M.I., Trapeznikova M.F., Yanenko E.K., Merinov D.S.


The study has evaluated the effect of combined treatment including slightly mineralized hydrocarbonate-magnesium-calcium mineral water «Naftusya» of Zbruchansk field on the urinary system of 47 adult patients with urolithiasis and chronic pyelonephritis aged 24 to 76 years and 3 children of different age groups. 14 patients dropped out of the study group after 1-3 days after the start of treatment due to the negative reaction of the gastrointestinal tract to the reception of water; thus, study group consisted of 36 patients. At baseline, kidney or ureteral stones were diagnosed in all patients. For adult patients, water was administered at a dose 200 ml 3 times a day, for children - 50-150 ml 3 times a day, 30-40 minutes before meals for 7-20 days. Examination of patients was performed using laboratory, ultrasound and radiographic methods. It was revealed that against the background of complex treatment, discharge of small stones, their fragments and urinary sand have occurred 1-3 days earlier than with standard treatment. There was no effect on calcium and inorganic phosphate metabolism. The trend to uric acid crystalluria and reducing the pH of urine was revealed. Statistically significant reduction of leukocyturia and erythrocyturia was identified. 60% of patients had a disappearance of bacteriuria or reduction of the titer of bacteria. The results led to the conclusion of advisability of use of mineral water «Naftusya» of Zbruchansk field in the complex treatment of inflammatory processes in the urinary system and for stimulation of discharge of ureteral stones with sizes enabaling to presume their independent discharge.
Urologiia. 2013;(6):9-13
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Dzeranov N.K., Egshatyan L.V., Mokrysheva N.G., Peretokina E.V.


The clinical and laboratory findings in 78 patients with various forms of urolithiasis depending on the presence of primary hyperparathyroidism (PHPT) were analyzed. PHPT was diagnosed in 17 patients. Group «without PHPT» and group «with PHPT» differed significantly in terms of parathyroid hormone (PTH) level, serum calcium, phosphorus, chloride, alkaline phosphatase, calciuria and kaliuria. In patients with staghorn calculi, PHPT was diagnosed in 12,5%, and staghorn calculi in the presence of PHPT were identified in 17,7% of cases. Hypercalciuria in the group «with PHPT» was detected in 82,4% of patients (all 3 patients with staghorn calculi), and in the group «without PHPT» — in 18% of patients (2 of 21 patients with staghorn calculi). Hyperoxaluria was observed in 42.3% of patients «without PHPT» and in 35,3% of patients «with PHPT», in 36,8% of patients with simple stones and in 57,2% — with staghorn calculi. In 39% of patients «without PHPT», secondary hyperparathyroidism (SHPT) was diagnosed. SHPT prevalence was 28% in patients with staghorn calculi, and 45% in patients with simple stones. In 87,5% of patients with hypomagnesemia, staghorn calculi were observed. Significant relationship between magnesium and triglycerides (r s=-0,296; P=0,041), and magnesium and high-density lipoproteins (r s=0,339; P=0,032) in all patients with urolithiasis were revealed. Thus, the study found no association between staghorn nephrolithiasis and PHPT. Elevated PTH levels usually indicate SHPT rather than PHPT. In hypocalcemia, there was more strong association between PTH and calcium, in normocalcaemia — between PTH and magnesium.
Urologiia. 2013;(6):14-19
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Nikulina E.S., Trapeznikova M.F., Urenkov S.B., Dutov V.V., Ivanov A.E., Podoynitsyn A.A.


Stones located in the U PJ are accompanied by the most severe violation of the upper urinary tract urodynamics compared to other localizations of stones, which often leads to severe septic complications requiring emergency care. The study has evaluated the results of treatment of 147 patients with UPJ stones using various methods of treatment, and their efficacy in these patients. Extracorporeal shockwave lithotripsy (ESWL) was performed in 55 patients, contact ureterolithotripsy (CULT) — in 23 patients, percutaneous nephroureterolithotripsy and nephroureterolithoextraction (PCNLT and PCNLE) — in 43 patients, and open surgery (ureterolithotomy, pelviolithotomy) — in 26 patients. The best results in all parameters were obtained from patients with stone size up to 1 cm after ESWL, as well as in patients with stone size greater than 1 cm after PCNLT (PCNLE). In these groups, full discharge of stone at 3 months after treatment was achieved in 95 and 97,7 % of patients, respectively. Complications in the ESWL group were recorded in 14,6 % of patients, in the PCNLT (PCNLE) group — in 9,2% of patients.
Urologiia. 2013;(6):20-23
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Kulchavenya E.V., Breusov A.A.


Prevention of recurrence of urinary tract infections by Uro-Vaxom is recommended by domestic and international guidelines; up to date, however, there is no reasonable standard regimen for the use of drug, and long-term results of immunoprophylaxis were not evaluated. The study included 48 patients who received a first course of Uro-Vaxom 5 years ago (2007-2008), including 19 men with chronic bacterial prostatitis/urethroprostatitis and 29 women with recurrent cystitis. Over 5 years, 125 recurrences of urogenital infection were observed; Uro-Vaxom along with antibiotics or uroseptics in combination with phytopreparations was used in 88 (70,4%) cases, and in the remaining 37 (29,6%) cases monotherapy with Uro-Vaxom was used for the relief of inflammatory processes. During the follow-up period, 254 1-month courses of treatment with Uro-Vaxom were conducted; 125 (49,2%) courses were assigned for the treatment of recurrent urogenital infection, and 129 (50,8 %) - for the prevention without exacerbation of underlying disease. The main indications for use were intercurrent infection, mainly respiratory - 86 (66,7%) cases, stress - 14 (10,8%); in 29 (22,5%) cases, the patients have received Uro-Vaxom focusing on their feelings without a doctor's prescription.
Urologiia. 2013;(6):24-26
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Optimization of surgical treatment of pelvic prolapse in women

Tarasov N.I., Mironov V.N.


The study was aimed to improving the efficiency and reducing the incidence of complications after transvaginal pelvic reconstructive surgery with the installation of synthetic mesh prosthesis for pelvic organ prolapse. The study involved 228 patients with II-IV stage pelvic prolapse, of which 144 (63,2 %) underwent surgery by the TVM (Tension-free Vaginal Mesh) method, and 84 (36,8 %) - by the original method with the installation of patented mesh implant. In the group of patients who underwent reconstruction of the pelvic floor with the implantation of mesh prosthesis, original in form and method of installation, in the postoperative period significantly less stress urinary incontinence was detected, better functional results have been found, and significantly fewer intra- and postoperative complications were diagnosed. Transvaginal pelvic floor reconstruction with the use of technology to minimize operational approaches when setting the original mesh implant allows to effectively restoring the normal anatomy of the vagina, and characterized by high safety and good functional results.
Urologiia. 2013;(6):27-31
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Sayapova D.R., Sitdykova M.E.


The article presents the results of the examination and treatment of 30 patients with overactive bladder receiving M-anticholinergic drug tolterodine at a dose of 2 mg twice a day for 1 month. Evaluating the effectiveness of the drug was performed on the basis of the data on voiding diary, urodynamic changes, and results of ultrasound examination. The analysis showed that treatment with tolterodine within 15 days has a positive trend: normalization of urination was observed in 96,6% of patients, 76,6% of patients have reported decrease of the frequency of urgency urination, and episodes of imperative urinary incontinence decreased in 83,3% of patients. The therapy promoted the increase the duration and volume of urination, reduction of maximum uroflow rate, indicating that the effectiveness of treatment. On the 30th day of treatment, the vast majority (80%) of the patients reported improvement of their wellbeing.
Urologiia. 2013;(6):32-35
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Experience of the use of extracorporeal shock wave therapy in the treatment of category III B chronic prostatitis

Kernesyuk M.N., Prouza O.


The randomized controlled study was aimed to the evaluation of the efficacy of extracorporeal shock wave therapy (ESWT) compared with drug treatment in patients with chronic prostatitis category IIIB. The study included 30 patients with category IIIB chronic prostatitis (CP IIIB), divided into two groups of 15 subjects. In group 1, prostate ESWT was used as monotherapy, in the group 2 - only drug treatment. The impact was carried on the perineal region using standard radial ESWT device. The procedure was performed 1 time per week for 4 weeks according to the accepted protocol. All patients completed the treatment at outpatient settings. Control examinations of 30 patients were performed at 1, 2, 4 and 12 weeks after treatment. Efficacy was evaluated using the NIH-CPSI score. All patients in group 1 had a statistically significant reduction in pain intensity and improvement of quality of life compared with group 2. The study showed that prostate ESWT is a simple and effective method of treatment of CP IIIB not accompanied by the development of side effects.
Urologiia. 2013;(6):36-39
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Application of methods of angiosurgery for the treatment of venogenic erectile dysfunction

Kurbatov D.G., Lepetukhin A.E., Dubsky S.A., Sitkin I.I.


The article presents the results of the use of alternative method of treatment - endovascular occlusion of the prostatic plexus - in patients with isolated venogenic erectile dysfunction. The IIEF-5 and AMS questionnaires were used for the evaluation of results of the operation. Improvement of quality of erection in the first 3 months after surgery was achieved in the majority of patients. The use of this innovative technology provides secure, minimally invasive and pathogenetically justified treatment of ED caused by abnormal venous drainage from the cavernous bodies.
Urologiia. 2013;(6):40-47
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Efficiency of safocid in the prevention of infectious and inflammatory complications after prostate biopsy

Ergakov D.V., Martov A.G.


The article is dedicated to the evaluation of the efficacy and safety of use of combined drug «Safocid» during transrectal prostate biopsy. The study included 80 patients with suspected prostate cancer who had indications for prostate biopsy. The study group (n = 40) of patients has received safocid, the control group (n = 40) of patients - pefloxacin at a dose 400 mg twice a day. Patients treated with safotsid significantly less often have reported the development of febrile hyperthermia on the 1st day after the biopsy; there was no need for changing the drug in study group compared with 6 (15%) patients in the control group. The frequency of adverse effects was not significantly different in the groups. Another positive feature of safocid is its satisfactory compliance and psychological comfort of patients used this drug. The data obtained allow to recommend the use of safocid for antibacterial prophylaxis when performing a prostate biopsy.
Urologiia. 2013;(6):48-53
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Treatment of recurrent large external genital warts in men

Ibishev K.S., Kogan M.I.


The article presents the results of treatment of 51 men with recurrent genital HPV infection in the form of genital warts. Patients were divided into two groups depending on the treatment. Group 1 of patients has received the combination treatment — electrocoagulation + pharmacotherapy (panavir intravenously and topically in the form of a gel), Group 2 of patients — only electrocoagulation. According to the results of foIIow-up within 6 months, disease recurrence rate was significantly higher in Group 2 — 39,5 % versus 9,6 % in the Group 1. Postoperative complications were also more frequently recorded in the Group 2. These findings suggest that the combined treatment of reccurent forms of genital warts is preferred than just using destructive methods of treatment.
Urologiia. 2013;(6):54-57
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Results of treatment of patients with prostatic adenoma using silodosin based on an assessment of the phenotype of male sexuality

Kogan M.I., Kireev A.Y.


The article presents the results of treatment of 40 patients with prostatic adenoma using silodosin (urorec®) at a dose of 8 mg per day. Patients were divided into three groups according to the phenotype of male sexuality based on author’s questionnaire. Evaluation of treatment results was performed after 24-week follow-up period. There was a high therapeutic effect of silodosin in all groups of patients with prostatic adenoma, but the greatest effect in terms of reduction of urination disorders and increases of maximum urinary flow rate was achieved in men with normo- and hyposexuality compared with hypersexual men. The development of ejaculation disorders during treatment with silodosin in patients with prostatic adenoma is less typical for the patients with hypersexual phenotype.
Urologiia. 2013;(6):58-61
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Effectiveness of vitaprost® plus in the treatment of patients with chronic bacterial prostatitis

Logvinov L.A., Kudryavtsev Y.V., Kumachev K.V., Popov S.V., Chernikov S.S.


The need for use of antimicrobial drugs in the treatment of patients with chronic bacterial prostatitis is indisputable. Given the variety of pathogenic mechanisms of chronic prostatitis, drug Vitaprost® Plus in the form of rectal suppositories is of particular interest; it combines antibacterial activity with a positive effect on the various links in the pathogenesis of this disease. The evaluation of the efficacy and safety of drugs Vitaprost® Plus and Lomflox was performed. Both groups showed a significant improvement in the NIH-CPSI score in summary and on individual domains; differences between groups were not statistically significant. The number of leukocytes in the prostatic exprimate decreased more markedly in the study group. Microbiological efficacy in the study group was 73.3%, in the control group - 70%. Thus, the use of the drug Vitaprost® Plus increased clinical and microbiological efficacy of treatment, which correlates with the data of previous studies.
Urologiia. 2013;(6):62-66
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The use of ProstaDoz in patients with chronic prostatitis. results of a multicenter nonrandomized 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 purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.
Urologiia. 2013;(6):67-72
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Obstructive complications of brachytherapy: endoscopic methods of treatment

Martov A.G., Abdullaev D.A., Dzhalilov D.O.


The article is devoted to evaluating the results of the use of endoscopic treatment in patients with obstructive complications after brachytherapy for prostate cancer. The study included 51 patients diagnosed with T1-T3 stage prostate cancer, who underwent interstitial radiation therapy with I125. The authors have analyzed the effectiveness of various endoscopic operative interventions - internal urethrotomy, recanalization of the urethra, prostate and urethral prosthetic repair, transurethral resection and incision of the prostate gland — against the background of radiation damage to the urethra and prostate.
Urologiia. 2013;(6):73-76
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Morphological results of repeated transurethral resection of the bladder for muscle-non-invasive cancer

Seregin I.V., Seregin A.V., Dadashev E.O., Polozhentsev M.S., Loran O.B.


Operating material taken from 101 patients aged 32 to 88 years with verified bladder cancer was investigated. Repeated morphological analysis of biopsy material obtained after repeated transurethral resection (TUR) has revealed 35,6% of residual tumors, and the same stage cancer was diagnosed in 23% of cases, lower stage Ta cancer — in 5% of cases. Underestimating the stage took place in 7,9% of cases. Residual tumors according to histological examination were revealed in 24,7% of patients. In tumor size larger than 3 cm, the frequency of detection of residual tumors and muscular invasion was 44,8 and 12,1%, and in tumor size less than 3 cm — 23,2 and 2,3%, respectively. Residual tumor was found in 45,7% of cases with rT1G3 and in 27,2% of cases with rT1G2. The muscle invasion was observed only in low-grade tumors — 13,5% of cases. In the presence of muscular tissue, invasion was diagnosed in 1,4% of cases, and in the absence of muscular tissue — in 20,5%. Repeated TUR of bladder for muscles-non-invasive cancer allows achieving optimal local control, obtaining additional histological material for morphological examination to confirm the stage of the disease, therefrom, choose the appropriate treatment and remove residual tumor.
Urologiia. 2013;(6):77-80
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Laparoscopic plasty in primary stricture of pyeloureteral segment

Komyakov B.K., Guliyev B.G., Aliyev R.V.


The article presents the results of laparoscopic pyeloplasty in 72 patients with primary stricture of pyeloureteral segment (PUS). The study included 34 men, 38 women; mean age was 32±4,6 years. The operation was performed by transperitoneal approach in side position of patients. 4 trocars were used. There were no conversions to open surgery. Urinary leak after surgery was observed in 4 patients; in 3 patients it has discontinued independently, and in one patient it has required a repeat laparoscopy and suturing of anastomotic defect. Due to recurrent narrowing of the PUS, two patients underwent retrograde endopyelotomy, and one patient - open pyeloplasty. The effectiveness of laparoscopic pyeloplasty in these series was 94,4 %. Impediments for performing laparoscopic pyeloplasty included small pelvis size, the presence of inferior polar vessels, and frequent exacerbations of chronic pyelonephritis, which led to the development of adhesive process in the PUS. Thus, laparoscopic pyeloplasty is the treatment of choice in patients with primary constrictions of PUS and is as effective as open plasty of PUS.
Urologiia. 2013;(6):81-84
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Features of drainage of pyelocaliceal system in children after laparoscopic pyeloplasty

Kagantsov I.M., Minin A.E., Sannikov I.A.


The study was aimed to improvement of results of treatment of children with congenital hydronephrosis due to reduction of invasiveness of operative approach and optimization of method of urine derivation in the postoperative period. From February 2008 to February 2012, 30 laparoscopic pyeloplasty were performed (16 boys, 14 girls, age from 2 months to 14 years, body weight 5500 g and more). Transabdominal pyeloplasty was performed by the Hynes-Anderson method. In 13 cases the ureteral stent deployment was performed, in 8 - pyelostoma was performed, nephrostomy performed earlier was maintained in 2 children, and in 7 children nephrostomy was performed by the proposed method. The mean duration of surgery was 110 (80-240) min. Results were followed for 3 to 53 months. 1 child on the 2nd day had falling pielostomy with the development of pyelonephritis, and 1 child had formation of urinoma. Both children had consistent anastomosis not required re-pyeloplasty. One child had persistent anastomotic stricture, which required re-pyeloplasty. Follow-up examinations included the ultrasound and intravenous urography. At the present moment, there are no complaints at all children, exacerbations of infections of the urinary system are not registered. Thus, laparoscopic pyeloplasty is an effective technique regardless of the age of the children, but it is necessary to further improve the drainage of the pelvicalyceal system in the postoperative period.
Urologiia. 2013;(6):85-89
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Features of neurohumoral regulation in children with combined dysfunction of the pelvic organs

Vishnevsky E.L., Loran O.B., Guseva N.B., Nikitin S.S.


During examination of 165 children aged 5 to 15 years (primarily identified during planned monitoring in Petrozavodsk children's institutions) with dysfunctional urination and encopresis without organic lesion of the central nervous system, autonomic dysfunction syndrome (ADS) was revealed. According to the results of urological examination, which was supplemented with the registration of spontaneous voiding rate and counting the radial pulse, overactive bladder syndrome and insufficient relaxation of the pelvic floor muscles during urination and defecation were detected; relationship between the number of heart rate (as a marker of sympathetic nervous system activity) and the effective volume was identified. It was revealed that the children with ADS in the presence of tachycardia show intermittent decrease of effective amounts of urination, and have residual urine. The standard course of treatment using colon hydrotherapy and biofeedback to activate cystic and obturator reflex caused a positive but short-term therapeutic effect; clinically and statistically significant increase in the effective volume of the bladder was not achieved, despite the reduction in residual urine volume. During the course of treatment using methods of biofeedback, bladder volume remained almost unchanged and tachycardia persisted, indicating the continued oppression of the sympathetic activity. The course of treatment using nootropic drug picamilon and α-adrenoblocker doxazosin with peripheral actions allowed to restore the reservoir and evacuation functions of the bladder, to achieve a regular bowel movement without encopresis. It was revealed that the combined dysfunction of pelvic organs occur in children with high activity of the sympathetic division of the ANS, which has a direct impact on the accumulation phase of voiding cycle and relaxation of the pelvic floor muscles.
Urologiia. 2013;(6):90-97
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Pathomorphological features of prostate diseases

Kovylina M.V., Pushkar D.Y.


Currently, the «gold» standard for the diagnosis of PCa is a histological examination of biopsy specimens obtained by transrectal ultrasound guided prostate fine-needle biopsy. As a result, a greater number of tumors have been detected at early stages (T1c). The key point is the correct preparation of microsections and their subsequent examination.
Urologiia. 2013;(6):98-102
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Diseases of solitary kidney: the history and evolution of scientific issues

Tyuzikov I.A., Grekov E.A., Martov A.G.


The lecture is devoted to one of the most important problems of modern urology, which has a long scientific history - the diseases of solitary kidney after nephrectomy. Fundamental theory of solitary kidney was laid in the early XX century, during which it was significantly enriched by fundamental provisions preserving their practical significance in the present time. In the domestic literature of the last decade, however, the problem of diseases of solitary kidney is undeservedly forgotten and slightly developed. At the same time, recent data suggest a certain theoretical and practical conflict in this section of urology: on the one hand, the incidence of diseases of solitary kidney in the last 50 years has increased by at least a 2 times; on the other — an effective conservative treatments of diseases of solitary kidney at different stages of kidney failure have not yet implemented in clinical practice, except hemodialysis and renal transplantation used in the terminal stages of chronic renal failure. Methods of primary and secondary prevention of diseases of solitary kidney are not developed at all. The history and evolution of problems of diseases of solitary kidney is a good example of fact that despite available data and accumulation of new scientific evidence of the close relationship between local and systemic factors in the pathogenesis of these diseases, their new rethinking in the framework of interdisciplinary interactions for the optimization of methods of clinical management of this specific group of patients as well as for the development of new effective methods for early diagnosis, treatment and prevention are required.
Urologiia. 2013;(6):103-110
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Role of nonclostridial anaerobes n the development of infectious and inflammatory diseases of the urinary and reproductive systems

Naboka Y.L., Kogan M.I., Gudima I.A., Chernitskaya M.L., Ibishev K.S., Khasigov A.V., Mitusova E.V.
Urologiia. 2013;(6):118-121
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In memory of A.Ya. Abramyan (on the 115th anniversary of his birth)

Trapeznikova M.F., Dutov V.V.
Urologiia. 2013;(6):123-126
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