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No 2 (2014)


Integrative approaches to the diagnosis and treatment in urology

Glybochko P.V., Alyaev Y.G., Gadzhieva Z.K.


Modern medical science is characterized by the rapid development of diagnostic equipment, the introduction of more sophisticated and science-based technology in the diagnosis and treatment of diseases. Features of the urologist’s work in the modern world and the diversity of manifestations of urologic diseases require close cooperation between physicians of different specialties. Interdisciplinary cooperation is necessary and urgent not only for professionals but also for patients. The authors summarize and present the problems that connect urologists with colleagues in medicine, biology, and other areas of our life.
Urologiia. 2014;(2):5-15
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Replacement plastic reconstruction of extended ureteral stricture using buccal mucosa autograft

Trapeznikova M.F., Bazaev V.V., Shibaev A.N., Lukyanchikov A.G., Vinogradov A.V.


The potentials for the use of free buccal mucosa graft in reconstruction plastic surgery of extended uretral stricture are evaluated. From 2007 to 2013, 9 operations in 8 patients (mean age 54,5±7,2 years) were performed. The average length of cicatricial uretral stricture was 5,1±0,7 cm. 1 patient has lesion in the upper third of the ureter, 4 patients - in the middle portion, and 4 patients - at the bottom portion. The causes of extended uretral stricture were following: long standing calculi (n=3), ureteral injury after ureterolithotripsy (n=2) and after bringing down the calcuus using loop (n=1), radiotherapy (n=3, one patient had bilateral injury). All patients underwent plastic reconstruction of ureter using buccal mucosa graft by «on-lay» type. During the follow-up (median, 42 months, from 3 to 72 months), in 7 (88,9 %) of 8 patients (8 operations) ureteral strictures relapses were not observed. They all had satisfactory renal excretory function without the pronounced violations of passage of urine along the ureter. The excretory urography showed moderate expansion of the ureter at the site of operation in 6 of them. Due to the progression of secondary renal scarring, one patient underwent nephrectomy 1.5 year after reconstruction plastic surgery. In this patient, pronounced anatomical and functional changes in the kidney occurred before the operation. Application of the buccal mucosa graft in reconstruction plastic surgery in extended uretral stricture is high effective due to the relatively low level of early and late postoperative complications and low recurrence rate.
Urologiia. 2014;(2):16-19
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Evaluation of the adhesive characteristics of uropathogenic Escherichia coli strains in patients with spinal cord injuries

Osipova E.V., Shipitsyna I.V.


The adhesion characteristics of 9 clinical E.coli strains, isolated from the urine of 9 patients with spinal cord injuries in late period were evaluated. Patient age was 21 to 54 years. Neurogenic urination disordes observed in patients were the result of a spinal injury in the cervical (5 patients), thoracic (2 patients) and thoracolumbar (2 patients) spine. The duration of disease ranged from 2 to 12 years. Despite primarily a low adhesion activity of tested strains, the formation of biofilm occurs on the surfaces having both hydrophobic (polystyrene) and hydrophilic (cover glass) properties. After 24 h, according to the photometric evaluation, 7 of 9 strains had weak, 1 - medium, and 1 - high ability to form biofilms. After 48 hours, only 4 strains had low ability to form biofilms, of whom 2 had an increase ability compared to the previous period of observation. Other strains possess the medium ability to form biofilm. When quantifying the ability of bacteria to form biofilms on the surface of the cover glass, it was revealed that a large fraction of the area of the field of view was accounted for microcolonies with size 10 μm 2 at 24 hours, and microcolony with size from 100 to 1000 μm 2 at 48 h. There were number of significant correlations between parameters studied. After 24 h, the correlation coefficient between the optical density (OD630) and the number, OD630 and proportion of microcolonies with size 10 to 10000 pm 2 varied from 0.79 to 0.9. After 48 hours, there was a direct correlation between the OD630 and the number (r = 0.73, P = 0.025), OD630 and proportion (r = 0.81, P = 0.009) of microcolonies with size 1,000 to 10,000 mkm 2.
Urologiia. 2014;(2):20-24
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Application of Rowatinex in the perioperative period in the extracorporeal shock wave lithotripsy

Popkov V.M., Blumberg B.I., Osnovin O.V., Shatylko T.V.


Despite the high efficacy and safety of ESWL used to disintegrate stones in pyelocaliceal system and upper ureter, the issue of further reduction of the risk of complications of this procedure remains unresolved. The inclusion of phytopreparations with anti-inflammatory and lithokinetic properties in the scheme of perioperative treatment is one of the ways for prevent complications of ESWL. The effect of the drug Rowatinex on the process of discharge of calculi fragments after ESWL is evaluated. The frequency and intensity of qualitative changes of urine after appointment this drug were assessed. It is concluded that Rowatinex has positive impact on the final result of ESWL in the case of its inclusion in the complex medical treatment, which manifests in terms of reducing the time of discharge of fragments, mitigation of subjective symptoms, as well as reducing the frequency of subclinical bacteriuria and severe complications.
Urologiia. 2014;(2):25-28
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Surgical treatment of tuberculosis of the kidney with a total lesion of the ureter

Zuban O.N., Skornyakov S.N., Arkanov L.V., Novikov B.I., Chotchaev R.M.


The study was aimed to improve the efficiency of surgical treatment of renal tuberculosis with total lesion of the ureter. The clinical course and the results of surgical treatment of 104 patients with extended or multiple ureteral strictures of specific (n=92) and non-specific (n=12) etiology. Thirty-five patients with nephrotuberculosis underwent percutaneous needle-guided nephrostomy (PNGNS), 79 underwent surgery with removal of organs: open nephrectomy with lumbar access (48), combined nephroureterectomy (31). According to the evaluation the glomerular filtration rate after PNGNS, value less than 10 ml/min led to performing nephrectomy, more than 10 ml/min - ureteroplasty. It was established that combined nephroureterectomy has significant advantages in the case of specific kidney disease, despite a long duration as compared with a nephrectomy. Removal of the kidney with ureter in patient with nephrotuberculosis is the prevention of persistent dysuria, empyema of ureter stump, its possible malignant transformation, and contributes to significant improvement of quality of life of the patient. Of the 35 patients after CHPNS, 25 underwent intestinoplasty of ureter: ileum was used in 23 patients, appendix- in 2 patients. It is shown that reconstructive surgery using small intestine allows to release 92% of patients from a lifetime external drainage of the kidney.
Urologiia. 2014;(2):29-33
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Differential diagnosis and treatment of complex renal cysts detected by ultrasound screening of the abdominal cavity organs

Ukhal M.I., Ukhal E.M., Kvasha A.N.


Ultrasound screening of the abdominal cavity organs was performed in 98 patients, and renal cysts were revealed in 31 patientsare. 11 (26,6%) of 31 patients had renal cysts with complex structure. In 4 patients, complex cysts were located in parapelvic zone, in 7 patients - in different parts of the renal parenchyma. Pharmaco-Doppler sonography and computed tomography with bolus contrast enhancement in 7 patients with complex parenchymal cysts had revealed indirect signs of a malignant process - septums, thickening of the walls of cysts and septums, foci of calcination, increased blood circulation in the thickened renal cyst walls, venous stasis on the periphery of cysts and renal medulla, increasing the density of the thickened walls. Results of morphological studies have confirmed the presence of a malignant process in 5 of these 7 patients. In 4 patients with parapelvic cysts malignant process in ectomized layers was not revealed.
Urologiia. 2014;(2):34-35
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Actual issues of pathogenesis of genital tuberculosis in men

Stepanov P.I.


Based on a survey of 467 men with genital tuberculosis, following conclusions were made. The presence of morphological signs of nonspecific prostatitis of toxic-allergic genesis in patients with newly diagnosed tuberculosis of the urinary and genital organs proves the possibility of primary infection of the epididymis with Mycobacterium tuberculosis. Primarily isolated epididymal tuberculosis was diagnosed in 21 (4,5%) patients. Tuberculous of testicles is in direct relationship to the duration of the existence of tuberculous infection in the epididymis. Bilateral tuberculous of the epididymis is always combined with tuberculosis of the prostate. Opportunity of both primary and secondary infection of the prostate gland with Mycobacterium tuberculosis can be considered as proved. 15 (3,2%) patients had initially isolated prostatic tuberculosis. Based on clinical observations, exogenous way of introduction of infection in tuberculosis of genital organs in men was not confirmed. The lymphogenous and hematogenous pathways are leading and most common pathways of Mycobacterium tuberculosis in the male genitals. In patients with tuberculosis of the prostate, which is combined with a lesion of urinary organs, without involvement of scrotum in the pathological process, infection of prostate occurs by urinogenous way. Tuberculosis of the seminal vesicles is always secondary; none of the patients were initially diagnosed with isolated process. Based on the clinical manifestations of the disease and a detailed examination of the patient, it is virtually impossible to establish a particular way of infection in the male genitals. The main value of the information about the possible ways of tuberculosis infection consists of fully examination of reproductive system with histological and bacteriological verification of the diagnosis of each genital organs in each man with suspected tuberculosis.
Urologiia. 2014;(2):36-39
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Evaluation of compensation abilities of kidneys using radionuclide examination

Vidyukov V.I., Bessolova O.V., Gerasimova N.P., Komarova N.L., Rusakov A.A.


The article presents the results of evaluation of compensation abilities of kidney based on the identification of volume of functioning renal tissue according to the single-photon emission scintigraphy (SPECT) and planar scintigraphy. The study included adult patients (65 patients with renal cell carcinoma, 32 patients with renal cysts and 20 patients without renal involvement) and pediatric patients aged 1 to 17 years (57 patients with various non-neoplastic lesions of the kidney). The following parameters were used: volume ratio of functioning tissue and the specific activities of the affected and contralateral kidneys, and the volumetric ratio of volumes estimated to the reference kidney volume depending on anthropomorphic data of patient (age and sex). It was found that the maximum compensatory renal reserve occurs in the case of reducing the volume of functioning tissue of the affected kidney and the simultaneous increase in the volume of contralateral kidney.
Urologiia. 2014;(2):40-43
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Morphological changes in bladder tissue after submucosal injection of mitomycin C solution in experiment

Kostyuk A.G.


The article presents the results of morphological examination of bladder tissue reactions on the submucosal injection of mitomycin-C solution in different (0.1, 0.05, 0.025, and 0.0125%) concentrations. The experiments were conducted using dogs weighing 13-15 kg. Tissue sampling for histological evaluation were performed at 1, 2 and 3 hours, and on Day 7, 14, and 30. Maximum expression of the inflammatory response in the submucosa (edema, foci of lymphohistiocytic infiltration, increased microvascular lumen, diffuse leukocyte infiltration around the vessels of connective tissue between muscle fibers) was developed early after injection of 0.1% mitomycin-C, and it was minimal 3 hours after injection of 0.0125 % solution.
Urologiia. 2014;(2):44-47
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Varicocele in adult and elderly men

Tarasko A.D., Bersenev A.E., Salamanov V.I.


The prevalence of varicocele in second adulthood and elderly men was evaluated. It was found that varicocele in this age group occurs in 15.8 % of cases , whereas in men up to 35 years - in 18.3 % of cases. 88.5 % of men older than 35 years had children. Varicocele is often asymptomatic. The course of varicocele includes compensation and decompensation stages. Proportion of adulthood and elderly patients with decompensated stage of varicocele in the structure of urological disease was 0.34 %. Pain is the main manifestation of varicocele at the stage of decompensation in second adulthood and elderly men. For surgical correction of varicocele in such patients, Sayfan technique seems appropriate, which uses transinguinal mini assess (2.5-3 cm incision) allowing to identify and eliminate most of the possible causes of pain: infantile hernia, benign tumors of adipose tissue, fibrotic changes in the tissues along the ilioinguinal nerve. This minimally invasive technique can be used in outpatient surgery. 18 patients underwent surgery using this technique. There were no early postoperative and long-term complications. At 1 to 3 years after surgery, 13 patients were re-examined, and relapses were not revealed.
Urologiia. 2014;(2):48-51
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Efficiency of Spematon in male infertility

Nashivochnikova N.A., Krupin V.N., Selivanova S.A.


The article presents the results of the application of spematon in 39 men from infertile couples with different forms of pathospermia (asthenozoospermia, oligozoospermia, teratozoospermia). It is shown that the effect in the first 3 months of use of spematon is mainly associated with normalization of acrosome reaction of sperm cells. It was established that spematon, due to content of L-carnitine content, zinc, vitamin E, contributes restoration of induction of acrosome reaction.
Urologiia. 2014;(2):52-54
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Comparative analysis of histological and remote oncological outcomes after radical prostatectomy in patients matching Johns Hopkins and the Royal Marsden Hospital criteria for active monitoring

Veliev E.I., Sokolov E.A., Loran O.B., Petrov S.B.


A retrospective comparative analysis of results of treatment of patients with prostate cancer who met the most stringent (Johns Hopkins - JH; 74 patients) and the most mild (Royal Marsden Hospital - RMH; 263 patients) selection criteria for the management according to the strategy of active monitoring was performed. Significant differences in the frequency of detection of adverse histological features and biochemical recurrence-free survival after radical prostatectomy in patients eligible for JH and RMH criteria were not identified. Extracapsular extension occurred in 2.7 and 4.9% (P=0,33), seminal vesicle invasion - in 1.4 and 2,6% (P=0.43), positive surgical margins - in 6 , 8 and 7.2 % (P=0.56) , Gleason score increase - at 6.8 and 9.1 % (P=0.49), respectively. Five-year disease-free survival rates were 95.7 and 95,8% (P=0.41). Regardless of the protocol selection for active monitoring, precise examination of patients and staging of the disease are absolutely necessary, as well as the future well-designed studies on the comparative analysis of the effectiveness of active monitoring and early curative treatment in the settings of national health care.
Urologiia. 2014;(2):55-59
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Experience of use of prolit super septo in the rehabilitation of patients after endoscopic surgery

Martov A.G., Ergakov D.V.


Numerous publications on the successful application of prolit super septo ( Greenwood, RF) in metaphylaxis of urolithiasis after extracorporeal shock wave lithotripsy, and in infectious and inflammatory diseases of the upper and lower urinary tract gave rise to research aimed at investigating the efficacy and safety of long-term use of prolit super septo in patients undergoing various transurethral and percutaneous interventions. From September 2012, to March 2013, 894 transurethral and percutaneous endoscopic interventions were performed. The main group (n=450) consisted of patients treating with prolit super septo at a dose of 2 capsules 2 times a day for a one month in addition to standard uroantiseptic therapy after endourological interventions. The control group (n=444) consisted of patients receiving standard therapy for the same period after same interventions. The evaluation of patients both main and control group was focused on pyuria, daily diuresis, symptoms and quality of life of patients. It was found that after transurethral surgery of the lower urinary tract, the use of prolit super septo reduces the severity of irritative symptoms, improves the quality of life, reduces the leucocyturia, and increases the diuresis. Application of prolit super septo after operations on the upper urinary tract leads to a decrease of leucocyturia, increase of dieresis, and improves the discharge of residual fragments. In patients with oxalate and urate calculi, persistent increase in the pH of urine was noteda, which may be a part of metaphylaxis of urolithiasis. Adverse effects associated with taking of prolit super septo were not observed.
Urologiia. 2014;(2):60-65
pages 60-65 views

Correction of erectile dysfunction in patients undergoing radical prostatectomy

Yudovsky S.O., Pushkar D.Y.


Radical prostatectomy (RPE) is a widespread surgery in the world performed in patients with localized prostate cancer. Despite the widespread introduction of nerve-sparing radical prostatectomy techniques, erectile dysfunction after radical prostatectomy occurs very frequently, which seriously affect the quality of life of patients. At the present stage of development of medicine, differentiated approach to each patient is required. "Patient’s expectation management" is an important prerequisite for successful sexual rehabilitation. The use of conventional methods for correction of erectile dysfunction after radical prostatectomy has its own characteristics. Currently, phosphodiesterase type 5 inhibitors, however, are still first-line agents for the recovery of erectile function. Their combined use with other methods has encouraging results.
Urologiia. 2014;(2):66-71
pages 66-71 views

Principles of continence in women: the formula of continence

Kasyan G.R.


Urinary incontinence in women is a widespread disease . In recent years, significant progress in its treatment was achieved. Despite this, the mechanisms of continence are still poorly understood. According to the principles of biomechanics, incontinence occurs when bladder pressure exceeds urethra pressure. We represent the formula for calculating the pressure loss of urine, which takes into account the main factors involved in the formation of urethral pressure. According to our data, the involuntary leakage of urine during physical conditions may occur if the bladder pressure exceeds intraurethral pressure, which can be calculated using a formula based on urethral closing pressure and passive resistance of the bladder neck.
Urologiia. 2014;(2):72-77
pages 72-77 views

Malignant schwannoma of the ureter

Loran O.B., Frank G.A., Andreeva Y.Y., Seregin A.V., Ghazaryan M.A., Danilova N.A.
Urologiia. 2014;(2):78-83
pages 78-83 views

Intestinoplasty of ureters

Komyakov B.K., Ochelenko V.A.


The review provides a comparative evaluation of reconstructive surgery in patients with extensive restrictions of ureter using intestinal transplants. The questions relating to the main stages of intestinal reconstruction of ureters, forming intestinal transplant, technique of creating of anastomoses are discussed; a comparative analysis of longterm results and complications of intestinoplasty of ureters is performed.
Urologiia. 2014;(2):84-89
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pages 94 views

Dzeranov Nikolay Konstantinovich (1951-2014)

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Urologiia. 2014;(2):95
pages 95 views

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