No 1 (2015)

Correspondence author: M. I. Andrjuhin - Ph.D., Prof, of Department of Urology And Operative Nephrology with the Course of Oncourology of PFU; tel. +7 (499) 263-01-55 This paper presents evaluation of rehabilitation effectiveness of 113 patients aged 19-78 years diagnosed as having mixed and uric acid stones. 88 patients with uric acid stones 0,5-2,5 cm were assigned to group 1 and treated with Trometamol N parenteral litholis and a complex metaprophilaxis by dietary supplements Prolit and Urisan. 25 patients with mixed stones 1-3,5 cm were allocated to group 2 and treated with external shock wave lithotripsy and complex metaprophilaxis by dietary supplements Prolit Super Septo and Urisan. Positive results were achieved in all the patients. In the patients of group 1 the stones were completely dissolved. In group 2 treatment resulted in stone disintegration and clearance of small fragments 0,4 cm after partial dissolution.

The present paper reports results of a comparative study of 48 patients with latent chronic pyelonephritis and 3-18 years of duration of the disease. Patients assigned to group 1 (n=23) received standard treatment. In patients of group 2 (n=25) standard treatment was supplemented by the administration of 30-day course of Kanferon N 2 dragees twice daily. Kanferon N supplementation was found to be effective as an antiinflammatory measure due to its positive impact on renal microcirculation and urinary bacterial composition. It reduces the level of proinflammatory cytokines, stimulates humoral and cellular immunity thus preventing further disease progression.

A comprehensive evaluation of renal function in 59 patients with spinal cord injury was performed. Excretory urography, biochemical and ion-selective analysis of serum and daily urine were used. Excretory urography had showed a reduction in the cumulative and excretory renal functions, which was accompanied by an increase in glomerular filtration rate, regardless of the level of damage and the period of traumatic disease. Excretory renal function has undergone a number of changes: 1) decrease in clearance of nitrogenous components; 2) an increase in clearance of mineral components in acute phase; 3) decrease in the rate of calcium excretion. Spinal cord injury contributed to an increase in the stimulating effect of aldosterone on the distal tubules of nephrons function of the kidneys, manifested in the form of increased excretion of potassium in the urine. In case of injury of the cervical and thoracic spine, significant increase in the K/Na coefficient was determined in acute phase, in patients with lumbar spine injury - in the late period.

Urinary incontinence is a significant health problem with considerable social impact. Prospective study was carried out to assess the efficacy and safety of erbium laser (Er:Yag 2940 nm) for treatment urinary stress incontinence in women of reproductive age and its influence on quality of life in the area of sexuality. 37 women (mean age 36,2 years) with mild and moderate urinary stress incontinence were enrolled in the study. The control group consisted of 20 women of similar age. Treatment was delivered in outpatient settings without anesthesia and sedation. Laser system Dermablate MCL 31 (Asclepion Laser Technologies, Germany) with a set of vaginal heads V-Asclepion was employed. All patients underwent examination including Q-tip test and Valsalva maneuver and completed ICIQ-SF and FSFI forms. Within 1 month postoperatively all 37 patients noted significant reduction of urinary stress incontinence symptoms and favorable changes in quality of sexual life. Positive trend was found in urethrovesical junction angle changes. No postoperative complications were registered. The findings from this prospective study confirmed high efficacy and an acceptable safety profile of the new treatment of urinary stress incontinence.

Accurate staging of prostate cancer is a prerequisite to forecast disease progression and to guide surgery planning. In current clinical practice, contrast-enhanced MRI is one of the imaging tools for improving the evaluation of prostate cancer patients. To assess the diagnostic value of MRI a retrospective study in a real clinical practice setting was conducted. Preoperative M RI images were compared to postoperative pathological findings after radical prostatectomy. Accuracy of 85,3% was found in detection of seminal vesicle involvement and 65% in extracapsular extension. Specificities achieved 93,9% and 98,5%, respectively.

This paper gives an account of an experimental and clinical application of super-low frequency scanning magnetic field in patients with noninvasive bladder cancer treated with adjuvant intravesical gemcitabine chemotherapy. Treatment of isolated bladder cancer cells incubated with gemcitabine by this physical factor increased the permeability of cell membranes to the chemotherapy drug. This effect was demonstrated by increased fluorescence intensity of cancer cells. Clinical application of this combination therapy technology showed 2,8-fold increase of disease-free survival interval compared to early recurrences in the control group. These results indicate the potential of biophysical mechanisms to increase chemotherapy effectiveness.

Objective: To determine the risk factors for anterior urethral strictures after transurethral resection of benign prostatic hyperplasia. Materials and Methods: The present study consists of a prospective and retrospective part. Prospective analysis of 110 patients who had undergone, at the urology clinic of First MSMU named after I.M. Sechenov in the period from January 2009 to February 2014 was performed transurethral resection (TUR) of the prostate. In the retrospective part, the case histories of 85 patients who were treated in the urology clinic First MSMU named after I.M. Sechenov from 2009 to 2013 with a diagnosis of urethral stricture were analysed. Of them, 29 cases urethral stricture occurred earlier after undergoing TURP. Patients from both sides were divided into two groups: group number 1 patients undergoing TURP for BPH who have not formed a urethral stricture, and group number 2 - patients who had urethral stricture formed. Results: According to the criteria for inclusion in group number 1there were 40 patients who did not form a urethral stricture after TURP and 33 patients were included in the group number 2, in which the late postoperative period was complicated by the formation of a stricture of the urethra. Prostate volume was significantly different in both groups. In group number 1 prostate volume averaged 60 cm3+23 cm3 in group number 2 prostate size equaled an average of 80 cm3+24 cm3. (p<0,05). Having a urethral catheter or cystostomic drainage before surgery was observed in 12% (n=5) in the first group and 27% (n=9) in the second group. Duration of operative benefits was assessed at intervals up to 60 minutes and more than 60 minutes. Thus, the results in the first group are divided into 75% (30) 25% (10), respectively. In the second group, these values were 24,2% (n=8) and 75.8% (n=25). Diabetes mellitus was noted in a first group in 12.5% (n=5) of the patients, in the second group - 30% (n=10). The number of patients seen earlier for hypertension in the group, which did not form a urethral stricture, was 37,5% (n=13) and in the group with urethral strictures - 60,6% (n=20). Having chronic inflammation, which was confirmed upon subsequent morphologic examination of prostate tissue resection, were detected in the first group at 32,5% (n=13) patients and in the group number 2 at 66,6% (n=22) patients and was significantly higher in the second group (p<0,05). Conclusions: The duration of TURP more than 60 minutes, prostate volume of more than 70 cm3, the presence of diabetes mellitus, and also chronic inflammation of the prostate significantly increases the risk of urethral stricture in the late postoperative period.

Case records of 3174 men aged 20-45 years living in a heterosexual marriage and having a regular sexual life were analyzed. Examination of couples and sperm analysis was conducted in accordance with the requirements of the WHO. Leukocytospermia was present in 19% of infertile cases. In 54% of those cases chronic prostatitis was associated with aerobic bacterial infection, in 9% - with chlamydial and in 12% with urea- and mycoplasma. It was found that concentrations of leukocytes in semen and clinical symptoms (pain and dysuria) were not independent risk factors for infertility. Infertile patients had higher incident rates of E. coli (OR=4,1) and bacterial associations (OR=6,9) with reduced antimicrobial resistance of seminal plasma(for E. coli OR=9,9; for Ps. aeruginosa OR=6,0). Other risk factors for fertility reduction in patients with HP are the duration of the disease (OR=2,7), frequency of exacerbations (OR=2,6), presence of fibrosis and prostatolites (OR=1,8) and functional prostate-vesicular obstruction (OR=1,4). Further studies are needed to understand HP pathogenesis and explain the negative impact of HP on male fertility.

This randomized comparative study was carried out to estimate efficacy and safety of the natural complex of fermented food fibers and short chain fatty acids (dietary supplement rekicen-RD ®) in antibacterial therapy of 64 patients with chronic infectious prostatitis. 32 patients of the treatment group received 8 week standard antibacterial therapy for chronic prostatitis in combination with dietary supplement rekicen-RD ® and 32 patients of the control group were treated only with antibacterial therapy. Short-term and longterm results were estimated after 8 weeks and 6 months follow-up, respectively. It was found, that addition of dietary supplement rekicen- RD ® to antibacterial therapy resulted in statistically significant improvement of the treatment efficacy. Compared to patients of the control group, patients of the treatment group had more pronounced positive changes of all indicators of treatment efficacy (NIH-CPSI total score, quality of life, echo-structure of prostate, the number of leukocytes in prostatic secretions). Long-term (after 6 months) clinical efficacy of the combination of antibacterial therapy with dietary supplement rekicen-RD ® was 96,9%, bacteriological efficacy after 8 weeks - 87,5%, after 6 months - 81%. Notably, there was 4,5-fold reduction in the rate of antibiotics adverse side effects in the treatment group patients without a single gastro-intestinal side effect.

Restoring the passage of urine through the upper urinary tract routinely is achieved by installing of external or internal drainage. Due to its objective advantages, internal drainage has been successfully used in surgery of the upper urinary tract. This review outlines the problems associated with the use ofinternal stents, namely difficultyininstallation, migration, and reflux and stent obstruction, bacterial colonization of the stent, the development of functional and morphological changes in the drained segment of urinary tract.

Based on analysis of domestic and international literature and his own long-standing experience the author gives clear-cut and unequivocal definitions of different forms of urogenital tuberculosis, its comprehensive classification, which allows guiding a patient management.

This paper reviews results of examination and treatment for benign prostatic hyperplasia (BPH) and infravesical obstruction in 16 patients observed in Department of Urology of Zhukovsky ССТ in 2013-2014. Most operated patients required particularly careful approach to the surgery planning due to advanced age and multiple comorbidities. Treatment of all patients was carried out in a single therapeutic session performed in two stages. Percutaneous cystolithotripsy was performed on the first stage and subsequently transurethral resection of the prostate (TURP) was carried out. It was found, that combination of minimally invasive percutaneous approach and TURP is the most sparing way to restore lower urinary tract urodynamics and eliminate bladder stones in all operated patients. With appropriate patient selection and a clear definition of indications, proposed treatment combination is a promising and effective strategy in management of patient with urolithiasis with infravesical obstruction and BPH.