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No 2 (2015)


Computer-assisted surgery for renal tumors

Aljaev J.G., Sirota E.S., Fiev D.N., Proskura A.V.


The main objective of this article is to show the role of modern computer technology in performing virtual and real surgical procedures for renal tumors. At the present time, 3D based modeling makes it possible to preoperatively identify individual strategy and tactics of treatment of a patient.
Urologiia. 2015;(2):4-8
pages 4-8 views

Effectiveness of extracorporeal shock wave lithotripsy in patients with urolithiasis of a solitary kidney

Parshenkova I.G., Dutov V.V., Rumjancev A.A., Mamedov E.A.


The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (p<0.0001), and the baseline urodynamics of the upper urinary tract (p<0.0001). The rates of complications (32.3%) and auxiliary procedures (16.1%) were relatively low, due to the usage of pre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (p<0.0001), they had increased time of lithotripsy (p=0.013), more sessions (p<0.0001), complications (19.4%, p=0.043) and auxiliary manipulation (9.7%). Nevertheless, the duration of stay in hospital in the postoperative period did not correlate with the size of calculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.
Urologiia. 2015;(2):9-12
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Incidence of nosocomial uropathogens and dynamics of their sensitivity

Kul'chavenja E.V., Cherednichenko A.G., Nejmark A.I., Shevchenko S.J.


In order to determine the basic spectrum of urinary tract infections and their sensitivity to modern antimicrobials, the 5-year (2009-2013) study of 2621 isolates of uropathogens from inpatients of two centers of Novosibirsk and Barnaul was carried out. Instability of proportion of the isolated microorganisms both in time and in two compared neighboring regions was found. The role of E. coli was insignificant: in Barnaul the maximum share E. coli among all uropathogens was 56.1% in 2009 (with a five-fold drop in the next year to 10.5%), Novosibirsk share of E. coli increased from 28,1% in 2009 to 49.4% in 2013, with an unaccountable fall to 33.5% in 2011. In evaluating the resistance of E. coli, many groups have shown a steady growth in antibiotic resistance. Resistance of microflora to 2nd generation cephalosporins increased by 3 times, to ciprofloxacin - by 2 times and to amoxicillin - by 7 times. However, there were virtually no strains resistant to carbapenems. Zero resistance to fosfomycin was found- all strains were susceptible to this antibiotic within 5 years. Range of UTI pathogen species in two adjacent regions was subject to significant fluctuations, no patterns were identified. In contrast, the level of microflora resistance increased. Within 5 years, it increased to basic antibiotics by 7 times, while maintaining a low resistance to nitrofurantoin, gentamicin and imipenem, and zero resistance to fosfomycin. The results of this study are consistent with international data on the partial loss of E. coli role as the leading uropathogen. Gram-positive cocci are becoming increasingly important, which is worth considering when choosing a drug for empiric therapy. Optimal antibiotics and uroseptics for treatment of patients with acute uncomplicated cystitis remain fosfomycin and nitrofurantoin, as was shown earlier.
Urologiia. 2015;(2):13-16
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Surgical treatment of strictures or obliterations of urethra

Kogan M.I., Krasulin V.V., Mitusov V.V., Shangichev \.V., Gluhov V.P., Naranov S.V.


The article introduces the clinical and statistical analysis of 113 patients treated for urethral strictures (US) in the urological clinic of the Rostov State Medical University in 2011. 58% of patients experienced a recurrent course of the disease. Radical curative surgery was possible in 93 (82.3%) patients. In other cases, non-invasive strategy was indicated (13.3%) or surgery for urethral stricture was impossible due to comorbidities (4.4%). Resection with urethral end-to-end anastomosis, which is the most effective approach to the treatment of patients with US, was possible in only half of the patients (51.8%). In the rest of the patients, one-, two- or more stage urethroplasty substitution was carried out. By the end of 2013, treatment of 84 (90.3%) patients was completed with a total of 110 operations. 9 (9.7%) patients were scheduled for operation in 2014.
Urologiia. 2015;(2):17-23
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The role of magnetic resonance imaging in the diagnosis of stricture disease of the male urethra

Dombrowski V.I., Kogan M.I., Banchik E.L., Mitusov V.V.


The article presents a comprehensive study of 121 patients with stricture disease of the male urethra. Diagnosis and staging of the disease were made on the basis of medical imaging, namely retrograde urethrography, voiding cystourethrography and magnetic resonance imaging with complex pulse sequences developed by the authors. The results were compared with surgical findings and morphological study of surgical specimens. Detailed semiotics of magnetic resonance imaging of stricture disease, differences in the visualization of traumatic and inflammatory strictures of various locations, as well as features of primary and recurrent lesions are described. Detailed analysis of the data shows significant advantages of MRI in identifying stricture disease of the male urethra over traditional methods of endoscopic visualization. It makes possible to increase the diagnostic accuracy for detection of the disease and better surgical planning strategy.
Urologiia. 2015;(2):24-30
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Injection of botulinum toxin type a in the bladder detrusor and submucosa in patients with overactive bladder without detrusor overactivity

Krivoborodov G.G., Tur E.I., Efremov N.S.


The objective of the study was to compare the efficacy and safety of injections of botulinum toxin type A in the submucosal layer of the bladder and in detrusor in patients who were refractory to anticholinergic therapy of overactive bladder without detrusor overactivity. 100 U botulinum toxin type A was diluted in 10 ml of 0.9% saline and injected with 0.5 ml (5 units) of this solution in 20 points of the bladder (the back and side walls except Letto triangle). In twenty-two patients (the first group) botulinum toxin was injected into the submucosal layer of the bladder, while in 34 patients (second group) - into the detrusor. In the first group after 1 and 3 months 3 (14%) patients and after 6 months 2 (9%) patients had positive treatment outcomes (improvement of symptoms in more than 50%). In 22 (65%) of the 34 patients of the second group positive results were observed at 1 and 3 months and in 17 (50%) - at 6 months. After 9 months, all patients had a relapse of urgent and frequent urination. Difficulties in emptying the bladder were observed in three (9%) of the second group patients who had to resort to periodic self-catheterization for 2-20 weeks. The obtained results allow us to state that the injections of 100 U of botulinum toxin type A in the submucosal layer of the bladder are ineffective in patients with overactive bladder without detrusor overactivity, whereas injections in the detrusor lead to a statistically significant improvement in symptoms of urgent and frequent urination for 6 months.
Urologiia. 2015;(2):31-34
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The quantification of sulphated glycosaminoglycans in rat urine in experimental hemorrhagic cystitis

Sobolev V.E., Shmurak V.I.


The paper presents the study of the excretion of sulfated glycosaminoglycans (GAG) in the urine of rats in experimental hemorrhagic cystitis induced by cyclophosphamide and treated with glycosaminoglycan replacement therapy. Rats were given intraperitoneal injections of cyclophosphamide at a dose of 100 mg per 1 kg body weight and subsequently treated with intragastric administration of the combined preparation of glycosaminoglycans containing glucosamine hydrochloride and chondroitin sulfate at a dose of 10 and 100 mg per 1 kg of body weight. Within 24 or 72 hours after cystitis induction there was a statistically significant increase in urinary GAG excretion. The study also found a decrease (from 1.34 to 1.22 mg/dL) in urinary GAG within 0 to 72 hours following induction of acute cystitis without glycosaminoglycan therapy. In the subchronic model of inflammation in the bladder, upon repeated administration of low doses of cyclophosphamide (50 mg/kg), decrease in urinary GAG within 0 to 72 hours (1,32±0,13 mg/dL) as well as increased excretion after 96 hours at a concentration of 2,29±0,13 mg/L after initiation cystitis were found.
Urologiia. 2015;(2):35-38
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Effectiveness of combined treatment of hpv infection

Nejmark B.A., Kondrat'eva J.S., Zologina V.S., Torbik D.V.


This study evaluates the effectiveness of immunomodulating drug isoprinosine in a comprehensive treatment of genital warts in men. Most of the patients were aged 20-30 years. The combination therapy was found to have long term effectiveness. In the group of patients undergoing only destructive methods of treatment relapse after 8 month follow-up was diagnosed in 32% and in patients of the combination therapy group (destruction plus isoprinosine) - in 7% of patients. The pharmacological action of the drug (immunostimulating, antiviral) and the effectiveness of its combination with destructive therapies justify the use of inosine pranobex (isoprinosine) both in the complex therapy of genital warts and for the prevention of the disease recurrence.
Urologiia. 2015;(2):39-42
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L.M. Rapoport, E.A. Bezrukov, Ju.L. Demidko, A.V. Kondrashina Application of diferelin and its perspectives

Rapoport L.M., Bezrukov E.A., Demidko J.L., Kondrashina A.V.


The article presents a brief overview of luteinizing hormone-releasing hormone analogs in the treatment of prostate cancer. The authors report their experience with this drug class by an example of Diferelin. The experience with abiraterone in treatment of patients with hormonal resistance is described.
Urologiia. 2015;(2):43-46
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Use of phytoand peloidotherapy in treatment and prevention of chronic cystitis in women

Sopotov A.V., Nejmark A.I., Nejmark B.A.


The article presents the findings of herbal- and peloidotherapy as a combination treatment in patients with chronic cystitis. The effectiveness of treatment was evaluated by the dynamics of clinical findings, results of laboratory and instrumental studies (increase functional bladder capacity, improvement / normalization of urinalysis, elimination of bacteriuria, improvement of microcirculation). The results showed high efficiency of phytoplankton and pelotherapy in normalization of urodynamics and microcirculation of the bladder mucosa. Upgraded combination scheme for the treatment of chronic cystitis significantly improved patient outcomes.
Urologiia. 2015;(2):47-51
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Features of percutaneous nephrolithotripsy in patients with urolithiasis of solitary kidney

Dutov V.V., Urenkov S.B., Parshenkova I.G., Rumjancev A.A., Mamedov E.A.


The article describes the results of percutaneous nephrolithotomy (PCNL) in 49 urolithiasis patients with a solitary kidney. In 44 (89.8%) patients the calculi were located in the kidney, in 5 (10.2%) patients - in the upper third of the ureter. The calculi were single (18; 36.7%), multiple (14; 28.6%) or stag-horn (17; 34.7%). Efficiency of PCNL estimated immediately after surgery and at the end of the third month of observation was 75.5 and 93.9%, respectively. Stone size (p=0.594), the baseline state of urodynamics of the upper urinary tract (p=0.205) did not affect the renal clearance at PCNL. Enlargement of initial calculus size positively correlated with the number of required treatment sessions (p=0.013), duration of surgery (p<0.0001), and the length of postoperative hospital stay (p<0.0001). Complications were common (44.9%), but the auxiliary manipulations were performed infrequently (26.5%). No associations were found between the size of calculus, the number of complications and secondary manipulations (p=0.361). No correlations were found between the clinical form of a solitary kidney with urolithiasis and the occurrence of complications during the treatment course (p=0.121), as well as between the presence of complications and the cause of the «loss» of the contralateral kidney (p> 0.05). Thus, percutaneous nephrolithotripsy is a highly effective method modality of treatment of solitary kidney urolithiasis. Appropriate selection of indications and contraindications for PCNL, preoperative preparation, surgical technique, postoperative patient management are of great importance.
Urologiia. 2015;(2):52-55
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Transurethral contact ureteral lithotripsy in a gaseous (CO 2) medium

Glybochko P.V., Aljaev J.G., Rapoport L.M., Carichenko D.G., Arzumanjan E.G.


The paper describes for the first time the method of contact ureteral lithotripsy in gaseous (CO 2) medium. It presents the results of a comparative study of urolithiasis patients treated with this treatment modality (study group, n=30) and with traditional contact ureteral lithotripsy in liquid medium (control group, n=30). The incidence of retrograde migration of calculus in the kidney in the study group was 0%, while it was 16.6% in the control group. Acute or exacerbation of chronic pyelonephritis was diagnosed in only 3 (10%) patients in the control group. The suggested method of contact ureteral lithotripsy is safe and provides several advantages over traditional contact ureteral lithotripsy in a fluid medium, such as: physiologic validity, absence of calculus hypermobility (increased mobility), improved visualization during surgery and high cost effectiveness.
Urologiia. 2015;(2):56-59
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Superselective prostatic artery embolization as a preparatory step before turp in the treatment of benign prostatic hyperplasia in patients with large prostates

Nejmark A.I., Nejmark B.A., Tachalov M.A., Arzamascev D.D., Torbik D.V.


The study included 59 patients with benign prostatic hyperplasia (BPH) and high risk of anesthesia who underwent superselective embolization of prostatic arteries. The examination included a survey on the International Prostate Symptom Score (IPSS), assessment of quality of life (QoL), estimation of prostate and node size with transrectal ultrasound, determination of prostate-specific antigen level; in doubtful cases a needle prostate biopsy was performed. To analyze the quality of urination uroflowmetry was conducted. The effectiveness of the treatment was evaluated after 6, 12 and 24 months follow-up. By the 6th month of observation I-PSS score significantly decreased, while the maximum urine flow rate increased. This trend kept up during the subsequent six-month follow-up. The results of 24 months follow-up after embolization showed stable effect. Prostate and node volumes and reduced on average by 53% and 47%, respectively; the maximal reduction of prostate volume was 82%. 17 (28.8%) patients with prostate size reduction to less than 80 cm 3 underwent transurethral resection of the prostate. In conclusion, prostatic artery embolization may be considered as a method of preoperative treatment of BPH patients with large prostates and multiple comorbidities, providing them with the possibility of endoscopic treatment. Further study will allow working out the methodology of embolization, to accurately determine the indications and contraindications for this treatment modality and to introduce it to clinical practice.
Urologiia. 2015;(2):60-64
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Intraoperative control of the effectiveness of transurethral resection of non-muscle-invasive bladder cancer

Zubkov A.J., Sitdykov J.N., Nuriev I.R., Sitdykova M.J.


This paper presents results of 82 patients treated for non-muscle- invasive bladder cancer. 28 patients underwent transurethral resection of bladder cancer (TURB) as a monotherapy, 28 - TURB with photodynamic control, 26 - TURB with dynamic transurethral sonography. Analysis of the 5-year recurrence rate, pattern and timing of recurrence depending on the modality of intraoperative control of TURB effectiveness was performed. The overall recurrence rate in the first group was 60.71%, of them local recurrence in the resection area occurred in 21.43% of cases, outside of the region of resection - in 28.57% of cases, and progression - in 10.71%. In the second group the overall recurrence rate was 25%, recurrence in the resection area was diagnosed in 7.14% of patients, outside of the region of resection - in 14.29% and progression - in 3.57%. In the third group of patients over a 5 -year period local recurrence in the resection area was identified in 3.84% of cases, outside of the region of resection - in 23.07% of cases and no cases of disease progression were observed. The results showed that TURB without additional intraoperative imaging of surgery effectiveness was not a radical treatment for non-muscle- invasive bladder cancer. Photodynamic control increases the surgery effectiveness by preventing recurrences outside the resection region. It allows identifying microscopic modified urothelium clones, but does not affect the rate of disease progression. Intraoperative transurethral ultrasound guidance increases TURB effectiveness by preventing both relapse in the area of resection and disease progression.
Urologiia. 2015;(2):65-67
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Correction of blood cir-culation in the prostate in patients with chronic prostatitis associated with urogenital infec-tions

Kondrat’eva J.S., Nejmark A.I., Zheltikova J.D., Subbotin E.A.


The aim of the study was to assess the effect of a combined preparation ofVitaprost on blood supply and microcirculation in the prostate gland in 35 patients with chronic infectious urethral prostatitis. The effectiveness of treatment was estimated by a combination of clinical, bacteriological and instrumental diagnostic methods. Transrectal ultrasonography with color Doppler and laser Doppler flowmetry were used to estimate all components of blood circulation in the prostate. Examination results obtained before and after treatment showed better clinical outcomes and improved parameters of blood flow and microcirculation in the prostate in patients receiving Vitapost. These results indicate that combination therapy including Vitaprost is effective in correcting blood flow and microcirculatory disorders of the prostate and can be utilized in the treatment of chronic infectious urethral prostatitis.
Urologiia. 2015;(2):68-73
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Incidence of acute urinary retention in patients with prostatic adenoma and 8-year long tamsulosin therapy

Davidov M.I., Lokshin K.L., Gorbunova I.S.


This report introduces results of an 8-year study estimating the risk of acute urinary retention in patients with stage I prostatic adenoma. Patients were randomly assigned into two groups. The first group consisted of 331 men was regularly taking Omnic (tamsulosin) 0.4 mg 1 time daily for 8 years as a means of medical therapy. The second group consisted of 334 patients treated with herbal preparations (Gentos, Tadenan or Speman). In the case of acute urinary retention patients were taken to the urological department to release urine from the urinary bladder by catheterization or by the surgical procedure. The incidence of acute urinary retention in group 1 ranged from 0.3 to 1.2% per year and, for a total of 8 years of follow-up was 6.45%. In the second group, it ranged from 1.8 to 7.3% per year, making a total of 36.2%. Therefore, the risk of acute urinary retention in patients receiving Omnic (tamsulosin) was reduced by 5.6 times in comparison with the group of patients treated with herbal medications. Thus, the need for surgery decreased from 27.8 to 6.3%. According to the results of an 8-year long tamsulosin was found as a safe and highly effective means to reduce the risk of acute urinary retention.
Urologiia. 2015;(2):74-81
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Structural abnormalities of the obstructed ureterovesical junction

Sharkov S.M., Rusakov A.A., Semikina E.L., Jacyk S.P., Burkin A.G.


The article presents a morphological study of UVJ removed during surgery in 110 children with stage III hydronephrosis. Morphological changes in resected UVJs indicate a predominance of sclerotic transformation accompanied by different types of dysplasia.
Urologiia. 2015;(2):82-87
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Vesicoureteral reflux into small kidney: diagnostic and therapeutic paradigm

Korol’kova I.A., Kolobova L.M., Dutov V.V.


The causes of renal size reduction in children by 20 percent or more from the age norm include abnormalities of urodynamics of upper (UUT) and lower (LUT) urinary tract, combined with vesicoureteral reflux (VUR) and infra-vesical obstruction (IVO). Several issues regarding diagnosis and choice of treatment in children with small kidneys depending on the severity of functional abnormalities and the presence of comorbidities still remain controversial. 101 children with small kidneys accounting for 3.1% of the entire number of urologic patients admitted to the clinic were followed for 25 years. 78 (77.2%) patients were simultaneously diagnosed as having ipsilateral vesicoureteral reflux (VUR) (2.4% of the total number of hospitalized children). Moreover, contralateral VUR was found in 63% of patients. In 5.1% of children, anomalies of the contralateral kidney were identified: lumbar dystopia (3.8%), duplication of the renal pelvis and ureter (1.3%). Combination with IVO was found in 25.5% of cases. 75 (96%) children with vesicoureteral reflux into the small kidney were operated on. Reconstructive plastic surgery was made in 72 (92%) those patients. Indications for conservative management were identified in patients with intermittent VUR of I-II degree into small kidney or both kidneys. In case of detection of IVO, initial surgery was carried out to eliminate the obstruction. Conservative therapy was aimed at getting rid of the inflammatory process, restoring the function of kidney and bladder, and at the treatment of concomitant vulvovaginitis. In the absence of positive results of 6-8 months of conservative treatment or in case of the negative clinical course, the operation was considered justified. Indications for antireflux surgery were the failure of conservative therapy for intermittent VUR into small kidney or both kidneys, the presence of VUR of III-V degree into one or both kidneys. In cases of bilateral VUR antireflux surgery was performed simultaneously. Indications for nephrureterectomy were complete loss of kidney function, a combination of several unfavorable prognostic signs, namely a significant reduction of the renal size (renal area less than 30% ofthe age norm); severely impaired kidney function (reduced contribution to the total accumulation of up to 10% or less); the presence of ultrasonic and radiographic evidence of secondary shrinkage; pronounced abnormalities of UUT urodynamics; failure of treatment of frequent and severe pyelonephritis exacerbations. It is shown that VUR is often combined with a decreased renal size, creating difficulties in selecting treatment tactics and determining the prognosis of the disease further. The proper strategy is to prevent disease progression and reduce the need for organ-removal surgery in children.
Urologiia. 2015;(2):88-93
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An evidence based update on the investigation and management of male lower urinary tract symptoms

Mangera A., Chapple C.


In this review, we aim to summarise the evidence regarding the diagnosis and management of male Lower urinary tract symptoms (LUTS). It is inevitable that with an ageing population the prevalence of male LUTS is likely to increase. Thus symptom prevention and preservation of quality of life (QoL) feature as high priorities for clinicians and patients alike. There are now a number of different pharmacological options available to men with LUTS which lead to significant improvements in symptom scores, flow rate and QoL. Meta-analyses have shown the benefits for 5-а reductase inhibitors, antimuscarinics, alpha blockers and more recently the phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above agents with alpha blockers except phosphodiesterase-5 inhibitors and so men with concomitant storage symptoms, prostate volume >30ml/ PSA>1.4 or erectile dysfunction may be considered for combination treatment. The last few years have seen an increase in the data regarding less invasive methods of cystometry. Although these do not provide the same information as cystometry, they may have a role in answering specific questions and counselling men with BPH/LUTS. The key to incorporating these newer techniques in the assessment of men will lie with standardisation and use for specific indications. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical investigative and management strategy.
Urologiia. 2015;(2):94-102
pages 94-102 views

Collagen biomatrix in reconstructive urology

Kamalov A.A., Kirpatovckij V.I., Ohobotov D.A., Kamalov D.M., Karpov V.K.


The paper presents leading problems faced by surgeons performing reconstructive plastic replacement of the bladder, types of biomatrix used in urology, their application and the perspectives for their further use.
Urologiia. 2015;(2):103-106
pages 103-106 views

Varicocelectomy in adolescents: who and when to operate

Sizonov V.V., Makarov A.G., Kramarov A.I., Kogan M.I.


In studying the problem of varicocele in children and adolescents, there was a consistency of objectives chosen by researchers both today and half a century ago. Nearly all researchers start with phrases about the absence of reliable evidence of a direct negative impact of varicocele on male reproductive function, but yet they express confidence in the need for prophylactic varicocelectomy in children and adolescents in some cases. This demonstrates the necessity of prognostic indicators that could be used for selection of adolescents requiring surgery in circumstances of the limited feasibility of investigating the reproductive function.
Urologiia. 2015;(2):107-111
pages 107-111 views

Sexual func-tion of patients undergoing radical prostatectomy: a modern view of the problem

Glybochko P.V., Matjuhov I.P., Aljaev J.G., Ahvlediani N.D., Inojatov Z.S.


Radical prostatectomy (RP) is deemed to be the most effective standard treatment option for men with prostate cancer (PC). However, RP is accompanied by a number of complications leading to a substantial decline in the quality of sexual life of operated patients. Major complications of RP include: decreased sex drive, deterioration of erectile function, deformation of the penis, abnormal ejaculation and orgasmic dysfunction. Based on the current literature, the article deals with the issue of prevention and rehabilitation of patients after radical prostatectomy, describes the methods of conservative and surgical correction of complications, associated with surgical treatment of PC.
Urologiia. 2015;(2):112-116
pages 112-116 views

Use of sildenafil citrate for treatment of erec-tile dysfunction of various etiology

Efremov E.A., Kasatonova E.V., Melnik J.I.


Erectile dysfunction is closely linked to the general state of both physical and psychological wellness. Among the major risk factors are heart disease, arterial hypertension, diabetes, hyperlipidemia, as well as sedentary lifestyle, smoking and alcohol abuse. Also, the disease is more frequently found in men undergoing radiation therapy or surgery for prostate cancer. Psychological correlates include anxiety, depression and irritability. Despite a higher prevalence among older men, erectile dysfunction is not considered an inevitable part of aging. Due to polyetiology of the disease, sildenafil is regarded as the gold standard of treatment, and new high quality generic drugs are marketed. The article covers the use of sildenafil in patients with diseases of the cardiovascular system, diabetes, hypogonadism. Effectiveness of sildenafil in patients on chronic hemodialysis as well as in patients undergoing radical prostatectomy is discussed. The issue of addiction to sildenafil is outlined.
Urologiia. 2015;(2):117-121
pages 117-121 views

Radical laparoscopic nephrectomy with inferior vena cava thrombectomy

Perlin D.V., Aleksandrov I.V., Zipunnikov V.P., Ljaljuev A.M.


Laparoscopic radical nephrectomy has proven itself as the "gold standard" treatment of renal cell carcinoma. Inferior vena cava (IVC) tumor thrombus is a complicating factor that occurs in 5% to 10% of patients with renal cell carcinoma. In world literature, there are only anecdotal reports on using laparoscopic approach for IVC thrombectomy in patients with renal cell carcinoma. Herein we report our experience of laparoscopic radical nephrectomy and thrombectomy of the level II tumor thrombus in the IVC. Two patients (79-year-old female and 48-year-old male) underwent radical nephrectomy with thrombectomy from IVC for renal cell carcinoma T3bNxM0 complicated by the formation of a tumor thrombus in the IVC. To do this, IVC was isolated, the right gonadal and lumbar veins were ligated and transected. The IVC and the left renal vein blood flow were controlled with a plastic clip and Satinski clamp. After thrombectomy and resection of the IVC, the wall the defect was sutured with continuous Prolene suture. Laparoscopic radical nephrectomy with thrombectomy without conversion to open surgery was successfully carried out in both patients. During 6-18 months follow-up no local recurrence or distant metastasis were observed. Laparoscopic radical nephrectomy with thrombectomy for renal cell carcinoma complicated with tumor thrombus level II is a safe and reproducible method, which can be applied to a specific population of patients.
Urologiia. 2015;(2):122-125
pages 122-125 views

Bilateral nephroureterectomy with cystoprostatectomy ad bloc and lymphadenectomy in a patient with end-stage renal failure and cancer of the urinary bladder T2BN0M0

Vtorenko V.I., Trushkin R.N., Lubennikov A.E., Podkorytova O.L., Motin P.I.


The article introduces a clinical example of a patient who was first diagnosed with bladder cancer, which contributed to the development of end-stage renal failure. Initially, given the significant upper urinary tract retention and post renal acute renal failure, the patient underwent bilateral percutaneous nephrostomy. Taking into account periodic gross hematuria, cystoscopy and transurethral electrocoagulation and biopsy of bladder tumor were performed and bladder cancer was identified. Despite adequate functioning of nephrostome drainage and daily urine output up to 3000 ml, kidney failure was not resolved. After creation of an arteriovenous fistula, a hemodialysis program was launched. The patient continued to experience persistent gross hematuria, he had a hectic fever, which was estimated as a symptom of acute pyelonephritis. The patient was scheduled for bilateral nephroureterectomy, cystoprostatectomy as the only option to remove the source of bleeding and infection. The operation was carried out without complications. The patient is currently maintained on chronic hemodialysis and followed by an oncologist at the place of residence; there are no data of bladder cancer recurrence.
Urologiia. 2015;(2):126-129
pages 126-129 views

Flexible nephscopy and nephrolitoextraction in a gaseous me-dium (CO 2) in a patient with residual calculi of the right kidney

Glybochko P.V., Aljaev J.G., Rapoport L.M., Carichenko D.G., Korolev D.O., Arzumanjan J.G., Abdusalamov A.F.


Flexible endoscopy is an integral part of modern endourology. However, the use of flexible endoscopes in a liquid medium predispose to some difficulties and disadvantages of this technique. This article presents a clinical observation of use of a flexible nephroscope for extraction of residual calculi in a gaseous medium (CO 2) in a patient with residual calculi of the right kidney.
Urologiia. 2015;(2):130-133
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