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No 3 (2015)


Tissue-engineered substitution urethroplasty based on decellularized vascular matrix and autologous cells of the buccal mucosa: the first experience

Glybochko P.V., Aljaev J.G., Nikolenko V.N., Shehter A.B., Vinarov A.Z., Istranov L.P., Istranova E.V., Abojanc R.K., Ljundup A.V., Danilevskij M.I., Guller A.E., Elistratov P.A., Butnaru D.V., Kantimerov D.F., Mashin G.A., Titov A.S., Proskura A.V., Kudrichevskaja K.V.


Urethral strictures and anomalies remain a challenging urological problem. Reconstructive plastic surgery has been shown to be the most effective way to treat them. There are two main types of urethroplasty: anastomosis (anastomotic urethroplasty) and expansion of the urethral lumen using of flaps and grafts (substitution urethroplasty). Currently the ideal material for substitution urethroplasty does not exist. Tissue engineering of the urethra seems to be one of the most promising approaches to address this problem. Various tissues-engineering techniques were proposed for substitution urethroplasty. In this study, tissue-engineering design was based on the decellularized cadaveric arterial wall. The study results demonstrated the feasibility of creating stable tissue-engineered structures with autologous cultured epithelial cells of the buccal mucosa and decellularized matrix from human cadaveric arterial wall (DMCAW). There was a complete engraftment of tissue-engineering design based on DMCAW and buccal mucosa cells, used for substitution urethroplasty in a patient with the bulbar urethral stricture. Postoperatively (within 4 months after surgery) no complications and/or adverse events were observed. However, in the late postoperative period (12 months) there was recurrence of urethral stricture in the middle of the tissue-engineering design and the native urethra that warranted another surgery. Tissue-engineering design based on DMCAW and autologous buccal mucosa is safe as a material for substitution urethroplasty. Further research is required to ascertain the effectiveness of the method.
Urologiia. 2015;(3):4-10
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Pathological changes in the kidneys in polytrauma fatalities

Dovbysh M.A., Voloshin M.A., Podgajnyj J.L., Dovbysh I.M., Gubar A.A.


This paper presents a morphological study of kidneys of 30 patients, who died as a result of multiple injuries. In 96.7% of decedents, in the absence of external signs of kidney integrity violation, there were plasmorrhagia, hemorrhage, destruction of glomeruli and tubules, epithelium desquamation, emergence of hyaline casts in the tubules. After 3 days lymphoid leukocyte infiltration in the parenchyma of the kidney was found, and after 30 days collagen fibers around the glomeruli and tubules were detected, which is representative of renal fibrosis.
Urologiia. 2015;(3):11-13
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Surgical treatment of patients with ureteral ruptures

Komjakov B.K., Guliev B.G.


The aim of the study was to analyze the causes of ureteral ruptures and the types surgical procedures used for their management. Over the period from 2006 to 2014, 7 patients with ureteral ruptures underwent surgical treatment in the Mechnikov N-WSMU clinic. All of them were males aged 50 to 71 years. In all cases, the ureter was injured during ureteroscopy and contact lithotripsy. In two patients the right ureter was cut off at the border of the upper and middle third, in four - at 3-4 cm below pyeloureteral segment, one patient diagnosed with a complete separation of the ureter from the kidney pelvis. Patients, who have suffered a detachment of the ureter in other hospitals, previously underwent surgical exploration of the retroperitoneal space, drainage of the kidney by pyelonephrostomy (5) and ureterocutaneostomy (1). In a case of a patient with an injury that occurred in our clinic, laparoscopic nephrectomy with autologous renal transplantation was carried out. Five patients with extended ureter defects underwent ileo-ureteroplasty. The patient with left ureterocutaneostomy underwent nephrovesical bypass. Patency of the upper urinary tract and kidney function were restored in all patients, all of them were relieved from external drains. The duration of the intestinal plastic averaged 160 minutes, laparoscopic nephrectomy with autologous transplantation - 210 min and nephrovesical bypass - 110 min. Blood transfusion was required only in autologous graft patient. The ureteral rupture is a serious complication of ureteral endourological procedures in upper urinary tract. It requires such complicated reconstructive operations as autologous transplantation of the kidney or intestinal ureteroplasty.
Urologiia. 2015;(3):14-18
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Nerve growth factor in the urine of patients with idiopathic detrusor overactivity and overactive bladder without detrusor overactivity

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


The purpose was to determine the concentration of the neurotrophin nerve growth factor in urine to assess its possible role as a marker in the diagnosis of various forms of overactive bladder. The study included patients with urinary frequency and urgency: 21 patients with idiopathic detrusor overactivity, 18 - with overactive bladder without detrusor overactivity and 11 healthy volunteers (control group). The level of nerve growth factor in the urine was determined in all participants of the study by the enzyme immunoassay (ELISA). In the control group the average ratio of nerve growth factor level to the level of urine creatinine was 0,2 ± 0,06, in patients with overactive bladder without detrusor overactivity - 0,33 ± 0,06 (p> 0.05). In patients with idiopathic detrusor overactivity the rate was significantly higher and amounted to 6,04 ± 0,9 (p <0.05). Therefore, measurement of the concentration of nerve growth factor in the urine may be used for differential diagnosis of the presence or absence of detrusor overactivity in patients with overactive bladder.
Urologiia. 2015;(3):19-23
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Distinctive features of vegetative and hormonal regulation in women with overactive bladder syndrome

Kotenko A.A., Smelysheva L.N., Kotenko I.N.


Using indices of heart rate variability the authors identified patterns in alterations of vegetative status in women with overactive bladder syndrome in different periods of the reproductive function. They established predominant role of sympathetic influences in the development of the OAB syndrome in reproductive period, during menopause and in postmenopause. The study results verified the role of hormonal levels in women with OAB syndrome in different periods of the reproductive function, having a different initial tone of the autonomic nervous system.
Urologiia. 2015;(3):24-28
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Reasons of delayed diagnosis of bladder tuberculosis

Kul'chavenja E.V., Holtobin D.P.


The fourth, terminal, stage of bladder tuberculosis (BT) manifests itself in irreversible changes and requires surgical treatment. Objective: To identify the reasons for delayed diagnosis of this urogenital tuberculosis complication. Medical history of 26 urogenital tuberculosis patients with a complicated form of stage 4 BT, referred to the Novosibirsk TB Research Institute for reconstructive surgery were analysed. In 22 patients, bladder volume ranged from 55 to 100 ml, 4 patients previously underwent cystostomy due to extremely small bladder volume. Average duration of BT hidden in the guise of «urogenital infection» was 6.2 years. Patients were treated with norfloxacin (a total of 104 courses), ciprofloxacin (86 courses), amikacin (43 courses), nitroxoline (27 courses), third generation cephalosporins (32 courses), lomefloxacin (17 courses), levofloxacin (11 courses), Amoxicillin clavulanate (4 courses), ampicillin (2 courses). It was demonstrated that all cases of BT stage 4 were iatrogenic. Irreversible debilitating complications occurred due to suboptimal therapy, primarily due to administration of amikacin and fluoroquinolones for urogenital infections, which was tuberculosis in disguise. Absence of M. tuberculosis growth does not exclude tuberculosis; pathological specimens must be further examined at least by PCR. Interventional material must be mandatory examined histologically and stained by Ziehl-Neelsen method to identify M. tuberculosis. Effective and not masking tuberculosis, optimal therapy for urogenital infections includes fosfomycin, furazidin (nitrofurantoin), gentamicin, III generation cephalosporins (in outpatient settings dispersible form of efixime should be preferable).
Urologiia. 2015;(3):29-32
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Clinico-morphological features of female urethral meatus polyps

Nejmark A.I., Jakovlev A.V., Nepomnjashhih L.M.


The aim of the study was to establish the clinical and morphological characteristics offemale urethral polyps including cases with concomitant sexually transmitted infections. A total of 150 women were enrolled in the study. The evaluation of microcirculatory changes, morphological parameters and immunogram indices of urethral polyps were carried out. The most common infectious agent in patients with urethral polyps was Ureaplasma urealyticum. In those cases predominance of inflammatory symptoms and elevated levels of serum proinflammatory cytokines were identified. It is found that the pronounced inflammatory reaction leads to an increase in the relative area of the subepithelial microvascular bed and the cellular elements population of lamina mucosa propria, as well as to the relative predominance of congestive forms of microcirculation disturbances according to the laser Doppler flowmetry.
Urologiia. 2015;(3):33-38
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Pelvic floor reconstruction after pelvic evisceration using gracilis musculocutaneous flap

Pavlov V.N., Bakirov A.A., Kabirov I.R., Izmajlov A.A., Kutlijarov L.M., Safiullin R.I., Urmancev M.F., Sultanov I.M., Abdrahimov R.V.


Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss - 595 mL and the average length of hospital stay - 19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap’s distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.
Urologiia. 2015;(3):39-42
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Quality of life in patients undergoing prostate cryoablation

Govorov A.V., Vasil'ev A.O., Pushkar' D.J.


Not long ago, survival rates were the primary outcome measures of surgical management of prostate cancer. Currently, more attention is paid to the quality of life, because even minor changes in the quality of life can lead to serious alterations in the psycho-emotional status and significantly reduce patients’ self-esteem. Most experts believe that the quality of life of patients treated for prostate cancer, is mostly affected by urinary incontinence, erectile dysfunction, urethral stricture, and bowel dysfunction. Thanks to advances in the treatment of prostate cancer, the incidence of complications was reduced to a minimum. To some extent, this was due to the use of novel minimally invasive treatment for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy. The quality of life in 65 patients undergoing cryoablation of the prostate was evaluated using EORTC QLQ-C30 questionnaire. Analyzing the findings of the survey enabled us to estimate the patients’ quality of life, as well as to identify the various components of the postoperative health problems.
Urologiia. 2015;(3):43-49
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The role of kallikrein-kinin and renin-angiotensin system in the pathogenesis of prostate cancer

Kogan M.I., Chernogubova E.A., Chibichjan M.B., Macionis A.J., Povilajtite P.J., Matishov D.G.


The aim of the study was to analyze the role of the kallikrein-kinin and renin-angiotensin systems in the molecular mechanisms of prostate cancer (PCa) and use the findings for identification of new markers of the disease. Analysis of proteolytic disturbances in the prostatic secretions in benign prostatic hyperplasia (BPH) and prostate cancer based on the identification of key indicators of the kallikrein-kinin and renin-angiotensin system in the prostate secretion showed that kallikrein activity in prostate cancer is higher and the activity of angiotensin converting enzymes (ACE), by contrast, is lower than in BPH, apparently reflecting the reduction of angiotensin II and increase of the bradykinin content. A characteristic feature of prostate cancer is a dramatic increase in the inhibitory capacity of prostate secretion. It was found that in BPH patients, expression of B1 receptors in the prostate tissue is completely absent. The specific response with anti-B1 antibodies in the glandular epithelium was observed in malignant foci acini and prostatic intraepithelial neoplasia. In contrast, expression of the B2 receptors occurs in the stroma of both BPH and prostate cancer independent of stage and Gleason score. Indicators of kallikrein and ACE activity in prostate secretion and expression of the B1 receptors in prostate tissue may be utilized for prostate cancer diagnosis.
Urologiia. 2015;(3):50-54
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Experimental validation of ND:YAG laser coagulation of the bladder tissue

Rasshupkina E.V., Teodorovich O.V., Kochiev D.G., Andreeva J.J., Shatohin M.N., Borisenko G.G.


Interstitial laser coagulation (ILC) is one of the minimally invasive and minimally traumatic methods for the destruction of small lesions in various organs and tissues. Selection of the optimal operation and exposure mode is critical for the safe use of ILC in clinical practice. The in-vivo study of ILC effects on bladder tissue was carried out in 6 rabbits weighing less than 3 kg. Macroscopic and microscopic analysis of the tissue was done directly after the ILK procedure, on days 3 and 7, 14 and 21 following specimen collection of experimental animals. Safety and efficacy of ND: YAG laser impact on bladder tissues were confirmed by morphological study, which established phasing and extent of changes in the bladder tissues. The results allow us to recommend ILC application for the destruction of small size bladder tumors without impairment of the bladder functions, as well as for the treatment of bottom after transurethral resection of bladder cancer.
Urologiia. 2015;(3):55-59
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Laparoscopic pyeloplasty with antegrade ureteral stenting

Guliev B.G.


Results of laparoscopic pyeloplasty (LP) with different the methods of the upper urinary tract (UUT) stenting were compared. A total of 76 patients with hydronephrosis were enrolled in the study. Antegrade and retrograde ureteral stenting was used in 42 (55.2%) and 34 (44.8%) patients, respectively. In the first group after resection of the narrowed pyeloureteral segment (PUS) and formation of posterior wall of pyeloureteral anastomosis, antegrade stent was placed into the bladder, which followed by suturing of anterior wall of pyeloureteral anastomosis. While performing transurethral ureteral stenting, cystoscopy with retrograde ureteropyelography was carried out in lithotomy position, and the stent was put into the renal pelvis. Next, the patient was put into the lateral position, and LP was performed by transperitoneal access. There were no cases of conversion. The duration of the LP with antegrade stenting was significantly shorter than LP with retrograde stenting - 135 versus 170 minutes (p <0.05). Differences in the blood loss (55 ± 20 and 60 ± 15 ml) and the length of hospital stay (5 ± 2 and 6 ± 1 day) were not statistically significant. In the group of retrograde stenting there were two cases of stent migration, which required repositioning of the stents. In one patient with antegrade stent placement, the distal end of the stent curled in ureterovesical junction. The stent position was corrected during the ureteroscopy. There was one case of antegrade stenting failure requiring ureteroscopy with retrograde ureteral stenting. Laparoscopic pyeloplasty is an efficient method of surgical management of patients with PUS narrowing. The duration of antegrade stenting was significantly shorter than retrograde stenting. LP with antegrade ureteral stenting as compared to LP with retrograde stenting enables significantly reduced surgery duration.
Urologiia. 2015;(3):60-63
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Laparoscopic uretero-cysto-anastomosis in treatment of pelvic ureteral strictures

Komjakov B.K., Guliev B.G.


The aim of the paper was to evaluate the efficacy of laparoscopic uretero-cysto-anastomosis (UCA) in patients with lower ureteral strictures of various etiologies. Over the period from 2010 to 2014, 12 patients (8 females and 4 males) aged 19 to 64 years (mean age 35.6 ± 8.5 years) underwent laparoscopic UCA. In all females, iatrogenic ureteral injury occurred during gynecological surgery. Types of gynecological surgeries were an open or laparoscopic hysterectomy (5), excision of endometriosis nodules (2), and resection of the ovaries (1). In men indications for surgery were ureteral strictures after ureteroscopy (3) and neuromuscular dysplasia (1). The operation was performed in lithotomy position by transperitoneal access using 4 trocars. In all cases, extravesical ureteral reimplantation into the bladder was performed. The stent was removed after week four, excretory urography and cystography were conducted. The operation was thought to be successful in all patients. There were no cases of conversion and no need in blood transfusion. In 4 patients we performed psoas-hitch + UCA, in 2 - Boari operation, in 5 - direct UCA. The patient with neuromuscular dysplasia longitudinal resection of the lower third of the ureter was carried out. Then it was sutured on the stent by interrupted sutures, and extravesical implantation into the bladder was performed. Mean duration of surgery was145 minutes (110 to 230 minutes), mean blood loss - 180 ml (from 120 to 245 ml). Passive asymptomatic vesicoureteral reflux was observed in 3 patients. Laparoscopic UCA is a highly effective intervention with the functional results similar to those of open surgery.
Urologiia. 2015;(3):64-70
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Antioxidant therapy for infertile couples

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


This study presents results of 113 infertile couples treated with supplements speroton and pregnoton containing folic acid, L-carnitine, vitamin E, zinc, and other vitamins and minerals. Infertility in couples was due to both the pathology of spermatogenesis, and female genital diseases. It has been demonstrated that intake of Speroton restores impaired motility in the ejaculate of patients with several forms of pathospermia, and Pregnoton ensure its preservation in vaginal secretions.
Urologiia. 2015;(3):71-74
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Doxycycline (Unidox Solutab®) and/or josamycin (Wilprafen®) in treatment of patients with prostatitis in real clinical practice. Results of the TAURUS observational program

Vinarov A.Z., Stojlov S.V., Kozyrev S.V., Surikov V.N., Chaban A.V., Kurbatov D.G., Shpilenja E.S., Nejmark A.I.


Treatment of chronic prostatitis is a vital and complicated problem, in which a large number of stamps and «stereotyped» approaches often result in uncured patients. The increasing use of intracellular microorganisms in prostatitis etiology requires a modification in the standard approaches. TAU RU S study shows high efficacy of doxycycline (Unidox Solutab ®) and /or josamycin (Wilprafen®) in chronic prostatitis. Therapy, studied in this program, according to physicians, was effective in 93.2% of patients. Treatment failure was observed in 1.3% of all patients, another 5.5% of patients had insufficient data for assessment. Low incidence of adverse reactions was observed. In the study population, adverse reactions occurred in 2.6% of patients, of them serious adverse events were registered in 0.7% of patients. The most common adverse event in all treatment groups was diarrhea.
Urologiia. 2015;(3):75-83
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Characteristics of the ureter contractions in children with chronic pyelonephritis

Goremykin V.I., Usanov D.A., Rytik A.P., Prosova E.E.


The article presents results of electrophysiological study of the function of the ureter in the frequency range of 0,6-35 Hz, conducted in 100 children aged 5 to 13 years with chronic pyelonephritis. Data of 35 healthy people were used as a control. It was shown that the features of ureter contractions were significantly different in the two groups. Marked decrease of amplitudes of signal harmonics was found at a frequency of 1.4 Hz in patients with pyelonephritis compared to controls. Myostimulation in pyelonephritis group has led to an approximation of harmonic amplitudes to the values of the control group.
Urologiia. 2015;(3):84-87
pages 84-87 views

Ureteral tissue engineering: challenges and prospects

Glybochko P.V., Aljaev J.G., Vinarov A.Z., Butnaru D.V., Titov A.S., Bibikova E.E., Sevostjanova S.I.


A broad range of pathologic conditions of the ureter (strictures, obliterations, fistulas, and so on) requiring reconstructive plastic surgery is a challenging urological problem. A variety of approaches to solve the problem indicates the need of searching for new opportunities. A new direction in reconstructive surgery of the ureter is the tissue engineering. Tissue engineering involves the usage of matrices and cells. The matrices can be used both with cultured cells, and without them. This review represents the results of preclinical studies on feasibility of tissue engineering using as a matrix both natural and synthetic materials for different ureter impairments. Presently, there are no data on the use of tissue-engineering for the ureter reconstruction in clinical trials (i.e. involving human subjects). The results of studies presented in the review inspire certain optimism, but ureteral tissue-engineering is a difficult task requiring a balanced approach and well-thought-out design of preclinical studies.
Urologiia. 2015;(3):88-92
pages 88-92 views

The modern prospect for citrate mixtures in the treatment of urolithiasis

Chepurov A.K., Pronkin E.A., Bolotov A.D.


The authors present a review of literature on the use of litholytic citrate medications for conservative management of urolithiasis. Urate urolithiasis is the most common clinical condition encountered by urologists. Citrate agents, in particular Blemaren, not only may be employed in a conservative therapy of uric acid stones, but can also be successfully used in the treatment of the calcium urolithiasis, i.e. mixed composition stones, which is supported by current international urology guidelines.
Urologiia. 2015;(3):93-96
pages 93-96 views


Efremov E.A., Kasatonova E.V., Mel'nik J.I.


Planning pregnancy is very important to ensure the most comfortable and optimal conditions for conception., gestation and the subsequent birth of a healthy child. This review examines the effects and mechanisms of the damaging effect of external factors., social habits and certain diseases on the ejaculate quality., as well as ways to overcome them aiming to optimum preparation of a man to conceive. Several studies have shown an inverse relationship between semen quality and common diseases. Unfavorable environmental conditions., varicocele., endocrine causes., such as diabetes., obesity., and metabolic syndrome., are thought to be among the factors that could adversely affect the quality of sperm. Oxidative stress in the testicular microenvironment may lead to suppression of spermatogenesis and sperm DNA damage resulting in a decrease of their mobility and causing morphological abnormalities.
Urologiia. 2015;(3):97-104
pages 97-104 views

3D-technology as an element of planning, effective implementation and surgical simulation training in staghorn nephrolithiasis management

Glybochko P.V., Aljaev J.G., Bezrukov E.A., Sirota E.S., Pesegov S.V., Proskura A.V.


Daily practice of a physician of any specialty is incomplete without an analysis of the data derived from the use of various imaging techniques. Over the past decade, there have been significant changes in the understanding of the clinical anatomy of the patient, which is largely the result of the introduction of modern computer technology in medicine.
Urologiia. 2015;(3):105-108
pages 105-108 views

Nocebo effect: an advice to a practitioner

Pushkar' D.J., Kasjan G.R., Zhivulko A.R., Popova A.S.


Nocebo effect is the onset or exacerbation of unwanted symptoms (adverse reaction) as a reaction to medical treatment. The nocebo effect is very common both in clinical practice and in clinical trials. Medical practitioner’s knowledge of the patient’s predisposition to nocebo effects can affect the management strategy and building doctor-patient relationship. It allows prediction and prevention of nocebo effect, especially if the patient has negative clinical encounters in the past. There is a dilemma: to inform the patient about the side effects and complications of treatment, which may lead to the development of nocebo effect and adversely influence the patient health and treatment outcomes, or conceal the information, thus infringing the patient civil rights. Solving this contradiction and minimizing the risk of nocebo effect allows choosing the proper strategy of doctor-patient communication. It is important not to ignore the various psychological, medical and organizational measures aimed at improving the patient comfort in the course of treatment. This prevents the accumulation of negative treatment experiences and is the key to successful treatment and prevention of nocebo effect.
Urologiia. 2015;(3):109-113
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