No 5 (2015)

С 18 по 20 сентября в Санкт-Петербурге прошло мероприятие всероссийского масштаба - XV Конгресс Российского общества урологов с участием Европейской ассоциации урологов. Ключевой темой конгресса стала «Урология в XXI веке». Программа XV Конгресса Российского общества урологов традиционно освещала наиболее актуальные проблемы урологии и пути их решения. Конгресс объединил 1609 участников, среди которых ведущие эксперты и молодые ученые в области урологии, андрологии, сексологии, генитальной хирургии, лучевой диагностики, уроонкологии, проктологии, нейроурологии, репродукции и других смежных специальностей. Было проведено 19 сателлитных симпозиумов, представлено 514 докладов, проведено 18 научных секций. Среди выступающих были 42 иностранных спикера. Своим опытом и знаниями делились ведущие профессионалы с мировым именем, а также зарекомендовавшие себя молодые ученые. Особенность мероприятия заключается в следующем: это первый конгресс, проведенный РОУ с широким участием Европейской ассоциации урологов. Немалая часть докладов была представлена спикерами из EUA, и практически в каждом секционном заседании председательствовал один из ведущих урологов Европы.

Currently, the patient-reported outcome measures are widely used for the analysis of the effectiveness of treatment. In 2011, the questionnaire to assess the effectiveness of treatment of men with anterior urethral stricture (PROM-USS) was proposed. Study objective: during validation to perform pilot testing of the Russian version of the PROM-USS questionnaire for determining its psychometric properties (reliability, validity and sensitivity). The study involved 35 men with anterior urethral stricture, who completed PROM-USS questionnaires before and 6 months after surgery. The questionnaire consists of 14 questions and 2 visual analogue scales (VAS), combined in 2 domains: 1 - evaluation of lower urinary tract symptoms (LUTS), 2 - assessment of the quality of life; questionnaire also includes questions about treatment satisfaction. The reliability, validity and sensitivity of the PROM-USS questionnaire were assessed. High intraclass correlation (ICC) coefficients (0.7-0.96) and Cronbach's α = 0.76, indicated reliability of the questionnaire. The correlation coefficient between LUTS scoring and an index of maximum urine flow rate (Qmax) - R=-0,81 (p<0,05) confirmed the criterion validity. After the surgery, the total LUTS scoring decreased from 14.0±0.72 to 5.66±0.58 (P<0.05); VAS EQ-5D index increased from 51.43±5.3 to 71.42±7.64 (P=0.01) with an increase of Qmax from 3.4±0.3 to 17.9±0.9 ml/s (P<0.001), indicating the sensitivity of questionnaire to changes. Ninety-four percent of men were satisfied and very satisfied with the result of the surgery; 88% had residual LUTS not affecting the quality of life or affecting slightly. For the final conclusions about the feasibility of this tool, further studies involving a larger number of patients are required.

The comparative analysis of changes of the functional (osmolar clearance and fractional excretion of urea) and structural (NGAL, β 2-microglobulin in the blood plasma, and NGAL, β 2-microglobulin, microalbumin in the urine) biomarkers of kidney damage before and at various stages after radical cystectomy was performed. The study included patients with T2N0M0 stage bladder cancer. The main group consisted of 37 patients receiving nephroprotective treatment (N-acetylcysteine), the comparison group - 31 patients receiving background therapy. It was revealed that severity of kidney dysfunction and the incidence of chronic kidney disease in the long-term period after surgery decreased in the main group.

Case records of 1994 patients with injuries of the pelvic ring were analyzed. The article presents the results of examination and treatment of patients with urinary tract dysfunction. A frequent complications of pelvic fractures include overactive bladder syndrome (OAB) (18.9%). Many factors play a role in the development of this syndrome, in particular damage to the pelvic diaphragm and the development of pelvic hematoma. OAB is more common in unstable pelvic fractures (24.8%). Surgical stabilization of the pelvic ring injuries and the use of M-cholinoblockers and a1-blockers lead to a reduction of OAB.

Morphological analysis of the biopsies for prostate cancer (PCa) often is a difficult task due to heterogeneity and multifocality of tumors. At the same time, a lot of data exist about the potential molecular genetic markers of PCa. The aim of our study is to determine of PCA3 and TMPRSS2:ERG genes expression in benign hyperplasia (BPH), low and high grade intraepithelial neoplasia (PIN), PCa for revealing of diagnostic value of those genes expression in benign and precancerous changes in prostate. Total RNA was isolated from 53 biopsies, reverse transcription was performed, gene expression was determined by real time PCR (RT-PCR) then deltaCt index was determined as Ct(PCA3) - Ct(KLK3). Average deltaCt and its SD in BPH were 8,28±3,13, low PIN - 8,56±2,64, high PIN -8,98±1,69, PCa - 1,08±2,36. We have demonstarted that deltaCt did not differ in patients with BPH, low and high grade PIN, whereas significantly increased in PCa relative to any of the three groups listed above (p<0.0001). Expression of TMPRSS2:ERG was absent in BPH, PIN, but it was detected in 40% (4/10) of PCa cases. ROC-analysis showed that the AUC (area under ROC-curve with 95% CI, p<0.0001) was 0,98 ± 0,02 in the analysis of a combination of overexpression of PCA3 and TMPRSS2:ERG. Thus, the expression analysis of the PCA3 and chimeric oncogene TMPRSS2:ERG in biopsy cannot be used for differential diagnosis of BPH, low and high grade PIN. However, overexpression of PCA3 and expression of TMPRSS2:ERG are characteristic in PCa. Expression analysis of these genes by the proposed RT-PCR modification at the threshold level deltaCt 3,22 has diagnostic accuracy 90% to detect PCa in biopsy specimens.

Tumors of epithelial origin occupy the first place in the structure of oncological diseases. This study was aimed to the evaluation of the possibilities of narrowed spectrum endoscopy and computer chromoendoscopy in the diagnosis of epithelial structures of the bladder and upper urinary tract. Materials and methods. Additional diagnostic endoscopic examination of the lower urinary tract was performed in 76 patients (132 urethrocystoscopies). For the evaluation of the efficacy of complementary technologies in the endoscopic examination of the upper urinary tract, 47 patients were examined (57 endoscopic examinations of UUT). Results. During endoscopic examination of the bladder only in the «white light», 80 suspicious lesions were identified and removed. The additional use of NBI - diagnosis allowed to reveale and remove 9 (9.5%), abnormal structures, 6 of them (66.7%) were representatives of transitional cell carcinoma. The additional use of a computer chromoendoscopy revealed 6 (6.3%) neoplasms missed during endoscopy in white light: 4 samples (66.7%) were transitional cell carcinoma, 1 (16.7%) - squamous papilloma. Endoscopic examination of the upper urinary tract only in the «white light» identified and removed 47 suspicious lesions. Additional application ofnarrowed spectrum regimen has allowed to identify and remove 8 (12.9%) pathological lesions, 3 (37.5%) of which were morphologically transitional cell carcinoma. The additional use of a computer chromoendoscopy indentified 7 (11.3%) tumors missed during endoscopy of UUT in «white light», 4 (57.1%) of which were transitional cell carcinoma. All other biopsies obtained were representatives of chronic inflammation, or material was not suitable for morphological examination. Conclusions. Our experience of the use of narrowed spectrum diagnostics and computer chromoendoscopy allowed to improve the diagnosis of bladder cancer by 14.3%, and to improve the detection of transitional cell carcinoma of the upper urinary tract by 14.9% at the stage of development of the method.

The study was aimed to the evaluation of the effect of the components of the metabolic syndrome (obesity, insulin resistance (IR)) and androgen deficiency on the clinical course of lower urinary tract symptoms against the background of benign prostatic hyperplasia (LUTS/BPH) and nocturia, as well as on some of the parameters of BPH (prostate volume, residual urine volume, total prostate-specific antigen (PSA) blood level). The comprehensive survey of 160 men with LUTS/BPH (mean age 56.7±3.3 years) was performed; based on the results of survey, three comparison groups were formed: Group 1 (n=70) - patients with isolated obesity; Group 2 (n=36) - patients with obesity and insulin resistance; and Group 3 (n=54) - patients with obesity, insulin resistance and androgen deficiency. The control group consisted of 30 patients with LUTS/ BPH without these metabolic and hormonal disorders. In patients with LUTS/BPH and obesity, higher frequency of nocturia compared with the control group was revealed (63.7% vs 23.3%; P<0.05), as well as the relationship between the waist circumference and free testosterone level (n=160; r=-0.322; P=0.005) and waist circumference and total prostate volume (n=160; r=0.121; P=0.005). In patients of Group 2, significant positive correlation between waist circumference and blood insulin level was identified (n=36; r=0.461; P=0.005). Patients with obesity, insulin resistance and androgen deficiency had the highest average prostate volume and residual urine volume compared with those of other groups (P<0.05). Thus, obesity, insulin resistance, androgen deficiency are associated pathological conditions, greatly aggravating the clinical course of LUTS/BPH due to adverse impact on the BPH parameters, acting both together and separately. The most severe LUTS/BPH were associated with the presence of all three of the above systemic disorders.

The aim of this study was to explore the potential of hyperbaric oxygenation (HBO) for reduction of sperm DNA fragmentation level and reactive oxygen species (ROS) in semen. The study included 90 men with idiopathic infertility. Patients of the treatment group (n=60) underwent HBO before the vitro fertilization (IVF) procedure. In the control group (n=30) IVF was carried out without prior course of HBO. Sperm DNA fragmentation analysis was carried out using the TUNEL assay, the level of ROS in the ejaculate was measured by chemiluminescence. HBO treatment resulted in a significant decrease in the mean level of sperm DNA fragmentation from 33.2±7.5 to 11.9±5.9%, and the median ROS in sperm from 0.89 to 0.39 mV/s (p<0,05). In the control group these changes were not statistically significant. Pregnancy after IVF occurred in 63.3% (38/60) of sexual partners of the treatment group men and in 36.7% (11/30) of the control group (p<0.05). The high efficiency of HBO in overcoming the adverse effects of oxidative stress on sperm parameters allows us to consider it as a promising method for the treatment of men with idiopathic infertility.

Restoration of patency of the upper urinary tract in the extended lesions is a complex urological problems whose solution can significantly improve the quality of life of patients, and allows to avoid patient’s disability. In the urological department of regional clinical hospital, for the first time we performed the plastic reconstruction of the left ureter for its extended (7 cm) stricture using segment of ileum, with good results in the early postoperative period. Restoration of the natural passage of urine allows to hope for a good functional outcome in the long-term period.

This article describes an extremely rare case of reconstruction of allograft ureteropelvic junction by ureter of contralateral kidney. The authors present a concise literature review of this pathology treatment options.

This literature review summarizes recent evidence on monotherapy and combined treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Particular attention is given to the latest publications on this topic presented at the 30th Congress of the European Association of Urology. α-blockers, 5α-reductase inhibitors, anticholinergics and phosphodiesterase type 5 inhibitors are the main classes of medications for monotherapy. Combination therapy of the above medications is the most promising part of this trend in urology allowing increase the effectiveness of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. A personalized approach to therapy involves a thorough examination of the patient and the administration of treatment according to his individual needs.

This article provides an overview of the current state of the problem of effective pharmacotherapy for overactive bladder (OAB). The review presents standard pharmacotherapy and a new stage in the treatment of OAB - innovative drug Mirabegron. International and domestic studies confirmed high and predominant in many respects efficacy of mirabegron and a good safety profile. Conducted at the Research Institute of Urology own research demonstrated no influence on the quality of the bladder emptying, which proves the urodynamics safety. Taking into account the efficacy of mirabegron for all OAB symptoms, proven in a Randomized Clinical Tials (RCT), mirabegron has big potential and is able to make a revolution in the pharmacotherapy of OAB.

The sequential algorithm of diagnosis of tuberculosis of the urogenital system with emphasis on the identification of the causative agent is presented; the approach to the examination of the patient is described in detail; regimens of ex juvantibus treatment are provided.