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No 1 (2016)


Modern diagnostic and management aspects of citrate therapy for uric acid nephrolithiasis

Alekseenko S.N., Tatevosyan A.S., Medvedev V.L., Tonyan A.G., Ryabokon' S.S.


Introduction. Iso-aciduria - long-term existence of urine pH within a narrow range (pH <0.8-1.2 units.) - activates certain enzymes for which these pH levels are favorable. Then, this activation induces precipitation of crystals corresponding to these enzymes. Objective. To enable citrate therapy without a risk of altering the stone chemical composition and to identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis. Material and methods. Citrate therapy was provided with a mixture comprising «Potassium citrate monohydrate» and «Tri-sodium citrate di-hydrate» in a ratio of 2: 1. The study group included 64 patients, who had ultrasound-detected calyx stones and hyperechoic inclusions from 2 to 4 mm without acoustic shadow, located in the papillary region of the renal pyramids. Statistical analysis was performed by cross tabulations (pairing). Results. The results of the statistical analysis have proven the legitimacy and feasibility of the proposed method of classifying patients into homogeneous groups according to the disease severity. Conclusion. Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), which will allow to avoid deposition of other crystals upon the existing stone and identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis. Conclusion. Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), thus avoiding deposition of other crystals upon the existing stone.
Urologiia. 2016;(1):4-10
pages 4-10 views

Quantitative mineralogical analyzes of kidney stones and diagnosing metabolic disorders in female patients with calcium oxalate urolithiasis

Kustov A.V., Moryganov M.A., Strel'nikov A.I., Zhuravleva N.I., Airapetyan A.O.


Objective. To conduct a complex examination of female patients with calcium oxalate urolithiasis to detect metabolic disorders, leading to stone formation. Materials and methods. The study was carried out using complex physical and chemical methods, including quantitative X-ray phase analysis of urinary stones, pH measurement, volumetry, urine and blood spectrophotometry. Results. Quantitative mineralogical composition of stones, daily urine pH profile, daily urinary excretion of ions of calcium, magnesium, oxalate, phosphate, citrate and uric acid were determined in 20 female patients with calcium oxalate stones. Discussion. We have shown that most of the stones comprised calcium oxalate monohydrate or mixtures of calcium oxalate dihydrate and hydroxyapatite. Among the identified abnormalities, the most frequent were hypocitraturia and hypercalciuria - 90 and 45%, respectively. Our findings revealed that the daily secretion of citrate and oxalate in patients older than 50 years was significantly lower than in younger patients. Summary and conclusion. In conclusion, daily urinary citrate excretion should be measured in female patients with calcium oxalate stones. This is necessary both to determine the causes of stone formation, and to monitor the effectiveness of citrate therapy.
Urologiia. 2016;(1):11-15
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Renal hemodynamic in hydronephrosis concurrent with hepatobiliary system disorders, its dynamics in the course of treatment

Mambetov Z.S., Salimov B.G.


This article examines measurements of renal vascular ultrasound in 85 patients with hydronephrosis concurrent with disorders of the gallbladder and biliary tract, depending on severity and dynamics during treatment. The estimation of blood flow changes depending on applied renoprotective and hepatoprotective therapy is provided.
Urologiia. 2016;(1):16-17
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Microbiota of urine and vagina of healthy postmenopausal women (a pilot study)

Naboka Y.L., Rymashevsky A.N., Kogan M.I., Gudima I.A., Borovleva O.A., Jalagonia K.T., Zarutskiy S.A.


Studying microbiota of different urogenital tract habitats in healthy postmenopausal women is of practical importance in deciding on the appropriateness of correction of dysbiotic disorders. The aim of this study was to examine the vaginal and urine microbiota of healthy postmenopausal women. The study included 20 healthy postmenopausal women (mean age 59,0±2,1 years). Duration of menopause in all subjects was more than 8 years. Bacteriological testing of urine and vaginal specimen was carried out on the extended media (15) for cultivating facultative anaerobic bacteria (FAB) and nonclostridial anaerobic bacteria (NAB) and included PCR of midstream morning urine. Among FAB in the urine and vagina dominated coagulase-negative staphylococci and NAB. Bacterial patterns of studied habitats turned out to be similar in many respects. In the urine Megasphaera spp., Veillonella spp., Prevotella spp., Mobiluncus spp., Fusobacterium spp. were found, whereas in the vagina these microorganisms were not present. Cluster analysis revealed no significant differences in the concentration of the same microorganisms isolated from the urine and vagina. When comparing the frequency of microorganism detection in urine by bacteriological method and by PCR, bacterial patterns were identical in 56% of cases.
Urologiia. 2016;(1):18-24
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Acute cystitis - do we always need antibiotics?

Kul'chavenya E.V., Breusov A.A., Brizhatyuk E.V., Shevchenko S.Y.


We attempted to skip the antibiotic therapy in 17 patients with acute uncomplicated cystitis in the early time of presentation (up to 12 hours from the disease onset). All patients received ketoprofen (Flamax forte) 100 mg once daily for 5 days and the combined herbal preparation Kanefron®H 2 tablets t.i.d. for 1 month. In 82.4% of patients acute uncomplicated cystitis was cured without antibiotics; 17.6% of cases required additional administration of antibacterial drugs.
Urologiia. 2016;(1):25-28
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Metagenomic analysis of samples in cystitis

Tets G.V., Tets V.V., Voroshilova T.M.


Detecting bacteria in pathological material and testing their sensitivity to antibiotics is essential in determining a treatment strategy and the choice of antimicrobial therapy. The results of the study showed that metagenomic analysis detects more bacteria in the pathological material than standard laboratory methods. We found a variety of bacteria, described as causative agents of urinary tract infections, evading the standard culture conditions used in routine diagnostic laboratories. These data show that in urinary tract infections mixed pathogens may be much more common than usually believed. At that, the pathological process involves bacteria with unexplored pathogenicity and sensitivity to antibiotics.
Urologiia. 2016;(1):29-31
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Pharmacoeconomic analysis of using mirabegron to treat overactive bladder in the setting of the Russian Federation health care

Kolbin A.S., Vilyum I.A., Proskurin M.A., Balykina Y.E.


Relevance. The present paper presents, for the first time in Russia, a comparative pharmacoeconomic analysis of using mirabegron (Betmiga®) to treat overactive bladder (OAB). Materials and methods. Three medical technologies were evaluated: treatment of OAB with mirabegron 50 mg/day, solifenacin 5 mg/day and solifenacin 10 mg/day. In addition, the strategies of mirabegron and botulinum toxin type A were analyzed as a result of simulating the second-line treatment. Results. When modeling for 1-year horizon, the lowest cost was found in mirabegron strategy, which was 16% lower than with solifenacin. When comparing the second line strategies using mirabegron and botulinum toxin type A, costs of mirabegron group were 61% lower. According to the selected performance criteria, mirabegron was more effective in comparison with other strategies. The findings of the budget impact analysis revealed that using mirabegron was preferable compared with solifenacin as the first line treatment, and compared with botulinum toxin type A as the second-line treatment. The analysis of cost-effectiveness and availability of technology showed growth when using mirabegron strategy; there was an increase in the efficiency of mirabegron strategy relative to solifenacin strategy, accompanied by cost reduction and, as a consequence, reducing the burden on the budget. Conclusions. Thus, using mirabegron to treat OAB both as the first and the second line treatment is absolutely cost-effective and profitable medical technology.
Urologiia. 2016;(1):32-39
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Assessments of longterm results of different types of sling procedures for stress urinary incontinence in women

Loran O.B., Seregin A.V., Dovlatov Z.A.


Aim: To evaluate long-term results of surgery for stress urinary incontinence in women using different types of sling procedures. The study included 698 patients aged 42 to 68 years (median 54 years) with stress urinary incontinence. TVT was used in 167 (23.9%) cases, TVT-O Gynecare system in 359 (51.4%), TVT-O Monarch system in 105 (15.0%), and TVT Secur mini-sling system - in 67 (9.6%). Follow-up ranged from 12 to 108 months (median 55 months). Patients' status was assessed using UDI-6 and IIQ-7 questionnaires, an improvised treatment satisfaction questionnaire, voiding diary, cough test and 1-hour Pad-test. The effectiveness of the treatment, according to objective criteria was 92.2%, 93.3%, 91.4% and 92.5% after surgery with TVT, TVT-O Gynecare, TVT-O Monarch and TVT Secur, respectively, and according to subjective criteria - 90.4%, 91.1%, 89.5% and 91.0%. No differences in the effectiveness of techniques were found. The data obtained in long-term observations of a large sample of patients treated with a variety of techniques in a single center showed the effectiveness and safety of modern sling procedures for correcting urinary incontinence in women.
Urologiia. 2016;(1):40-45
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Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis

Lysenko M.A., Vtorenko V.I., Trushkin R.N., Lubennikov A.E., Sysoev A.M., Sokolov A.A.


This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.
Urologiia. 2016;(1):46-51
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An improved method of risk prediction and prevention of esophagogastroduodenal bleeding in geriatric urology

Leshhenko I.G., Dodonova N.A., Sidash B.V., Shatohina I.V., Nizhegorodcev A.S., Lazarev I.J., Krechko N.A.


With the aim of prediction and prevention of early postoperative esophagogastroduodenal bleeding (EPEGDB), 1296 elderly patients with BPH were examined during the preoperative period before isolated or simultaneous operations. Patients in group 1 (n=357) with a history of gastric or duodenal ulcer underwent esophagogastroduodenoscopy (EGDS). In group 2 (n=522) EGDS was performed and gastric acidity was determined using AGM-03 acid-gastrometer. Patients of group 3 (n=417) underwent EGDS and gastric acidity was determined by hromogastroscopy. The differentiated approach to treating patients of group 3 on the basis of preoperative comprehensive examination resulted in preventing severe complications such as EPEGDB. Prevention of EPEGDB in this category of geriatric patients should be as mandatory as preventing thromboembolic, respiratory, cardiovascular and septic complications.
Urologiia. 2016;(1):52-57
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Concomitant use of abiraterone acetate and triptorelin in patients with castration-resistant prostate cancer

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


The relevance of drug treatment for prostate cancer increases with the number of patients who develop castration resistance. Currently, no unified treatment regimen for castration-resistant prostate cancer exists, but the standard treatment for these patients is continuous androgen deprivation therapy. This paper presents the experience of concomitant use of abiraterone acetate and triptorelin in patients with castration-resistant prostate cancer. Ten patients with disease duration of 1.5 to 18 years and established castration resistance are currently being followed up. Nine of ten patients have long-term bone metastases, one patient has visceral metastases. The combination therapy produced a significant PSA decrease in nine patients and regression of bone lesions in two patients.
Urologiia. 2016;(1):58-61
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Causes of death among prostate cancer patients of different ages

Dariy E.V.


To date, there is no unified approach to evaluating and treating patients with suspected prostate cancer taking into account their age and comorbidities. That was the rationale for conducting this study. Aim. To assess the clinical course of prostate cancer in men of all ages with comorbidities. Materials and methods. The study included 408 patients aged 50 to 92 years (mean age 74.3 years) with histologically verified prostate cancer. 30 (7.4%) patients had stage T1 disease, 273 (66.9%) - T2, 91 (22.3%) - T3 and 14 (3.4%) - T4. The maximum follow-up was 22 years, the minimum one - 6 months (on average 15.4 years). Results. During the follow-up 159 patients died (39%), 51 of them (32%) of prostate cancer, 108 (68%) - from other diseases. Among the latter the causes of death were cancer (20.4%), cardiovascular and bronchopulmonary diseases (79.6%). Cancer-specific survival rate was 41.4 ±12,4%, the survival rate for other diseases 23.4 ±10,6% (p<0.05). Conclusion. We need a differentiated approach to selecting treatment for patients with prostate cancer, especially of old age, including the option for active surveillance of patients with clinically insignificant prostate cancer.
Urologiia. 2016;(1):62-69
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Hypofractionated radiation therapy for localized prostate cancer (first experience)

Vorob'eva T.G., Bednyj I.V., Drobjazgin E.A., Polovnikov E.S.


This paper presents a study of 74 prostate cancer patients divided into 2 groups (study group and comparison group). The comparison group patients (n=50) were treated with radiation therapy in standard fractionated mode, while study group patients (n=24) underwent hypofractionated radiation therapy (STD 7.5 Gy; TTD 37.5 Gy). Early radiation-induced complications occurred only in the comparison group patients. Late radiation-induced complications were observed in 4 and 8 patients in the study group and the comparison group, respectively. Significant statistic differences in quality of life between groups were found in patients with excellent (FET; p=0.0145) and satisfactory (FET; p=0.03) well-being. Hypofractionated radiation therapy is safe given that the necessary technical and clinical conditions are observed. It significantly reduces treatment time and enables quickly bringing a course of radiation therapy to radical doses. This is a noninvasive treatment that significantly reduces risks and cost of procedures.
Urologiia. 2016;(1):70-74
pages 70-74 views

Evaliating men's health survey results within the framework of "men's health school"

Alchinbaev M.K.


Within the framework of «Men's Health School» 571 men were examined in 2014. The mean age of the surveyed men was 49.66±14.5 years. 86% (227) of the surveyed men had PSA levels from 0 to 4 ng/ml. Prostate ultrasound scan showed prostate enlargement in 37.2%±6.0 of men. The disturbances of libido or sexual life were registered in 45.5% (221) of the surveyed men. 58% of patients reported insufficient penile rigidity for sexual intercourse, 50% reported a sharp decrease in the amount of ejaculate, and 10% - pain during erection. Detailed medical history showed that in many patients the disease was provoked by family discord. The study findings revealed the poor condition of the male reproductive system in Kazakhstan. Resolving this problem requires considerable logistical costs, and an integrated approach to the early detection of diseases of the male reproductive system. The reproductive health of men was found to be affected by somatic, psychological and sexual health factors. At present we can say about the need for such «Men's Health School» in all regions on a regular basis, especially with the training of the primary care physicians.
Urologiia. 2016;(1):75-81
pages 75-81 views

Application of temporary polyurethane-covered nitinol endoprosthesis in treating urethral stricture

Kurbatov D.G., Martov A.G., Dubskiy S.A., Lepetukhin A.E., Andreev Y.G., Raff L.S.


The incidence of urethral strictures and their recurrences is high. The effectiveness of optical urethrotomy in men is insufficient. Reconstructive urethropIasty is the «goId standard», but it is traumatic and accompanied by a proIonged period of rehabiIitation. The resuIts of using metaI endourethraI stents were unsatisfactory because of their incrustation and migration. This paper presents the resuIts treating urethraI strictures of various etiologies in 22 patients, who underwent optical urethrotomy with temporary placement of a new generation polyurethane-covered nitinol stents. After removing the stents from 3 to 8 months after impIantation, there was a stable effect of preserving the urethral lumen. The recurrence of the stricture occurred in 1 case 1 month following the stent removal. In other cases, there were no recurrences over 1-3 year follow-up. We consider placing an internal stent as an alternative adjunctive treatment of patients with urethral strictures.
Urologiia. 2016;(1):82-85
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The efficiency of combined methods of lithotripsy for ureteral stones

Kutluev M.M., Pulin I.L., Kruglov D.S., Ryakhov A.Y.


Extracorporeal shockwave lithotripsy (ESWL) is the first line treatment of uncomplicated upper ureteral stones. Ureterorenoscopy with contact lithotripsy (URS) are useful for middle and lower ureteral stones. However, the presence of residual calculi, the stone fragments migration and the formation of “steinstrasse”, when using those methods separately, prompts employing combination of lithotripsy modalities. The aim of this article is to find out the optimal combination of stone disintegration methods. The study compared the use of lithotripsy as stand - alone methods with their combined application. All patients were divided into 3 groups: group 1 - 131 patients with lower ureteral stones, group 2 - 45 patients with middle ureteral stones, group 3 - 48 patients with upper ureteral stones. A secondary intervention was required in 9.2% of cases with lower ureteral stones, in 51.1% of cases with middle ureteral stones and 43.75% of cases with upper ureteral stones. In our cases such number of patients required repeated interventions are most likely associated with frequent stone migration in pyelocaliceal system and residual stones after ESWL. On the other hand, it is related to achieve of urinary tracts “stone free condition” within one hospitalization in accordance with recent guidelines. The effectiveness of extracorporeal shockwave lithotripsy is significantly affected by the composition of the stones. Usage flexible ureterorenoscopy and percutaneous nephrolithotripsy based upon laser lithotripsy enables to achieve clinical effectiveness regardless of the density and location of the stones.
Urologiia. 2016;(1):86-90
pages 86-90 views

Validation of the combined medical therapy for LUTS using ai-adrenergic blockers and M-cholinoblockers

Gadzhieva Z.K., Kazilov Y.B.


In the majority of patients, urination disorders are caused by both mechanical and functional factors. In patients with BPH timely determination of the type and nature of urinary dysfunction, especially bladder outlet obstruction and detrusor overactivity is of great practical importance. Without accounting for this factor, functional results of surgical treatment may be significantly impaired. a1-adrenergic blockers are the first-line therapy for men with moderate to severe lower urinary tract symptoms (LUTS). In selecting the appropriate therapy, more selective ш-adrenergic blockers should be chosen. The selectivity of the a1- adrenergic blockers provides high performance along with a favorable side effect profile especially regarding cardiovascular event rate. Like ш-adrenergic blockers, M-cholinoblockers have varying degrees of selectivity regarding the impact on the bladder. Solifenacin has greater selectivity for the bladder receptors than tolterodine and oxybutynin. The selectivity of this medication regarding the bladder manifests itself in the relatively low incidence of side effects, such as dry mouth, which enables the possibility of long-term therapy. Combined therapy with ш- adrenergic blockers and M-cholinoblockers may be considered as a treatment modality in patients with moderate to severe LUTS with a predominance of filling symptoms, especially if monotherapy proves not effective enough.
Urologiia. 2016;(1):91-99
pages 91-99 views

Point somatic mutations in bladder cancer: key carcinogenesis events, diagnostic markers and therapeutic targets

Mikhailenko D.S., Nemtsova M.V.


Development of bladder cancer (BC) involves accumulating several genetic alterations in somatic cells: point mutations, extended deletions in the localization of tumor suppressor genes, amplification of oncogenes, aberrant DNA methylation, changes in the expression pattern of regulatory RNAs and numerous structural genes. From all of the above, point mutations have the greatest potential as diagnostic markers, as they frequently occur in carcinogenesis, characterize initiation and further clonal evolution of malignancy and represent a change in DNA detectable by routine molecular genetic methods. If we look at the clinical classification of bladder cancer, 90% of the BC presented by urothelial carcinoma, 80% of patients had superficial and 20% - of muscle-invasive tumors. The differences in morphological classification, staging and prognosis of bladder cancer represent different pathogenic pathways of tumor development. Superficial bladder cancer develops through a stage of hyperplasia involving activation of mutations in the genes FGFR3, PIK3CA, HRAS, ERBB2, TERT and others. It is shown that frequent point mutations FGFR3, PIK3CA and TERT are present in the tumor cells in the urine sediment and can be considered as markers for non-invasive molecular genetic diagnosis of primary BC and for monitoring of disease recurrence. Muscle-invasive bladder cancer develops through the stages of dysplasia and carcinoma in situ, in which mutations initially occur in key suppressor genes (TP53 and RB1) and a number of chromatin remodeling genes. This leads to genomic instability and multiple chromosome aberrations that are subjected to selection in the further clonal evolution of tumors towards predominance of more malignant subclones. This review presents systematized information about the main mutations in BC carcinogenesis, their role in the primary tumor progression, metastasizing and role as a target for diagnosis and targeted therapy.
Urologiia. 2016;(1):100-105
pages 100-105 views

Indocyanine green fluorescent imaging in urology

Alyaev Y.G., Bezrukov E.A., Sirota E.S., Morozov A.O.


This paper gives an overview of the prospects for indocyanine green fluorescent imaging, which is used in different fields of surgery, transplantation and urology. This method offers new opportunities in angiography, lymphography; it allows measuring tissue perfusion and differentiating healthy tissue and tumors in real time. The safety of the method has been proven and its diagnostic value is being extensively studied.
Urologiia. 2016;(1):106-111
pages 106-111 views

The list of literature (review) on studying urinary stones by russian researchers (Dated between 1965 and 2015, in 2 parts) Part I

Polienko A.K., Boshchenko V.S., Sevost'yanova O.A.


Urolithiasis is one ofthe most common urological diseases. Determination of mineral composition and structure of urinary stones is necessary for urologists to provide targeted therapeutic and preventive measures. Existing global standards for management of kidney stones require analysis of stone composition to be done for each urolithiasis patient. The list of literature representing the scientific work of the Russian scientists on studying the mineral composition and structure of urinary stones, includes articles, abstracts, monographs, dissertations presented as reports and presentations at conferences and seminars (mineralogical and urological). Over half a century (1965-2015) there were 178 articles published in geological and urological journals, 7 published monographs and 8 defended dissertations (2 on Medical Sciences and 6 on Geological and Mineralogical Sciences).
Urologiia. 2016;(1):112-116
pages 112-116 views

The list of literature (review) on studying urinary stones by russian researchers (Dated between 1965 and 2015, in 2 parts) Part II

Polienko A.K., Boshchenko V.S., Sevost'yanova O.A.


Research on urinary stones involves urologists, crystallographers, mineralogists. A considerable amount of literature has been published as articles, abstracts of articles presented at conferences and seminars (mineralogical and urological), and monographs, dissertations. The authors of the scientific review prepared the list of the literature, reflecting the scientific activities of Russian scientists in studying the mineral composition and structure of urinary stones for half a century (1965-2015). The list is presented in two parts. The information provided in the 2nd part (2002-2015), is an update of the scientific review on studying urinary stones (Part I, 1965-2001).
Urologiia. 2016;(1):117-121
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pages 122-125 views
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Chumakov Petr Il'ich (on the 70th anniversary)

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Urologiia. 2016;(1):128
pages 128 views
pages 129-130 views

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