No 1 (2016)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).