No 2 (2016)

Aim. To examine the results of intestinal ureteroplasty and present the technical features of left-sided ileoureteroplasty. Material and methods. From 2001 to 2015, 78 patients underwent isolated substitutions of the ureter using a segment of the ileum, including 57 (73.1%) one-sided and 21 (26.9%), two-sided. One patient underwent concurrent left ileoureterocystoplasty and right appendicular ureterocystoplasty. In two observations of duplicated ureter Wallace-type ileoureterocystoplasty was carried out. In total, isolated segments of the ileum were used to substitute 101 ureters. Left and right ureters were substituted in 56 (55.4%) and 45 (44.6%) patients, respectively. In 7 (8.9%) patients laparoscopic approach was used. Results. Early postoperative complications occurred in 8 (10.2%) patients and 5 (6.4%) of them required reoperation. Long-term postoperative complications occurred in 7 (8.9%) patients and 4 required surgical treatment. These patients developed strictures of ileal-ureteral anastomosis 3 and more months after surgery. Urinary tract patency was restored by antegrade stricture dilation. All patients were found to have good results of conservative treatment and repeated operations. There were no deaths. All patients achieved restoration of urodynamics and normalization of kidney function. Conclusion. Using isolated segment of the ileum allows replacing the defects of one or both ureters of any location and extent. Left-sided ileoureteroplasty is one of the most developed and simple modifications of gastrointestinal ureteral reconstructions. Isoperistaltic substitution of the left ureter is possible when the ileo-transplant is below and behind the intestinal anastomosis. The graft should be placed in isoperistaltic position and intraperitoneally, i.e. be left it in the conditions inherent in this organ.

Aim. Improvement in the results of the treatment of patients suffering from staghorn and multiple nephrolithiasis, using open method of surgery and a retrospective analysis of the surgical data. Material and methods. There was executed asurgical treatment of the 730 patients with staghorn and multiple nephrolithiasis in the period from 1998 to 2012. 480 of the patients had one-sided staghorn stones and 250 of them had double-sided staghorn stones. Age of the patients varied from 4 to 76 years old (average - 49). There were 351 men (48,0%) and 379 women (51,9 %). 290 (39,8%) patients had only staghorn stones, but 440 (60,2%) patients suffered from staghorn stones combining with multiple ones. Results. There were executed 1065 surgical operations at the 730 patients. There was used pyelotomy and nephrolithotomyfor the purpose of the ablation of stones. Nephrostomy was placed on the right of the 116patients (15,8%), on the left - 93patients (12,7%), pyelostomy on the right - 46 patients (6,3%), on the left - 31patients (4,2%), intrarenalstent on the right - 181 patients (24,7%), on the left - 167patients (22,8%), stent and nephrostomy on the right - 29 patients (3,9%), on the left - 6 patients (0,8%). Surgical operations of 184 patients (25,2%)fulfilled throughcross-clamping of the nephritic artery.Cross-clamping time of the nephritic artery in average was 16.5 minutes (5-50), average duration of the surgical operation - 2,6 hours (1,5-6), intraoperative hemorrhage - 110 ml (50-300). During the re-examination there was found that 175 patients (23,9%) had recurrent stones.During first ten years after operation there were found recurrent stones at 238 patients (32,6%), 100 (13,6%) of them had the second operation. Conclusion. Taking into account that minimally invasive methods of the staghorn and multiple nephrolithiasistreatment is ineffective and demand a few courses of medical treatment, open surgical operations still have a leading positions as they create extensive possibilities for the favorable and safe revision of the kidney during ablation of stones.

Aim. To develop a method for early diagnosis of renal venous blood flow disorders as a factor determining complicated course of hypermobile kidney (HK). Material and methods. Rotation angles in the three coordinate planes and six static conditions were determined in 92 patients with HK (in 3312 coordinate planes and in 1104 the static state). The fixed probe and "dancing kidney” method was used. The same 92 patients underwent polypositional Doppler sonography in six static states. Statistical analysis was performed using the statistical software STATISTICA 7.0 (Statsoft Inc., USA). Results. In 226 (93%) patients with HK ASAD exceeded 30 mm Hg in at least one static state. Evaluation of 552 variants in assessing hemodynamic features of hypermobile kidney revealed that 92 patients had signs of impaired unilateral or bilateral renal vein outflow as determined by RMS and dVven. in 415 (75.18%) cases. The accuracy in determining belonging to the group, according to the classification matrices of STATISTICA 7.0 software was 89.13%. Discussion. The developed methods for evaluating kidney rotation make it possible to diagnose significant disturbances of the renal major blood flow and monitor dynamics of the process in real-time. All disturbances of the renal major blood flow occur only in ptosis and rotation; that confirms the need for early diagnosis of these conditions. Conclusion. The findings of the multi-positional study of HK and the results of the data mathematical processing suggest that our method of HK imaging enables screening to determine the group of patients in need of further examination and observation.

Objective: To estimate prevalence and types of urinary incontinence (UI) among women living in the South Priaralye region, and to analyze risk factors associated with UI. Materials and methods. The population-based study was conducted by nested-typological method. Analysis was carried out on the data of 1487 women collected by a standard ICIQ-SF questionnaire, an assessment tool for female urinary incontinence recommended by the European Association of Urology. Results. The study showed that the prevalence of UI among women aged 18 years and older in the South Priaralye region was 27%. The predominant type of the disease was stress UI since in 44.8% of women, the uncontrolled urine loss occurred during exercise. In 16.1% of women urgent type UI was observed, and in 38.6% mixed type of UI was found. The most significant risk factors for UI were recurrent urinary tract infection (odds ratio (OR) of 5.9 (95% confidence interval (CI) 4.12-8.38), gynecological disease (OR 2.7 (95% CI 1.99-3.59), enuresis in childhood (OR 2.4 (95% CI 1.21-4.88), constipation (OR = 2.1 (95% CI 1.45-2.93) the number of births (OR = 1.2 (95% CI 1,05-1.28), and occupation, namely work involving physical strain (odds ratio of 1.2 (95% CI 1.04-1.43). Conclusion. In the area of the South Priaralye, more than a fourth of adult females were found to have a UI. Understanding the nature and risk factors for UI will allow planning the resources required to provide treatment and preventive measures in the future.

Introduction. The so-called stent-related symptoms caused mainly by detrusor overactivity due to distal ("cystic") curl of the internal stent are common among patients with this type of drainage. The need for long-term stenting makes the quality of life of cancer patients one of the challenging problems of modern urology. The aim of this study was to optimize treatment of stent-related symptoms in cancer patients with internal long-term stents by complementing the treatment regimen with m-anticholinergic solifenacin. Materials and methods. From November 2013 to November 2015 68 cancer patients (26 males, 42 females, age 36-79 years) underwent elective internal ureteral stenting for drainage of the upper urinary tract (UUT) with special long-term stents coated with the hydrogel. The urinary tract obstruction was caused by urological (24), gynecological (26) and colorectal (18) cancers. Before deciding on urinary tract drainage, all patients were treated with radiation or chemotherapy, 28 (41.2%) patients underwent surgery, but on admission all of them had contraindications to radical surgery for different reasons. In 52 (76.5%) patients UUT stenting was performed using transurethral access, in 12 (17.6%) by percutaneous access and in another 4 (5.9%) by the combined access with patients in the supine position. Percutaneous and combined access was used in cases of impracticability (failure) of transurethral stenting. Patients in group 1 (n=32) after stent placement received standard therapy co-administered with solifenacin 5 mg daily, group 2 (n=36) - only standard therapy. The data analyzed were the technical features of the internal drainage, optimal access and registered solifenacin-related adverse events. Control examinations were scheduled once in 3 months after stent placement according to the following algorithm: ultrasound scanning, laboratory test monitoring and, if indicated, plain urography. To objectify the severity of stent-related symptoms, a survey of patients using a special questionnaire was conducted. Visual analog scale was used to measure subjectively the patients’ condition. Results. After 12 months only 48 patients (26 from group 1 and 22 from group 2) completed the study. Follow-up examinations revealed that the patients in group 1 had significantly lower score of stent-related symptom severity and better ratings in visual analog scale. The greatest difference (1-2 points) was found in urgency and urinary frequency scores. The safety profile of solifenacin 5 mg corresponded to the findings of previous studies, there was no serious adverse events requiring discontinuation of the drug. Conclusions. Installing internal stents in UUT in cancer patients requires relevant experience in Roentgen-endoscopic operations using transurethral and percutaneous approaches and special equipment. In most cases, for preventing and eliminating supravesical obstruction in cancer patients, special internal stents for the long term placement are required. The add-on solifenacin therapy 5 mg/day resulted in almost 20% reduction in the severity of stent-related irritative symptoms and improved the quality of life in this extremely challenging category of patients.

The problem of detecting localized prostate cancer following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia is fairly common. Historically, radical prostatectomy (RP) after previously performed TURP was associated with poor surgical and functional outcomes. It is believed that the periprostatic fibrosis, scar tissue and inflammation after previous TURP may interfere with the optimal RP results. The present retrospective study evaluates intraoperative characteristics, postoperative oncological and functional outcomes of RP in patients with a history of TURP.

Aim: To evaluate in a prospective study the results of transurethral resection (TUR) for non-muscle invasive bladder cancer (NMIBC) and analyze the prognostic factors for the detection of residual tumor to develop indications for this intervention. Materials and methods: The study included 111 patients with primary or recurrent NMIBC and intermediate or poor prognosis after visually radical TUR of the bladder. All patients underwent repeat TUR, which included a thorough cystoscopy, biopsy or TUR of all suspicious areas of the bladder, a deep biopsy of the area of the previous resection including the muscular layer. All prognostic tumor characteristics for assessing risk factors were available in 81 patients. Results: In total, repeat TUR resulted in the detection of 29/111 (26.1%) malignant tumors, while muscle-invasive cancer was diagnosed in 4/29 cases (3.6% of all included patients). The analysis of the relationship of residual tumor detection with various factors showed that the results of repeat TUR correlated with cystoscopic data at the repeat intervention and the degree of the tumor differentiation. Stratification of data depending on these factors revealed that in the absence of a visible tumor and G1, residual tumor was detected in 3.5% of cases, compared with 28.1% for the negative cystoscopy and G2-G3, and 52.6% for the positive cystoscopy regardless of G. Conclusions: Cystoscopy may be applied for selecting NMIBC patients with G1 differentiation for repeat TUR. In the absence of cystoscopic confirmation of tumor, the repeat TUR can be avoided.

Introduction. Percutaneous nephrolithotripsy (PNL) is the recommended method of surgical treatment of kidney stones of size greater than 2 cm. Trends in the development of modern urology have been steadily toward less traumatic method to treat nephrolithiasis - minimally invasive PNL. The present work aimed to explore of the possibilities of one of the modern variants of minimally invasive PNL - ultra-mini-PNL in treating nephrolithiasis. Materials and methods. The study included 60 patients (mean age 45.6±7.2 years) with isolated kidney calculus, up to 2.0 cm or several stones with a total size of up to 2.5 cm. All patients were found to have 77 kidney stones, six of which had a size of 10 mm, 51 had a size of 11-15 mm and 20 had a size of 16-20 mm. 45% of patients had isolated renal pelvic stones and 28.3% had stones in the renal pelvis and lower calyx. All patients underwent ultra-mini-PNL using nephroscope size 7.5 Ch and tube size 12 Fr. Results. The average duration of surgery from the moment of the puncture of the pyelocaliceal system to installing the nephrostomy tube was 65.4 minutes. Complete clearance of stones after single-stage ultra-mini-PNL was observed in 80% of cases. Nephrostomy tube was removed on days 2-3. The average postoperative hospital stay was 5.1 days. The most common complication was postoperative exacerbation of pyelonephritis (13.3% of patients), successfully treated with conservative measures. There were no cases of postoperative bleeding, accompanied by anemia and needed a blood transfusion. Conclusion. Considering high effectiveness and low rate of complications of ultra-mini-PNL, it can be successfully used in treating nephrolithiasis among a wide group of patients.

Globally, the number of patients with end-stage renal disease (ESRD) has been steadily increasing every year. These patients need renal replacement therapy which includes peritoneal dialysis, programmed hemodialysis and kidney transplantation, which is the ultimate form of replacement. Living donor kidney transplantation has significant advantages over cadaveric kidney transplantation regarding the long-term functional results of renal transplant and the survival of recipients. Open nephrectomy, previously used to retrieve a healthy kidney from a donor is associated with traumatic access and a long recovery period of the donor. With the development of minimally invasive technologies, laparoscopic living donor nephrectomy has been developed, which currently is the best method for retrieving transplant kidney. The review outlines the characteristics and outcomes of laparoscopic living donor nephrectomy for kidney transplantation.

Aim. To analyze the results of surgical treatment of patients with long ureteral fibroepithelial polyps (FEP). Materials and Methods. From 2005 to 2014 three patients (1 man and 2 women) with large FEP were observed in our hospital. In 2 patients the base of the polyp was located in the proximal ureter and in 1 patient in the middle calyx of the single kidney. The fibroepithelial polyps were long and extended down to the lower third of the ureter (2) or protruded into the bladder (1). Endoscopic resection of the polyp was made in 1patient, resection of parenchyma in the middle calyx along with the base of FEP in 1 patient with the single kidney, and another patient underwent laparoscopic nephrectomy due to the absence of kidney function. Results. Endoscopic resection was successful; the operation lasted 45 minutes without complications. In the patients with a single right kidney operative time was 3.5 hours; during the operation, she received a blood transfusion. In the postoperative period, she underwent two hemodialysis sessions due to acute renal failure. Subsequently, her kidney function was restored. No FEP recurrences occurred in cases of organ sparing operations during follow-up. The postoperative period of the third patient submitted to laparoscopic nephrectomy was uneventful, creatinine levels remained in the normal range. Conclusion. For long, large ureteral FEPs with a broad base the choice of surgical option depends on possibility of tumor visualization and functional state of the kidney.