Nº 3 (2016)

Aim: To present the results of intestinal ureteroplasty and technical features of right-sided ileoureteroplasty. Material and methods: From 2001 to 2015, 78 patients underwent isolated reconstruction of the ureter using a segment of the ileum, of whom 57 (73%) and 21 (27%) patients had unilateral and bilateral operation, respectively. In total, isolated segments of the ileum were used to substitute 101 ureters including 45 (44.6%) right ureters. Results: The follow-up period ranged from 3 months to 14 years (mean 8.3 ± 0.8 years). 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. All patients had good results of conservative treatment and reoperations. There were no deaths. All patients achieved restoration of urodynamics and normalization of kidney function. Conclusion: Right-sided, especially total, ileoureteroplasty is the most technically challenging among other possible options to substitute the ureter with a small bowel segment. To avoid mesenteric torsion when performing isoperistaltic ureteroplasty, the graft should be placed above and in front of the intestinal anastomosis.

Introduction: Genital tuberculosis impairs male reproductive function. Given that tuberculosis of the prostate has been found at autopsy in 77% of men who died of tuberculosis of all locations, the problem is highly relevant. Aim: To develop and test a method of restoring/preserving fertility in patients with prostatic tuberculosis and to evaluate its effectiveness. Material and methods: TThis is an open, prospective, comparative, randomized study, comprising 72 patients with prostatic tuberculosis. Patients of the main group (n=49) received standard TB treatment in combination with pathogenetic spermatoprotective therapy including zinc and selenium based dietary supplement and chorionic gonadotropin. The men in the comparison group (n=23) were treated only with etiotropic TB therapy. Results: TB treatment had a negative effect on the ejaculate: in the comparison group a two-month course of drug therapy resulted in a decrease in sperm cell count by 23.9%, in the number of actively motile sperm cells by 10.6% and in the number of normal sperm cells by 32.3%. Pathogenetic spermatoprotective therapy increased the sperm cell count by 47.8%, the number of active mobile forms of spermatozoa (total of A and B) by 40.5%, the number of normal sperm cells by 41.9%. Conclusions: Spermatoprotective therapy, including human chorionic gonadotropin and zinc and selenium based dietary supplement significantly increases the ejaculate fertility.

Currently, practical health care does not have a means to transfer patients’ health data when they change the place of residence and employment. In this regard, there was a need to develop a health-related instrument to accompany an individual when he/she changes the place of residence and work. The aim of the study was to develop an «individual resistance card» to use in health care for patients with diseases of the genitourinary system. Materials and methods: We developed an «individual resistance card» proposed to implement in the practice of health care, as an information document on the state of reactivity and resistance (health) of the organism in terms of urologic diseases. Results: The degree (index) of relative organism resistance is calculated based on impaired individual reactivity and power (intensity) of the environmental pathogenic factors. Its application allows for significant improvement in the effectiveness of periodic health checks, primary and secondary prevention of diseases, because it takes into account both a primary (genotypic) and secondary (acquired) reactivity. Conclusion: The developed Card can be used to record the state of the organism reactivity and resistance regarding urologic diseases and monitor these indicators when the patients change the place of residence and employment. This e-card (in encrypted form) and paper versions may accompany the individuals throughout their lives and will be used for to effectively organize primary and secondary disease prevention by a general practitioner and an urologist.

Purpose: to compare various methods of upper urinary tract drainage in patients with urolithiasis. Patients and Methods: 60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal. Results: the average operative time in group №1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group №2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group №1, in group № 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group №1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group №1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group №2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5. Conclusion: A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.

The article outlines oncological and functional outcomes of salvage external beam radiation therapy after HIFU-ablation in 49 patients. The study determined overall and relapse-free survival, compared the rates of adverse events stratified by CTCAE, erectile function and continence scores assessed by questionnaire survey. Univariate and multivariate analysis of risk factors for failure of salvage radiation therapy after prostate HIFU-ablation were conducted. In univariate analysis the level of prostate-specific antigen (PSA) prior to radiotherapy, the risk group, PSA nadir after radiotherapy, PSA nadir greater than 0.2 ng/mL and the time to nadir after salvage therapy were predictors of failure. There were no serious gastrointestinal side effects. The most frequent urinary adverse event was urgency. The difference in the rates of urinary incontinence before and 1 year after radiotherapy was not statistically significant. The study confirmed the appropriateness of radiotherapy after HIFU-ablation. Radiation therapy can be considered as a treatment option for prostate cancer recurrence after HIFU-ablation.

Objective: To assess the effectiveness of extracorporeal partial nephrectomy. Material and methods. The article presents a comparative analysis of 65 radical nephrectomy, 47 partial nephrectomy and 5 extracorporeal partial nephrectomy on the renal parenchymal tumors. Results and discussion. This article discusses the advantages and disadvantages of extracorporeal partial nephrectomy in comparison with the intracorporeal interventions. The results of their observations are illustrated by two clinical examples. Conclusion. The authors concluded the feasibility of extracorporeal partial nephrectomy for renal cell cancer in selected patients.

Introduction. Modern TB patient has lost the physical appearance (habitus phtisicus) typical for the previous years. Moreover, patients with different tuberculosis localizations also have different anthropomorphic characteristics. Material and methods. To determine anthropomorphic characteristics of patients with tuberculosis of the prostate, several parameters were compared between 95 male patients with pulmonary tuberculosis and 49 patients with prostatic tuberculosis. Results. Compared to pulmonary tuberculosis patients, patients with prostatic tuberculosis were significantly more likely to be overweight and have greater waist circumference. Among patients with pulmonary tuberculosis, there were significantly more people of short or very tall stature, while patients with prostatic tuberculosis, on the contrary, were significantly more likely to be of average height (166-180 cm). Conclusions. The findings regarding body structure of a patient with tuberculosis of the prostate (fat stocky man) could possibly reflect the presence of the metabolic syndrome that may account for the greater susceptibility to urogenital infections.

Stem and progenitor cells being introduced into the body have the ability to stimulate regeneration of tissues and organs by differentiating into specialized cells. Stem cell therapy is used in urology to treat various disorders, including erectile dysfunction, urinary incontinence, Peyronie’s disease, and male infertility. This review presents the results of international preclinical and clinical research on stem cell based medications for treating the above diseases. The most promising appears to be the use of adipose tissue-derived mesenchymal stem cells.

Currently, debate continues about the etiological role of pathogens, in particular viruses, in the development of bladder tumors, their impact on the rate of recurrence and invasive and metastatic forms. The etiological role of high-risk human papillomavirus (HPV) in squamous carcinoma of the cervix and upper respiratory tract is considered proven. However, some published studies show the role of oncogenic HPV in causing bladder cancer, its invasiveness and metastasizing. The review is dedicated to examining the role of HPV in the carcinogenesis of bladder cancer.

The article outlines the chronology of the discovery of the bulbourethral glands. Their first image appeared in 1600 in a collection of anatomical tables by Italian anatomist Hieronymus Fabricius of Acquapendente. In the scientific literature, they were first mentioned in one of the editions of «Journal des scavans» in 1684 as discovered by the French surgeon Jean Méry. The first detailed description of the structure, topography and function of these glands was presented in the work of English physician and anatomist William Cowper in 1699.

The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.