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No 4 (2016)


Technical features of uretral intestinoplasty. Part 3: laparoscopic ileoand appendiceal ureteroplasty

Komyakov B.K., Guliev B.G., Ochelenko V.A.


Purpose. Presentation of the results and the technical features of the laparoscopic intestinal and appendicular ureteroplasty. Materials and Methods. From 2001 to 2015, intestinal and appendicular ureteroplasty was performed in 103 patients. ileum was used for the replacement of ureteral defects in 78 (75.7%) patients, appendix - in 21 (20.4%), and colon - in 4 (3.9%). In 10 (9.7%) cases, the surgery was performed laparoscopically. Among them, 7 patients underwent ileoureteroplasty (6 - laparoscopic ileoureterocystoanastomosis, 1 - right-sided laparoscopic ileoureterocystoanastomosis by Yang-Monti) and 3 patients underwent appendiceal ureteroplasty. In one case, ileoureteroplasy was performed in patient with complete ureter duplication. Results. The period of follow-up varied from 2 to 14 years, and the average follow-up period was 8±5.8 years. Complications occurred in 8 (8.1%) patients who underwent open ileo- and appendiceal ureteroplasty. Among the 10 patients who underwent laparoscopic surgery complications were not observed. The length of postoperative hospital stay was significantly shorter in patients who underwent laparoscopic surgery (median, 6 days) than in patients who underwent open surgery (median, 12 days). The results of treatment in all patients were successful. There were no fatal outcomes. Conclusion. The use of endovideosurgery for intestinal and appendicular ureteroplasty reduces surgical injury and reduces the length of hospital stay. However, there are not enough publications on this issue available in modern literature. To date, there are few number of operations performed, and it is not allow to consider the findings and conclusions as statistically significant.
Urologiia. 2016;(4):4-9
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Cystine as a risk factor of the stone formation in kidney: the reference value range of urinary excretion, the stage diagnosis of cystine metabolism disorder

Gres A.A., Nitkin D.M., Juraha T.M., Sivakow A.A.


Objective: to define the reference value ranges of cystine, lysine and arginine urinary excretion relative to creatinine in the morning urine samples for the metabolic disorders diagnosis leading to the formation of urinary stones. Materials and methods: the study involved 695 healthy individuals aged 1-17 and 1564 patients with urolithiasis aged 7-45. The content of cystine in the urine samples was determined by high performance liquid chromatography. The chemical composition of urinary stones was investigated by methods of the qualitative chemical reaction and the crystals microscopy. Results: the reference value ranges of cystine, lysine and arginine urinary excretion relative to creatinine in the morning urine samples were developed in the age aspect. Excess in cystine level in the urine samples of the relatively healthy individuals detected in 1.4% of cases. From 1564 urinary stones submitted for analysis, the frequency of cystine stones was 0.8%. Conclusion: for the objective assessment of the cystine metabolism status the evaluation of the degree of cystinuria is necessary in order to form the risk group for cystine nephrolithiasis. The reference value ranges of cystine urinary excretion developed in the age aspect and «cystine / creatinine index» in morning urine samples will provide the opportunity to identify the state of the cystine exchange from early childhood and develop differentiated program for the prevention of stone formation in the kidneys.
Urologiia. 2016;(4):10-14
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The influence of alternating magnetic field on in vitro litholysis of uroliths in blemaren water solutions

Popkov V.M., Usanov D.A., Rebrov V.G., Usanov A.D., Verkhov D.G., Bulanov V.M.


The aim of the research: increase of efficiency of urolith in vitro solution using water Blemaren medication solutions after their exposure to 2 Hz alternating magnetic field. Materials and methods: water solution of Blemaren medication with pH=6,15 in concentrations corresponding to single portion of medication (1 tablet m=3,5282 g per 250 ml of water) and uroliths (oxalates, urates including uncommon xanthine calculi). Composition of calculi was determined by means of X-ray tests and IR spectroscopy. Photometry of Blemaren with saluted portion of calculi was conducted. Results: it was established that in the Blemaren solutions which had been previously exposed to 2 Hz alternating magnetic filed during one hour the solution process is 1.92 - 2 times more effective than in common water solutions. Discussion - in control solutions pH values increased 5.65 - 6.8 times in the course of time, whereas in the Blemaren solutions exposed to alternating magnetic field pH values remained virtually unaltered during the whole experiment. Conclusion: there were detected significant differences in pH values of Blemaren solutions and its solvent properties between solutions which were exposed to alternating magnetic filed and those which were not.
Urologiia. 2016;(4):15-19
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Genetic risk factors for recurrence-free urolithiasis in the russian population

Apolikhin O.I., Sivkov A.V., Konstantinova O.V., Slominsky P.A., Tupitsyna T.V., Kalinichenko D.N.


Purpose. Search for and identification of possible associations of recurrence-free urolithiasis with polymorphisms of urolithiasis candidate genes in the Russian population. Materials and methods. The study involved 43 patients with recurrence-free urolithiasis, 13 (30.2%) women and 30 (69.8%) of men (main group) from Central Russia, and 189 healthy adults (control group) from the same region. The mean age of the main group was 42.5+13 years. The venous blood samples were used for the evaluation. Real-time PCR using the «Applied Biosystems» test systems was performed to determine the spectrum and frequency of eight urolithiasis candidate genes polymorphisms: tumor necrosis factor receptor gene (TNFRSF11B (rs3134057), vitamin D receptor gene (VDR, (rs1540339), extracellular calcium-sensing receptor gene (CASR, (rs2202127), calcium release -activatedcalcium modulator 1 gene (ORAI1, rs7135617), Klotho gene (KL, rs526906), nuclear estrogen receptor alpha-subunit gene (ESR1, rs851982), tumor necrosis factor 11 gene (TNFSF11, rs9525641), and 26 gene family anionic membrane transporter gene (SLC26A6, rs2310996). Fisher’s angular transformation and x2 test were used for statistical analysis of the data. Results. For ORAI1 gene, differences in genotype and allele frequencies in the control and main groups are significant: p=0.0001 and p=0.013, respectively. For polymorphisms of the other seven genes studied, the differences in genotype and allele frequencies are non-significant. The results indicate the presence of the association between recurrence-free urolithiasis and calcium release-activatedcalcium modulator 1 gene polymorphism (ORAI1, rs7135617), both in genotypes and alleles. Conclusions. In Russian population, genetic factors, in particular, ORAI1 (rs7135617) gene polymorphism, can play the role in the development of recurrence-free urolithiasis.
Urologiia. 2016;(4):20-23
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Complex treatment of chronic cystitis in women

Neymark A.I., Razdorskaya M.V., Neymark B.A.


Purpose: Evaluation of the efficacy and safety of Phytolysin in complex treatment of female patients with chronic cystitis. Materials and Methods: 40 women with chronic cystitis were examined from January 2016 to March 2016. Depending on the treatment, all patients were divided into two groups of 20 people. Main group of patients was treated with Fosfomycin (Monural) and Phytolysin. Control group of patients received monotherapy with fosfomycin. Results: The results were assessed at 1 and 2 months after initiation of therapy. Rapid normalization of the status and laboratory parameters, improvement of dynamics of the endoscopic view was observed in main group of patients. Conclusion: The complex of biologically active substances contained in Phytolysin has antimicrobial, anti-inflammatory, antispasmodic, and immunomodulatory effects, promotes the normalization of urodynamics of lower urinary tract, reduces the risk of relapse of chronic recurrent cystitis. Thus, Phytolysin can be recommended as a component of complex therapy of exacerbations of chronic cystitis, as well as a drug for prevention of the disease in disease-free periods.
Urologiia. 2016;(4):24-28
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High doses of trospium chloride in patients with idiopathic overactive bladder. Data of large-scale, multicenter observational program “Resource”

Krivoborodov G.G., Tur E.I., Efremov N.S., Shkolnikov M.E.


Purpose. Evaluation of the efficacy and safety of different doses of trospium chloride in patients with idiopathic overactive bladder. Materials and Methods. Large-scale observational program «Resource» included 669 patients with idiopathic OAB - 359 women and 310 men. At the first visit, all patients were assigned to use of trospium chloride at a standard dose of 45 mg per day. The results of treatment were evaluated during follow-up visits at 3, 6, 9 and 12 weeks. Depending on the results of examination, the dose was reduced in the presence of adverse events and increased in case of insufficient treatment effects. Results. After 12 weeks, 102 patients have been receiving the drug at a dose of 30 mg/day, 241 - at a dose of 45 mg/day, 257 - at a dose of 60 mg/ day, and 22 - at a dose of 75 mg/day. Conclusions. Individual approach to the selection of doses of trospium chloride in patients with idiopathic OAB can be quite effective and safe measure to achieve optimal clinical outcome with a good safety profile.
Urologiia. 2016;(4):29-34
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Surgical treatment of stress urinary incontinence

Kravtsova N.A., Melkoniants T.G., Gvozdev M.Y., Krutova V.A.


Objective. Urinary stress incontinence considerably decreases the life quality of women, which makes search for effective methods of treatment essential. The research presents results of surgical treatment of 230 patients with stress urinary incontinence between 2011 and 2014. Materials and methods. Efficiency of treatment of urinary incontinence in women, using Tension-free Vaginal Tape (TVT-O) and mini-sling Ophira was presented. The evaluation was made out of complaints and physical examination in target groups, including patients with concurrent genital prolapse and mixed urinary incontinence. For correct diagnosis all patients were submitted to urodynamic and ultrasound tests. In case of need M-cholinomimetic drugs were applied. To evaluate different complaints 5-graded visual analogue scale was worked out. Results of cough stress test were taken as main objective way to estimate effectiveness of the treatment. Results. The research showed that application of TVT-O mesh and mini-sling Ophira turned out to be highly effective in treatment of urine stress incontinence in women. Among short-term complications urinary retention was most common (3,5 percent). To correct those complications alfa-adrenergic agonists, physiotherapy, and acupuncture were applied. Erosions of vaginal mucous had developed at the place where meshes were planted in 1,3 percent of cases. Only once it required mesh excision.
Urologiia. 2016;(4):35-41
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Prevalence of various urination disorders in residents of the Republic of Dagestan

Kazilov Y.B., Gadzhieva Z.K., Mugutdinov T.M., Kazilov B.R.


Purpose: to evaluate the prevalence of various urination disorders in residents of the Republic of Dagestan, and, thus, to improve their diagnosis and treatment. Materials and methods. 584 residents (264 men and 320 women) from different regions of the Republic of Dagestan took part in an anonymous questionnaire survey: 165 residents of Makhachkala, including 92 men and 73 women; 86 residents of Derbent and villages of Southern Dagestan, including 30 men and 56 women; 73 residents of Khasavyurt and Kizilyurt, including 34 men and 39 women; 53 residents of Buynaksk, including 19 men and 34 women; 42 residents of Izberbash, including 19 men and 23 women; 58 residents of the Kaspiysk, 29 men and 29 women; 42 residents of Kayakent, 4 men and 38 women; 65 residents of other regions of the Republic of Dagestan (Karabudakhkent, Gumbet, Gunibsk, Shamil, Khunzakh, Botlikh, Kazbek, Levashin, Tlyaratin, and Tsumadin regions), 37 men and 28 women. Results. According to the survey of the residents of the Republic of Dagestan, a significant prevalence of various urinary disorders (63.5%) was found among both men (61.7%) and women (65.0%). Unfortunately, not all patients seek medical advice with complaints of dysuria (55.5%). The fact that 18.8% of patients do not know that they can get help, and 24.1% believe that they do not have a good doctor in their region can be considered as the most an unfavorable moment in terms of the reasons for the refusal of visiting a doctor.. Conclusions. All this findings suggest the need for educational programs both for physicians and the population (educative activities).
Urologiia. 2016;(4):42-47
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Features of diagnosis and treatment of various disorders of urination by physicians of the Republic of Dagestan and other regions of the North Caucasus and Southern Federal districts

Gadzhieva Z.K., Kazilov Y.B., Alyaev Y.G., Aboyan I.A.


Purpose. This study was aimed to the evaluation of the features of diagnosis and treatment of various urination disorders by physicians of the Republic of Dagestan. Materials and Methods. A anonymous questionnaire survey of 32 urologists of the Republic of Dagestan was performed. In addition to urologists, survey was performed among 104 doctors of other specialties, who also treat patients with various urination disorders in their practice: neurologists (9), obstetricians (22), therapists (38), and surgeons (35). Together with the doctors of the Republic of Dagestan, 323 specialists working in different areas of the Southern Federal District, and 144 specialists of the North Caucasus region participated in the survey. Results. The findings suggest the confusion in determining the manifestations of overactive bladder, as well as various forms of urinary incontinence, incomplete knowledge on the issues of differential diagnosis of various forms of urinary incontinence and treatment policy in respect of each of these forms. Unfortunately, there is still unjustified use of M-anticholinergics in the treatment of stress urinary incontinence in terms of the its pathogenesis. In addition, there is misunderstanding of the importance of the correct and rational use of antimicrobial drugs according to Russian clinical guidelines in the light of the worldwide problem of antibiotic resistance, as well as lack of knowledge of both Russian and European recommendations for the treatment of LUTS in men with BPH, and the indications and the need for combination therapy. Interestingly, a small number of urologists use M-anticholinergics in the treatment of men with symptomatic BPH. Conclusions. The findings of the present study revealed inadequate degree of training of medical specialists of the Republic of Dagestan and the North Caucasus and Southern federal districts in this interdisciplinary field of medicine, which dictates the need for educational programs for urologists, as well as for specialists in related specialties.
Urologiia. 2016;(4):48-57
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Changes in the structure of pathogens of calculous pyelonephritis complicated with diabetes mellitus type ii, in the hospital urology of the city of Volgograd

Petrov V.I., Vinarov A.Z., Vekilyan M.A., Kulchenko N.G.


Among the diseases complicating the course of calculous pyelonephritis, are among the leaders of diabetes mellitus, which is associated with reduced immune response, deterioration of renal hemodynamics, the reduced sensitivity to antibacterial drugs. The purpose of the study is to improve the results of treatment of patients with calculous pyelonephritis and diabetes mellitus type 2. The materials and methods of research. We studied 179 people. This was a retrospective pharmaco-epidemiological analysis of medical records of patients who were treated in 2009 and 2013, in hospital of Volgograd. Women in the study was greater than 99(by 55.4%), males - 80 (44,6%). All patients underwent standard clinical examination, with mandatory bacteriological urine analysis, ultrasound study of kidneys. Results. During the observation period of 2009 and 2013 in patients with calculous pyelonephritis and type 2 diabetes, the major pathogens were representatives of the family Enterobacteriaceae. E.coli strains are constituted - 12 (54,5%), K. pneumoniae - 4 (18.1%) strains. In other etiologically significant microorganisms were Enterococcus spp. - 3 (13.6%) strain, P. aeruginosa - strain 2 (9%). The group of other (4.5%), we have carried pathogens isolated in the singular: Erobacter spp, S. aureus, and Klebsiella oxytoca. In patients with infection of the upper urinary tract and diabetes, there is a pronounced trend to decrease sensitivity to all groups of antibiotics. Sensitivity to unprotected penicillins and fluoroquinolones has decreased almost twice. Resistance to aminoglycosides of patients in this group increased by 23%. In patients with chronic calculous pyelonephritis and diabetes mellitus type 2 is high sensitivity of the main causative agents of infection to cephalosporins of the third and fourth generation (92%), protected beta-lactam penicillins (amoxicillin/clavulanate) - 86,4%, to carbapenemam is 89.4%. Conclusions. For the empiric treatment of infections of the upper urinary tract in patients with diabetes mellitus, can be recommended drugs: protected beta-lactam penicillins, cephalosporins of the third and fourth generation, carbapenem.
Urologiia. 2016;(4):58-62
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Holmium laser enucleation of the prostate (HOLEP) for small, large and giant prostatic hyperplasia. Practice guidelines. Experience of more than 450 surgeries

Enikeev D.V., Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev M.E., Tsarichenko D.G., Sorokin N.I., Sukhanov R.B., Dimov A.M., Khamraev O.K., Davydov D.S., Taratkin M.S., Simberdeev R.R.


Introduction and objectives. Most of modern endoscopic procedures (e.g., TURP) are only confined to small and medium-sized glands (up to 80 cm3), but not HoLEP, which allows to enucleate large and extremely large prostates (200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes. Methods. A total of 459 patients were divided into three groups: Group 1 included 278 patients (prostate volume <100 cm3); mean prostate volume, 70.8±16.1 cm3; IPSS, 18.7+5.5; QoL, 4.1±0.5; Qmax, с ? ? ? ? -4. ? 6.2+1.5 mL/s; post-voided residual volume, 64.2+30.5 mL. Group 2 included 169 patients (prostate volume 100-200 cm3); mean prostate volume, 148.1+25.2 cm3; IPSS, 19.7+3.3; QoL, 4.2+0.7; Qmax, 5.9+0.7 mL/s; post-voided residual volume, 70.9+20.1 mL. Group 3 included 12 patients (prostate volume >200 cm3); mean prostate volume, 230.1+18.1 cm3; IPSS, 19.5+4.5; QoL, 4.1+0.3; Qmax, 4.7+0.9 mL/s; post-voided residual volume, 72.3+10.9 mL. All the patients underwent HoLEP from 2013 to 2015. For the prostate to be enucleated, a 100-W laser system, 550-micron end-fire fiber, and a morcellator for tissue evacuation were used. Results. The average duration of surgery in Group 1 was 56.5+10.7 min; in group 2, 96.4+24.9 min; in Group 3, 120.9+35 min. The average duration of morcellation in Group 1 was 37.5+7.3 min; in Group 2, 63.3+11.2 min; in Group 3, 84.0+25.6 min. The efficiency of enucleation in Group 3 (1.70 g/min) was significantly higher (p < 0.05) than in Group 1 (1.05 g/min) and Group 2 (1.23 g/min). Similar results were obtained for the efficiency of morcellation. It was lower in Group 1 and Group 2 (1.58 and 1.87 g/min, respectively) than in Group 3 (2.45 g/min) (p<0.05). In order to compare the long-term results of HoLEP for prostates of different sizes, all the 459 patients were followed up for 18 months. IPSS, Qmax, QoL, and post-voided residual volumes were measured. There were no significant differences (p> 0.05) in the postoperative outcomes for 1, 3, 6, 12, and 18 months after surgery. Conclusions. It follows from our two years’ experience that HoLEP is a safe, highly efficacious and a size-independent procedure, which is why it has become a new gold standard for treatment of extremely large prostatic hyperplasia in our clinic.
Urologiia. 2016;(4):63-69
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Monopolar transurethral enucleation of benign prostatic hyperplasia. Our initial experience

Tsarichenko D.G., Simberdeev R.R., Glybochko P.V., Alyaev Y.G., Rapoport L.M., Sukhanov R.B., Sorokin N.I., Enikeev D.V., Davydov D.S.


Introduction. The choice of surgical treatment in patients with BPH is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of medium and large sizes by means of enucleation has become increasingly popular. Objective. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients with BPH-transurethral monopolar enucleation BPH. Patients and methods. In the period from December 2014 to the current time 35 monopolar enucleations were performed in the clinic of urology Sechenov FMSMU. The mean age was 70,3±3,7 years; Prostate volume was 60,3±12,5 cm3; IPSS / Qol 24,6±3,3 / 5,1±1,1; Qsr 7.7±2.1 ml/s. We used resectoscope 26 Ch with constant irrigation, Hook-electrode, pusher-electrode, as well as a standard set of electrodes for mono- and bipolar surgery during the procedure. Enucleated adenomatous nodes were resected either by mono- or bipolar TURP and were laundered by Rene-Alexander syringe, or morcellated. Results. Comparative analysis of different methods of surgical treatment of prostatic hyperplasia (laser and monopolar enucleation) shows the advantages of monopolar enucleation in patients with prostatic hyperplasia. Conclusion. Monopolar enucleation of prostate hyperplasia is a radical, as well as a safe and effective surgical method in the treatment of patients with BPH. Further observation of the operated patients will allow us to make a final conclusion about the place of this technique in the treatment of patients with BPH and adequacy of data.
Urologiia. 2016;(4):70-75
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Glybochko P.V., Alyaev J.G., Potoldykova N.V., Polyakovsky K.A., Vinarov A.Z., Glukhov A.I., Gordeev S.A.


Purpose: To evaluate the potentials of determining the telomerase activity (TA) in the cellular material of the urine for noninvasive diagnosis of bladder cancer (BC). Materials and Methods. Evaluation of TA was performed in the urine of 48 patients with bladder cancer (study group) before and after transurethral resection of the bladder wall (n=38), an open resection of the bladder (n=4), and cystectomy (n=6). TA was also evaluated in 48 tumor tissue samples obtained from these patients during removal of the bladder tumor. Each sample of the tumor tissue was separated into two parts, one of which was subjected to histological examination, and the latter was used to determine the telomerase activity. In all cases, the diagnosis of bladder cancer was confirmed morphologically. Determination of TA in the samples was performed by the modified TRAP-method (telomerase repeat amplification protocol), RT-PCR, PCR, and electrophoresis. As a control, cell material of the urine and tissue in 12 patients with chronic cystitis was investigated. Results. TA before surgery was found in 45 (93.75%) of 48 samples of cellular material of the urine from patients with suspected bladder cancer. BC was histologically verified in all patients in this group. In the postoperative period, TA was not observed in the 48 samples of cellular material of the urine from patients with BC. In the control group of patients with histologically verified cystitis, weak TA was determined only in one sample of cellular material of the urine. The analysis indicates statistically significant predominance of patients with bladder cancer in case of TA in the urine (P=0.001). TA was detected in all samples of tumor tissue. We also analyzed the dependence of TA levels in urine and tissue on the degree of BC differentiation. In patients with highly differentiated BC, mean AT in the cellular materials of the urine was 0,61% (n=15), in patients with moderately differentiated BC - 0.95% (n=23), in patients with low-grade bladder cancer - 1.33% (n=10); in other words, increase in the TA levels with decreasing the degree of differentiation was observed. This finding can be used in the prognosis of the course of disease based on determining the TA level in these patients. Conclusions. Preliminary data indicate the possibility of use of determining the TA in cellular material of the urine for the diagnosis and monitoring of bladder cancer recurrence.
Urologiia. 2016;(4):76-81
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Teratozoospermia and karyopathological abnormalities in epithelial urogenital tract cells in male shift workers with varicocele in oil fields of the north of Siberia

Ilyinskikh N.N., Ilyinskikh E.N., Saushkin S.A.


The purpose of the research: The aim of this work was to study associations between varicocele and the various types of karyopathologic abnormalities in epithelial urogenital tract cells or teratozoospermia in oil field shift workers of the north of Siberia. Materials and methods. We examined 139 male individuals in several oil field of the north of Tomsk and Tyumen regions. The examined individuals were divided in 4 groups: 1) driller-workers with varicocele; 2) driller-workers without varicocele; 3) oil field administrative staff with varicocele, and 4) oil field administrative staffwithout varicocele. Samples of both the sperm ejaculate and the epithelial urogenital tract cells were obtained from all the individuals for microscopic assay. Results. It was found that the frequencies of both the teratozoospermia and the various karyopathologic abnormalities in epithelial urogenital cells were significantly higher in the workers with varicocele compared to all the other groups. There were correlations between karyopathologic abnormalities in epithelial urogenital cells and teratozoospermia in both the driller-workers with varicocele and the oil field administrative staff with varicocele. However, the frequencies of damaged cells in this workers group were significantly higher than the ones in the administrative staff with varicocele, which can be associated with the genotoxic effects of work conditions at oil fields of the north of Siberia. Conclusions. From the data it was concluded that the increased frequencies of the abnormalities in the epithelial urogenital cells and the sperm in the driller-workers with varicocele may be associated with both the disease’s endogenous factor and the genotoxic effects of work conditions at the oil fields.
Urologiia. 2016;(4):82-86
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Phosphatidylserine externalization and functional-morphological impairment of sperm in men with long barren marriage

Ploskonos M.V.


Aim: To identify the relationship between phosphatidylserine externalization, as an early marker of apoptosis, and functional and morphological sperm impairment in infertile men to subsequently evaluate the effect of apoptosis on sperm fertility. Materials and Methods: Ejaculates of 18 fertile and 78 subfertile men were examined. Phosphatidylserine externalization was detected by staining the sperm with fluorochrome conjugated Annexin V (AnV-FITC) and propidium iodide using fluorescence microscopy. Results and conclusions: Ejaculates of fertile and subfertile men differed in the percentage of annexin-V-positive sperm. The correlation of (AnV+/PI+) - sperm of subfertile men with sperm concentration, motility and defects of sperm morphology shows the adverse effects of apoptosis on sperm quality and suggests that phosphatidylserine externalization is a factor for reducing sperm fertility.
Urologiia. 2016;(4):91
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Metabolic syndrome as a cause of reduced ejaculate fertility in patients with prostatic tuberculosis

Osadchii A.V., Kulchavenya E.V.


Introduction: Metabolic syndrome (MS) negatively affects the quality of ejaculate, especially in patients with chronic prostatitis. Material and methods: To determine the effect of metabolic syndrome on semen parameters in patients with tuberculosis of the prostate (TP), a study of 72 patients with prostatic tuberculosis was conducted. MS was diagnosed when at least three of the five following medical conditions were found: central obesity, elevated levels of plasma triglycerides, high blood pressure, hyperglycemia and decreased levels of high-density lipoproteins. Semen parameters were compared in patients with tuberculosis of the prostate with and without MS. Results: 41% of patients with prostatic tuberculosis had metabolic syndrome, which was associated with a 1.5, 1.4 and 2.5 fold decreases in the number of sperm, sperm concentration, and the number of normal sperm forms, respectively. Conclusions: These findings provide the rationale for developing specific therapies aimed at restoring ejaculate fertility in patients with prostatic tuberculosis, considering that almost a half of them have MS.
Urologiia. 2016;(4):92-96
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Rare case giant cancerous tumor «forgotten» after kidney heterotopic transplantation

Tyapochkin Y.A., Zubarev V.F., Golikov A.V., Afanasyeva T.V., Klimkin A.S.


The annual number of cases of kidney transplantation in the Russian Federation varies from 900 to 1000. The generally accepted method of operation is the heterotopic allotransplantation into one of the iliac region. Proper kidney recipient are psychologically «forgotten», often completely lost sight of postoperative monitoring, especially in the long term, but may remind of itself in extraordinary cases like ours.
Urologiia. 2016;(4):97-99
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The first national experience of laparoscopic removal of the transplanted kidney

Lysenko M.A., Vtorenko V.I., Trushkin R.N., Lubennikov A.E., Kuvyrdin D.A., Kolesnikov N.O.


As a rule, the excision of a non-functioning renal graft in late (over 12 months) post-transplant period is performed using Fedorov subcapsular technique. This is because the kidney is embedded in scar tissue due to immune response to the allograft. This surgical approach is associated with the two major complications: bleeding during surgery or early postoperative hematoma and infection of hematoma confined in the remaining kidney capsule. To reduce blood loss and the risk of inflammatory complications, we, for the first time, carried out laparoscopic transplantectomy in a 42 year old female patient using the extracapsular technique. The operative time was 245 min, intraoperative blood loss - 350 ml. The patient was discharged to outpatient treatment on the 10th day. For the first time, such a surgery was successfully performed in 2010 in Turkey; in 2014 robotic transplantectomy was reported in the United States. No data on laparoscopic transplantectomy was found in the available national sources.
Urologiia. 2016;(4):100-105
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Cancer and genitourinary tuberculosis (literature review and clinical observations)

Kholtobin D.P., Kulchavenya E.V., Khomyakov B.T.


Tuberculosis has been regarded as a counter-regulatory process to cancer. The development of tumors in the kidney that is affected by tuberculosis is considered as extremely rare, almost impossible case. The analysis of the literature on combined/sequential damage of urogenital organs by tuberculosis and cancer, and own clinical observation were performed. The case history of 72-year-old patient who sought medical advice for violation of urination is described. Previously he suffered from tuberculosis of the lungs and prostate cancer, and he was healed. The PSA level was 11 ng / mL. Urethroprostatogram showed a large cavity with calcification in the prostate. Biopsy of the prostate gland was performed; histologically solid-glandular cancer, Gleason 7 (3 + 4) was confirmed. There were no signs of tubercular inflammation. Radical prostatectomy was caried out; in the section, prostate caverns were filled with large fragments calcified caseation. Pathomorphological evaluation of surgical material has revealed proliferative glandular prostate cancer with invasion into the capsule of both lobes. In seminal vesicles invasion into muscle layer was detected. Tuberculosis can predetermine conditions for the development of a malignant tumor. In any case, the increase in PSA levels is an indication for prostate biopsy, especially if the patient had a history of long-term infectious inflammation of the prostate gland.
Urologiia. 2016;(4):106-109
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Experimental modeling of acute pyelonephritis

Kogan M.I., Naboka Y.L., Gudima I.A., Bedjanyan S.K.


Acute pyelonephritis (AP) predominates among inflammatory infection kidney affections. In accordance to internationaI cIassifications, AP is an upper urinary tract infection, subdivided into non-compIicated (nonobstructive) and compIicated (obstructive) forms. The cIinicaI significance of AP presently is defined by the condition’s frequent occurrence and its progression into chronic kidney disease. For a limited number of pathogens the involvement in AP is considered proven: representatives of the Enterobacteriaceae family (E.coli, Klebsiella spp., Proteus spp., etc.), Pseudomonas spp., a number of gram-positive microorganisms (S.aureus, Enterococcus spp.). Beside that, over the last 3 decades there have been rare pubIications in the worId Iiterature describing cIinicaI cases of AP caused by microorganisms not readiIy cuItivated on standard mediums (mostIy anaerobic). This was accompanied by an idea that AP might deveIop in case of kidney invasion not onIy by aerobic, but aIso by anaerobic microorganisms, which is practicaIIy not taken into account in current cIinicaI practice. In this regard it was deemed feasibIe to perform an analysis of experimental disease models to refine the discussion points of the disease etioIogy, to do so an attempt of aII-encompassing study in the Russian and English literature databases (Qinical Key, MEDLINE, PubMed, HighWire Press, The Cochrane Library, BioMed CentraI, CentraI scientific medicaI Iibrary of the I.M. Sechenov Moscow medicaI academy, Russian State Library). A total of 356 literature sources have been studied, of which 41 were selected for the current review.
Urologiia. 2016;(4):110-113
pages 110-113 views

Bacterial prostatitis and prostatic fibrosis: modern view on the treatment and prophylaxis

Zaitsev A.V., Pushkar D.Y., Khodyreva L.A., Dudareva A.A.


Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidase. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.
Urologiia. 2016;(4):114-121
pages 114-121 views

Extracorporeal shock wave lithotripsy: benefits, limitationsand prospects

Pavlov V.N., Alekseev A.V., Pushkarev A.M., Iskhakova R.S., Garipov M.R., Makhmut’yanova A.A.


The article provides an overview of current approaches to the treatment of urolithiasis using extracorporeal shock wave lithotripsy (ESWL). The clinical aspects of use of ESWL in patients with urolithiasis are reported; the main technical specifications of lithotripters are described; the limitations and contraindications for lithotripsy are discussed. Based on the analysis of the main barriers to successful ESWL, data on current trends in the development of this method and increase of its efficacy are presented.
Urologiia. 2016;(4):122-127
pages 122-127 views

Focal laser thermocoagulation for localized prostate cancer

Glybochko P.V., Vinarov A.Z., Shpot E.V., Sorokin N.I., Dymov A.M., Chinenov D.V., Enikeev D.V., Shmeleva E.A., Koshkarev A.V., Lumpov I.S.


Focal therapy involving destruction of prostate specific region containing a clinically meaningful tumor is a new treatment for prostate cancer. Despite the absence of long-term results of applying this method of treatment, there are prerequisites that allow to consider focal therapy as a method with a lower risk of side effects typical of conventional treatment. Focal laser thermocoagulation is a developing technique with a number of advantages, the most important of which is the ability to perform the treatment under the real-time magnetic resonance imaging control. This review describes the principles of laser thermocoagulation, and presents the data of already published clinical studies, as well as the eligibility criteria for focal laser thermocoagulation of prostate cancer. The prospects of development of the method are discussed.
Urologiia. 2016;(4):128-136
pages 128-136 views

A systematic review and meta-analysis to assess the recurrence-free survival in nonmuscle invasive bladder cancer after transurethral resection guided by 5-aminolevulinic acid-induced photodynamic diagnosis compared with white-light transurethral resection

Rolevich A.I., Evmenenko A.A.


Introduction. We conducted a meta-analysis assessing the effect of photodynamic diagnosis (PDD) -guided transurethral resection of the bladder tumor (TURB) on the recurrence-free survival in patients with non-muscle invasive bladder cancer within prospective randomised trials that used 5-aminolevulinic acid as a photosensitizer. Matherial and methods. Medical literature search was performed up to February 2016. Recurrence hazard ratios (HRs) and its 95% confidence intervals (CI) were calculated for each selected study with direct and indirect methods and the pooled estimates were obtained with randomeffects model. Results. Data from 5 prospective randomized trials with inclusion of 1089 patients were selected. Pooled estimate of recurrence HR was 0.71 (95% CI 0.48-1.04, p=0.08) with significant heterogeneity across selected publications: p=0,001; 1=78%. The subgroup analysis substantially reduced the heterogeneity: in subgroup comprising single/two-center studies or with moderate to high risk of bias or with long follow-up there was significant benefit of PDD-assisted TURBT (HR 0.51, 95% CI 0.38-0.69;p<0.0001), while in multicenter studies or those with low risk of bias or short follow-up the effect size was within the statistical error limits (HR 1.04, 95% CI 0.77-1.42, p=0.78). Conclusions. Statistically significant benefit of PDD-guided TURBT over the white-light TURBT was limited to single/two-center studies or with moderate to high risk of bias or with long follow-up. True meaning of these finding it is not clear due to possibility of alternative explanations of identified differences. Generally there was low quality of evidence from significant proportion of studies and risk of publication bias.
Urologiia. 2016;(4):137-147
pages 137-147 views
pages 148 views

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