No 5 (2016)

Introduction The study proposed a technique for early detection of the damaging effect of shock waves on the urinary tract tissues, for monitoring the state of urothelial cells in the early post-procedure period and choosing an adequate method for preventing and managing possible compIications. Materials and methods The study analyzed the urine samples of 300 patients aged 20 to 50 years, who for the first time underwent ESWL for kidney stones. The urine sediment smears were fixed in the May-Grunwald stain and stained with azure eosin solution according to Pappenheim. Besides evaIuating generaI cytoIogic characteristics, a morphometric examination of urine sediment was performed. Results and discussion To define quantitative parameters, the total number of epithelial cells (£ep) was determined with further calculation of the mean number of epithelial cells in the field of view (Xep= £ep/10). Correlation between the number of abnormal epithelial cells (Xcp) and the total number of epithelial cells (£ep) was analyzed. The resulted «destruction index» (DI) was the «pool» of all cytopathological changes in epithelial cells DI = Xcp/£ep. Immediately after ESWL, DI markedly increased with significant difference (р<0.05) in numeric values. Two hours after the procedure, the DI reduced compared to the previous value. And only at day 4 DI was close to the norm, although remaining somewhat elevated. Conclusion Extracorporeal shock waves lithotripsy produces the acute urotheIiaI damage resuIting in cytopathoIogicaI changes of varying severity. The above-mentioned technique provides objective and highly significant clinical and diagnostic information on the state of the urothelium after the exposure to shock waves.

Introduction: Currently, extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive treatment for patients with urolithiasis. With advancing medical technology, elastography has evolved as a method for measuring the elasticity of tissues. Aim: To investigate the elasticity of urinary stones for assessing their physical and chemical composition. Materials and Methods: The elasticity of urinary stones was determined before ESWL in 30 urolithiasis patients (18 men and 12 women, aged 25-65 years) using shear wave ultrasound elastography (SWUE). In 40%, 23.3% and 20% of patients, urinary stones were located in the renal pelvis, the middle calyceal group and the lower calyceal group, respectively. Results: Elastography is a method of determining the elasticity of urinary stones, measured in kPa. Mean elasticity (Emean) of calcium oxalate monohydrate stones, uric acid stones and mixed urinary stones was 39.8, 14.6 and 26.3-29.8 kPa, respectively. Urinary stones smaller than 5 mm did not differ in the color spectrum. Excess body mass index (BMI) also reduced the informative value of the method. Conclusions: The findings of SWUE are comparable with the results of computer densitometry and physical and chemical composition of the investigated urinary stones

Relevance The IPSS-QOL questionnaire is frequently used to assess symptoms and quality of life of men with urethral strictures. However, the psychometric properties of the questionnaire in assessing these patients have not been evaluated. Aim To test the psychometric properties of the IPSS- QoL questionnaire in assessing patients with anterior urethral strictures. Material and methods Thirty five men with anterior urethral strictures self-completed the IPSS-QoL questionnaire. The reliability of the questionnaire was estimated by computing Cronbach’s a coefficient and the «point-scale» correlation coefficients. Validity was assessed by the «external criteria» - the correlations between the questionnaire scores and objective indicators - maximum urinary flow rate (Qmax) and residual urine volume (Ures), between QoL scores and index values and EQ-5D scores using a VAS rating scale. Results The content validity of the IPSS-QoL was assessed by experts and patients: the storage symptoms were found insignificant for patients with anterior urethral stricture, while the symptoms of primary importance (post-micturition dribbling) were not covered. Cronbach’s a coefficient of reliability was 0.65 (0.55-0.69 with one of the questions removed), i.e. it was below the generally accepted threshold of 0.7. The «point-scale» correlation coefficients ranged from 0.146 to 0.585; for 2 of the 7 questions they were lower, than the conventional threshold of 0.2, showing the internal inconsistencies of the questionnaire. The construct validity assessment showed no correlation between the questionnaire scores and objective indicators Qmax (R=0.178, p=0.306), Ures (R=-0.074, p=0.673). Correlations between QoL scores and index values and EQ-5D scores on the VAS were weak and statistically insignificant: R=-0.26, p=0.18 and R=-0.21, p=0.27, respectively. Conclusion IPSS-QoL questionnaire in assessing men with anterior urethral stricture does not have sufficient reliability and validity. Its design does not allow for adequate assessment of all the symptoms, reliability indices are unsatisfactory, the questionnaire scores do not correlate with objective indicators. This questionnaire cannot be recommended for evaluating health status and quality of life of this category of patients.

Introduction Despite the prevalence of acute cystitis, there are still many unsolved problems of diagnosis and treatment of this disease. Material and methods To determine the nosological structure of dysuria, 126 female patients who sought medical attention for frequent painful urination were examined. To determine the incidence of outpatient visits to an urologist for patients with cystitis, medical records of 6753 patients of municipal outpatient clinic were analyzed. The results of treating cystitis in 85 patients also were evaluated. Results Among 126 patients with dysuria, 31 (24.6%), 42 (33.3%) and 47 (37.3%) patients had acute uncomplicated cystitis, recurrent (chronic) cystitis without the complicating factors and recurrent (chronic) cystitis with complicating factors, respectively. Three (2.4%), 2 (1.6%) and 1 (0.8%) patients had trichomoniasis, urogenital herpes and tuberculosis, respectively. As a result of 6753 visits to the urologist, inflammatory diseases of the genitourinary system were detected in 3194 (47.3%) patients, of which 64.7%, 19.6%, 5.3% and 2.7% had chronic pyelonephritis, chronic cystitis, chronic prostatitis and acute cystitis, respectively. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively. Conclusions Most of clinical guidelines and scientific publications aimed at acute uncomplicated cystitis, while the proportion of the disease does not exceed 26% among the patients presenting with dysuria, and comprise only 2.7% among outpatient urologist visits for infectious and inflammatory diseases of the urogenital tract. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively.

Aim To evaluate the effectiveness of combined use of the imiquimod 5% cream and vaccination against human papillomavirus (HPV) using a quadrivalent recombinant vaccine to achieve long-term clinical remission of chronic HPV infection manifested by anogenital warts. Material and methods The study comprised 36 patients, including 22 men, aged 26.4±4.1 years, who had from 1 to 5 anogenital warts. Participants of the study were vaccinated by quadrivalent recombinant vaccine under a 3-dose scheme 0-2-6 months co-administered with imiquimod 5% cream three times per week up to 16 weeks. The follow-up period was 2 years. Results Complete disappearance of genital warts within 1 year from baseline was observed in 34 (94.4%) patients. Two patients with anogenital warts after 1 year were treated for 1 year 3 months and 1 year and 4 months with Solcoderm which lead to the complete disappearance of genital warts. There were no recurrences of genital warts during the 2 years of follow-up. Conclusion Vaccination with a recombinant quadrivalent vaccine concurrently with using imiquimod 5% cream results in prolonged clinical remission of chronic HPV infection manifested by anogenital warts in at least 94.4% of the cases (2 year follow-up).

Aim Horseshoe kidney is often associated with other congenital abnormalities and obstruction of pyeloureteral segment (PUS). The aim of our study was to evaluate the results of laparoscopic pyeloplasty (LP) in patients with hydronephrosis of horseshoe kidney. Materials and methods From February 2010 to March 2016, 130 patients underwent LP. Ten (7.7%) of them (6 men and 4 women) had a hydronephrosis of horseshoe kidney. Left and right PUS obstruction were diagnosed in 6 and 4 patients, respectively. All the patients underwent PL transperitoneally using the Anderson-Hynes method. In patients with left hydronephrosis, surgery was performed by transmesenteric access. Results There were no cases of conversion to open surgery and drainage urine leakage. Exacerbation of chronic pyelonephritis was observed in 2 cases. Operating time ranged from 125 to 160 minutes (median 130 minutes), time of performing pyeloureteral anastomosis - from 50 to 105 minutes. Patients were ambulated within the first day after surgery, the length of hospital stay was 3 - 4 days. One patient with recurrent strictures of PUS 8 months after the LP underwent retrograde endopyelotomy with the placement of endopyelotomy stent. The effectiveness of operations over a 6-38 month follow-up was 90%. Conclusion LP is an effective and minimally invasive treatment for patients with hydronephrosis of horseshoe kidney. In a left PUS obstruction, pyeloplasty can be performed using transmesenteric access.

Aim To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators. Materials and methods This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified. Results During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 (a = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Student’s t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 (a = 0.73; Cv = 28.6%, paired Student’s t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life. Conclusions The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients’ quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients’ quality of life.

Aim In patients with prostate cancer to trace the pathway of the malignant cells of the basal layer of the prostate epithelium during their differentiation into luminal cells and/or migration in the mesenchyme. Materials and methods We used histological and immunohistochemical staining of the markers of the basal layer of the prostate: cytokeratin 5 (CK5), E-cadherin and AMACR, and Western blot to assess the production of the same markers in epithelial and stromal compartments of malignant and normal prostate tissue in patients with prostate cancer. Results Our findings revealed that prostate cancer is associated with losing of the basal epithelial layer in the prostate tumor tissue, which is accompanied by a complete loss of CK5 secretion, increased levels of E-cadherin and AMACR in luminal epithelium and the emergence of cells producing E-cadherin and AMACR in the stromal compartment of the prostate. Discussion These findings suggest that in prostate cancer the transformation the basal layer of the epithelial cells is associated with their differentiation into luminal cells and migration into the surrounding mesenchyme due to epithelial-mesenchymal transition. Conclusion Prostate cancer pathogenesis of associated with changes in epithelial cell pathways and the levels of the markers’ expression. Their assessment can be used for studying the disease mechanisms and seeking new diagnosis and treatment options.

Self-inflicted injury to external genitalia in men is an uncommon type of trauma. The international and domestic literature report isolated cases of injury to the external genitalia, caused by a patient intending to harm himself. This type of injury often occurs in patients with mental disorders. The authors describe their own clinical observations of rare types of self-inflicted genital injuries in patients without a history of mental disorders. During the period from 2012 to 2015, 4 patients with self-inflicted genital injuries were admitted to the hospital. There was a penile self-amputation, self-orchiectomy, penile rupture, and foreskin cut wound. Despite the sufficient public awareness and availability of urological care in a large industrial city, cases of selfinflicted genital injury occur. In addition to medical care, such cases warrant psychological and possibly psychiatric counseling.

To investigate the effectiveness of Ingaron (interferon-y) in the treatment of HPV infection associated with sexually transmitted infections, the authors analyzed the scientific literature on the association of human papillomavirus infection with other viral and microbial pathogens. A clinical case of the association of human papillomavirus infection, urogenital infections (urogenital chlamydia and genital herpes) and localized scleroderma penis is described. The results of integrated therapy of diseases with the help of Interferongamma have been presented. According to the literature, up to 70-80% of HPV infections are associated with microbial (opportunistic, obligate pathogens) and viral infectious agents. Chronic inflammation caused by bacterial and viral associations destroys the immune system and it leads to the ineffectiveness of the therapy. Pathogenic therapy of sexually transmitted infections in combination with interferon-gamma (Ingaron) contributes to the eradication of bacterial pathogens, prevention of viral STI recurrence and elimination of high oncogenic risk types of HPV. Thus, we can reasonably infer that Ingaron (interferon-Y) alleviates the initial immune disturbances, improves the effectiveness of the treatment and may be recommended for treating HPV infection associated with sexually transmitted infections.

The combination of bladder cancer with benign prostatic hyperplasia (BPH) occurs in 5-27% of cases. The link between these diseases has not yet been closely investigated. The main role in the pathogenesis of bladder cancer combined with BPH is played by the residual urine and prolonged exposure of urothelium to the urine carcinogens. The choice of surgical treatment modality for the combination of non-muscle invasive bladder cancer and BPH is still a matter of debate. There is no consensus on the safety and appropriateness of simultaneous transurethral resection of the bladder and prostate in these patients. On one hand, opponents of simultaneous surgery suggest sustained exposure to carcinogens and the spread of tumor cells in a transurethral resection through the prostate wound surface in the blood and lymphatic vessels. On the other hand, supporters refer to studies and meta-analyzes showing that the simultaneous resection neither increases the recurrence rate of bladder cancer nor causes metastasis and tumor progression.

By analyzing relevant domestic and international literature and their own long-standing experience, the authors discuss the problem of urinary incontinence in the context of estrogen deficiency. They outline the conservative management of patients with mild incontinence and recurrent forms after plastic surgery with taking into account the morphological findings of paraurethral tissue.