Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

No 5 (2016)


Cytological evaluation of urothelial damage in extracorporeal shock-wave lithotripsy

Grabsky A.M., Manukyan E.V., Muradyan A.A.


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.
Urologiia. 2016;(5):4-9
pages 4-9 views

Molecular mechanisms of individual platelet reactivity in hematuria secondary to lithotripsy

Barinov E.F., Tverdokhleb T.A., Kravchenko A.N., Balykina A.O., Cherkasova N.A.


Aim To investigate the mechanisms of individual platelet reactivity to ADP and adrenaline associated with the variability of hematuria after lithotripsy in patients with chronic obstructive pyelonephritis (COPN). Materials and Methods The study included 41 COPN patients admitted to the Department of Urology for lithotripsy (LT). The contact ultrasonic LT was performed using the Karl Storz Calcuson Ultrasonic Lithotripsy System. Postoperative hematuria was assessed by microscopic red blood cell count. Platelets were separated from the citrated peripheral blood by centrifugation. Platelet aggregation was measured by Chrono-log aggregometer using agonists (ADP, adrenaline) at a concentration of EC50 and EU10. Results There were three types of platelet functional response to ADP and adrenaline after LT (increased, unchanged and decreased aggregation), but the predominant type of individual response was increased platelet aggregation. Testing 24 hours after LT revealed 7 platelet phenotypes differing in functional activity of a2-adrenoceptor agonist and purine receptors (R2Yt and R2Y12). Normal purine receptor activity was associated with the ability of platelets to respond to adrenaline by increasing the functional activity aimed at limiting hematuria. Reduced platelet response to ADP after LT reaching the level of hyporesponsiveness may be viewed as a predictor of severe hematuria after surgery. Conclusion Individual platelet reactivity, manifested by the interaction of ADP and adrenaline agonist, determines the effectiveness of the increase in pro-aggregation capacity of platelets in developing postoperative hematuria.
Urologiia. 2016;(5):10-15
pages 10-15 views

Clinical implications of shear wave ultrasound elastography for evaluation of urinary stones

Kraev I.G., Rudenko V.I., Amosov A.V., Krupinov G.E., Ganzha T.M.


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
Urologiia. 2016;(5):16-20
pages 16-20 views

Technical features of intestinal ureteroplasty. Part 4: YANG-MONTI ureteric reconstruction with reconfigured ileal segment

Komyakov B.K., Guliev B.G., Ochelenko V.A., Al-Attar T.K., Mkhanna K.M.


Aim To present the results of ureteroplasty and technical features of ureteric replacement using the Yang-Monti procedure. Material and methods From 2001 to 2016, 105 patients underwent intestinal appendiceal ureteroplasty. In 5 (4.8%) cases, ureteric replacement using the Yang-Monti procedure was performed. Among them, 2 and 3 patients had left and right ureter replacement, respectively. Results Postoperative complications occurred in 2 of the 5 operated patients, and one of them required re-surgery. Repeat operations were successful; there were no deaths. Conclusions The advantages of ureteric replacement using the Yang-Monti procedure include the ability to replace any ureteral defects 5-6 cm in length by using one ileal segment. However, this may result in an ileal segment with insufficient blood supply and partially lost contractility included in the urinary tract. For this reason, for more than a decade, this operation has not been widely adopted, and Yang-Monti procedure needs to be further assessed in larger comparative studies with longer follow-up.
Urologiia. 2016;(5):21-26
pages 21-26 views

IPSS-QOL questionnaire in assessing symptoms and quality of life in patients with anterior urethral stricture

Bazaev V.V., Shibaev A.N., Pavlova Y.V.


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.
Urologiia. 2016;(5):27-31
pages 27-31 views

Quality of life as an effectiveness criterion of surgical treatment for anterior urethral strictures

Shibaev A.N., Bazaev V.V., Pavlova Y.V.


Relevance Recent trends in the contemporary medicine have shown a growing request for the personalized choice of treatment and evaluation of its results. PROM-USS questionnaire has been designed for patients undergoing surgical correction of anterior urethral strictures to measure the treatment success using patient reported outcomes in numerical terms. Aim To test the effectiveness of different surgical modalities for anterior urethral strictures using patient reported outcomes. Material and methods Ninety men self-completed the PROM-USS questionnaire after surgical treatment of anterior urethral strictures. Mean and median follow-up was 6-132 months and 72 months, respectively. Measures included lower urinary tract symptom score, overall quality of life (QOL) and overall health, and patient satisfaction with treatment. Results At the median follow-up of 72 months after surgery for anterior urethral stricture, the survey findings showed LUTS total score 7.4±1.2 and urination score on VAS scale 2.3±1.1. Sixty-five (72%) of the men believed that residual LUTS did not significantly affect their quality of life. Fifteen (17%) and 10 (11%) patients reported a slight and moderate/ strong negative impact of urinary symptoms on their quality of life, respectively. The EQ-5D score of overall health state on VAS was 73±4.2 out of 100, the EQ-5D score of the overall quality of life was 0.79±0.2. Seventy-eight (86.7%) of 90 men were satisfied (32.2% very satisfied and 54.5% satisfied) with the surgery results, and 12 (13.3%) were dissatisfied. Reasons for dissatisfaction were the emergence of new problems (postmicturition dribbling) with an overall improvement of urinary symptoms (5) and the lack of improvement in urinary symptoms (7). Among patients treated with OIU, 79% were satisfied, which was significantly less than in groups of men who underwent anastomotic urethroplasty - 89% (p<0.05) and substitution urethroplasty using a buccal mucosal grafting - 95% (p<0.05). Conclusion The patient-reported outcomes showed that surgery for anterior urethral stricture is highly effective and characterized by a long term patient satisfaction and quality of life.
Urologiia. 2016;(5):32-36
pages 32-36 views

Diagnosis and treatment of cystitis: more questions than answers?

Kulchavenya E.V., Shevchenko S.Y., Cherednichenko A.G.


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.
Urologiia. 2016;(5):37-42
pages 37-42 views

Using autonomous electrostimulation device «Erektron» in treating female overactive bladder

Yarin G.Y., Shelyakina O.V., Fedorenko V.N., Alekseeva A.V., Vil’gel’mi I.A.


Introduction: Overactive bladder (OAB) is one of the most common syndromes of lower urinary tract dysfunction. Besides standard therapy using anticholinergic medications, comprehensive management of overactive bladder includes physiotherapy. Aim: To test the clinical effectiveness and safety of autonomous electrostimulation device «Erektron» in treating OAB in women. Materials and Methods: The study was conducted at the Urology and Gynecology Clinic of the Innovative Medical Technology Center between 25.04.2014 and 30.01.2015. It included 20 women with newly diagnosed OAB both with and without urinary urgency incontinence or urinary stress incontinence. The patients were divided into 2 groups. All patients were treated with the first line anticholinergic agent solifenacin 5 mg daily. In patients of group 1, anticholinergic therapy was administered concurrently with intravaginal electrostimulation using «Erektron» device. Results: In both groups, the treatment resulted in positive results, but a more pronounced improvement was found in group 1 patients with mixed incontinence. Conclusion. Autonomous electrostimulation device MT-RV «Erektron» can be used in comprehensive management of patients with OAB, including those with stress urinary incontinence.
Urologiia. 2016;(5):43-46
pages 43-46 views

Anogenital warts: a new way of solving the common problem of urology (results of long-term follow-up)

Protasov A.D., Lipatov I.S., Kostinov M.P., Tezikov Y.V., Shmit’ko A.D., Pakhomov D.V., Blagovidov D.A., Zhestkov A.V., Ryzhov A.A., Vekhova E.V.


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).
Urologiia. 2016;(5):47-51
pages 47-51 views

New data on the effectiveness of Tadalafil alone and in combination with NeyroDoz® in treating erectile dysfunction associated with secondary premature ejaculation

Akhvlediani N.D., Matyukhov I.P.


Aim To compare the effectiveness of the phosphodiesterase type 5 inhibitor (PDE-5i) tadalafil alone and in combination with a biologically active dietary supplement (BADS) NeyroDoz®, containing the precursors of serotonin in patients with erectile dysfunction (ED) associated with secondary premature ejaculation (SPE). Material and methods 105 patients (mean age 36.2+9.1 years) with concomitant ED and SPE were included in a prospective study and divided into 2 groups. The patients of group 1 (n=47) received PDE-5i 5 mg daily for 1 month. In patients of group 2 (n=58) PDE-5i was co-administered with BADS 2 capsules twice daily. Treatment efficacy was evaluated using «Criteria for premature ejaculation” (CriPE) and IIEF-5 questionnaires at baseline and on completion of the treatment course. Besides, a polymorphism in the serotonin transporter gene (5-HTTLPR) was tested. Results The treatment was effective in 35 (74.5%) and 48 (82.7%) patients of group 1 and 2, respectively (p<0.0001) with similar statistically significant (p<0.001) improvement in erectile function. According to CriPE scores, 6.4, 8.5, 23.4, 10.6 and 12.8% patients of group 1 and 10.3, 1.7, 40.0, 25.9, 10.3 and 31.0% patients of group 2 with LaLa, LaLg, LgLg, Sla, SLg, SS genotypes were rendered free of SPE, respectively. Conclusion Treating ED-associated SPE with the combination of serotonin precursors and tadalafil can better improve ejaculatory function recovery compared with PDE-5i monotherapy.
Urologiia. 2016;(5):52-56
pages 52-56 views

Laparoscopic pyeloplasty for hydronephrosis of horseshoe kidney

Guliev B.G.


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.
Urologiia. 2016;(5):58-62
pages 58-62 views

Pyeloureteral stenting using nitinol stents

Guliev B.G., Zagazezhev A.M.


Aim To test the effectiveness of nitinol stents in restoring patency of pyeloureteral segment (PUS). Materials and methods Endoureteral nitinol stents were used in 54 patients. The indications for stenting were recurrent strictures of upper urinary tract and ureteral tumor obstruction in 34 and 20 patients, respectively. In 9 (16.6%) of them, including 4 women and 5 men aged 28-65 years, stenting was performed for extensive recurrent PUS strictures. In 8 patients extensive strictures resulted from various surgical interventions on the PUS. In 2 patients, PUS narrowing was caused by open pyelolithotomy, in 6 patients by pyeloplasty, both open (4) and laparoscopic (2). A female patient with solitary right kidney and Bourneville - Pringle disease of the PUS received two metal prostheses. Results In all cases, nitinol stents were adequately installed in PUS. Hematuria was observed in 1 patient. During the follow-up period of 8 to 60 months, the results of stenting were considered good in 6 (66.7%) and satisfactory in 2 (22.2%) patients. At month 10, 1 (11.1%) patient developed the stent obstruction by proliferative tissue and underwent ureteroscopy with recanalization of the nitinol stent. The patient with Bourneville - Pringle disease was found to have a stone formed in the renal pelvic end of the endoprosthesis; she underwent percutaneous nephrolithotripsy. In another patient a lower calyceal stone migrated and wedged into the proximal end of the stent. The stone was extracted using percutaneous nephroscopy. Conclusion Pyeloureteral stenting is an effective method to restore patency of the PUS in patients with extensive recurrent strictures. For adequate functioning of the stents, they need to be of optimal length and correctly installed.
Urologiia. 2016;(5):63-69
pages 63-69 views

Vesicourethral anastomotic strictures and urinary incontinence following radical prostatectomy: relationship and impact on patients’ quality of life before and after endoscopic correction

Reva I.A., Zhivov A.V., Okishev A.V., D’yakov V.V., Bernikov A.N., Bormotin A.V., Pushkar D.Y.


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.
Urologiia. 2016;(5):70-79
pages 70-79 views

Psychological aspects of treating staghorn nephrolithiasis using percutaneous and retrograde nephrolithotripsy

Podoinitsyn A.A., Dutov V.V.


Aim To investigate the level of anxiety and the severity of asthenic state in patients with staghorn nephrolithiasis treated by of minimally invasive therapies - percutaneous nephrolithotripsy (PNLT) and retrograde nephrolithotripsy (RNLT). Patients and methods This study analyzed the psychological state of 150 patients with staghorn nephrolithiasis aged 25 to 75 years before and after PNLT and RNLT. Testing was performed at baseline, at 5-7 day of hospital stay (average time of preparing for surgery) and after treatment with the use of various questionnaires: Anxiety Scale, Asthenic conditions scale and Pain questionnaire. Results The follow-up findings shower positive changes, including reduction in the level of anxiety and severity of asthenia in patients of different age groups. The decrease in anxiety level and severity of fatigue was associated with decreased rates of neuropathic component of pain. Conclusion The psychological state of patients with staghorn nephrolithiasis depends on the characteristics of minimally invasive methods of treatment and requires attending physicians and medical personnel to take into consideration the mental and emotional state of patients.
Urologiia. 2016;(5):80-84
pages 80-84 views

Basal-luminal epithelial cell differentiation in prostate cancer is associated with epithelial-mesenchymal transition and epithelium migration in the mesenchyme

Korshak O.V., Sushilova E.N., Voskresenskii M.A., Grozov R.V., Komyakov B.K., Zarytskey A.Y., Popov B.V.


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.
Urologiia. 2016;(5):85-91
pages 85-91 views

Choosing treatment for patients with bladder cancer combined with prostatic hyperplasia

Glybochko P.V., Alyaev Y.G., Pshikhachev A.M., Sorokin N.I., Dymov A.M.


Aim To define treatment selection criteria for patients with bladder cancer combined with benign prostatic hyperplasia (BPH). Materials and methods Between 2006 and 2015, 1148 patients were treated for bladder cancer and 3368 patients for BPH. Among them, 258 (22.5%) patients had both bladder cancer and BPH. 113 (11.6%) patients had indications for surgical treatment of both diseases. In this group, 18 (13.5%) patients also had bladder stones. Only 2 (1.6%) patients had tumor invading the muscle wall, while the remaining patients had non-muscle invasive bladder cancer. Results In 18% of patients the surgery was done in two stages, the first for bladder cancer and the second for BPH. The remaining 82% of patients underwent simultaneous surgery. Bladder cancer recurred in 34.4% of patients. Discussion Comparative evaluation of the results of transurethral resection of the bladder and prostate showed a greater number of intraoperative complications in patients who underwent staged surgery. In our opinion, it may be attributed to the lack of adequate visualization and access to the tumor, located near the opening of the ureter, to the intravesical prostate growth or large median lobe of the prostate. Bladder tumors greater than 3 cm, the multiple lesions and the low tumor differentiation were associated with a higher risk of bladder cancer recurrence, but recurrence rates of simultaneous and staged surgeries were not significantly different. The treatment of patients with bladder cancer in combination with BPH and bladder stones depended on the prostate volume, the number and size of stones. To reduce the risk of complications, in cases with assumed operating time more than 2 hours, it is advisable to split the treatment into two stages with BPH surgery on the second stage.
Urologiia. 2016;(5):92-96
pages 92-96 views

Selfinflicted genital injury

Abdurakhmanov R.A., Abdurakhmanov A.K., Kopylov V.A.


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.
Urologiia. 2016;(5):97-99
pages 97-99 views

Large urethral stones: a case report

Teodorovich O.V., Krasnov A.V., Shatokhin M.N., Borisenko G.G., Abdullaev M.I.


The article describes a clinical observation of a 68 y/o patient with large stones of the urethra, reaching 5 cm in length and located in the penile urethra. The patient underwent a three-stage treatment: the first stage consisted of drainage of the urinary bladder, the second stage of the urethrolithotomy and a double-barreled fistula, the third was an anastomotic urethroplasty. After removing the cystostomic drainage tube, normal urination was restored.
Urologiia. 2016;(5):100-102
pages 100-102 views

Interferon γ in combined therapy of human papillomavirus infections associated with sexually transmitted infections. Clinical observation

Rakhmatulina M.R., Bol’shenko N.V.


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.
Urologiia. 2016;(5):103-108
pages 103-108 views

Prevalence of various voiding disorders

Kazilov Y.B., Gadzhieva Z.K.


The article presents the data of Russian and international epidemiological studies on the prevalence of various lower urinary tract symptoms (LUTS) among male and female populations. The overall summary of these data highlights the need for the national data on LUTS prevalence, severity and impact on quality of life to project the spending for LUTS management.
Urologiia. 2016;(5):109-114
pages 109-114 views

The risk of bladder cancer in patients with prostatic hyperplasia and strategies to manage this combination

Alyaev Y.G., Pshikhachev A.M., Perekalina A.N.


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.
Urologiia. 2016;(5):115-119
pages 115-119 views

Contemporary aspects of using sildenafil

Efremov E.A., Kasatonova E.V., Mel’nik Y.I., Simakov V.V.


Sildenafil has been thoroughly studied in 74 registered double-blind, placebo-controlled clinical trials assessing the efficacy and safety of the drug in a total of more than 16 000 men with erectile dysfunction (ED). However, practicing urologists have some questions regarding administering the drug in patients with multiple comorbidities. In this review, on a par with the now «classic» research, we outline the latest updates of meta-analyzes and comparative studies relating to the use of sildenafil in different groups of patients. We also discuss the problem of self-discontinuation of sildenafil therapy and the possible risks of using counterfeit phosphodiesterase type 5 inhibitors (PDE-5i).
Urologiia. 2016;(5):120-129
pages 120-129 views

Estrogen deficiency and urinary incontinence in menopausal women

Neimark A.I., Razdorskaya M.V., Gadzhieva Z.K.


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.
Urologiia. 2016;(5):130-137
pages 130-137 views
pages 138-142 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies