No 6 (2016)

Relevance and goals. The evaluation of the results of the primary introduction into clinical practice of two new models of the urethral catheter. Considering the advisability was evaluated the efficiency of using new models of urinary catheter for the prevention and treatment of postoperative complications after radical prostatectomy, as well as in the treatment of major pathological conditions accompanied by the infectious-inflammatory complications Materials and methods. The study included 25 patients who underwent radical prostatectomy (the first group) or transurethral resection of the bladder / prostate (the second group). After surgery, the bladder was installed specially designed urethral catheter with controlled filling the balloon is located in the area formed by the anastomosis (the first group) and urinary catheter irrigation urethra drugs (the second group). In the control group (n=22) in the bladder has been established a standard twoway silicone Foley urinary catheter. Results. Hypersensitive of the new model of the urethral catheter none of the patients were observed. The average period when the urinary catheter in the main and control groups, exactly as the incidence of dysuria did not differ. After removal of the urethral catheter in all patients in the study and control groups restored self urination. Conclusions. The preliminary data showed a good tolerability the new models of the urethral catheter. Evaluation of the effectiveness of distant occupy additional time and will require inclusion in the study a larger number of patients.

Aim To specify the pathogenetic link between blood supply of the bladder neck and lower urinary tract symptoms (LUTS). Material and methods The study involved 78 men aged 26 to 50 years, including 19 patients with multiple sclerosis (MS) and LUTS, 29 patients with chronic prostatitis category IIIB with LUTS and 30 patients with chronic prostatitis category IIIB without LUTS (control group). All the patients underwent Doppler ultrasonography of prostatic arteries and selective study of blood flow in the neck of the bladder. Pharmacological test using combinations of a1-blockers (a1-AB) with m-anticholinergics (m-CB) and phosphodiesterase type 5 inhibitors (PDEI-5). Results The changes in the blood circulation of VUS were found to correlate with LUTS. The response of blood flow depended not only on the type of pharmacological agents, but also on the degree of vascular changes and neurological deficit in VUS. Discussion The findings of VUS vascular pharmacological tests with PDEI-5 and a1-AB + m-CB were comparable in chronic prostatitis with non-neurogenic LUTS and in MS with neurogenic LUTS. Vascular reaction in VUS depends on the presence of neurological deficit. The combination of (a1-AB+ m-CB) increases the blood circulation of the bladder neck and prostate and reduces the LUTS. PDEI-5 reduces LUTS due to the positive effect on the blood circulation of the prostate and VUS. Conclusion Circulatory abnormalities (=hypoxia) in VUS is an important pathogenetic mechanism of neurogenic and non-neurogenic LUTS and the way to compensate them using a combination of (a1-AB+ m-CB) or PDEI-5. Therefore, one of the mechanisms of LUTS is associated with impaired blood flow in the bladder neck and VUS.

Aim To present the results and the technical features of the various methods of bilateral ileal ureteroplasty. Materials and methods From 2001 to 2016, 154 patients (mean age 52±9.2 years) underwent ileal and appendicular substitution of the ureter and urinary bladder. Study participants comprised 70 (45.4%) men and 84 (54.6%) women. All patients underwent comprehensive examination, including ultrasound, X-ray, radioisotope and endoscopic tests. Bilateral isolated ileal ureteroplasty was performed in 20 patients (40 substituted ureters) whereof in 14, 5 and 1 cases U-shaped, 7-shaped and two separate grafts were used, respectively. Results Postoperative complications occurred in 2 (10%) of 20 patients who underwent bilateral intestinal ureteroplasty. Acute small bowel obstruction occurred in a patient after a U-shaped substitution of extended defects of both ureters. He underwent relaparotomy, bypass ileotransverse side-to-side anastomosis. Another patient developed right-sided ureteral-intestinal anastomotic leak following bilateral 7-shaped ureteroplasty. After relaparotomy and right ureter ligation, the breakdown site of the graft was closed with suturing. Repeat operations were successful; there were no deaths. Conclusion Bilateral ileal ureteroplasty is much more complicated surgery than a unilateral operation. For proper collection and preparation of ileal graft in isoperistaltic position without mesenteric torsion, one should know how to place it in relation to intestinal anastomosis. Depending on this, several types of bilateral ileal ureteroplasty may be used: U-shaped, bilateral 7-, J- or L-shaped or separate isoperistaltic ileoureteroplasty.

Introduction Varicocele is one of the most common diseases among men and a proven cause of male infertility, which is directly proportional to its clinical prominence. The aim To evaluate the immediate and long-term outcomes of different surgical methods to treat varicocele in athletes. Materials and methods. A total of 165 athletes were treated for varicocele. Of them, 82 patients (group 1) underwent varicocele surgery using Marmar technique and 83 patients (group 2) were treated by laparoscopic clipping of testicular vein (endoscopic analogue of Ivanissevitch open surgery). Results The incidence of postoperative complications and relapse at 6 months after surgery in groups 1 and 2 was 1.2% and 8.4%, and 4.9 and 14.5%, respectively. The study findings showed a statistically significant (p<0.05) improvement in the spermogram parameters in both groups compared with preoperative values. Conclusions The length ofhospital stay and postoperative rehabilitation period were shorter in patients after Marmar’s varicocelectomy than in patients of group 2. Besides, Marmar technique for varicocele was cost-effective and justified.

Purpose of the study. Develop a method of treatment of prostatitis based on the use of a standard antibiotic, immunomodulatory therapy, and transrectal ultrasound physiotherapy. Materials and methods. The dynamics of the accumulation of the antibiotic was investigated in male rats. Sonication was performed immediately before the administration of the antibiotic and its accumulation in the process at 10, 20, 40, 60, 80, 100 min after dosing. The clinical study included 138 patients with chronic prostatitis. Patients of the experimental group, in addition to standard therapy, 10 sessions of transrectal ultrasound physical therapy was performed. The efficacy of treatment was assessed after 14 and 28 days after initiation. Results and its discussion. Experiments on laboratory animals have shown that the highest concentration and the residence time of antibiotic in the prostate tissue is noted ultrasonic treatment in the period of maximum blood concentration of the test drug. The data obtained allow to determine that the ultrasonic treatment must be performed considering the pharmacokinetics of the antibiotic. In conducting clinical trials on day 14 of treatment and clinical manifestations of prostatitis bacterial microflora in prostatic secretions were no patients in both groups. In 15% of patients of the experimental group the number of leukocytes decreased to the normal range. After 28 days the amount of leukocytes was normal in 51% of patients in the control and 85% in the experimental group. Conclusion. In animal experiments defined the optimal time interval separating the moment of injection of the antibiotic from the beginning of sonication. Clinical studies have shown that the transrectal ultrasound exposure during the period of maximum concentration of the antibiotic in the blood, improves patient outcomes by 33.8%.

Introduction Tuberculosis remains one of the most important problems of our time. Late diagnosis of urogenital tuberculosis (UGT) results from a lack of a clinician awareness, paucity of pathognomonic symptoms and suboptimal therapy for urinary tract infections while U GT often manifests under their disguise. Aim To determine the incidence of urogenital tuberculosis and its structure in an epidemiologically unfavorable region. Material and methods The study compared the temporal changes in the structure of UGT morbidity from 1999 to 2015 in the Siberian and Far Eastern Federal Districts and analyzed outpatient medical records of 456 UGT patients. Results The highest (46%) proportion of UGT in the structure of extrapulmonary disease was found in 2003, the lowest (22.9%) in 2014. According to outpatient medical records, the proportions of patients with stage 1, stage 2 and cavernous forms of nephro tuberculosis ranged from 21.2 to 37%, 26 to 53.5% and 21.6 to 37%, respectively. The incidence of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013, averaging to 33.9%. Conclusions Currently, it is impossible to estimate the true prevalence of UGT, we can only speak about the detection rate. Every fourth UGT patient was under the medical supervision with a wrong diagnosis for 5 or more years. The proportion of UGT in the structure of morbidity from all forms of extrapulmonary TB reached a minimum (22.9%) in 2014 but went up again. Introducing new technologies has led to an improvement of bacteriological verification of U GT and increased prostate tuberculosis detection rate to 35.7%.

Aim. To determine the treatment strategy for patients with renal tumors and coexistent contralateral kidney stone. Materials and methods. From 2006 to 2015, 1380 and 4833 patients underwent surgery for renal tumours and kidney stones, respectively. The combination of stone disease and renal tumor was found in 159 (11.5%) patients, of whom 61 patients had indications for surgical treatment of both diseases at the time of hospital admission. Of these, 17 (27.9%) patients (8 men and 9 women) had renal tumors and coexistent contralateral kidney stone. Results.. Initial surgery for stones was performed in 10 (58.8%) cases. In the remaining 7 (41.2%) patients, the first operation was for renal tumors. None of the patients underwent simultaneous removal of the contralateral kidney stone. The most common types of treatment for kidney stones were percutaneous nephrolithotripsy and extracorporeal shock-wave lithotripsy. Twelve (70.6%) patients underwent partial nephrectomy, the remaining 5 (29.4%) had nephrectomy. In total, 17 patients with renal tumors and coexistent contralateral kidney stones were treated using 11 different treatment combinations. These results show the need to define treatment strategies for each patient individually, taking into account all possible factors. Conclusions. In patients with renal tumors and coexistent contralateral kidney stone, the basic principle of surgical treatment is to perform an organ-sparing surgery, given technical feasibility and normal function of kidney, affected by the tumor.

Aim. To identify markers for predicting aggressive forms of prostate cancer. Materials and methods. The study retrospectively evaluated expression of angiotensin II type 2 receptors (AT2-R) in prostate needle biopsy tissue from patients with and without biochemical recurrence after combined hormone and radiation therapy. Results. The study findings showed that low expression of AT2-R in prostate tissue was associated with a high risk of biochemical recurrence. The data on the nature of AT2-R expression in prostate tissue of prostate cancer patients may be considered as a tool for predicting biochemical recurrence after combined hormone and radiation therapy. The test has a sensitivity of 87.5% and specificity of 85.71%.

Aim. To assess the results of organ-sparing endoscopic treatment of patients with tumors of the upper urinary tract (UUT). Materials and methods . Twenty four patients underwent percutaneous and ureteropyeloscopic interventions for tumors of the upper urinary tract and were followed up at the Urology Clinic, I.M. Sechenov First MSMU. Retrograde removal of benign tumors of the renal pelvis and ureter (tumors sized from 5 to 35 mm), percutaneous removal of papillary carcinoma of renal pelvis of a solitary kidney, percutaneous removal of papillary carcinoma of renal pelvis of only one functioning kidney and percutaneous removal of papillary carcinoma of the lower calyx of the L-shaped kidney were performed in 21, 1, 1 and 1 patients, respectively. The patients had stage T1 papillary cancer of the upper urinary tract. There were 7 (29.2%) men and 17 (70.8%) women with mean age 64±5 years. Electroresection/ vaporization was carried out in 18 patients, and 6 patients were treated using Holmium laser. Results. None of the endoscopic procedures required conversion to open surgery or a more extended surgical operation. There were no recurrences or impaired UUT urinary flow in patients with benign UUT tumors at different points of follow-up. In 3 cases of malignant UUT tumors no recurrences occurred during 12-20 months follow-up. Conclusion and discussion. Nephroureterectomy with resection of the urinary bladder is the standard radical treatment of patients with tumors of the UUT. Technological advances in endoscopic and percutaneous surgery for UUT have allowed for organ-sparing procedures in patients with neoplasms of pelvicalyceal system and ureter. The absolute indications for such organ-sparing operations now include solitary kidney or only one functioning kidney and chronic renal failure. Endoscopic resection of the tumor and renal pelvic wall within healthy tissue, including by holmium laser, with tumor stage not exceeding T1 and followed by trans-fistula chemotherapy can be regarded as an effective treatment for patients with tumors of pelvicalyceal system.

Relevance. Age-related androgen deficiency often coexists with benign prostatic hyperplasia (BPH), which requires surgical treatment. At the same time, severe lower urinary tract symptoms secondary to BPH are considered a relative contraindication to testosterone replacement therapy. The aim of this study was to evaluate the importance of correcting age-related androgen deficiency in patients with benign prostatic hyperplasia after transurethral operations. Materials and methods. The study comprised 60 patients with androgen deficiency (plasma testosterone levels below12.1 nmol/L) detected during preoperative workup for BPH surgery. All patients were operated on within 30 days after the study enrollment. During that time prior to surgery, all patients received tamsulosin 0.4 mg once daily to prevent acute urinary retention. In all cases, bipolar transurethral resection (TUR) of the prostate was performed. The patients were divided into two groups of 30 men. The patients of the study group received 50 mg of testosterone as a 1% topical gel Androgel® from the time of diagnosis and for 12 weeks postoperatively. In the control group, the patients were managed without testosterone replacement therapy. The primary endpoint of the study was the libido scores measured by the AMS and IIEF-5 scales. Secondary endpoints were total testosterone level by the end of treatment, the incidence of hemorrhagic and infectious complications after surgery, I-PSS and QoL scores, prostate volume and urinary flow rate. Results. In the study group, AMS score, IIEF-5 score and testosterone level were 48, 15 and 4.2 nmol/L preoperatively, and 21, 22 and 18 nmol/L after treatment completion, respectively. In the control group post-treatment values did not differ from baseline. The incidence of bleeding complications was 3% in the study group and 10% in the control group; the incidence of postoperative prostatitis was 6 and 13%, respectively. There were no differences in the prostate volume and urinary flow rate. I-PSS scores and quality of life indices were not statistically significantly better in the study group. No adverse events associated with the use of Androgel® were observed. Conclusion. Detection of age-related androgen deficiency should be included in the preoperative evaluation of patients with BPH. Correcting androgen deficiency results in greater effectiveness and safety of the surgery and leads to a more favorable postoperative course. Testosterone replacement therapy after transurethral resection of the prostate enables achieving sexual and social rehabilitation of patients.

The article outlines the experience with radical surgical treatment of muscle-invasive bladder cancer in two patients with dialysis-dependent end-stage chronic kidney disease. The authors describe diagnosis and surgical technique in this category of patients.

The article reports a case of a robot-assisted cystprostatectomy in a 36 y.o. patient with a malignant bladder neoplasm (highly differentiated infiltrative urothelial bladder cancer, Gr 2, invading the bladder wall mucosa, the multicentric growth type, with the focal tumor growth in the urethral mucosa and prostate). The ileal neobladder was constructed using intracorporeal access. Operating time was 6 hours, intraoperative blood loss was 150 ml. There was no intra - or postoperative complications. Voiding function was restored at day 10 postoperatively.

In recent years, the number of organ-sparing operations for renal tumors has been increasing steadily due to comparable oncological outcomes and the desire to preserve functioning renal parenchyma. Another technique, which is becoming increasingly popular, is so-called zero ischemia partial nephrectomy, which allows bleeding to be controlled during the operation without clamping the renal artery, thus avoiding renal ischemic injury. One of the most interesting and promising instruments for partial nephrectomy is a laser radiation. It combines good cutting and coagulating properties, thus enabling partial nephrectomy to be carried out without vascular clamping. This literature review presents the physical basis of laser technology and evidence from published clinical studies on using of various types of laser radiation for partial nephrectomy. The prospects for further development of the technique are discussed.

Modern medicine tends to use minimally invasive treatments. Selected patients with prostate cancer may be treated using irreversible electroporation that involves the application of a NanoKnife device. The procedure directs short electrical pulses that open microscopic pores in the cells in the treatment area and effectively destroy cancer cells. This literature review outlines the history of irreversible electroporation, its use in surgery for treating cancers of the pancreas, liver, lung, kidney and brain. This technique is relatively new and is not yet applied in routine urologic practice, but has been increasingly used in Europe and North America and, no doubt, will find an appropriate utilization in Russia.

Increasing prostate cancer incidence rates highlight the importance of more timely diagnosis with the ultimate aim of reducing cancer-specific mortality, while maintaining patients’ quality of life. Until recently, digital rectal examination and prostate-specific antigen have been used for diagnosis of prostate cancer. Recent advances in medical technologies and laboratory testing have led to introducing new cancer markers into clinical practice. The most highly demanded of them are the PCA-3, -2proPSA and Prostate Health Index. Despite the wide range of laboratory tests, a prostate biopsy with a subsequent morphological examination of biopsy tissue specimens remains the only way to definitively diagnose prostate cancer.