No 1 (2017)

Aim To improve the results of surgical treatment of benign prostatic hyperplasia. Materials and methods The study investigated the effectiveness of a comprehensive preoperative preparation of patients with benign prostatic hyperplasia. The clinical efficacy of traditional methods of preoperative preparation (compression bandaging of the lower extremities during surgery and in the postoperative period and Fraxiparine at a prophylactic dose) was compared with the same preoperative protocol used in combination with intravenous laser blood irradiation. The explored parameters included changes in clinical and laboratory coagulation indices and prostatic blood flow measured by Doppler sonography. The real time visualization was used to assess the effect of intravenous laser irradiation of blood on the morphofunctional state of platelets. Conclusion The study findings showed a high effectiveness of intravenous laser blood irradiation in preoperative preparation of patients with benign prostatic hyperplasia. It was found to reduce the incidence of thrombotic events by 6% and hemorrhagic complications by 4.9% (p<0.05).

Introduction Among urologic diseases, ureteropelvic segment stenosis with hydronephrosis is a common indication for instrumental or surgical correction. The restriction of urine flow with dilatation proximal to obstruction develops in 6.5-37% of cases at different times after the ureteral reconstruction. All this urges to develop and improve stents and search for effective ways to place stents and control their function. Aim To investigate the effectiveness of polyhydroxyalkanoates based biodegradable stent compared with a commercial analogue in upper urinary tract drainage after ureteropelvic segment pyeloplasty. Materials and methods Morphological and functional changes in the stented ureter were investigated in 45 male rabbits of «Soviet chinchilla» breed weighing 4550-5200 g that underwent stenting of ureteropelvic segment (UPS). The study used polymeric stents based on poly-3-hydroxybutyrate, poly-4-gidroksibutirotom P (3GB/4GB) and a mixture of poly-3-hydroxybutyrate with polycaprolactone II (3GB)/PCL with the inclusion of PCL 75%; the control material was polyurethane stents. Morphologic evaluation was conducted on ureteral fragments and UPSs in the area of the stent placement at 7, 14 and 28 days after operation. Results Throughout the experiment, excretory urography and spiral tomography in experimental groups showed no changes in the pelvicalyceal system after placing polymeric stents. The morphologic examination in the experimental group at day 28 after surgery revealed preserved longitudinal folding of ureteral mucosa and absence of muscle hypertrophy. Transitional epithelium had no signs of atrophy and desquamation, its mean thickness was 112.4±8.5 mm, whereas in the control group a productive inflammation resulting in sclerosis was found to develop. Conclusions We conducted a comparative study of morphologic and functional changes in rabbit ureters after stenting using polyurethane stents (control group) and polymeric stents made of poly-3-hydroxybutyrate, poly-4-hydroxybutyrate II (3GB /4GB) and a mixture of poly-3-hydroxybutyrate with polycaprolactone II (3Gb)/PCL (experimental group). Despite the difference in physical and mechanical properties of biodegradable PGA-based stents, the tissue response to both types of stent was comparable. Ureteral wall preserved longitudinal folds, there was no muscle layer hypertrophy, and mucous membrane had smooth contours with a uniform thickness of the transitional epithelium, whereas in the control group a productive inflammation resulting in sclerosis was found to develop.

Aim To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. Materials and methods From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. Results and discussion The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. Conclusion The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.

Introduction Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients’ psycho-emotional status reducing the quality of life and treatment satisfaction. Aim To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period. Materials and methods The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to D’Amico risk classification. Results Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence. Conclusions Waterjet dissection of NVB significantly improves patients’ postoperative quality of life due to early recovery of urinary continence and EF.

Aim To evaluate the efficacy and safety of superselective embolization and chemoembolization of the prostatic artery as an independent method of treating prostate cancer and BPH. Materials and methods From 2004 to 2015, 116 patients with BPH (mean age 73.2±5.2 years) underwent prostatic artery embolization. Mean prostate volume ranged from 55 to 296 cc3. From 2011 to 2015, 37 patients with prostate cancer (mean age 72.3±2.06 years) were treated with X-ray-guided endovascular chemoembolization. All patients had confirmed PCa, of whom 7 had stage T2a and 30 stage T2c disease. PSA ranged from 0.8 to17 ng/ml (mean 13.1±3.9). Prostate volume ranged from 61 to 93 cc3 (mean 69.4±9.3). The follow-up ranged from 8 to 42 months. Results Prostatic artery embolization in BPH patients resulted in a significant reduction in IPSS symptom score and increase in Qmax. The volume of prostate and nodular mass decreased on average by 53% and 47%, respectively, maximum by 82%. Chemoembolization was effective in 31 (83.7%) patients. An objective response was achieved in reducing the PSA level and prostate volume measured by TRUS, and improved urination. The median PSA at 6 months was - 3.4 ± 0.02 ng/ ml. In all patients, chemoembolization resulted in a marked reduction in the prostate volume. The greatest decrease in the prostate volume was observed at 6 months after treatment. Chemoembolization led to a marked improvement in the quality of urination confirmed by uroflowmetry and IPSS symptom scores. At 12 months, 16 patients with prostate cancer underwent the follow-up biopsy. In 12 cases pathology showed fibrosis and epithelial degeneration without signs of atypia and in 2 cases curative pathomorphosis was observed. Chemoembolization was well tolerated and did not cause any significant complications. Conclusion Embolization techniques for BPH and chemoembolization for localized PCa showed good effectiveness and safety in patients who had medical contraindications to traditional treatments.

The incidence of the renal cell carcinoma in Russia and worldwide remains high. Current literature reports isolated cases of patients who were diagnosed and treated for malignant neoplasms of dystopic kidneys. In addition, the absence of patient complaints and the paucity of nonspecific symptoms of pelvic dystopic kidneys lead to late diagnosis of this anomaly and the kidney diseases. This article presents a case study of a radical nephrectomy in a patient with renal cell carcinoma of the left pelvic dystopic kidney.

Currently, despite the growing prevalence of female pelvic floor dysfunction, no consensus exists among researchers regarding its etiology and pathogenesis. There is no doubt, however, that this is a multifactorial disorder with a genetic predisposition. The risk for developing pelvic floor dysfunction is determined by the interaction of multiple additive genetic (mutations and/or polymorphic alleles) and environmental factors. This review of the world literature presents a rationale for searching specific molecular genetic factors shaping the structure of the genetic susceptibility to female pelvic floor dysfunction. The pelvic organ prolapse in women has been found to be associated with the rs1800012 polymorphism of the COL1A1 gene, genotype rs1800255-A/A of COL3A1 gene and the rs2228480 polymorphism of ESR1, although this data still controversial and need to be validated in the independent samples. The systematic accumulation of data, their reproduction in different populations and ethnic groups is necessary to further generalize the evidence on the pathogenesis and the functional significance of each gene variant.

Introduction. Tissue engineering has become a new promising strategy for repairing damaged organs of the urinary system, including the bladder. The basic idea of tissue engineering is to integrate cellular technology and advanced bio-compatible materials to replace or repair tissues and organs. Aim of the study is the objective reflection of the current trends and advances in tissue engineering of the bladder using acellular matrix through a systematic search of preclinical and clinical studies of interest. Materials and methods Relevant studies, including those on methods of tissue engineering of urinary bladder, was retrieved from multiple databases, including Scopus, Web of Science, PubMed, Embase. The reference lists of the retrieved review articles were analyzed for the presence of the missing relevant publications. In addition, a manual search for registered clinical trials was conducted in clinicaltrials.gov. Results and discussion Following the above search strategy, a total of 77 eligible studies were selected for further analysis. Studies differed in the types of animal models, supporting structures, cells and growth factors. Among those, studies using cell-free matrix were selected for a more detailed analysis. Conclusion Partial restoration of urothelium layer was observed in most studies where acellular grafts were used for cystoplasty, but no the growth of the muscle layer was observed. This is the main reason why cellular structures are more commonly used in clinical practice.

This review article describes the differences in efficacy and side effects between available phosphodiesterase type 5 (PDE-5) inhibitors used for treating erectile dysfunction. The most studied PDE-5 inhibitor is sildenafil.

The manuscript presents the analysis of scientific manuscripts written by Russian and foreign researchers devoted to chronic pelvic pain syndrome (CPPS) studies. In spite of widespread disease, there is no clear understanding on etiopathogenetic mechanisms of CPPS development and it is shown that besides infectious process cardiovascular, neuronal, locomotor, endocrine and immune systems are involved into pathological process of CPPS. Mentioned factors complicate the doctors’ task on effective therapy choice and stress the reasonability of complex approach to CPPS treatment. Combination drug containing affinity purified antibodies to endothelial NO-synthase and prostate-specific antigen in released-active form influences different pathogenetic mechanisms of CPPS and thereby reveals pronounced clinical efficacy.