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No 4 (2017)


The R.M. Fronshteyn Urology Clinic 150th Anniversary

Alyaev Y.G., Akhvlediani N.J.


В 2017 г. урологической клинике Сеченовского Университета исполняется 150 лет. С момента ее основания в 1866 г. ею руководили выдающиеся деятели медицины России. Сегодня клиника объединяет передовой коллектив, который чтит традиции школы, сформировавшейся здесь за многие годы.
Urologiia. 2017;(4):5-11
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Laparoscopic pyelolithotomy and its role in modern surgery of nephrolithiasis

Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev M.E., Tsarichenko D.G., Shpot E.V., Korolev D.O., Vorobyev A.A., Enikeev D.V.


Aim. To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. Materials and Methods. We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of ≥ 40 cm3 (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51±8 years). The average density of stones was 1012 (160-1483) HU. Results. There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. Discussion. We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.
Urologiia. 2017;(4):12-17
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Structure of microorganism species cultured from urine of urolithiasis patients

Kuz’min M.D., Peshkova Y.I., Pashkova T.M., Kartashova O.L., Pashinina O.A., Meshcheryakov A.O.


Aim. To investigate the incidence of microorganisms of different taxonomic groups and their associations in the pelvic and bladder urine of adult urolithiasis patients. Materials and methods. A bacteriological method and metagenomic sequencing were used to investigate the bacterial spectrum of microflora cultured from pelvic and bladder urine sampled during surgical interventions in urolithiasis patients. Results. The both microbiotas had approximately the same spectrum, but in 26.1% of patients it was inconsistent. Metagenomic analysis detected DNA of microorganisms in urine samples which were found free of microflora by the bacteriological method. Conclusion. The study findings showed species diversity of microorganisms cultured from pelvic and bladder urine sampled during surgical interventions in urolithiasis patients.
Urologiia. 2017;(4):18-21
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Mineralogical composition of urinary stones, risk factors and metabolic disturbances in patients with calcium-oxalate urolithiasis

Kustov A.V., Strel’nikov A.I., Moryganov M.A., Airapetyan A.O., Smirnov P.R., Lyalyakina E.V., Toms S.R.


Aim To identify the most likely metabolic disturbances and risk factors for stone formation in a group of patients with calcium oxalate urolithiasis, and to establish the relationship between the mineralogical composition of calculi and impaired excretion of inhibitors and promoters of stone formation. Materials and methods Fifty patients with calcium oxalate urolithiasis were tested using a complex of physicochemical methods. Patients’ assessment included evaluation of quantitative mineralogical composition of calculi, daily urine pH profile and daily urinary excretion of urates, calcium, magnesium, oxalate, phosphate and citrate ions. Results The main mineralogical phase of the stones in over 80% of patients was calcium oxalate monohydrate; none of the patients had pure dihydrate stones. The most frequent metabolic disorders were hypocitraturia, hypercalciuria and hyperuricosuria. Predominant risk factors were excessive body weight and insufficient fluid intake. Only one patient had an idiopathic stone formation. It was established for the first time that patients with calcium oxalate stones, containing 10 or more mass percent of apatites had statistically significantly lower daily urinary calcium and oxalate excretion and simultaneously increased phosphate excretion. Conclusions The study findings showed that patients with calculi based on calcium oxalate dihydrate should undergo testing for daily urinary excretion of calcium and citrate while patients with calcium oxalate stones containing 10 or more mass percent of apatites should also be tested for daily phosphate excretion and urine pH-profile. Daily urinary citrate excretion was reduced in all study patients, and urate excretion was significantly increased, apparently due to an imbalanced diet and excessive intake of animal protein. Menopausal and postmenopausal women are at a particular risk due to low urinary citrate excretion and high urinary calcium excretion regardless of stone composition.
Urologiia. 2017;(4):22-26
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Antimicrobial resistance of uropathogens in patients with acute obstructive pyelonephritis

Naboka Y.L., Gudima I.A., Mitusova E.V., Bedzhanyan S.K., Morgun P.P., Kogan M.I., Dzhalagoniya K.T., Akimenko M.A.


Relevance. Acute pyelonephritis is known to be the most complicated and severe urinary tract infection occurring in all age groups and accounting for 14% of all kidney diseases. The generally recognized standard antibiotic therapy cannot completely prevent the progression of the disease to its chronic form after relief of its acute manifestations thus leading to a high incidence of relapses. The aim of our study was to investigate the spectrum of uropathogens and their antibiotic sensitivity in acute obstructive pyelonephritis. Materials and methods. The study comprised 72 patients who underwent semi-rigid ureteroscopy and ultrasonic lithotripsy for ureteral stones. In all patients, bladder urine samples collected by a transurethral catheter were tested bacteriologically using an extended set of culture media within 3 hours after hospital admission. Antibiotics used in antibiotic sensitivity testing for all uropathogens, were grouped into 4 classes (carbapenems, fluoroquinolones, cephalosporins, penicillins). Etiotropic treatment was started upon the availability of the spectrum of microbial patterns, the level of bacteriuria and antibioticogram of uropathogens, 5-6 days after administering initial empirical antibiotic therapy. Results. The study patients had a high detection rate (83.3%) of canonical uropathogens in the bladder urine identified due to using an extended set of culture media, with a bacteriuria of ≥ 103 CFU/ mL. Given the results of local antibiograms, a rational antimicrobial therapy should include carbapenems, namely ertapenem or meropenem as initial empirical antibiotics. Using fluoroquinolones as the first line treatment can lead to an inadequate effect in 15.0 to 67.0% of the cases. The findings of the antibiotic resistance testing of uropathogens to cephalosporins and semisynthetic penicillins showed that they should not be used as initial empirical antibiotic therapy for acute obstructive pyelonephritis in the given department of urology.
Urologiia. 2017;(4):27-31
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Experience of using phytolysin in combination therapy of chronic cystitis in patients with urate nephrolythisis

Spivak L.G., Enikeev D.V., Platonova D.V.


Aim. To evaluate the effectiveness of the herbal preparation Phytolysin in the comprehensive management of urate nephrolithiasis against the background of chronic cystitis exacerbation. Materials and methods. The study comprised 21 patients aged 19 to 57; 11 of them (the study group) received ciprofloxacin 500 mg once daily for 7 days, Phytolysin (for 1 month) and Blemaren (for 3 months), while 10 patients of control group were treated with antibacterial therapy and Blemaren. The clinical evaluation of the patients included laboratory testing and ultrasound imaging. Results. The combination therapy resulted in a decrease in leukocyturia and bacteriuria. There was no tendency to relapse. The occurrence of relapse was identified by dysuria, urgent and frequent urination, suprapubic pain and results of laboratory testing (leukocyturia, bacteriuria >103) on days 15, 29, 57, 85 and 112 of the study. Conclusions. The findings suggest that the use of Phytolysin can be an effective and safe way to prevent exacerbation of chronic cystitis in patients with urate nephrolithiasis.
Urologiia. 2017;(4):32-36
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Efficacy of tamsulosin for treating lower urinary tract symptoms in patients with advanced prostate cancer

Govorov A.V., Vasilyev A.O., Pushkar D.Y.


Relevance. From the moment of their first use to the present day, α-adrenoblockers remain the most popular medication in urology. Indications for their clinical use for various pathological conditions are constantly expanding. Aim. To compare the efficacy of androgen deprivation therapy (ADT) alone and ADT with concomitant use of tamsulosin in treating lower urinary tract symptoms (LUTS), and to estimate the efficacy and safety of tamsulosin in relieving voiding dysfunction symptoms in patients with advanced PCa treated for 6 months. Materials and methods. This paper presents data from a randomized, open, single-center trial that evaluated the efficacy and safety of tamsulosin co-administered with ADT for LUTS in patients with advanced prostate cancer. The study comprised 50 people aged below 75 years. In the first group of patients (n=25), ADT was used as a monotherapy, in the second group (n=25) ADT with concurrent administration of the α-adrenoblocker. The duration of treatment was 6 months. Results. Both groups showed an improvement in the severity of LUTS, decrease in the total I-PSS score and residual urine volume and increase in the urinary flow rate. At the same time, co-administration of ADT and α-adrenoblocker resulted in greater and faster relief of LUTS than using ADT alone. There were no significant side effects in any of the groups. Conclusions. Co-administration of ADT and the α-blocker is an effective and safe treatment for advanced prostate cancer in patients with LUTS.
Urologiia. 2017;(4):37-41
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Concomitant oncopathological changes in the prostate of urinary bladder cancer patients undergoing radical cystoprostateectomy

Komyakov B.K., Sergeev A.V., Fadeev V.A., Ismailov K.I., Ul’yanov A.Y., Shmelev A.Y., Onoshko M.V.


Aim To determine the incidence of spreading bladder transitional cell carcinoma and primary adenocarcinoma to the prostate in patients with bladder cancer undergoing radical cystectomy. Materials and methods From 1995 to 2016, 283 men underwent radical cystectomy with removal of the bladder, perivesical tissue, prostate, seminal vesicles and pelvic lymph nodes. Prostate sparing cystectomy was performed in 45 (13.7%) patients. The whole prostate and the apex of the prostate were preserved in 21 (6.4%) and 24 (7.3%) patients, respectively. Results and discussion The spread of transitional cell cancer of the bladder to the prostate occurred in 50 (15.2%) patients. Twelve (3.6%) patients were found to have primary prostate adenocarcinoma. Clinically significant prostate cancer was diagnosed in 4 (33.3%) patients. Conclusion We believe that the high oncological risk of prostate sparing cystectomy, despite some functional advantages, dictates the need for complete removal of the prostate in the surgical treatment of bladder cancer.
Urologiia. 2017;(4):42-45
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Investigation of mechanisms of action of growth factors of autologous platelet-rich plasma used to treat erectile dysfunction

Epifanova M.V., Chalyi M.E., Krasnov A.O.


Aim. To determine the quantitative and qualitative composition of growth factors (PDGF-AA, PDGF-BB, VEGF, VEGF-D, FGF-acid, FGF-basic) and platelets in various modifications of APRP. Materials and methods. Blood of 12malevolunteers(controlgroup)and 12 patients with ED was used to prepare APRP and the subsequently determine the concentration of growth factors. The growth factor concentrations (FGF acid, FGF basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D) was determined using a flow cytometry-based xMAP Fuminex (Gen-Probe) system. Results. Concentration of platelets in APRP obtained by two stage centrifugation, reached 1480 (1120-1644) in the control group and 1232 (956-1502) in patients with ED. The concentration of growth factors in the samples prepared without preliminary freezing was: PDGF-AA 842 (22-3700), PDGF-BB 2837 (1460-4100), FGF-basic 7.9 (0.28-127), FGF-acid 3, 4 (0.14-11), VEGF 19 (4.6-46), VEGF-D 21 (14-38). After thawing, the concentration of all growth factors in the samples increased. Discussion. The study findings suggest that the mechanism of erectile function recovery following the use of APRP is through the active substances detected in APRP, i.e. FGF-basic, PDGF-AA, PDGF-BB, VEGF, VEGF-D and FGF-acid. Also, the study showed that the content of growth factors in APRP after of freezing/thawing is higher than in APRP that has not been frozen. This is due to the cell membrane destruction at extremely low temperatures during freezing.
Urologiia. 2017;(4):46-49
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Laser enucleation of the prostate (HOLEP and THUlEp): a comparative effectiveness analysis in treating recurrent prostatic hyperplasia

Enikeev D.V., Glybochko P.V., Alyaev Y.G., Rapoport L.M., Sorokin N.I., Enikeev M.E., Dymov A.M., Sukhanov R.B., Khamraev O.K., Taratkin M.S., Dymova A.V., Inoyatov J.S.


Introduction. The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. Aim. To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. Materials and methods. This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmax<10). All patients were divided into four groups. Groups 1 («=489) and 3 (n=153) underwent holmium (HoLEP) and thulium (ThuLEP) laser enucleations of the prostate, respectively. Groups 2 (n=23) and 4 (n=11) included patients with BPH recurrence after HoLEP (group 2) and ThuLEP (group 4). All patients underwent diagnostic evaluation at baseline and at 6 months after surgery. Results. The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). Conclusion. We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser enucleation of the prostate is not only an effective treatment for infravesical obstruction due to benign prostatic hyperplasia, but is also a method of choice in the treatment of patients with recurrent BPH.
Urologiia. 2017;(4):50-54
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Transperineal ultrasound imaging of the internal pudendal artery in arteriogenic erectile dysfunction

Povelitsa E.A., Dosta N.I., Parhomenko O.V., Nitkin D.M., Shesternja A.M., Anichkin V.V.


Aim To determine the practical and diagnostic value of transperineal ultrasound imaging of the internal pudendal artery (IPA) in patients with arteriogenic erectile dysfunction (ED). Materials and methods Transperineal IPA and penile Doppler ultrasonography was performed in 50 healthy young male volunteers aged 23.6±3.4 years without ED (IIEF-5 score of 21-22) and 60 patients with ED (IIEF-5 score of 6-18, mean age 49±4.6 years), including 30 men with prostate cancer (PCa) after comprehensive treatment and 30 patients with type 1 and type 2 diabetes mellitus. To determine the diagnostic value of the transperineal IPA imaging, the results were compared with the findings of magnetic resonance or contrast-enhanced dynamic CT angiography of the iliac arteries. Results In all healthy men no abnormalities were found in the perineal primary arterial blood flow, in 100% of cases perineal branch of IPA was rectilinear, while patients with arteriogenic ED had low IPA and penile peak systolic blood flow velocity (р<0.05), pathologically altered type of blood flow and non-rectilinear course of IPA, stenosis and occlusion in the pelvic and extrapelvic branches of IPA. When comparing the findings of IPA Doppler ultrasound and angiography studies of the small pelvis in healthy men, they completely matched, showing satisfactory arterial IPA perfusion, absence of stenoses or occlusions. Sensitivity and specificity of the transperineal IPA ultrasound imaging were 95% and 90%, respectively. Conclusion Transperineal IPA ultrasound imaging allows to assess the important morphometric features of the perineal branches of IPA - the arterial diameter, the response to stimulation, the course of the artery, the type of arterial blood flow, the presence or absence of arterial stenoses and occlusions, and to measure peak systolic blood flow velocity.
Urologiia. 2017;(4):55-61
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Effects of smoking and alcohol consumptionon reproductive and metabolic indicators in young men in western siberia

Osadchuk L.V., Popova A.V., Erkovich A.A., Voroshilova N.A., Osadchuk A.V.


Introduction Smoking and alcohol consumption remain widespread throughout the world, including Russia. Recently, due to the increase in male infertility and subfertility, special attention has been paid to the effects of smoking and alcohol on the reproductive health of young men. The aim of this study was to assess the effects of smoking and moderate alcohol consumption on spermatogenesis, reproductive hormone levels and metabolic status in young men living in Western Siberia (Novosibirsk). Materials and methods One hundred thirty-three volunteers (mean age 21.1+0.3 years) were tested for the sperm concentration, the proportion of mobile and morphologically normal spermatozoa in the ejaculate, blood serum levels of follicle-stimulating and luteinizing hormones, prolactin, testosterone, estradiol, inhibin B, triglycerides, total cholesterol, high and low density lipoprotein cholesterol, glucose and uric acid. Results and conclusions The studied lifestyle factors were found to have no effects on spermatogenesis. Smoking more than 10 cigarettes per day and a moderate frequency of alcohol consumption (up to 1 time per week) was associated with higher blood serum testosterone levels and engaging in more frequent sexual contacts compared to non-smoking and non-drinking men. Drinking alcohol more than once a week and smoking more than 8 cigarettes per day was associated, along with the increase in testosterone levels and the frequency of sexual contacts, with lower levels of follicle-stimulating hormone and higher serum triglyceride levels. Thus, in young men, frequent drinking and smoking can alter the hormonal and metabolic balance, which, as the duration of the exposure and the strength of the factors increase, will increase the risk of reproductive disorders.
Urologiia. 2017;(4):62-67
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Buccal mucosa transplant - the concept of «ideal graft» in surgical management of peyronie’s disease

Kotov S.V., Yusufov A.G., Semenov M.K.


Introduction. Surgical techniques in managing Peyronie’s disease include plication corporoplasty, plaque incision, grafting and penile prosthesis implantation. The question of an ideal transplant for corporoplasty remains open. Aim. To evaluate the effectiveness of the substitution corporoplasty using buccal mucosa transplant (BMT) in treating Peyronie’s disease. Materials and methods. From January 2011 to February 2016, 28 patients with stable stage Peyronie’s disease underwent substitution coroproplasty using BMT (incision and grafting). The mean age of patients was 54.8±6.2 years. All patients completed an IIEF-5 questionnaire and underwent a standard preoperative examination: anamnesis, physical examination, penile duplex pharmaco-ultrasonography and penile fixation photography to assess the type and angle of curvature. The average angle of penile curvature was 82.8° (45-120°). All patients underwent incision and grafting using BMT; in 5 patients additionally the plication of the penile tunica albuginea was performed. Follow-up examinations were concluded at 3, 6 and 12 months and more after surgery. Results. Median follow-up was 30 months. Postoperative penile straightening was achieved in 93% of patients. The duplex peak systolic velocity of the right and left cavernosal arteries improved from 42.59 to 45.64 cm/s and from 34.55 to 43.48 cm/s, respectively (p<0.05). Conclusion. Penile corproroplasty using BMT is a safe and effective method of treating patients with Peyronie’s disease. Follow-up clinical and instrumental examination showed no impairment of the erectile function or penile hemodynamics.
Urologiia. 2017;(4):68-72
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Application of 3D printing in urology

Alyaev Y.G., Bezrukov E.A., Fiev D.N., Sirota E.S., Pesegov S.V., Byadretdinov I.S.


The purpose of this article is to outline the role and possible applications of 3D printing in urology. At present, this technique provides the opportunity to choose the individual strategy of patient management, to conduct preoperative planning and surgical rehearsal; for medical specialists to reduce the learning curve in mastering modern complex surgical techniques, and for doctors and students to improve understanding of pathological processes in the kidney and the prostate gland.
Urologiia. 2017;(4):73-78
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Molecular and cellular mechanisms of damage to renal parenchyma in renal warm ischemia

Popov S.V., Guseinov R.G., Martov A.G., Muratov T.M., Tabynbaev N.B.


Warm ischemia of the renal parenchyma is a forced feature of laparoscopic partial nephrectomy. It is accompanied by oxygen deprivation of the organ and followed by re-oxygenation, which can cause additional damage to the renal tissue. This damage can result in acute functional and structural disorders of individual parts of the nephron, increasing the risk for a renal dysfunction. Timely diagnosis of the dysfunction is vital for the success of the treatment. The article provides an overview of current scientific data on the mechanisms of ischemic and reperfusion injuries at the molecular-cellular level and describes the current methods of their detection. Experimental and clinical study of the molecular-cellular mechanisms of ischemic-reperfusion injury of the renal tissue made it possible, first, to determine the main targets of alteration (cytolemma, mitochondria, lysosomes), and second, to establish its consequences, among which the most important are hypoergosis, DNA damage, simultaneous activation of intracellular systems of the suicidal program and induction of electrical breakdown of membranes of target nephrocytes; thirdly, to reveal the range of possibilities for limiting the consequences of hypoxia and/or re-oxygenation, among which interference in the metabolism of purines, measures ensuring the preservation of colloid osmotic pressure inside and outside the cell and membrane stabilization, antioxidant defense and inhibition of cysteine proteinases, etc. However, despite the advances in understanding the pathogenesis of cell damage, including ischemic-hypoxic injury, the problem of intraoperative ischemia-reperfusion safety remains relevant.
Urologiia. 2017;(4):79-84
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Local recurrence of prostate cancer after radical prostatectomy

Petrovskii N.V., Glybochko P.V., Alyaev Y.G., Amosov A.V., Krupinov G.E.


The article presents an analysis of domestic and international literature on local recurrence of prostate cancer after radical prostatectomy. The authors describe the most advanced methods of diagnosis and treatment of local recurrence commonly used in clinical practice.
Urologiia. 2017;(4):85-90
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The role of fosfomycin in the management of urinary tract infections

Zaitsev A.V., Kolontarev K.B.


The article analyses major guidelines on the management of uncomplicated cystitis. The authors outline and substantiate the role of fosfomycin in the management of urinary tract infections. They provide current evidence on the resistance of uropathogens, including those producing extended-spectrum β-lactamase. Combination therapy (fosfomycin + β-lactams or aminoglycosides) is often used to treat infections caused by multiresistant microorganisms. The possibility of using fosfomycin for perioperative prophylaxis of UTI during endourologic operations and transrectal prostate biopsy is shown.
Urologiia. 2017;(4):91-96
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Sling procedures to treat urinary incontinence in the Russian Federation

Gvozdev M.Y., Pushkar D.Y.


Surgical treatment of urinary incontinence using synthetic slings is one of the most frequently used procedures in modern urogynecology. The availability of almost identical surgical sets manufactured by different companies can at times significantly hamper the choice of a synthetic sling for a particular patient. This article presents a brief overview of the literature on the efficacy and safety of sub-urethral synthetic slings registered in the Russian market.
Urologiia. 2017;(4):97-101
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Cell technology in the treatment of male infertility caused by nonobstructive azoospermia

Epifanova M.V., Chalyi M.E., Pereverzina N.O., Artemenko S.A.


The article is devoted to new methods for treating male infertility caused by nonobstructive azoospermia using different cells technologies: spermatogenic stem cells (SSC), mesenchymal stem cells (MSCs), platelets rich plasma (PRP), Stromal Vascular Fraction (SVF) as well as the creation of «artificial sperm» from somatic cells. In recent years, increased interest in these methods because of their high efficiency at a high level of security. At the same time, efficacy and safety of these technologieshas not yet been clinically studied from the perspective of evidence- based medicine.
Urologiia. 2017;(4):103-106
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Reflux nephropathy in children: early diagnosis and monitoring

Morozova O.L., Morozov D.A., Lakomova D.Y., Iakovlev V.V., Rostovskaya V.V., Budnik I.A., Maltseva L.D.


Vesicoureteral reflux (VUR) is the most common type of obstructive uropathy in children. Reflux nephropathy (RN) is one of the most common complications of VUR that inevitably leads to chronic kidney disease. Patients with end-stage kidney disease require costly treatment, and the only way to cure them is kidney transplantation. A timely institution of renoprotective therapy is a key factor helping to preserve the function of the native kidneys. Hence, it is necessary to devise new highly sensitive and minimally invasive methods for early diagnosis of RN. The purpose of this article is to review the molecular mechanisms of initiation and progression of kidney fibrosis and the opportunities of instrumental and non-instrumental methods for its diagnosis. Special attention is paid to highly specific and highly sensitive non-invasive methods for the detection of minimal changes in the renal parenchyma. The authors discuss the promising biomarkers for the diagnosis and prediction of RN.
Urologiia. 2017;(4):107-112
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Complications of contact ureteral lithotripsy

Mamedov E.A., Dutov V.V., Bazaev V.V.


Shows the current real time terminology and variants of systematization and grading of complications of contact ureteral lithotripsy (CULT). Research papers related to complications of CULT published over the last three decades were analyzed. Currently there is no clear terminology, classification, systematization and grading of CULT complications. The terms used are deficient because they do not adequately characterize specific complications of CULT. For example, some researchers define a complete ureteral avulsion as a defect at two levels, but others interpret it as a defect of the ureter at only one level. And the use of such terms as extravasation of the contrast media and/ or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureter wall. Therefore, these conditions are complications not of CULT but of the ureteral wall perforation. Presently, the classical classification of CULT cannot be adequately used, since it is low-structured. Universal instruments (PULS, Satava, Clavien-Dindo) have low specificity and sensitivity to CULT complications and limited possibilities of their application. Both developers of different scales of systematization of CULT complications (PULS; Satava; Clavien-Dindo) and EAU consider further international randomized studies warranted for their greater integration and adaptation.
Urologiia. 2017;(4):113-119
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Combination therapy for benign prostatic hyperplasia in the light of clinical guidelines

Vinarov A.Z., Spivak L.G., Mironov A.V.


The article reviews clinical trials on the effectiveness of combination therapy with 5a-reductase inhibitors and a-blockers in men with benign prostatic hyperplasia (BPH). These trials have demonstrated a significant improvement in the symptoms and quality of life in this group of patients. The authors outline main strategies offered by the Russian clinical guidelines for BPH patients.
Urologiia. 2017;(4):120-128
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Prostate cancer of high oncological risk. Current trends in diagnosis and surgical treatment

Bezrukov E.A., Rapoport L.M., Shpot’ E.V., Enikeev M.E., Morozov A.O.


A group of patients with high risk prostate cancer was identified in the late 1990s. Since then, management of this group of patients has undergone some serious changes. The article provides a brief overview of the most significant changes, primarily in surgical treatment, over the past 3 years. Besides, the authors present their views on perspective treatments and possible changes in the near future.
Urologiia. 2017;(4):129-134
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