No 2 (2018)

Relevance. The prevalence of urolithiasis and osteoporosis (OP) indicates that these diseases may be found concurrently in the same patient. The detection of risk factors for OP and disorders of calcium metabolism in patients with urolithiasis is of interest in the context of primary stone formation and metaphylaxis. Aim. To identify risk factors for osteoporosis and disorders of calcium metaboIism in patients with uroIithiasis. Materials and methods. Osteoporosis risk factors were studied in 45 urolithiasis patients undergoing surgical treatment. Patients were asked to fill out the osteoporosis risk factor questionnaire, and urinary calcium excretion was measured in 24-h coIIections. Results Risk factors for osteoporosis were detected in 20 (44.4%) uroIithiasis patients. Patients with osteoporosis risk factors identified by the questionnaire were statistically significantly older (p=0.032). Osteoporosis risk factors were found in 20% of patients with newly diagnosed urolithiasis and 24.4% of patients with recurrent urolithiasis. The study patients showed increased urinary calcium excretion and decreased diuresis. The negative correlation between urinary calcium excretion and 24-h diuresis was greater in patients who had than in those who did not have osteoporosis. Conclusion. An increase in urinary calcium excretion and a decrease in diuresis can be a predisposing factor for the recurrence of urolithiasis. In patients with risk factors for osteoporosis, it can provide a rationale for administering drugs aimed at preventing stone formation (thiazide diuretics).

Aim. To investigate the role of structural changes of the urinary bladder extracellular matrix in the occurrence of different grades of adverse events after radiation therapy. Materials and methods. The connective tissue matrix was studied using 126 images obtained from the histological sections of the bladder biopsy specimens of 12 patients classified according to the clinical presentation and the grades of late bladder toxicity according to RTOG/EORTC Late Radiation Morbidity Scoring Scheme. Control images of the normal bladder (n=23) were collected from the autopsy samples. We used nonlinear microscopy imaging method capturing the second harmonic generation (SHG) signal and two-photon excitation auto-fluorescence (TPEA). Results. The findings of nonlinear microscopy of urinary bladder histological sections showed that the structural changes in the connective tissue differed depending on the grade of adverse events: grade II adverse events were associated with the preservation of the structure of collagen fibers and their compression, grade III adverse events caused pronounced disorganization of collagen fibers, blurring without a definite fiber direction. At the same time, in a normal bladder, the structure of collagen fibers was visualized; they had a spiral shape and in some areas were collected in bundles. Collagen fibers and bundles were loosely arranged and accompanied by elastic fibers. The findings suggest that the grade of urinary bladder radiation injury correlates with the data detected by nonlinear microscopy. Discussion. The mosaic structure of radiation-induced alterations of the bladder tissue, even in the areas most affected by radiation (posterior bladder wall, bladder trigone, and bladder neck) indicates that patients with radiation-induced high-grade toxicity need comprehensive care designed to preserve the bladder functional reserves and capacity. The prevention of radiation-related adverse events before radiation therapy should be based on urologic care aimed to detect and treat chronic inflammatory diseases of the bladder and preserve its functional reserves. Another way to improve outcomes is to optimize the management of adverse events. Conclusion. The examination of bladder tissue specimens taken from different parts of the bladder carried out using nonlinear microscopy in the SHG and TPEA modes revealed that the degree of structural changes in the connective tissue matrix in the post-radiation period varies and correlates with the grades of the radiation bladder toxicity. The results of this study can be used to substantiate measures to prevent the onset of high-grade toxicity after radiation therapy of pelvic malignancies.

Introduction. Traditionally, evaluation of the split renal function is performed using nephroscintigraphy. However, as shown in several studies, there might be quite significant inaccuracy in the interpretation ofdynamic nephroscintigraphy results. But due to the lack of alternative methods for evaluation of split renal function, nephroscintigraphy remains the method of choice. Aim. To investigate the feasibility of digital analysis of contrast-enhanced MSCT imaging for evaluation of the split renal function. Materials and methods. This is a prospective study conducted at the R.M. Fronshteyn Clinic of Urology from November 2015 to February 2017. The study comprised 31 patients with urolithiasis (n=7), hydronephrosis (n=9), kidney cancer (n=14) and urinary bladder tumor (n=1). During the preoperative period, the patients underwent contrast-enhanced MSCT, 3D-reconstruction, and digital analysis. The obtained data were compared with the results of dynamic nephroscintigraphy. Results Contrast-enhanced MSCT findings were not inferior to data obtained with dynamic nephroscintigraphy regarding information content (p<0.004). Conclusions. The new method of digital processing of three-dimensional contrast-enhanced MSCT allows for concomitant assessment of both the anatomical features of the kidney and renal function that may help to improve the accuracy of surgical planning to choose the optimal extension of the intervention.

Aim. To investigate the impact of ureteral stent surface on encrustation and biofilm formation. Materials and methods. Polyurethane stents of two manufacturers were examined using the scanning electron microscopy and scanning probe microscopy before use and three weeks after their initial ureteral placement in patients with no evidence of a urinary tract infection and urolithiasis. Results. In one case, there were irregularities in the form of pyramids with a height of 0.15+0.02 ^m with a tendency to occur at regular intervals, forming ordered rows, with a density of 2.67 per 10 ^m2. The cross-sectional area of the irregularities in the probe displacement direction was 1.015 ^m2, after use - 1.271 μm2 (25.2% increase). In another case, pyramids with a height of 0.39+0.03 μm (p<0.0001) were detected without the pattern of repetition in the form of a network, the density was 3.31+10 μm2. The cross-sectional area of the irregularities was 1.158 and 2.29 ^m2, respectively (an increase of 97.8%). In the first case, after three weeks of stent placement, the pyramids increased twofold, were amenable to counting, the biofilms had the appearance of scattered «loose» formations. In the second case, there were polygonal conglomerates of salts dozens of times larger than the primary elements; biofilms had the appearance of well-formed massive layers. Conclusion The nature of the ureteral stent surface exerts a direct independent effect on the degree of encrustation and the formation of biofilms.

Relevance. Erectile dysfunction (ED) is a common condition. Pharmacological management of ED involves medications produced by chemical synthesis. Despite high efficiency, their use is often accompanied by some side effects. Considering this, herbal preparations with sufficient efficacy and greater safety have received much attention. Aim. To compare the efficacy and safety of two herbal preparations (EFFEX Tribulus and Tribestan) based on Tribulus Terrestris herb dry extract in patients with ED. Materials and methods. A total of 173 patients were enrolled in the study, of whom 87 (group I) and 86 (group II) received EFFEX Tribulus and Tribestan, respectively. The mean age of patients was 42.2+11.5 years in group I and 42.8+11.2 years in group II. One hundred fifty two patients completed the study. The follow-up was 13 weeks (the herbal preparation dose was titrated at week five after the treatment initiation). The effectiveness of treatment was assessed on five follow-up visits using the IIEF, AMS, MSF, GAQ questionnaires, and a complex of diagnostic and laboratory studies. Results. At visit five compared to visit 1, the mean IIEF erectile function domain score increased by 5.7+4.6 and 5.2+4.3 points in group I and II, respectively. In both groups, all other IIEF domain scores demonstrated a statistically significant increase. The AMS scores decreased from 32.93+10.04 to 25.02+7.62 points in group I and 31.78+10.37 to 24.55+7.31 points in group II. The SMF scores increased from 22.36+4.85 to 27.16+4.80 points in group I and from 22.13+3.69 to 26.10+5.69 points in group II. Besides, the use of the herbal preparations was associated with a decrease in the serum cholesterol level, more pronounced with increasing patient age (correlation coefficient -0.06, p=0.41). Conclusion. The herbal preparations EFFEX Tribulus and Tribestan have a similar efficacy and safety profiles.

Patients and methods. The study comprised 7000 patients with a verified diagnosis of lower urinary tract symptoms/benign prostatic hyperplasia who received Omnic Ocas (tamsulosin) administered by 700 urologists in various Russian medical institutions. The mean age of the patients was 63 years. The study program involved three visits. At the baseline visit, patients filled out the IPSS and EQ-5D-5L questionnaires, provided a blood sample for PSA, and underwent a digital rectal examination. At visits 2 and 3 scheduled at 3 and 6 months after visit 1 the patients were assessed for the outcomes of the prescribed therapy. Results. During the 6-month treatment, the patients showed an improvement in the IPSS in the study's age groups. There was a gradual improvement in the storage and voiding symptoms subscale scores of the IPSS. The assessment of the EQ-5D-5L questionnaire results showed significant changes in the quality of life regarding various aspects of life. Adverse events were reported in 0.51% of patients during the study follow-up. Conclusion. The study findings suggest that Omnic Ocas is highly effective in all age groups of patients with LUTS/BPH and has a favorable safety profile.

Introduction. The duplex kidney is one of the most common congenital abnormalities of the urinary tract, and various surgical procedures exist for the management of this condition. Depending on the surgeon preferences, patients with duplex kidney may undergo heminephrectomy with ureterectomy using open or laparoscopic approach, uretero-cysto-anastomosis of the ectopic ureter or two ureters in a single block. Recently, there have been reports of inter-ureter anastomoses. Here we report our multicenter experience in open and laparoscopic uretero-ureteral anastomosis (UUA). The study aimed to improve the treatment results in children with urodynamic dysfunction due to the duplicated upper urinary tract. Materials and methods. We retrospectively analyzed medical records of 64 children treated from 2007 to 2017. There were 22 (32.8%) boys and 43 (67.2%) girls with mean age 40.2 months at the time of surgery. All of them had duplex kidneys, including 27 (42.2%) right-sided and 37 (57.8%) left-sided. Of them, 15 (23.4%) children underwent distal UUA (DUAA), and 49 (76.6%) had proximal UUA (PUUA). Results. After surgery, acute pyelonephritis occurred in three patients. In the early postoperative period, a prolonged urinary leakage from surgical site drainage was observed in three (6.1%) patients after laparoscopic PUUA. One (4.2%) child developed a stumpitis. Thus, complications occurred in 7 (10.9%) children; one of them (1.6%) needed additional treatment. Conclusion. Distal and proximal UUA is a safe and effective surgical treatment for urinary outflow disorders in patients with the duplicated upper urinary tract, minimizing the risk of the duplex kidney dysfunction.

Aim. To improve treatment results of children undergoing laparoscopic genitourinary surgery by optimizing intraoperative hemostasis. Materials and methods. The study comprised 110 children with various genitourinary diseases. The study group included 70 children who underwent laparoscopic surgery with optimized hemostasis with the use of an automated electrosurgical vessels ligation device LigaSure. Forty children who received standard intraoperative hemostasis with mono- or bipolar coagulation made up a control group. Results. The operative time was significantly shorter with the optimized method of hemostasis than when using mono- and bipolar coagulation [77.02 min versus 112.5 min (p<0.05)]. The blood loss in the study group was also significantly lower than in the control group [17.9 and 34.2 ml, respectively (p<0.05)] due to precise control and final hemostasis. There were no intraoperative complications and conversion to open surgery in patients in the optimized hemostasis group, whereas in the control group two complications were observed. Conclusion. Laparoscopic urogenital surgery with the optimized hemostasis using the automated electrosurgical vessels ligation device LigaSure in children is optimal due to the minimal injury to the coagulated tissues, the ability to forgo clipping and ligation of the vessels, which results in shorter operative time and reduced intraoperative blood loss.

This article presents a case study of a female patient with primary immunodeficiency, who underwent percutaneous nephrolithotripsy. The presence of a serious concomitant disease affects different aspects of preoperative and postoperative management of the patient. The choice of percutaneous nephrolithotripsy is necessitated by the need to render the patient stone free using a one-stage and the most effective surgical modality. The article describes the choice of antibacterial therapy to treat inflammatory complications in this category of patients. Broad-spectrum antibiotics should be used to prevent the onset of pyelonephritis, while pyelonephritis exacerbation requires administration of reserve antibiotics in combination with human immunoglobulin.

This literature review focuses on the use of Serenoa repens extracts in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Extracts of Serenoa repens produce marked anti-inflammatory, anti-androgenic and antiproliferative effects. Various extracts differ in their activity depending on the concentration of free fatty acids and the method of extract preparation. Extracts of Serenoa Repens from different manufacturers vary considerably in composition, effectiveness and supporting evidence. Evaluation of the effectiveness of Serenoa Repens extracts should be carried out for each extract separately, depending on the method of preparation and brand. The most studied and clinically effective is the hexane lipidosterol extract of Serenoa Repens Permixon. This assessment is supported by a report on Serenoa Repens, issued by the European Medicines Agency. In this report, only Serenoa repens hexanic extract Permixon is considered to be a well-established medical use product for the symptomatic treatment of BPH.

This literature review outlines the most common methods of diagnosis of benign prostatic hyperplasia. Promising diagnostic modalities include uroflowmetry, assessment of International Prostate Symptom Score (IPSS), transrectal ultrasound and prostate elastography. The authors address social implications and epidemiological features of the disease in Russia and developed countries.

Internal drainage of the upper urinary tract by stenting is a common urological procedure. The use of stenting in modern urological practice is on the rise due to widespread adoption of modern endourological, laparoscopic, percutaneous and high-tech robotic interventions. The presence of a stent in the patient’s body may cause stent-related symptoms and negatively affect the quality of life, resulting in additional outpatient visits and hospitalizations. The review provides an analysis of the causes, diagnostic evaluation, prevention and treatment of stent-related symptoms. The authors describe the management options including a-blockers, anticholinergics, and their combinations.

Currently, transurethral resection of a bladder tumor (TUR) is the gold standart treatment for non-muscle invasive bladder cancer (NMIBC). Standard TUR for a bladder wall tumor has a high recurrence rate, which is caused mainly by malignant cell implantation during the surgery. Besides, specimens obtained with conventional TUR are insufficient for accurate pathological staging. The nonconformity of the standard TUR with the established oncological principle of dissecting through normal tissue prompted a search for the optimal surgical modality. En-bloc resection of the bladder wall tumor has been proposed as an alternative method for surgical management of NMIBC. This technique involves the resection of bladder tumor through the underlying muscle layer as a single piece thus providing high quality material for subsequent morphological study and reducing the risk of metastasizing by implantation of malignant cells. This paper presents an analysis of relevant research literature published in the last twenty years, describes all currently existing techniques of the bladder tumor resection using a variety of energy sources, including laser.

This article pays tribute to Anatoly Pavlovich Frumkin on the 120th anniversary of his birthday. It describes his life, the creative scientific path of a prominent researcher, military urological surgeon, founder of a urological school and the first in the Soviet Union Head of the Department of Urology at the S.P. Botkin hospital, author of fundamental studies in the field of military urology, endoscopic and radiologic diagnostics in urology, the founder of the first in the Soviet Union Department of Pediatric Urology at the St. Vladimir Children’s Hospital.