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No 2 (2018)


Characteristic features of urinary calcium excretion and osteoporosis risk factors in patients with urolithiasis

Demidko L.S., Rudenko V.I., Grigoryan V.A., Demidko Y.L., Enikeev M.E., Inoyatov Z.S., Amosova M.V.


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).
Urologiia. 2018;(2):5-8
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Management of urinary bladder radiation injury

Loran O.B., Sinyakova L.A., Nezovibat’ko Y.I., Plesovskii A.M.


Aim. To investigate the role of hyperbaric oxygen therapy in the management of patients with radiation induced urinary bladder injury (radiation cystitis). Materials and methods The study comprised 23 patients with late radiation induced urinary bladder injury who were evaluated and treated using hyperbaric oxygen therapy and bladder instillation. Before and after treatment, all patients underwent cystoscopy with the bladder mucosa biopsy.- Results. In all patients, the treatment resulted in positive outcomes manifested by resolution of hematuria, alleviation of dysuria, decrease in urination frequency to 6.5 ± 0.5 times a day, increase the bladder capacity, which ultimately improved patients’ the quality of life. Hyperbaric oxygen therapy was well tolerated, there were no adverse effects. Morphological studies confirmed positive clinical changes following hyperbaric oxygen therapy. Conclusion The study findings support wider use of hyperbaric oxygen therapy in the management of radiation cystitis.
Urologiia. 2018;(2):9-13
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The role of structural changes of the urinary bladder extracellular matrix in the occurrence of different grades of adverse events after radiation therapy

Strel’tsova O.S., Dudenkova V.V., Maslennikova A.V., Kiseleva E.B., Tararova E.A., Yunusova K.E., Sinyakova L.A.


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.
Urologiia. 2018;(2):14-19
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Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women

Neimark A.I., Yakovleva A.Y., Lapii G.A.


Aim. To evaluate the effectiveness ofa new method of treatment for stress urinary incontinence in women using an ER: YAG laser in SMOOTH mode and investigate pathophysiological and pathomorphological changes induced by erbium laser. Materials and methods. This study comprised 98 women aged 37-63 years, who between 2014 and 2016 were diagnosed with SUI (type 1 and 2a, 2b) and grade 0-2 vaginal prolapse. The treatment was performed with a 2940 nm Er:YAG laser (Fotona, Slovenia) using a SMOOTH mode. Clinical assessment included PFIQ-7 and PISQ-12 questionnaires, uroflowmetry, laser Doppler flowmetry and biopsy of the anterior vaginal wall. The examination was carried out at baseline and 1-2 months after the treatment. Results. The effectiveness of treatment was 73%. There was no deterioration after the procedure. Analysis of PFIQ-7 and PISQ-12 questionnaires showed that patients with mild incontinence had the greatest difference between pre- and posttreatment results. Uroflowmetry parameters improved in a majority of patients. Results of laser Doppler flowmetry demonstrated the improvement of blood flow in the microvascular bed. An important feature of the vaginal biopsy after laser exposure was an increase in neoangiogenesis. Discussion. The findings of questionnaires and clinical evaluation of patients with SUI and vaginal prolapse before and after treatment with Er: YAG laser showed high therapeutic effectiveness of this treatment modality. Conclusion. Clinical effectiveness of ER: YAG laser in SMOOTH mode was 73%. Patients with type 1 and 2a SUI and mild or moderate incontinence have the best prognosis after treatment with this method.
Urologiia. 2018;(2):20-25
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A new method of evaluation of split renal function based on contrast-enhanced multislice spiral computed tomography

Alyaev Y.G., Dzeranov N.K., Khokhlachev S.B., Borisov V.V., Fiev D.N., Demidko Y.L., Proskura A.V., Yurova M.V.


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.
Urologiia. 2018;(2):26-33
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Subcapsular renal hematomas after ureteroscopic lithotripsy

Guliev B.G., Komyakov B.K., Zaikin A.Y.


Introduction. Renal hematomas (RH) are a rare complication of retrograde endoscopic lithotripsy (REL). This study aimed to investigate the incidence and causes of RH after REL in patients with ureteral stones of different locations. Materials and methods. From 2001 to 2016, 1214 REL were performed at the Urology Clinic of the Mechnikov NWSMU. The analyzes of patients who had RH after REL included the following parameters: age, gender, history of upper urinary tract (UUT) surgery and concomitant diseases (diabetes mellitus, hypertension), the baseline kidney function, the stone characteristics and the degree of hydronephrosis observed in the postoperative period, results of laboratory tests, ultrasound and spiral computed tomography (SCT) of the kidneys. Results. Renal hematomas were diagnosed in 4 (0.3%) of 1214 patients aged 36 to 50 years who had obstructive upper ureteral stones measuring from 0.8 to 1.2 cm in diameter. Three of them previously had UUT surgery: two had REL, and one female patient with a solitary left kidney twice underwent percutaneous nephro- and ureterolithotripsy. All four patients had a triad of symptoms: side flank pain, fever, and anemia. In three patients hematomas were diagnosed on day 2-3 and in one it was found two weeks after the surgery. Two of them were managed with conservative therapy, including bed rest and antibiotics. One patient underwent an ultrasound guided puncture and drainage of the hematoma. In the patient with a solitary kidney, laparoscopic drainage of RH was performed due to growing hematoma and aggravating renal insufficiency. Two patients received blood transfusions. Follow-up kidney SCT showed complete resolution of hematomas in all patients. Conclusion. Renal hematomas are a rare but serious complication of REL. The presence of side flank pain, fever and anemia may be indicative of REL and requires a kidney ultrasound. Management of RH should be patient specific, depending on the severity of the patient’s condition.
Urologiia. 2018;(2):34-39
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The impact of ureteral stent surface on encrustation and biofilm formation

Tsukanov A.Y., Akhmetov D.S., Blesman A.I., Rogachev E.A.


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.
Urologiia. 2018;(2):40-45
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Evaluation of upper urinary tract function in patients undergoing autoplastic surgery for hydronephrosis of the intrarenal pelvis

Kurbanaliev R.M., Usupbaev A.C., Kolesnichenko I.V., Sadyrbekov N.Z., Sultanov B.M.


Aim. To investigate the functional state of the upper urinary tract in patients undergoing autoplastic surgery for a hydronophrosis of the intrarenal pelvis. Material and methods. The study comprised 78 patients with the intrarenal pelvis and impaired urinary outflow due to stricture of the ureteropelvic junction and vascular conflict (interatrial and arteriovenous narrowing), who underwent pyeloplasty using autologous tunica vaginalis. All patients underwent an incision of ureteropelvic stricture and resection of the parietal layer of the tunica vaginalis which was used to repair the obstruction site and internal stenting of the upper urinary tract. Results. The patients were examined at baseline and during follow-up ranging from 3 months to 3 years. At three months after surgery, there was a decrease in the size of the renal pelvis and calyces with an improvement of all parameters of uro- and hemodynamics. At three years after surgery, the structural and functional parameters of the upper urinary tract were completely restored. Conclusion. Obstructive uropathy, resulting from the intrarenal pelvis, leads to persistently impaired urinary outflow from the upper urinary tract. Surgical intervention is the only curative treatment able to restore the urinary flow. In men with the intrarenal pelvis, the autoplastic surgery of the ureteropelvic junction obstruction using a parietal layer of the tunica vaginalis is an effective surgical modality improving renal pelvis capacity and contributing to the recovery of urinary outflow from the upper urinary tract.
Urologiia. 2018;(2):46-53
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Results of a comparative multi-center randomized clinical study of efficacy and safety of EFFEX Tribulus and Tribestan in patients with erectile dysfunction

Spivak L.G., Platonova D.V., Enikeev D.V., Rapoport L.M., Vinarov A.Z., Demidko Y.L.


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.
Urologiia. 2018;(2):54-61
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The effects of combination therapy with 5a-reductase inhibitor and a-blocker on the prognosis of BPH

Neimark A.I., Davydov A.V., Aliev R.T.


Introduction. Benign prostatic hyperplasia (BPH) is a polyethological disease of elderly and old men. The symptomatic pharmacological treatment of BPH involves the use of drugs that reduce either the dynamic component of obstruction or the size of the prostate (a mechanical component of obstruction). 5a-reductase inhibitors (5-ARI) and a-blockers are considered first-line therapy in the management of prostate adenoma. Aim. To investigate the efficacy of combination therapy with Fokusin and Penester in BPH patients. Materials and methods. The study is based on the analysis of medical records of 67 BPH patients aged over 50 years. All patients included in the study were randomized to 3 groups and had comparable age, sex, clinical manifestations and severity of the disease. Group 1 comprised 21 patients (mean age 63.8+9.7 years), who received a 5a-reductase inhibitor (5 -ARI) Pentester (Sanofi, France) 5 mg once daily. Group 2 included 22 patients (mean age 65.2+7.8 years), who received an a-blocker Fokusin (Sanofi, France) 0.4 mg once a day. Group 3 comprised 24 patients (mean age 64.2+8.6 years) who received combination therapy with 5a-reductase inhibitor (5-ARI) (Penester 5 mg once daily) and a blocker (Fokusin 0.4 mg once daily). Results. The study findings showed that in comparison with monotherapy, the concurrent administration of Fokusin and Penester was more effective in reducing the clinical manifestations of BPH, slowing the growth of adenomatous tissue thus reducing the size of the enlarged prostate. Conclusion. Combination therapy with Fokusin and Penester can be recommended to improve the treatment results of BPH patients.
Urologiia. 2018;(2):62-66
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The effectiveness and safety of Omnik OCAS in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in the routine clinical practice in the Russian Federation (prospective multi-center observing program)

Loran O.B., Seregin A.A.


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.
Urologiia. 2018;(2):68-74
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Erectile dysfunction associated with radical prostatectomy: appropriateness and methods to preserve potency

Shpot’ E.V., Chinenov D.V., Amosov A.V., Chernov Y.N., Yurova M.V., Lerner Y.V.


Relevance. Erectile dysfunction (ED) associated with radical prostatectomy (RP) affects 25-75% of patients and has a significant negative impact on their quality of life Aim. To analyze the maintenance of erectile function after RP depending on the type of endoscopic access and nerve-sparing. Materials and methods. This retrospective study comprised 231 patients with localized prostate cancer, who underwent surgery between February 2015 and February 2016. Surgery was performed using one of three approaches: laparoscopic, extraperitoneoscopic or robot-assisted. Nerve-sparing surgery was chosen were based on the Briganti nomogram (low risk of extraprostatic extension), Partin’s table, and taking into account the patient’s desire to maintain EF. EF and the quality of life were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire and the QoL (Quality of Life) scale. Results. Nerve-sparing RP was performed in 153 patients. Nerve-sparing RP did not differ significantly from non-nerve sparing RP with regard to operative time (p=0.064) and blood loss (p=0.073). According to the pathomorphological study, the prostatic capsule was intact, and surgical margins were negative in all cases. The incidence of significant ED and complete loss of erectile function was greater in patients after non-nerve sparing RP compared with nerve sparing RP [(5.0 (0-10.0) vs. 6.5 (0.8- 19,0) points according to the IIEF-5 scale, p=0.271)]; 96.2% versus 72.2% (p<0.001). Nerve-sparing RP had a statistically significant better effect on the quality of life: 1.63+1.16 points against 1.88+1.02 points (p=0.035). Conclusion. The best outcomes were observed in patients undergoing robot-assisted RP. Nerve-sparing RP resulted in a lower rate of ED. This advantage without compromising the completeness of resection allows us to consider nerve-sparing RP as an appropriate and validated modality of preventing erectile dysfunction in properly selected patients.
Urologiia. 2018;(2):75-82
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Uretero-ureteral anastomosis (ureteropyeloanasto-mosis) for the duplicated upper urinary tract in children

Kagantsov I.M., Sizonov V.V., Dubrov V.I., Bondarenko S.G., Akramov N.R., Shmyrov O.S., Kuzovleva G.I., Surov R.V., Logval’ A.A.


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.
Urologiia. 2018;(2):83-88
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The volume of the contralateral testis in unilateral non-palpable cryptorchidism - a diagnostic criterion to optimize surgical strategy

Orlov V.M., Kogan M.I., Sizonov V.V., Kagantsov I.M.


Aim. Given the need to reduce the number of unnecessary laparoscopies, this study aimed to calculate the threshold values of contralateral testicular volume in unilateral non-palpable cryptorchidism to optimize diagnosis and surgical strategy. Materials and methods. From 2010 to 2016, contralateral testicular volume was prospectively evaluated in 78 patients aged under nine years with unilateral non-palpable cryptorchidism. The volume of healthy testes was calculated by multiplying length * width * height * 0.71. The patients were divided into two groups. Group 1 comprised 41 (52.6%) children with inguinal or intra-abdominal testes, who underwent orchiopexy for undescended testis. The second group consisted of 37 (47.4%) patients with severely hypoplastic testes that needed to be removed, or with testicular aplasia. In both groups, we matched the age (in months) at the time of surgery and the volume of the contralateral testis. Logistic regression was used to develop the diagnostic model. For the model, the ROC-curve (Receiver Operating Characteristic) was constructed, and the threshold of the contralateral testicular volume was selected. Results. All patients with contralateral testicular volume greater than 2.25 ml had testicular aplasia, or hypoplasia (sensitivity 100.0%, specificity 73.0%). All patients with a contralateral testicular volume less than or equal to 1.04 ml had inguinal or intra-abdominal testes (specificity of 100%, the sensitivity of 34%). The area under the ROC curve calculated to assess the quality of the model was 92.6%, suggesting the high predictive power of the model. Conclusion. Revision scrototomy is indicated in patients with testicular volume exceeding 2.26 ml, while diagnostic laparoscopy is the optimal primary intervention in patients with the contralateral testicular volume of less than or equal to 1.04 ml.
Urologiia. 2018;(2):89-93
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Using various methods of intraoperative hemostasis in laparoscopic genitourinary surgery in children

Turov F.O., Yatsyk S.P., Poddubnyi I.V., Glybina T.M., Bespalyuk O.I.


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.
Urologiia. 2018;(2):94-99
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A case of sigmoid cancer occurring after uretero-sigmoid anastomosis

Efetov S.K., Kochetkov V.S., Sorokin N.I., Pavlov P.V., Tsar’kov P.V.


Colonic neoplasia occurring in an uretero-sigmoid anastomosis is a rare case of colon cancer in the clinical practice of Russian colorectal surgeons and urologists. The article presents a case of sigmoid adenocarcinoma causing obstructive pyelonephritis.
Urologiia. 2018;(2):100-103
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Percutaneous nephrolithotripsy in a patient with primary immunodeficiency (a case report)

Kozachikhina S.I., Martov A.G., Dutov S.V., Andronov A.S., Yarovoi S.K., Dzhalilov O.V.


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.
Urologiia. 2018;(2):104-107
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The role of tadalafil in the management of sexual dysfunctions

Efremov E.A., Kasatonova E.V., Melnik Y.I., Nikushina A.A.


Erectile dysfunction (ED) has a significant negative impact on the quality of life of the patients and their partners. The sequence and regimens of ED therapy have become quite evident since the advent of phosphodiesterase type 5 inhibitors (PDE-5). However, there have been continued basic research of the efficacy and safety of these agents and studies aimed at new therapeutic goals. In recent years, the attention of researchers has shifted into a wider range of issues related to the personalized PDE-5 therapy, including sexual satisfaction, psychosocial variables (e.g., confidence, selfesteem, quality of relationships) and other potentially related factors. In particular, there are more and more new data on male sexual dysfunction. This review focuses on the relationship between erectile dysfunction and concomitant conditions: depressive symptoms, libido and sexual satisfaction disorders, ejaculation and orgasm abnormalities. The authors outline the possibilities and potential benefits of PDE-5 for patients with comorbid sexual dysfunction and depression with a special focus on tadalafil.
Urologiia. 2018;(2):108-113
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Extract of Serenoa repens in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms

Amdii R.E., Al’-Shukri A.S.


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.
Urologiia. 2018;(2):114-120
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Non-neurogenic activators of myocyte contraction and their role in the realization of the accumulative-evacuating functions of the urinary bladder

Berdichevskii V.B., Berdichevskii B.A.


The search for and use of aIternative biomarkers of the hyperactive bIadder has garnered increasing attention in recent years because they may be considered pathogeneticaIIy significant and used as surrogate biomarkers. Promising agents that have met these criteria include proteins cytokines, neurotrophins, tumor necrosis factor (TNFa), nerve growth factor (NGF), fibrinopeptides A and B, C-reactive protein, membrane-bound ATPase. AnaIysis of current scientific Iiterature has demonstrated that specialists in many fields of medicine show interest in endogenous proteins that do not belong to neurotransmitters but affect the contractile ability of myocytes. The presented data indicate the feasibiIity and prospects of their use, but further studies and evaIuation are needed. Based on the present Iiterature review, the authors concIude that endogenous proteins activating myocyte contractiIity are of great cIinicaI vaIue as promising markers for detecting detrusor overactivity, its severity, and evaIuation of the treatment effectiveness. The authors suggest that proteins of this group can pIay an important roIe not onIy in the pathogenesis ofbladder function disorders but also in the physiological process ofurination as an additional non-neurogenic humeral component.
Urologiia. 2018;(2):121-123
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Current concept of diagnosis of benign prostatic hyperplasia

Vinnik Y.Y., Andreichikov A.V., Klimov N.Y.


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.
Urologiia. 2018;(2):124-129
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Endoscopic enucleation of the prostate: a short term trend or a new treatment standard?

Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev D.V., Okhunov Z., Netsch C., Spivak L.G., Taratkin M.S.


Endoscopic enucleation of the prostate (EEP) techniques such as HoLEP (holmium laser enucleation of the prostate), ThuLEP (thulium laser enucleation of the prostate) and electroenucleation (mono- or bipolar) are highly effective and safe. They have been endorsed by the latest version of the European Association of Urology guidelines as an alternative to not only open adenomectomy but also transurethral resection of the prostate (EAU Guidelines on Treatment of Non-neurogenic Male LUTS 2018). Therefore, many urologists face the possibility of replacing the treatments of BPH. In this article, we analyze the history of EEP techniques, both their pros and cons and, what are they today - just a popular trend or a new standard procedure for the surgical treatment of BPH?
Urologiia. 2018;(2):130-133
pages 130-133 views

Current prospects for improving the quality of life of patients with internal stents

Martov A.G., Ergakov D.V., Novikov A.B.


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.
Urologiia. 2018;(2):134-141
pages 134-141 views

Current role of sildenafil in the management of erectile dysfunction

Akhvlediani N.D., Matyukhov I.P.


Sildenafil is the first phosphodiesterase type 5 inhibitor (PDE-5), used in the management of erectile dysfunction (ED). The effectiveness and safety of the original drug have been studied most extensively among ED medications. Sildenafil has been successfully used for ED of different etiology and severity. To date, this PDE-5 remains the drug of choice for many patients with erectile dysfunction.
Urologiia. 2018;(2):142-146
pages 142-146 views

En-bloc laser resection of the urinary bladder tumor

Alyaev Y.G., Rapoport L.M., Vinarov A.Z., Sorokin N.I., Dymov A.M., Kislyakov D.A., Afanasyevskaya E.V., Lekarev V.Y.


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.
Urologiia. 2018;(2):147-153
pages 147-153 views
pages 154-157 views

A.P. Frumkin: a prominent founder of soviet urology. On the 120th anniversary

Plygunov E.A., Georginova O.A.


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.
Urologiia. 2018;(2):158-160
pages 158-160 views
pages 161-163 views

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