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No 3 (2018)


The first domestic lithotripter «URAT-Р»: to the 30th anniversary of introduction

Beshliev D.A., Martov A.G., Golubchikov I.V., Dutov V.V.


This article is a historical overview of our recent past describing the enormous theoretical and experimental contribution of the research staff members who took part in the development of the first domestic lithotripter «Urat-Р».
Urologiia. 2018;(3):5-11
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Morphological evidence of the ischemic nature of the prostatic fibrosis in the classical chronic pelvic pain syndrome / IIIB chronic prostatitis

Kogan M.I., Matsionis A.E., Belousov I.I., Povilaitite P.E.


Aim. To examine the structure of the prostate tissue in patients with III B chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS). Materials and methods. The study analyzed transrectal fine-needle biopsy specimens of 10 patients with the verified diagnosis of chronic pelvic pain syndrome/category III B chronic prostatitis (CPPS/IIIB CP) according to the National Institutes of Health classification. Tissues were examined using light and electron microscopy, and immunohistochemical study of the expression of CD31, CD34, NSE and S-100 markers. Results. All biopsy specimens of all patients showed fibroplastic changes of the prostate tissue most markedly pronounced in the stroma and muscle fibers in the form of total fibrosis, myofibril atrophy, and extracellular lipofuscin deposition. The examination revealed a significant reduction in the density of microcirculatory bed vessels and arteriolar luminal stenosis, a reduction in the number of nerve fibers, and compression of their fibrous tissue. No inflammatory changes were found in the prostate. Discussion. In patients with CPPS/IIIB CP, the changes in the prostate at the microscopic and ultrastructural levels are characteristic of severe chronic tissue hypoxia, which leads to the development of fibrosis resulting in stenosis of microcirculatory bed vessels and degenerative changes in nerve fibers and cells. No signs of an inflammatory reaction in the examined tissue were established. Conclusion Changes in the prostate tissue in CPPS/IIIB CP suggest the presence of chronic pelvic ischemia and exclude its association with inflammation as the main pathological process.
Urologiia. 2018;(3):12-19
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Specific features of lower urinary tract symptoms in men living in the moscow region. Results of the epidemiological study

Pushkar D.Y., Rasner P.I., Kotenko D.V., Gerasimov A.N., Shabalkin S.A.


Introduction. Voiding disorders in men are manifested by various symptoms associated with impairment of the urinary flow along the urinary tract and worsening of the urinary bladder storage function. There is a considerable lack of data on the prevalence of LUTS, their severity, and correlation with data from objective studies in men in the Russian Federation in general and in the Moscow region in particular. Materials and methods. A prospective multicenter epidemiological study «Specific Features of Lower Urinary Tract Symptoms in Men Living in the Moscow Region» was conducted based on data acquired from April 1 to May 31, 2017 by an anonymous survey of 525 men (mean age 64.2+9.93 years old), residing in Moscow and presenting with complaints of urination disorders. The respondents answered questions of a specially developed 140-item questionnaire. All demographic and medical information was taken into account, including concomitant diseases and ongoing therapy. The patients filled out the IIEF, I-PSS, QoL, and AMS (Aging Male Screening) questionnaires. Results. Analysis the I-PSS scores showed that symptoms of the emptying phase predominated over the symptoms of the filling phase in all age groups. The most frequent complaints were «frequent urination» and «weak urine stream». Forty and 30% of respondents had moderate and severe LUTS, respectively. The remaining 30% of men had mild LUTS. Prostate volume was significantly greater than that reported in similar studies conducted in Asia, Europe and North America (mean 55.27 cm3). The level of total prostate-specific antigen (PSA) was known in 98.8% of patients over the age of 50 and averaged 3.87±4.41 ng/ml. The mean age at the first testing for total PSA in Moscow is 56.7+9.0 years. Conclusion. This study is the first epidemiological study of this scale and focus. Its findings can be used to compose a «portrait» of a standard patient and identify patterns that limit the extrapolation of international epidemiological studies to the population of Russian patients. It seems necessary to develop an updated LUTS management strategy, taking into account the identified national characteristics.
Urologiia. 2018;(3):20-29
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Computer-assisted laparoscopic surgery for renal carcinoma

Alyaev Y.G., Sirota E.S., Bezrukov E.A., Sukhanov R.B.


Aim. To investigate the effectiveness and benefits of using 3D planning and virtual surgery in the management of patients with localized renal carcinoma undergoing laparoscopic surgery. Materials and methods. A retrospective analysis was performed on 558 patients with renal cell carcinoma (RCC) who underwent surgical treatment at the Clinic of Urology, I.M. Sechenov First MSMU from January 2012 to May 2017. Of them, 244 (43.7%) and 314 (56.3%) patients underwent laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN), respectively. In addition to the standard diagnostic work-up, 248 (44.4%) patients underwent multispiral computed tomography (MSCT) for 3D modeling and virtual surgery using the 3D modeling program Amira. Matched pairs of patients with and without 3D planning were selected based on similarity of urologists’ experience in performing the operation, the size and location of the tumor (relative to the renal segment, anterior and posterior surfaces), and the surgical approach. As a result, two homogeneous subgroups of patients were chosen comprising those who underwent LRN (22 pairs of patients) and LPN (53 pairs of patients). Results. Patients with RCC who underwent LPN with 3D planning had a significant advantage over patients without virtual planning: by warm ischemia time 12.0±6.4 min (p=0.010), operative time 113.4±39.4 min (p=0.0001), blood loss 102.8±98.2 ml (p=0.001). Among patients with RCC who underwent LRN, the subgroup with 3D planning also had an advantage: operative time was 135.2±27 and 202.9±55.5 min (p=0.0001), blood loss was 143.2±137,4 and 472,0±395,4 ml (p=0,014), and regarding the rate of intraoperative (p=0,017) and postoperative (p=0,017) complications. Conclusion. The use of computer-assisted 3D planning and virtual operations improves immediate results of surgery in RCC patients undergoing organ-sparing and organ-removing laparoscopic surgery.
Urologiia. 2018;(3):30-38
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Comparative assessment of the quality of life of kidney transplant recipients and hemodialysis patients

Babloyan S.A.


Aim. To compare the quality of life of chronic kidney disease (CKD) patients after kidney transplantation and hemodialysis patients. Material and methods. A prospective controlled trial comprised 110 CKD patients, divided into two groups. The study group included 51 (46.4%) kidney transplant recipients and 59 (53.6%) hemodialysis patients represented a control group. Assessment of health related quality of life was done using the KDQOL-SF™ questionnaire. Results. Kidney transplant recipients reported significantly greater satisfaction with their physical and emotional health than hemodialysis patients. Kidney transplant recipients experienced fewer somatic symptoms of CKD and everyday problems. It is very important that unlike hemodialysis patients transplant recipients were physically capable of working. There were no differences between groups regarding sleep quality, sexual activity, communication with others and time spent with family and friends. Conclusion. Patients receiving long-term hemodialysis therapy experience a marked decrease in physical and mental components of QOL, whereas kidney transplantation results in better QOL for these parameters.
Urologiia. 2018;(3):39-43
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Sensitivity and specificity of urinary and serum neurotrophins in the diagnosis of neurogenic detrusor overactivity in multiple sclerosis

Bazhenov I.V., Filippova E.S., Bazarnyi V.V., Sazonov S.V., Volkova L.I., Zaitseva L.N.


Lower urinary tract dysfunction is common among neurological patients. Traditionally, the basic method of diagnosis is a complex urodynamic study. In recent years, many studies have focused on the search for new non-invasive diagnostic modalities. In particular, neurotrophins are considered as potential biological markers of a neurogenic bladder. Aim. To estimate the sensitivity and specificity of the serum and urinary nerve growth factor (NGF) and brain neurotrophic factor (BDNF) in MS patients as markers of detrusor overactivity. Materials and methods. The study comprised 20 patients with multiple sclerosis, who complained of voiding problems. The control group consisted of 20 people without neurological diseases, lower urinary tract symptoms and detrusor overactivity estimated by filling cystometry. Apart from standard laboratory tests, diagnostic evaluation included a complex urodynamic study, ultrasound of the urinary tract, cystoscopy, testing serum and urinary NGF and BDNF using the enzyme immunoassay. The diagnostic significance of neurotrophins was evaluated using ROC analysis. Results. According to the ROC analysis, the diagnostic sensitivity and specificity of serum NGF as a marker of detrusor hyperactivity was 57% and 93%, respectively (for serum NGF ≥26 pg/ml). The quality of the test according to the expert scale of AUC values was «very good» (AUC=0.806). Detecting NGF in patients’ urine was less effective. The sensitivity and specificity were 52% and 40%, respectively (for NGF ≥6 pg/ml). The quality of the test according to the expert scale of AUC values was «average» (AUC=0.64). The serum BDNF demonstrated high sensitivity (90%) and low specificity (23%), AUC=0.56. The urinary BDNF was more informative, (AUC=0.65). The combination of all four markers provides a sensitivity of 85.7% and a specificity of 66.7% (AUC=0.824). Conclusions. Testing serum and urinary neurotrophins in patients with multiple sclerosis can be used to diagnose detrusor overactivity. The NGF is a highly specific biomarker, while the BDNF is highly sensitive. Combined testing for serum NGF and BDNF is most informative.
Urologiia. 2018;(3):44-48
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The incidence and antibiotic resistance of common nosocomial uropathogens in the urine of urological patients in the Ivanovo region

Pochernikov D.G., Strel’nikov A.I., Bazunov D.S., Efimychev K.A., Serdyutskaya U.S.


Aim. To clarify the etiology of nosocomial UTIs occurring in the urology departments and the outpatient clinic of the Ivanovo Regional Clinical Hospital (IvRCH), to develop recommendations on the empirical use of antibiotic therapy. Materials and methods. Bacterial composition of urine in urological patients was monitored from 1999 to 2015. The sensitivity of the pathogens to the main antibacterial agents was determined using the Kirby-Bauer disk diffusion susceptibility test. Results. The study determined the frequency of detecting pathogens associated with urinary tract infections in adults and children, established the association between the spectrum of pathogens and patient age and determined the most effective antibacterial drugs in patients with nosocomial UTI in the Ivanovo region. High resistance levels of E. coli strains were detected against fluoroquinolones, nalidixic acid, and nitrofurans; they were three times higher than that against cephalosporins. Conclusion. The findings show the need to reduce the empirical use of fluoroquinolones, nalidixic acid, and nitrofurans and completely exclude the use of ampicillin in patients with nosocomial UTI in the Ivanovo region. To reduce the occurrence of nosocomial infections, patients discharged from the hospital should be administered empirical therapy with third-generation cephalosporins.
Urologiia. 2018;(3):49-53
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Comparative effectivenesss of standard antibiotic therapy and Canephron N asymptomatic bacteriuria in pregnant women

Lokshin K.L.


Current international and Russian clinical guidelines recommend treating asymptomatic bacteriuria in pregnancy to prevent acute gestational pyelonephritis. At the same time, the growing resistance of uropathogens and the risks associated with antibiotic therapy in pregnancy dictate the need to limit the use of antibiotics and seek alternative approaches to antibacterial therapy. Materials and methods. A retrospective analysis was performed on 60 pregnant women who received either a standard antibiotic regimen (n=32) or the herbal preparation Canephron N (n=28). The primary outcomes were the incidence of symptomatic infections (cystitis or pyelonephritis), premature birth and low birth weight delivery, and incidence of persistent/ recurrent bacteriuria. Results. In the group of antibiotic therapy, one patient developed cystitis and three had pyelonephritis; in the Canephron N group, cystitis occurred in one patient, no pyelonephritis cases were observed. Among the whole study cohort (n=60), the incidence of symptomatic infections and pyelonephritis was 8.3 and 5.0%, respectively. The incidence of symptomatic infections (cystitis, pyelonephritis) did not differ statistically significantly between the study groups (p=0.2157). There were three and one premature births in the group of antibiotic therapy and the Canephron N group, respectively (p=0,373), and two low birth weight deliveries in each group (p=0.891). Recurrent bacteriuria was registered in 17 patients from the group of antibiotic therapy and in three in the Canephron N group (p=0.0006). Conclusions. The management of asymptomatic bacteriuria in pregnancy using Canephron N is not inferior to standard antibiotic therapy regarding the incidence of symptomatic infection, premature birth, and low birth weight delivery. Persistent/recurrent bacteriuria was more common in women receiving the antibiotic therapy.
Urologiia. 2018;(3):54-57
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Issues of spectrum and local sensitivity of E. coli in female patients with acute uncomplicated lower urinary tract infection - a review of M. Seitz study and own observations

Spivak L.G., Rapoport L.M., Platonova D.V., Tsarichenko D.G., Evdokimov M.S., Demidko Y.L., Enikeev D.V., Rossolovsky A.N.


Relevance. Acute uncomplicated lower urinary tract infections (AULUTI) are one of the most common diseases in urological practice. The management of cystitis is commonly based on antibacterial therapy. Despite the high efficiency, inadequate prescription of antibiotics leads to an increase in microorganisms’ resistance. In light of these matters, the selection of antibacterial agents to which the sensitivity of bacteria is the highest is becoming increasingly challenging. Aim. To estimate the spectrum and local sensitivity of E. coli in patients with AULUTI. Materials and methods. The present study analyzed the results of bacterial culture sampled from 45 patients with AULUTI. The mean age of the patients was 44±17 years. All bacterial cultures were obtained in out patient settings in the framework of a multicenter initiative study on the prevention of recurrent AULUTI with d-mannose. Results. Microbiological studies of the urine of patients with AULUTI revealed the growth of E. coli in concentrations ranging from 104 to 107 CFU/ml. Assessment of sensitivity demonstrated 100% sensitivity of Escherichia coli to fosfomycin trometamol. Conclusion. According to the findings of microbiological studies, the patients with the AULUTI retain the highest sensitivity level of E.coli to phosphomycin trometamol, which allows it to be used as a first-line drug.
Urologiia. 2018;(3):58-62
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Effects of oral hypoglycemic drugs on lithogenic properties of urine in nephrolithiasis patients with concurrent type 2 diabetes

Yarovoi S.K., Kareva E.N., Dzhalilov O.V.


Aim. To investigate the effects of oral hypoglycemic drugs on the lithogenic properties of urine in nephrolithiasis patients with concurrent type 2 diabetes. Materials and methods. The study comprised 376 patients with recurrent nephrolithiasis and compensated type II diabetes mellitus who attended the N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - branch of the NMRRC of Minzdrav of Russia and D.D. Pletnev City Clinical Hospital, Moscow Health Department in 2012-2017. Patients were divided into five groups according to the administered oral hypoglycemic agent: metformin, glibenclamide, pioglitazone, canagliflozin, vildagliptin. The control group consisted of patients receiving insulin therapy. Results. Metformin tended to acidify urine, thus producing a negative effect on urate nephrolithiasis, which is the most prevalent form of nephrolithiasis among patients with type II diabetes. Glibenclamide, on the contrary, alkalized the urine, but urine pH did not go beyond the ranges of normal values. Pioglitazone increased urine density with a simultaneous tendency to decrease diuresis, which is bad for any form of nephrolithiasis. Empagliflozin increased diuresis due to drug-induced glucosuria and also increased renal excretion of uric acid salts. However, at normal urine pH values, the uricosuric effect of the drug did not lead to a significantly increased risk of urate stone formation. Vildagliptin did not have a significant effect on urine output, urine pH, and renal salt excretion. Conclusion. Drug therapy for type II diabetes significantly affects the properties of urine in patients with nephrolithiasis, and it should be taken into account in the metaphylaxis of nephrolithiasis.
Urologiia. 2018;(3):63-69
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Approaches to medical management of patients with high risk of progressing of benign prostatic hyperplasia depending on concomitant erectile dysfunction

Kamalov A.A., Takhirzade A.M.


Aim. To investigate the efficacy and safety of various medical treatment schemes in the management of patients at high risk of progression of benign prostatic hyperplasia (BPH), depending on concomitant erectile dysfunction (ED). Materials and methods. The study comprised 247 men with an I-PSS score of 8 or more, a prostate volume of more than 40 cm3, and a prostate specific antigen level of 1.5-4.0 ng/ml. Patients were divided into 2 groups: group 1 included patients without ED (IIEF-5 score >21); patients of group 2 had ED (IIEF-5 score ≤21). Within the groups, two subgroups of patients with a maximum flow rate (Qmax) >10 ml/s were identified (subgroup A), and with Qmax≤10 ml/s (subgroup B). Patients of subgroup A of group 1 received a 5α-reductase inhibitor, subgroup B of group 1received an a1-adrenoblocker, and 5α-reductase inhibitor, subgroup A of group 2 were treated with a 5α-reductase inhibitor and a phosphodiesterase type 5 inhibitor (PDE-5), subgroup B of group 2 received an a1-adrenoblocker, 5α-reductase inhibitor, and PDE-5 inhibitor. The results were evaluated at 3, 6, and 12 months. Results. All schemes of combination therapy showed a significant improvement in I-PSS, QoL, Qmax and residual urine volume after three months of treatment, while in patients receiving monotherapy with 5α-reductase inhibitor improvement occurred at six months after treatment initiation. There were no significant differences in the incidence of side effects between these treatment options. The use of the PDE-5 inhibitor can successfully compensate the negative effect of the 5α-reductase inhibitor on male sexual function. Conclusion. The most effective treatment option for BPH patients without ED is a combination of a1-adrenoblocker and 5α-reductase inhibitor. In BPH patients with ED, a two- and a three-component combination including a PDE-5 inhibitor provides a significant improvement in both erectile function and lower urinary tract symptoms secondary to BPH. Multicomponent therapy schemes are not accompanied by a significant increase in the incidence of adverse reactions.
Urologiia. 2018;(3):70-77
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The effectiveness of the Speroton complex in the management of male factor infertility

Kuz’menko A.V., Kuz’menko V.V., Gyaurgiev T.A.


Introduction. One of the principles of contemporary management of male infertility is a correction of oxidative stress, replenishment of vitamins, microelements and low molecular weight peptides, and therefore multicomponent biologically active complexes, one of which is the Speroton, are widely used. Aim. To investigate the effect of the Speroton complex on the functional sperm characteristics and fertility of men with pathozoospermia. Materials and methods. We examined 60 men aged from 25 to 40 years old with male infertility against the background of various spermatogenesis disorders. Patients were randomized into two groups of 30 people each. A control group (CG) underwent general therapy. In the study group (SG) patients received a combination of general therapy and Speroton. The study participants were subsequently examined at four study visits. The parameters of the spermogram were assessed according to WHO criteria: sperm concentration, sperm motility, the total number of sperm with normal morphology, ejaculate volume and ejaculate liquefaction time, the level of fructose and zinc, and cases of pregnancy in the partner. Results. The use of the Speroton complex resulted in a 10% increase in ejaculate volume, a 15.6% increase in sperm concentration, and a 32% reduction in liquefaction time. The proportion of progressively motile spermatozoa (grade A + B) showed a 2.6 fold increase due to activation of grade C spermatozoa. This, in our opinion, may be associated with a change in the ejaculate enzyme composition, which is indirectly confirmed by a 1.6 fold increase in the level of fructose and 15% increase in the amount of zinc in sperm biochemistry. The effectiveness of therapy in SG patients is also confirmed by 4 cases of spontaneous pregnancy, which occurred against a background of qualitative changes in sperm count. Conclusion. The use of Speroton increases the sperm concentration and motility in patients with male factor infertility, and an increase in the number of spontaneous pregnancies in their partners.
Urologiia. 2018;(3):78-82
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En bloc holmium laser enucleation of the prostate (HOLEP EN BLOC): our experience

Rapoport L.M., Sorokin N.I., Sukhanov R.B., Dymov A.M., Enikeev D.V., Davydov D.S., Danilov S.P.


Introduction. Some authors consider HoLEP a new gold standard for the surgical management of prostatic hyperplasia. The increasing utilization of holmium enucleation has led to the development of various modifications of this treatment modality, including the so-called enucleation as a single piece (HoLEP en bloc), which reduces the operative time and, according to some authors, facilitates acquiring new surgical technique by surgical trainees. Aim. To compare the effectiveness and safety of the traditional HoLEP and HoLEP en bloc. Materials and methods. The study comprised 227 BPH patients aged from 53 to 86 years old (mean - 61.38+5.09 years). HoLEP en bloc was performed in 114 patients, of whom 39 patients had prostate volume (Vpr) less than 80 cm3, and in 75 patients it was more than 80 cm3. The standard HoLEP was performed in 113 patients, of whom 41 patients had Vpr less than 80 cm3, and in 72 patients it was more than 80 cm3. Results. Enucleation time: HoLEP - 48+12 min, HoLEP en-bloc - 35±10; morcellation time: HoLEP - 20±3 min, HolEp en-bloc - 16±12; duration of urinary bladder drainage by a urethral catheter: HoLEP - 58±3 h, HoLEP en-bloc - 41±2; length ofhospital stay: HoLEP - 5.93±0.39 days, HoLEP en-bloc - 4.45±0.35; bladder tamponade, urethrocystoscopy and coagulation of bleeding vessels: HoLEP-3, HoLEP en-bloc-1; infectious-inflammatory complications (prostatitis): HoLEP-3, HoLEP en-bloc-2; acute urinary retention, stress urinary incontinence: HoLEP-6, HoLEP en-bloc-2; stress urinary incontinence: HoLEP - 5, HoLEP en-bloc - 2. Conclusion. En bloc holmium enucleation of the prostate results in the reduction of enucleation and total operative time compared with traditional HoLEP due to the fast identification of the surgical capsule and the right layer. Using this technique can improve the effectiveness of learning holmium laser enucleation of the prostate by surgical trainees.
Urologiia. 2018;(3):83-87
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Comparative study of extraperitoneoscopic adenomectomy and monopolar transurethral resection in surgical management of benign prostatic hyperplasia with prostate volume of 100-180 cm3

Biktimirov R.G., Martov A.G., Biktimirov T.R., Marapov D.I., Kaputovskij A.A.


Introduction. Monopolar transurethral resection (M-TUR) is a standard for comparing various endoscopic techniques for benign prostatic hyperplasia (BPH), including extraperitoneoscopic adenomectomy (EA). Aim. To compare the effectiveness and safety of M-TUR and EA in the surgical management of BPH with a prostate volume of 100-180 cm3. Materials and methods. Medical records of 797 patients, who underwent surgery for BPH from 2011 to 2016, were retrospectively evaluated. The study comprised patients with a prostate volume of 100-180 cm3, who received either EA (group 1, n=34) or M-TUR (group 2, n=24). Results. The groups did not statistically significantly differ in age (69.3±6.9 vs 71.4±6.4 years in group and 2, p=0.328); complication rate (4 (11.7%) and 6 (25%), respectively, p=0.31); increase in the maximum urinary flow (10 ml/ s (Q1-Q3: 10.0-10.5), 13.5 ml/s (Q1-Q3: 7.5-17), respectively, p=0.538); postoperative hospital stay (11 (Q1-Q3: 10-14) and 10.5 (Q1-Q3: 8-17), respectively, p=0.875). There was statistically significant difference in operative time (190 and 82.5 min in the 1st and 2nd groups, respectively, p=0.041), and in blood loss (200 ml (Q1-Q3: 150-300) and 400 ml (Q1-Q3: 400-500), respectively, p=0.008). During 12 month follow-up, only 5 (20.8%) patients in the 2nd group (p=0.012) needed repeat surgery. Urinary incontinence of different severity at the time of discharge from hospital was also observed only in 4 (16.6%) patients the 2nd group (p=0.036). Conclusion. EA and M-TUR have similar safety and effectiveness in the surgical management of patients with BPH with the prostate volume of 100-180 cm3. EA is associated with longer operative time than M-TUR, but is accompanied by less blood loss, does not require repeat surgery, and confers less risk for urinary incontinence.
Urologiia. 2018;(3):88-91
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Prognostic significance of prostate-specific antigen in defining indications for initial prostate biopsy

Popov S.V., Guseinov R.G., Skryabin O.N., Orlov I.N., Martov A.G.


Currently, prostate biopsy remains the main method used to diagnose prostate cancer (PCa). The indication for the procedure is an elevated level of the serum level of the total prostate-specific antigen (PSA). However, the PSA test is organ- but not cancer-specific, and patients may undergo an unnecessary biopsy, which is an invasive procedure associated with a risk of complications. Additional tests have been developed aimed to improve the diagnostic performance of PSA for detecting PCa. They include PSA derivatives such as free PSA fraction, -2proPSA, PSA density, PHI and the free /total PSA fraction. Aim. To investigate the diagnostic accuracy of PSA and its derivatives in detecting benign and malignant diseases of the prostate after an initial prostate biopsy. Materials and methods. The current study analyzed 65 initial biopsies performed due to an elevated serum PSA level and compared them with the results of extended PSA testing with the use of PSA derivatives. Results. The histological findings consistent with PCa were found in about 30% of initial biopsies performed due to elevated serum levels of total PSA. The incidence of histologically confirmed PCa increased with age, and 70-79 year old men were more likely to have it than 60-69 years old patients. PSA density in 85% of PCa cases exceeded that for benign prostatic hyperplasia (BPH). In all PCa patients, PHI and free /total PSA fraction were greater than 25 and less than 0.15, respectively. In most patients with BPH, the PHI and free /total PSA fraction did not exceed 25 and were greater than 0.15. Conclusions. 1. Initial biopsy triggered by elevated serum level of total PSA allows detection of PCa in about 30% of cases. 2. The age of 60 years and older should be regarded as a risk factor for PCa. The probability of malignant transformation of prostate epithelial cells in men over 70 years of age is greater than in 60-69-year-olds. 3. The density of PSA in men with morphologically verified PCa is statistically significantly greater than that in men with BPH and the threshold value in 85% of cases. 4. Determination of PHI and free/total PSA fraction can improve the accuracy of predicting malignant lesions of the prostate and adjust the indications for histological examination, reduce the number of unnecessary biopsies. 5. When defining indications for initial prostate biopsy in cases with serum PSA varying from 2 to 10 ng/ml, PSA derivatives should be used, including PSA density, prostate health index, and the free /total PSA fraction.
Urologiia. 2018;(3):92-97
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Multi-parametric MRI/US fusion guided biopsy for the diagnosis of prostate cancer. Our experience

Glybochko P.V., Alyaev Y.G., Amosov A.V., Enikeev D.V., Chinenov D.V., Krupinov G.E., Puzakov K.B., Koshkarev A.V., Lerner Y.V., Petrovskii N.V., Dzhalaev Z.K., Chernov Y.N.


Introduction. Prostate cancer is one of the most common types of cancer in men. The gold standard for the detection of prostate cancer is ultrasound guided transrectal prostate biopsy. The detectability of cancer using this method is from 30 to 50%. As a result, many men undergo multiple repeat biopsies for suspected prostate cancer. The European Association of Urology does not give any recommendations on this matter. A revolutionary new method in the diagnosis of prostate cancer is a targeted prostate biopsy using a fusion of multiparametric magnetic resonance imaging (MRI) and ultrasound. Materials and methods. At the R.M. Fronstein Clinic of Urology, 55 patients with suspected prostate cancer from September 2017 to January 2018 underwent fusion prostate biopsy. Of them, 21 patients had negative primary biopsies. Two patients had verified prostate cancer. 32 patients did not undergo primary biopsies. Results. The findings of the study suggest that using MRI-ultrasound fusion for guidance of targeted prostate biopsy improves the quality of the histological material, allows patients to avoid unnecessary biopsy, reduces the number of punctures, thereby offering higher diagnostic performance in detecting prostate cancer. MRI-ultrasound fusion targeted biopsy has a high sensitivity in detecting clinically significant cancer and low for clinically insignificant cancers. Conclusion. The technique affords accurate detection of the location and extent of pathological lesions in the prostate thus allowing focal therapy for prostate cancer.
Urologiia. 2018;(3):98-104
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Diagnostic performance of 68GA-PSMA PET/CTin patients with prostate cancer

Veliev E.I., Tomilov A.A., Goncharuk D.A., Bogdanov A.B., Golubtsova E.N.


Introduction and aim. Most of the patients with biochemical recurrence after radical prostatectomy undergo salvage radiotherapy without guidance from imaging. In recent years, there has been an increasing role of Gallium-68 prostate specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging in the management of prostate cancer. This study aimed to investigate diagnostic performance of 68Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy. Materials and methods. From 2016 to 2017, 19 prostate cancer patients were evaluated by 68Ga-PSMA PET/CT at the Urology Clinic of S.P Botkin City Clinical Hospital; 17 of them had a biochemical recurrence and needed restaging of the disease. The age, prostate specific antigen (PSA) values, therapy at the time of the study, and maximum standard uptake value (SUVmax) were evaluated. Results. The median age of patients was 65 years (interquartile range (IQR) 58.5-70.5), the median total PSA level was 2.36 ng/mL (IQR 1.5-4.19). In 8 of 17 patients, the PSA values did not exceed 2 ng/ml. The median time after radical prostatectomy was 33.2 months. (IQR 12-54.5). Positive PET/CT sites of recurrence were detected in 15 of 17 patients. Nine patients had only one positive site, and in six patients several positive sites were detected. Four patients with PET/CT positive pelvic lymph nodes and/or retroperitoneal space underwent salvage lymphadenectomy. Histological findings confirmed the presence of malignant growth in 3 out of 4 cases. Conclusion. 68Ga-PSMA PET/CT is an effective tool for the early detection of oligometastatic lesions in recurrent prostate cancer.
Urologiia. 2018;(3):105-110
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The incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the BOSNIAK classification into multilocular cystic renal cell carcinoma

Darenkov S.P., Proskokov A.A., Agabekian A.A., Trofimov I.A.


Relevance. Renal cysts remain the most common of benign renal lesions, but current literature is lacking large observational studies on the incidence of their malignant transformation. Aim. To assess the incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the Bosniak classification into multilocular cystic renal cell carcinoma. Materials and methods. From January 2009 to December 2017, 177 patients with renal cysts of category 1 (n=50), 2 (n=74), and 2F (n=53) underwent laparoscopic decortication. In 10 cases, post-operative histological and immunohistochemical studies revealed foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma. Results. Foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma were detected in 10 (5.65%) patients (five men, five women, mean age 58.9 years). The incidence of malignant transformation of renal cysts of categories 1, 2, and 2F was 0%, 2.7% (2 of 74 patients), and 15.1% (8 of 53 patients), respectively. Subsequently, all ten patients were submitted to surgical treatment: eight of them underwent a partial nephrectomy, and two received a nephrectomy. During a median of 49.3 (31-72) months follow-up, no metastasis, and recurrence of multilocular cystic RCC were observed. Conclusion. A more modern algorithm for managing patients with Bosniak category 1, 2 and 2F cysts need to be developed to establish early surveillance of patients starting with category 1 cysts. Given the low malignant potential of these tumors, they should be treated with organsparing surgery.
Urologiia. 2018;(3):111-115
pages 111-115 views

Disorders of sexual differentiation in children: a critical look at open questions (part I)

Shiryaev N.D., Kagantsov I.M., Sizonov V.V., Dubrov V.I.


Management of children with disorders of sexual differentiation (DSD) continues to cause questions and receive criticism. This review discusses some contradictions concerning the newly proposed terminology, nomenclature, and classification. Congenital adrenal hyperplasia (CAH) is the most common cause of DSD, and its management also remains controversial. Therefore, in this part of the article, we critically analyze available literature on gender identity, the need and timing of surgery in children with DSD and 46, XX karyotype.
Urologiia. 2018;(3):116-120
pages 116-120 views

Disorders of sexual differentiation in children: a critical look at open questions (part II)

Shiryaev N.D., Kagantsov I.M., Sizonov V.V., Dubrov V.I.


Surgical management of children with disorders of sexual differentiation (DSD) is one of the most difficult problems in pediatric urology. In the second part of the article we continue to discuss the controversies concerning the surgical management of patients with the classical form of congenital adrenal hyperplasia and 46, XX karyotype -feminizing genitoplasty and its different types.
Urologiia. 2018;(3):121-125
pages 121-125 views

Congenital seminal vesicle cysts in children

Solov’ev A.E., Shatskii V.A., Kul’chitskii O.A.


The article reports two cases of seminal vesicle cysts with ipsilateral renal agenesis in children. The congenital nature of this condition, characteristic features of the clinical manifestation of seminal vesicle cysts makes it difficult to recognize this rare genitourinary disease. Using current methods of diagnosis and surgical treatment result in successful outcomes.
Urologiia. 2018;(3):126-128
pages 126-128 views

Laparoscopic segmental ureteral resection with ileal-ureter substitution for ureteral urothelial carcinoma

Kochkin A.D., Sevryukov F.A., Krupin V.N., Bezrukov E.A., Knutov A.V.


Ureteral resection for the mid-ureter urothelial carcinoma is the operation of choice in patients with low-grade tumors. However, extensive excision within normal tissues may lead to difficulty in appropriate apposition of the ends of the ureter, while incomplete resection increases the risk of oncological progression. This article describes the first experience with laparoscopic segmental ureteral resection with the ileal - ureter substitution for mid-ureter urothelial carcinoma. In this case, a short nonreconfigurated segment of the ileum was interposed between the distal and proximal ends of the resected ureter. Operative time was 230 min, and blood loss was less than 100 ml. No complications were observed. The patient’s postoperative hospital stay was seven days. Follow-up examination 12 months after surgery showed no evidence of the disease progression and preserved normal renal function. The proposed method may be considered as an alternative treatment for carefully selected patients.
Urologiia. 2018;(3):129-133
pages 129-133 views

Epidemiology and theories ofthe origin of hypospadias

Nikolaev V.V., Solontsov Y.N.


The increase in the prevalence of hypospadias, which has lasted for several decades, signals the need to find ways to prevent the disease. Development of measures aimed to reduce morbidity is impossible without a unified concept of the etiology and pathogenesis of hypospadias. The article analyzes the existing theories of the origin of hypospadias. According to the literature, there are 5 types of causes of hypospadias, some of which are currently established. Among the causes under investigation, the emphasis is on placental factors.
Urologiia. 2018;(3):141-145
pages 141-145 views

Uncomplicated female urinary tract infections - comprehensive therapy

Pronkin E.A.


Urinary tract infections are among the most common infectious diseases. Due to high recurrence rates and the increasing resistance of uropathogens to antibacterial drugs, phytotherapyhas become animportant treatment option in modern urology. Phytotherapeutic medications are characterized by a wide spectrum of pharmacological action, efficacy, and low toxicity, thus allowing for a long term use for treating and preventing many chronic diseases without the risk of adverse effects. Medicinal plants that make up Phytolysin nefroCAPS contain substances that have a wide direct or indirect antimicrobial effect. Plant components of Phytolysin nefroCAPS also have anti-inflammatory and antispasmodic effects. The combination of antibacterial, anti-inflammatory and antispasmodic effect is especially beneficial for the treatment of uncomplicated UTIs. In patients with chronic recurrent cystitis, co-administration of the plant based medication Phytolysin nefroCAPS and an antibacterial drug is more effective than antibacterial therapy alone. Using Phytolysin nefroCAPS, as a part of the comprehensive management of urinary tract infections, can increase the effectiveness of antibiotic therapy, while reducing the treatment duration and the incidence of adverse effects.
Urologiia. 2018;(3):146-148
pages 146-148 views

Outstanding contribution of german professors J. Israel (1848-1926) and M. Nitze (1848-1906) to clinical urology (to the 170th anniversary of their birth)

Morgoshiia T.S.


The article describes the achievements of James Israel and Max Nitze, who were successfully developing European medicine for more than 30 years of their scientific and practical activities, enriching it with both experimental and large clinical experience. Their scientific and practical accomplishments greatly contributed to the development of modern urology. The author analyzes the fact that the history of medicine gives rich material not only for understanding evolution but also for the possibility to foresee its further development. The current state of clinical urology has been achieved by the progress of basic research in biology, physics, biochemistry, bacteriology, immunology, pharmacology. At the same time, the personality of the scientist-physician, his observation, non-standard view, the ability to see the opening perspectives, to bring up worthy successors and create a scientific and clinical school of urologists, is of utmost importance. The great German urologists J. Israel and M. Nitze had all these fundamental characteristics of a great scientist-physician.
Urologiia. 2018;(3):149-152
pages 149-152 views

The ailments of the greats. Urological problems of I.S. Turgenev

Dvoretskii L.I.
Urologiia. 2018;(3):153-157
pages 153-157 views

To the 70th Anniversary of Altai Krai Urologic Health Service

Neimark A.I.
Urologiia. 2018;(3):158-161
pages 158-161 views
pages 162-163 views
pages 164 views

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