No 3 (2018)

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».

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.