No 4 (2018)

Introduction. Lower urinary tract infections (LUTI) are the most common urological diseases. Fosfomycin is one of the antibiotic agents with proven efficacy that are most frequently used to treat UTIs. Despite the high effectiveness of antibiotic therapy with this drug, in some patients, the LUTIs persist or recur. It is advisable to prevent the development of recurrent infections using herbal preparations. The study aimed to evaluate the effectiveness of integrated treatment of women with acute uncomplicated cystitis using the plant-based medication Phytolysin. Materials and methods. The study comprised 63 women with acute uncomplicated cystitis, who were randomly assigned to two groups. The women in the control group (n = 31) received a single 3-g dose of fosfomycin. In the study group (n = 32), women received a single 3-g dose of fosfomycin and Phytolysin according to the manufacturer’s instructions three times daily for a month. The examination was performed on admission and on days 3, and 7, and included daily filling out voiding diaries, a 5-point verbal assessment of pain, urinalysis and urine culture. During the next three months, cases of recurrence were registered, and bacteriological analysis of urine was conducted. Results. On admission, all patients complained of pain in the projection of the urinary bladder, frequent urination in small portions, and a sensation of urethral discomfort. All women had leukocyturia and bacteriuria. By the 3-rd day after taking fosfomycin, both groups showed similar improvement in the clinical manifestations of the disease. All urine cultures were negative. By the 7th day after the initiation of therapy, the patients in the study group had normal laboratory parameters and no clinical manifestation of LUTI, while in the control group leukocyturia (p <0.05) persisted. During a 3-month follow-up, recurrence of LUTI was observed in 6 (19.4%) and 3 (9.4%) patients in the control and study group, respectively. Also, bacteriological studies of urine showed the same pathogen as on admission in 5 (16.1%) and 1 (3.2%) patients of the control and study group, respectively. Conclusion. Phytolysin can be recommended for use in the integrated management of acute uncomplicated cystitis, as well as a means of preventing recurrences of this disease.

Drugs for preventing stone formation can be selected based on the average regional indicators, which have features depending on the region of the world. Aim. To investigate the features of urinary factors for lithogenesis (UFL) of calcium urolithiasis in Tashkent and evaluate the variants of their pharmacological correction. Materials and methods. The study analyzed data from 779 patients with calcium urolithiasis. Ninety-nine patients with uncomplicated calcium urolithiasis received non-selective preventive pharmacotherapy. Of them, patients of group 1 (n=21), 2 (n=56) and 3 (n=22) received alkaline citrate (AC) for 1 month, phytotherapy (PT) for 2 months, and combined therapy (AC + PT) for 1 month, respectively. Statistics of UFL in 779 patients with calcium urolithiasis were calculated, and the results of non-selective prophylaxis in 99 patients with uncomplicated calcium urolithiasis were analyzed. Results. The most common UFLs were hypocitraturia (96.7%), decreased diuresis (96.3%), and hyperoxaluria (92.94%). In the patients of group 1, the treatment resulted in an increase in citrate by 54.14% and urine pH by 18.63%; diuresis did not change, and CaOx decreased by 50.63%. In group 2, there was an increase in citrate by 3.88% (on average for 2 months), urine pH by 10.82%, and diuresis by 32.17%; CaOx decreased by 32.59%. In group 3, citrate increased by 71.52%, urine pH by 18.07%, and diuresis by 34.71%; CaOx decreased by 69.15%. Correction of citraturia was effective in patients with initial hypocitraturia: in 80.95%, 78.6%, and 86.4% in groups 1-3, respectively. Conclusion. The findings confirm the potential of empirical therapy based on the average statistical indicators of the region. The combination of AC (Litren) and PT (Canephron N) proved to be most effective: CaOx decreased to a low level, it was possible to compensate for the undesirable effects of prolonged intake of the synthetic drug (AC). Nevertheless, we believe that long-term controlled studies are needed to confirm the validity of this approach, and the results of this study should be regarded as promising.

This study aimed to evaluate the feasibility of the prostate artery embolization (PAE) in the management of patients with benign prostatic hyperplasia (BPH) in different age groups, depending on the severity of voiding dysfunction, findings of the prostate ultrasound, and the ASA surgical risk. Materials and methods. The study comprised 39 patients with grade II-III BPH. Patients were divided into three groups, depending on the prostate volume and the grade of anesthesia risk. Patients of the group 1 (n=12), group 2 (n=19), and group 3 (n=8) underwent a classical transvesical prostatic adenomectomy (TPA), bipolar transurethral resection (TUR) of the prostate, and PAE, respectively. The treatment outcomes were assessed at 3 and 6 months after the operation. Results. When comparing the outcomes in three groups, a statistically significant difference in the IPSS was found both at 3 and 6 months when comparing TPA and TUR groups (p<0.0001) and PAE and TPA groups (p=0.0003). At 3 and 6 months after surgery, postvoid residual urine volume in the TPA and TUR group did not differ statistically significantly, but in the PAE group, it was significantly higher at 6 months than in the other two groups (p=0.004). Conclusion. As a minimally invasive procedure, prostate artery embolization can become an alternative to TUR and one-stage TPA for patients with verified BPH and grade III ASA risk. This treatment modality can be performed in patients of any age and any prostate volume. The age of the patient does not significantly affect the outcomes of TPA, TUR, and PAE. To recommend this treatment modality as a method of choice, further multi-center, randomized trials are warranted involving longer study duration and larger patient groups.

The generally accepted standard of antibiotic therapy aimed at causative agent does not exclude the risk of acute obstructive pyelonephritis (AOP) to become chronic after the end of antibiotic therapy, resulting in a high incidence of relapses. To assess the outcomes of the AOP, we undertook a prospective clinical trial. Materials and methods. The study comprised 51 consistently selected patients (12 men and 39 women) with AOP occurred as a result of unilateral ureteric calculus obstruction. Inclusion criteria for the study were as follows: no history of urological diseases, including urinary stones; the first presentation to the urologist with AOP; the level of the bladder bacteriuria before the drainage of the obstructed kidney ≥103 CFU/ml. Bladder urine samples were collected for bacteriological examination by catheterization. At one, 3 and 6 months after completion of the treatment of AOP, the patients underwent a general clinical examination, and midstream specimens of urine were collected from the patients for bacteriological analysis to control leukocyturia and bacteriuria. Results. Eradication of causative uropathogens from urine occurred within 6 months in 96.1% of patients, and at that point, leukocyturia persisted in 23.5% of the patients. The decrease in detecting uropathogens in the urine was accompanied by an increase in the frequency of the presence in the urine of other aerobes and anaerobes, i.e., no sterile urine cultures were obtained from any patient. The rates of eradication of uropathogens were associated with the patients’ age, the duration of the pre-hospital stage of AOP, and the complicated course of AOP.

Introduction. Iatrogenic urethral damage is the leading etiologic factor for urethral stricture in men in developed countries and second after traumatic injury in developing ones. This study aimed to evaluate the frequency of iatrogenic strictures of the urethra and the results of their treatment. Materials and methods. This retrospective analysis comprised 133 patients who were treated for iatrogenic urethral stricture from 2011to 2016. Group I included 72 (54%) patients after trans(intra)urethral interventions (transurethral resection of the prostate or urinary bladder), urethral dilation, traumatic catheterization, etc. Forty-five (34%) patients with post-catheter strictures (ischemic/post-inflammatory), 7 (5%) patients after failed treatment of hypospadias, and 9 (7%) patients after open adenomectomy made up groups II, III, and IV. The diagnosis of recurrent stricture and the need for repeat surgical intervention were determined based on uroflowmetry, urethrography, and urethrocystoscopy. Results. In group I, the mean extent (rank) of the stricture was 2 (0.1-15) cm, the most frequent location (85%) was the bulbar urethra. In group II, the most frequent location (71%) was also the bulbar urethra with a mean stricture length of 2.4 (0.3-13) cm. There were 4 cases of panurethral strictures, lesions of the penile urethra and meatal stenosis. In group III, the strictures were on average 6 (2-12) cm long. Patients group IV had strictures of the bulbar and prostatic urethra. In general, the effectiveness of endoscopic treatment (direct vision internal urethrotomy, DVIU) was 52%, the effectiveness of urethroplasty varied from 83 to 100% depending on the method. In group I, the effectiveness of the DVIU was 52%, various types of urethroplasty - 88-100%, in group II - 50% and 82-100%, respectively. In group III, the effectiveness of the single-stage/multi-stage buccal mucosa urethroplasty was estimated at 0%/100%. In group IV, the effectiveness of DVIU/urethroplasty/perineal prostatectomy was 20%/75%/100%. Conclusion. The proportion of iatrogenic urethral strictures in large megacities can reach 45%. Iatrogenic urethral strictures most commonly result from catheterization and transurethral interventions. Each subgroup of iatrogenic strictures is characterized by its location, extent and degree of urethral spongiofibrosis. With the correct choice of surgical modality, urethroplasty is almost twice more effective than DVIU.

The study aimed to characterize patients with newly diagnosed benign prostatic hyperplasia (BPH) and identify patterns that lead to late diagnosis of the disease. Study design. Simple open retrospective non-comparative study. Material and methods. To determine the frequency of requests for medical care for BPH, the study analyzed medical records of3544 patients who sought outpatient urological care at the municipal polyclinic # 26 in Novosibirsk in 2013. Outpatient medical cards of 165 patients with newly diagnosed BPH were analyzed. Results. Among 3544 patients seen by the urologist of the polyclinic, 960 (27.1%) had BPH. Analysis of medical records of 165 men with newly diagnosed BPH showed that the disease was associated with age. The shortest duration of the disease (0.8+0.5 years) was noted in patients under 50 years old, the longest (4.7±2.1 years) in men over 70 years old. The smallest prostate volume was 32 ml, the largest 150 ml. The mean size of the gland naturally increased with age. The mean PSA level also naturally increased with age: from 1.1+0.8 ng/ml in individuals up to 50 years to 3.0±0.7 ng/ml in patients older than 70 years. The maximum IPSS was in the 61-70 year age group (16.7±5.9 points); the minimum IPSS was in the age group up to 50 years (9.5±3.6 points). The duration of the symptoms directly correlated with the prostate volume. At the prostate volume of 60 ml and more, symptom scores showed a 1.5 fold increase. In married patients, the mean IPSS was 13.8+5.4, while in single men it was 16.3+5.5 (p=0.008). Conclusion. Patients with BPH account for 27.1% of all patients seeking urological care at the polyclinic. In young men, symptom severity is lower than that in senior men. However, the elderly are more concerned about their symptoms, they have worse quality of life, and they seek medical attention earlier. Married patients are more likely to see a urologist with significantly less severe symptoms than single men.

Introduction. Androgens play a key role in the male development. All the physiological processes in the body, including the production of testosterone, have their chronobiological features. Aging is accompanied by a disruption in the regulation of chronobiological processes. With androgen deficiency, these changes occur at any age. In recent years, transdermal forms of testosterone have become very popular in the treatment of this condition. Aim. To evaluate the effectiveness and chronobiological features of various regimens of testosterone gel therapy for external use in men with androgen deficiency. Materials and methods. The study comprised 90 men aged 45 to 60 years with testosterone deficiency. Patients were randomized into three groups of 30 people each. In group I (control) patients received basic therapy, including exercise, diet, and multivitamins. In group II, patients received basic therapy concurrently with testosterone gel for external use (Androgel) at a daily dose of 5 g (1 sachet). Patients in group III were administered basic therapy in combination with 10 g testosterone (2 sachets). The effectiveness of treatment was assessed at 3 (visit 2) and 6 (visit 3) months. Depending on the results of visit 2, a correction of therapy was carried out, if necessary. During each visit, the patients underwent evaluation, including hematocrit, levels of FSH, LH, prolactin, total testosterone, blood SHBG, waist circumference, and body weight. Patients completed the ICEF-5 questionnaire, the Hamilton scale (HDRS, HARS), and the SF-36 questionnaire. We also tested the patients for the chronobiological status and desynchronosis. Results. During the visit I, the homogeneity of the study population was confirmed. At three months, the patients of groups II and III showed a more pronounced increase in testosterone, a decrease in body weight and waist circumference, as well as an improvement in the psycho-emotional status and quality of life according to the questionnaires. Desynchronosis persisted in 25 (83.3%), 9 (30%), and 4 (13.3%) patients in groups I, II, and III, respectively. Given the findings, the treatment was adjusted. The patients in the groups were divided into subgroups A and B. In subgroups A, patients continued to receive initial therapy, and in subgroups B, the treatment was adjusted. At six months, the level of GT increased to normal values in all subgroups except subgroup IA. The most marked reduction in body weight and waist circumference was noted in subgroups IA, IIA, and IIIB. A significant decrease in the average scores on the HDRS and HARS scales and an improvement in the SF-36 scale were observed in the subgroups IA, IIA, IIIB. Desynchronosis persisted in 3, 2, and one patient in subgroups IB, IIB, and IIIA. Conclusion. The testosterone gel therapy in patients with androgen deficiency can effectively reverse the manifestations of the disease and normalize the chronorhythm. Transdermal testosterone gel at a daily dose of 5 g in the morning can be recommended to alleviate clinical manifestations of the disease and eliminate desynchronosis in this category of patients. In patients with low baseline testosterone levels, it is advisable to administer the drug at a daily dose of 10 g.

Aim. To investigate the rates, types and risk factors for intraoperative complications in patients with bladder cancer undergoing radical cystectomy with various types of urinary diversions. Material and methods. The study comprised 257 patients, including 241 (93.8%) men and 16 (6.2%) women who underwent radical cystectomy. The mean age of the patients was 58.5 (37-81) years. The analysis included intraoperative blood loss and blood transfusion, the rates of vascular, rectum and nerve injury, and operative time as a function of type of urinary diversion and cystectomy, the type of surgery, tumor stage (pT and pN), body mass index, and the total number of radical cystectomies performed by the surgical team. Results. Intraoperative mortality was 0.4%. Intraoperative complications were registered in 34 (13.2%) patients. The mean blood loss was 597 (1002500) ml, mean volume of intra- and perioperative blood transfusion was 950 and 310 ml, respectively. Statistically significant predictors of intraoperative blood loss were body mass index (p=0.001), the surgeon’s experience (p=0.004) and the presence of lymph node metastases (N+) (p=0.033). A significant factor affecting the rate of rectal injury is a stage pT4 disease (p=0.028). Nerve injury rates did not differ statistically significantly depending on the above factors (p>0.05). Conclusion. Patients with locally advanced bladder cancer and high body mass index should be operated on by highly qualified surgeons performing at least 50 radical cystectomies per year.

The article presents the experience of successful surgical treatment of a patient with complete ureteral obliteration after transurethral endoscopic pyelolithotripsy in the left renal pelvis with lithoextraction and stenting. Two months later the patient developed stent obstruction and underwent repeat stenting and insertion of a left nephrostomy tube. After another 1.5 months, he was found to have complete obliteration of the left ureter. Ileal substitution of the left ureter was performed with the formation of a pyelo-ileal anastomosis and antireflux ileo-cysto-anastomosis. Contrast-enhanced MRI-urography performed on the 21st day ascertained the complete patency of the anastomosis. The patient was discharged in a satisfactory condition. At a follow-up examination five months after hospital discharge, the patient was in satisfactory condition with no complaints. Renal ultrasound and MRI showed no signs of obstruction of the ileal autograft.

This article presents a case of a 59-year-old patient with a primary tumor of the right kidney with bladder and liver metastases. The patient was treated in three-stages. In the first stage, he underwent ureteral stone extraction, laser resection of the tumor with subsequent vaporization. In the second stage, a repeat laser resection and vaporization of the tumor was performed. During the third stage, the patient underwent TUR of the bladder wall with the tumor, followed by laser vaporization of the tumor bed. During a 9-year follow-up, no signs of tumor growth or metastasis were observed.

A renal calyceal diverticulum is a cystic cavity within the renal parenchyma, which is lined by transitional epithelium and communicates with the calyx or, more rarely, the renal pelvis. In children, this anomaly is extremely rare. The article describes the resection of the middle calyceal diverticulum in an 8-year-old child using retroperitoneoscopic access.

This review article presents the data on the epidemiology of renal cell carcinoma and describes minimally invasive surgery for this disease. The authors discuss the use of warm and cold ischemia, vascular microdissection, and artery embolization in renal tumor surgery, and analyze treatment outcomes.

The article presents pooled results of domestic and international studies investigating genetic aspects of urolithiasis associated with impaired calcium metabolism. The review highlights the importance of early and accurate diagnosis of hereditary diseases associated with kidney stone formation. Of more than 80 currently known monogenic forms of urolithiasis, the authors provide the list of the most significant forms. Using such molecular genetic methods as NGS (next generation sequencing) allows accurate detection of the genetic cause of the disease, develop an individual approach the patient’s management and timely prevention of the disease among the relatives of the proband.

In recent years, researchers have become increasingly interested in urinary microvesicles. They contain disease-specific biomarkers and can be used for predicting and diagnosing various diseases of the urinary system without resorting to invasive procedures. This review presents data on domestic and international research investigating the importance and potential application of urinary microvesicles for the diagnosis and prediction of diseases of the urinary system.

This review, based on the results of modern epidemiological and clinical-experimental studies, highlights the important pathophysiological role of vitamin D and the disturbances of its metabolism (deficiency/ insufficiency) in the pathogenesis of the metabolic syndrome (MS) in men, which according to available literature, is associated with adenoma of the prostate (AP). General information about the endocrinology of vitamin D and its role in maintaining various aspects of men’s health is presented. The authors analyze currently known pathophysiological mechanisms involving vitamin D interacting with each other within the framework of the pathogenesis of MS and AP. At present, there is much evidence that MS and AP have common universal interacting mechanisms of pathogenesis (obesity, insulin resistance, dyslipidemia, systemic chronic subclinical inflammation, endothelial dysfunction) that are realized with the direct participation of vitamin D. The authors argue that taking into account a global prevalence of vitamin D deficiency in the modern population, accompanied by an increasing incidence of both MS and AP affecting younger populations, a rational management of vitamin D metabolism in men can be regarded as a promising and effective pathogenetic prevention of MS and BPH.