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No 4 (2018)


Lower urinary tract symptoms among women in the Russian Federation: data from an online survey

Pushkar D.Y., Kasyan G.R., Potapova L.V., Sukhikh S.O., Dzhuraeva M.D.


Aim. To estimate the prevalence and severity of lower urinary tract symptoms in the female population using a LUTS-specific questionnaire. Materials and methods. The study analyzed the prevalence of LUTS in the population of women residing in the Russian Federation. Information about voiding disorders in women, which was announced on federal television health-related programs, was posted on the website of the medical portal All questionnaires were filled in by the patients anonymously. The questionnaire was prepared by the editors of the website. We analyzed the survey results. Results. After the TV announcement, the survey website was visited by more than 15,000 people. Of them, 2,600 people filled the questionnaire (17% of the number of visitors). The findings of the survey suitable for the analysis were obtained from 2419 women (93.07%) and 181 men (6.93%). The mean age of female participants was 55 years old. Conclusion. The study had some limitations and was not truly epidemiological, as it involved only those women who had information and technical access to the Internet portal and questionnaires. Despite this, the findings suggest the high prevalence of LUTS among women in our country.
Urologiia. 2018;(4):5-9
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The effectiveness of complex phytotherapeutic medications in the management of uncomplicated lower urinary tract infections in women

Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A.


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.
Urologiia. 2018;(4):10-13
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Biological properties of microorganisms isolated from the urine of patients with urolithiasis

Kuz’min M.D., Pashkova T.M., Kartashova O.L., Pashinina O.A., Popova L.P.


Aim. To define persistent properties and antibiotic resistance of microorganisms isolated from the urine of adult patient undergoing surgery for urolithiasis. Materials and methods. Urine specimens were obtained from the renal pelvis and urinary bladder during percutaneous nephrolithotripsy. Microorganisms that were isolated from the urine were examined for their persistent properties (anti-lysozyme activity, the ability of biofilm formation) and antibiotic resistance using photometric and bacteriological methods. Results. Strains of microorganisms isolated from the urine of patients with urolithiasis have high anti-lysozyme activity and the ability of biofilm formation, and variable antibiotic resistance. These properties should be taken into account when selecting an empirical antibiotic therapy for preventing infectious-inflammatory complications after percutaneous nephrolithotripsy. Conclusion. The high level of resistance of microorganisms isolated from the urine of patients with urolithiasis to the studied antibiotics, their ability to inactivate lysozyme and form biofilms may be the cause of the development of postoperative complications.
Urologiia. 2018;(4):14-18
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Urinary factors for calcium urolithiasis and their correction

Gaibullaev A.A., Kariev S.S.


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.
Urologiia. 2018;(4):19-23
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Comparative assessment of Canephron N and ciprofloxacin as monotherapy of acute uncomplicated cystitis in women

Davidov M.I., Bunova N.E.


The study aimed to compare the efficacy and safety of Canephron N and ciprofloxacin as monotherapy in the management of mild forms of acute uncomplicated cystitis in women of working age. Materials and methods. A prospective, randomized study of Canephron N and ciprofloxacin for treating mild forms of acute uncomplicated cystitis (ACSS score <10) comprising 160 women aged 18-55 years was conducted from 2015 to 2017. Group I consisted of 80 women, who received oral Canephron N 2 tablets 3 times daily for 30 days. Group II included 80 women who took oral ciprofloxacin 0.5 g twice daily for 3 days. The results were assessed using the ACSS scale, urinalysis by microscopy, bacteriological examination of urine, etc. The outcomes were evaluated at 3, 6 and 30 days, and one year after the treatment initiation. Results. In group I, monotherapy with Canephron NH resulted in a marked improvement in symptoms, a decrease in the ACSS scores from 7.9 at baseline to 0.1 at day 30. The indicator of clinical efficacy (recovery) was 93.75%, bacteriological efficiency was 91.3%, relapse of cystitis within one year was observed in 5% of patients; no side effects were registered. In group II, the symptoms and bacteriuria decreased more rapidly in the early periods, but after 30 days the results of clinical and bacteriological efficacy did not differ from the group I (93.75 and 91.3%, respectively). Side effects and cystitis relapses were noted in 18.8% and 12.5% of patients, respectively. Conclusion. The findings of the study show that Canephron N is an effective and safe alternative to treating mild forms (ACSS score <10) of acute uncomplicated cystitis in women, allowing the use of antibiotics to be reduced. In our opinion, patients with more severe forms of acute uncomplicated cystitis should be treated with traditional antibiotic therapy.
Urologiia. 2018;(4):24-32
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First experience with prostate artery embolization for benign prostatic hyperplasia

Soluyanov M.Y., Shumkov O.A., Smagin M.A., Nimaev V.V.


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.
Urologiia. 2018;(4):33-37
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Biopotentials of the urinary bladder during functional load

Rytik A.P., Kutikova O.Y., Usanov D.A., Goremykin V.I., Prosova E.E.


The study aimed to investigate the specific bioelectrical activity of the urinary bladder walls at a functional load. Materials and methods. The study comprised five subjects aged 18-22 years who had no diseases of the urinary system. Participants signed an informed consent form before entering the study, which was approved by the Ethics Committee of our organization. Biopotentials from the ureter and urinary bladder area were recorded using the Neuro-Spectrum NeuroSoft-21 Neuron Spectrum-4 electroencephalograph, which has a higher sensitivity compared to other biopotential amplifiers. The sensitivity range of the electroencephalograph according to the manufacturer was in the frequency range from 0.05 to 250 Hz 1-1000 цУ/mm, the quantization frequency - up to 5000 Hz, the noise level - less than 0.3 μV The obtained data were in agreement with the results of the ultrasound and urodynamic studies, which implied the possibility to consider this method of registration of bladder biopotentials suitable for such a purpose. Results. The analysis of the background spectra for the same time (at rest and under load) identified a correlation between them (correlation coefficient > 0.8). Three frequencies were chosen in the range from 0.5 to 2 Hz, for which the changes of the amplitude were most clearly traced in time. A correlation analysis (using the STATISTICA 10 software) showed a correlation between these three frequencies and background load (correlation coefficient 0.2). Conclusions. The water loading resulted in an increase in the activity of the bladder wall biopotentials after the 10th minute of registration. The functional load changed the pattern of the changes of the harmonics of the bioelectrical activity spectrum of the bladder walls: in the background record, the harmonics behaved almost identically in time, but after water loading, the amplitudes of the harmonics changed with the passage of time. One of the main findings of the work is the detection of several frequencies ranged from 0.5 to2 Hz (0.7, 1.5 and 1.7 Hz), which can be used to assess the functional state of the bladder wall.
Urologiia. 2018;(4):38-43
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Long-term monitoring of leukocyturia and bacteriuria after acute obstructive pyelonephritis

Naboka Y.L., Kogan M.I., Gudima I.A., Mitusova E.V., Bedzhanyan S.K., Chernitskaya M.L.


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.
Urologiia. 2018;(4):44-48
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Rehabilitation of patients after modern endourological procedures for urolithiasis

Martov A.G., Ergakov D.V.


Introduction. Numerous publications on the successful use of NefraDoz® (Stada, Germany) in the metaphylaxis of urolithiasis after extracorporeal lithotripsy, and the prevention and treatment of infectious inflammatory diseases of the lower and upper urinary tracts, served as the rationale for a study aimed to evaluate the effectiveness and safety of longterm use of NefraDoz® in patients after transurethral and percutaneous interventions performed for urological diseases. Patients and methods. The study analyzed results of 116 transurethral and percutaneous endoscopic operations for urolithiasis performed in 62 men and 54 women aged 21 to 84 years from November to December 2017 at the D.D. Pletnev City Clinical Hospital. Depending on the localization of the stones, all patients were divided into three groups: kidney stones (n=68), ureteral stones (n=28), and bladder stones (n=21). In each group, patients were assigned either to receive (study group, n=50) or not to receive (control group, n=66) postoperative NefraDoz®, which was administered at a dose of 1 capsule three times daily for one month. Patients in the control group (n=66) received standard antibacterial therapy for one month. The analysis included leukocyturia, 24-hour diuresis, the severity of the symptoms of the disease and the patients’ quality of life. Results. The use of NefraDoz® after transurethral lower urinary tract procedures, reduced the severity of irritative symptoms, improved the patients’ quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis. The use of NefraDoz® after upper urinary tract procedures improved the patients’ quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis, and improved the clearance of residual fragments. There were no adverse events associated with NefraDoz®. Conclusions. We have proved the advantage of using the NefraDoz® complex in the rehabilitation of patients after endourologic procedures.
Urologiia. 2018;(4):49-55
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Iatrogenic urethral structures in men

Kotov S.V., Belomyttsev S.V., Guspanov R.I., Semenov M.K., Iritsyan M.M., Ugurchiev A.M.


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.
Urologiia. 2018;(4):56-63
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Rationale of use and effectiveness of Longidaza in patients with chronic prostatitis

Kulchavenya E.V., Shvetsova O.P., Breusov A.A.


Introduction. Chronic inflammation of the prostate leads to the formation of excess fibrous connective tissue, which hinders patients’ recovery and aggravates the symptoms. Aim. This study aimed to confirm the correlation between inflammation and prostatic fibrosis and the abnormalities of urodynamic and microcirculation in the prostate gland in humans, and the possibility of increasing the effectiveness of treatment of patients with chronic nonbacterial prostatitis using antisclerotic therapy. Material and methods. The study was carried out in two stages. At the first stage, pathomorphological findings, uroflowmetry data and degree of microcirculation disturbance were studied in 18 patients with chronic prostatitis who underwent prostate biopsy. At the second stage, an open prospective randomized comparative study was conducted. Two groups of patients with chronic nonbacterial prostatitis with signs of inflammation were formed. A control group (n=29) received standard treatment, rectal 0.5 methyluracil suppositories three times per week, 20 suppositories per course. In addition to the standard treatment, the patients of the study group (n=31) were administered Longidaza 3000 IU rectal suppositories also three times a week, 20 suppositories per course. Results. Prostatic fibrosis worsens microcirculation by one and half times and statistically significantly negatively affects urodynamic. Using Longidaza resulted in neutralizing the negative consequences of the formation of excess fibrous connective tissue. Overall, an excellent and good effect was achieved in 21 (67.7%) and 9 (29.1%) patients of the study group, respectively; only in one case (3.2%) there was no effect. In the control group, an excellent and good effect was achieved in 14 (48.3%) and 11 (37.9%) patients, respectively; in 4 patients (13.8%) the treatment was considered of low effectiveness. Conclusions. Prevention of the fibrous connective tissue formation and regression of the fibrosis are pathogenetically valid. Anti-sclerotic enzyme therapy with Longidaza in the form of rectal suppositories results in a significant improvement in the symptoms of prostatitis, an increase in the maximum urinary flow rate and an improvement in the microcirculation of the prostate.
Urologiia. 2018;(4):64-71
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Patients with newly diagnosed benign prostatic hyperplasia

Meshkov I.O., Kulchavenya E.V., Shevchenko S.Y., Neimark A.I.


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.
Urologiia. 2018;(4):72-80
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The effectiveness of the integrated approach to the treatment of chronic prostatitis, including in patients with benign prostatic hyperplasia

Zhiborev A.B., Martov A.G.


Introduction. Concurrent chronic prostatitis (CP) plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH), increasing the severity of lower urinary tract symptoms (LUTS), lowering the quality of life, and increasing the risk of acute urinary retention. However, in the management of patients with BPH, the role of CP is not always taken into account. Aim. To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate. Materials and methods. Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I-II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern. Results. Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate- specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH. Conclusion. In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I-II stage BPH.
Urologiia. 2018;(4):81-87
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Chrono-biological features of different regimens of testosterone gel therapy in men with androgen deficiency

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


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.
Urologiia. 2018;(4):88-95
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Multi-tract percutaneous nephrolithotomy in the management of staghorn stones

Merinov D.S., Artemov A.V., Epishov V.A., Arustamov L.D., Gurbanov S.S., Polikarpova A.M.


Aim. To compare the results of a single tract versus multi-tract percutaneous nephrolithotomy (PNL) Materials and methods. Over a period of 6 years, a total of 2,264 PNLs was performed at the N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, of which 875 PNLs were done for stage K3-K4 staghorn calculi. Among them, 244 (27.7%) patients underwent multi-tract PNL. We included 873 patients in our study. The median stone size was 59 (46; 88) mm. Two, three and four percutaneous tracts were used in 165 (67.6%), 63 (25.8%) and 14 (5.7%) patients, respectively. In 126 of 244 (52%) patients, a set for mini-percutaneous surgery with 14.5 and 15.5 Ch tubes was used as additional access. Results. The effectiveness of single and multi-track PNL was 53.6%, and 83.8%, respectively. The mean operating time for PNL using one, two, three and four percutaneous tracts was 77.2±29.9, 85.7±26.9, 116.6±28, and 144.0±12.2 min, respectively. The median length of hospital stay for single and multi-track PNL was 6.6 (5.4, 8.7) vs. 10.2 (8.6, 12.3) days. Intra- and early postoperative infectious complications occurred in 101 (16.1%) and 54 (22.4%) patients, who underwent single and multi-track PNL, respectively. Bleeding occurred in 88 (13.9%) and 50 (20.8%) patients, respectively. After single and multi-track PNL, 54 (8.6%) and 21 (8.8%) patients needed a blood transfusion, respectively. Conclusion. Multi-track PNL is highly effective as a treatment modality for patients with complex forms of nephrolithiasis. Using the mini-tool significantly reduces the risk of bleeding when performing the additional access.
Urologiia. 2018;(4):96-101
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Intraoperative complications of radical cystectomy with various types of urinary diversions

Musayev T.N., Guliev F.A.


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.
Urologiia. 2018;(4):102-105
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Use of multiparametric magnetic resonance imaging in t-staging of prostate cancer: a multicenter study

Abdullin I.I., Kossov F.A., Kamolov B.S., Kapustin V.V., Grigor’ev N.A., Gubskii I.L., Chernyaev V.A., Panov V.O., Buidenok Y.V., Matveev V.B.


Aim. The study aimed to analyze the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) in the staging of prostate cancer (PCa) versus postoperative histological examination and determine the most sensitive pulse sequence from the mp-MRI protocol in estimating the local extent of PCa. Materials and methods. The study comprised 112 men aged 52 to 84 years with a morphologically verified diagnosis of prostate cancer. All patients underwent pelvic mp-MRI before radical prostatectomy (RPE) no earlier than six weeks after the prostate biopsy. Radical prostatectomy was performed within two weeks after mp-MRI. MP-MRI findings and the results of postoperative histology were compared using a binary logistic regression model. Results. The sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative (NPV) predictive values for predicting extracapsular extension were 87.5, 92.6, 91, 84 and 94.3%, respectively; for predicting seminal vesicles invasion, they were 85, 95, 90, 80.9 and 96.7%, respectively. When stratified by the presence or absence of the pseudocapsule invasion, the reliability of detecting the tumor spread for different types of images decreases in the following order: DWI - T2 + DWI - T2 VI - DCE-MRI. Conclusion. mp-MRI has high sensitivity, specificity, general diagnostic accuracy, high NPV, and PPV values in detecting an extracapsular extension of prostate cancer. According to the binary logistic regression model, the greatest contribution to the decision on the presence or absence of extracapsular extension is also made by the DWI.
Urologiia. 2018;(4):106-113
pages 106-113 views

Complete ileal substitution of the obliterated ureter

Kolyadko V.P., Degovtsov E.N., Kolyadko P.V., Prokhorov V.G., Satinov A.V.


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.
Urologiia. 2018;(4):114-117
pages 114-117 views

An interdisciplinary approach to the management of bladder endometriosis

Yarin G.Y., Vil’gel’mi I.A.


Urinary endometriosis a rare condition accounting for 1-5.5% of all of the extragenital endometriosis locations. Bladder endometriosis is the most common form of urinary endometriosis, comprising 85% of cases. There is no single approach to treating bladder endometriosis patients with this pathology. Multidisciplinary collaboration between urologists and gynecologists aimed to develop an appropriate treatment strategy is essential in the management of bladder endometriosis. We report two cases of patients with different location of endometriotic lesions in the bladder, surgical strategy and collaboration between urologists and gynecologists at all stages of treatment.
Urologiia. 2018;(4):118-121
pages 118-121 views

Interstitial laser coagulation in the management of urothelial papillary carcinoma of the renal pelvis

Teodorovich O.V., Shatokhin M.N., Abdullaev M.I., Krasnov A.V., Khommyatov M.R.


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.
Urologiia. 2018;(4):122-126
pages 122-126 views

Buccal mucosa substitution urethroplasty in a patient with an extensive urethral stricture

Kyzlasov P.S., Martov A.G., Zabelin M.V., Bokov A.I., Kazhera A.A.


Urethral strictures are one of the most common reasons to see a urologist and are considered a socially significant disease. Management of urethral strictures is one of the challenging issues in urology. The article presents a case of a patient with extensive iatrogenic stricture of the penile urethra. The patient underwent penile augmentation urethroplasty using buccal mucosa resulting in the restoration of the whole length of the urethral lumen and non-obstructive urination according to uroflowmetry findings.
Urologiia. 2018;(4):127-129
pages 127-129 views

Retroperitoneoscopic resection of the calyceal diverticulum wall in an 8-year-old child

Kadyrov Z.A., Demin N.V., Sarukhanyan O.O., Shvelidze M.G.


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.
Urologiia. 2018;(4):130-134
pages 130-134 views

The combined symptoms of male lower urinary tract: current treatment options

Gadzhieva Z.K., Gazimiev M.A., Kazilov Y.B., Grigoryan V.A.


This literature review presents current data on epidemiology and views on the pathogenesis of male lower urinary tract symptoms. The authors discuss current options for the management of male lower urinary tract symptoms using a fixed-dose combination drug that includes one of the most selective and safe α1-blockers tamsulosin OCAS and the most selective of anticholinergic agent solifenacin.
Urologiia. 2018;(4):135-141
pages 135-141 views

Nephron-sparing surgery for renal tumors

Maksimov A.V., Martov A.G., Neustroev P.A., Vinokurov R.R.


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.
Urologiia. 2018;(4):142-146
pages 142-146 views

Complications of percutaneous nephrolithotomy and their management

Malkhasyan V.A., Semenyakin I.V., Ivanov V.Y., Sukhikh S.O., Gadzhiev N.K.


To date, percutaneous nephrolithotomy (PNL) is the standard treatment modality for large-volume renal stones and staghorn stones in patients with urolithiasis. Despite low invasiveness, this method is not without complications. This review discusses the most common complications and suggests methods for their prevention and appropriate management. To unify the study of complications they were categorized based on the modified Clavien classification. According to the available data, about 80% of the PNL complications belong to grade I-II complications and does not require any additional treatment. The most serious complications include sepsis, bleeding, and injury to nearby organs.
Urologiia. 2018;(4):147-153
pages 147-153 views

Genetic factors for monogenic forms of calcium urolithiasis

Filippova T.V., Litvinova M.M., Rudenko V.I., Gadzhieva Z.K., Rapoport L.M., Kazilov Y.B., Asanov A.Y., Subbotina T.I., Khafizov K.F.


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.
Urologiia. 2018;(4):154-160
pages 154-160 views

Methanaphylaxis of urolithiasis. Part 1. Factors for increasing incidence of urolithiasis. Current theories of renal stone formation

Saenko V.S., Gazimiev M.A., Pesegov S.V., Alyaev Y.G.


Urolithiasis is one of the most actively progressing diseases, a metabolic disorder that is strongly associated with a combination of genetic, lifestyle, and environmental factors. The first part presents current views on the factors triggering the formation of stones and the theory of stone formation. More specifically, the article discusses factors that contribute to the activation and inhibition of nucleation and aggregation of stone-forming substances.
Urologiia. 2018;(4):161-169
pages 161-169 views

Diagnostic and prognostic significance of urinary microvesicles

Baksheeva E.G., Tsybikov N.N.


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.
Urologiia. 2018;(4):170-171
pages 170-171 views

Magnetic resonance imaging in the diagnosis of recurrent prostate cancer

Shariya M.A., Glybochko P.V., Ternovoi S.K., Petrovskii N.V.


The article reviews the domestic and international literature on local recurrence of prostate cancer both after surgery and non-invasive treatments. The authors describe modern high-precision techniques used in magnetic resonance imaging that are used today in clinical practice for the most accurate detection of recurrent prostate cancer lesions.
Urologiia. 2018;(4):172-178
pages 172-178 views

Vitamin D deficiency, metabolic syndrome, and prostate adenoma: current epidemiological trends and pathophysiological mechanisms of interaction

Bratchikov O.I., Artishchev S.O., Tyuzikov I.A.


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.
Urologiia. 2018;(4):179-185
pages 179-185 views

Dmitry Yurievich Pushkar (to the 55th anniversary)

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Urologiia. 2018;(4):186-186
pages 186-186 views

Oleg Borisovich Loran (to the 75th anniversary)

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Urologiia. 2018;(4):187-187
pages 187-187 views
pages 188 views

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