No 5 (2018)

Aim. to study the pathologic features of chronic oxalate stone disease. Materials and methods. a model of the experimental oxalate stone disease was done in rats that drank the 1% ethylene glycol solution for 16 weeks. The pathologic analysis of the rats’ kidneys was done. Results. After 16 weeks of oxalate stone disease modeling in all parts of kidneys the large crystals deposits were found, which plugged renal tubules. Moreover, purulent calculous pyelonephritis developed complicated by fibrosis.

Aim: to determine the importance of a presepsin plasma level for early identification of urosepsis, assessment the severity and efficiency of therapy. Material and methods. From 2017 to 2018 r. a prospective controlled randomized cohort study with 32 patients (6 men, 26 women) aged from 20 to 60 years was conducted. Patients with diagnosed or suspected purulent pyelonephritis were randomized into two groups depending on the treatment strategy. In Group 1, patients received drug therapy, while in Group 2 surgical treatment was performed due to ineffectiveness of drug therapy. In both groups a level of presepsin was assessed and compared with the clinical manifestation of acute pyelonephritis and the choice of adequate treatment. Results. The mean presepsin level in Group 1 at the admission was 338.4 pg/ml (normal value - 97 pg/ml), while in Group 2 it was 501.125 pg/ml. The presepsin level significantly decreased in both groups on Days 6-7 (p<0.005), to 120.4 pg/ml and 66.875 pg/ml, respectively. Consequently, according to clinical and laboratory data, acute purulent pyelonephritis in patients who received combined therapy was successfully managed without surgical treatment, which was confirmed by the positive changes in body temperature, pain severity, blood analysis (leucocytes, ESR) and urine (protein, leukocytes) due to timely detection of presepsin level. Discussion. Our analysis showed that recovery occurred in both groups, but there are differences in the duration of the disease depending on treatment strategy. Using the presepsin level, we found: In Group 1 the level was 338.4 pg/ml (1.5 times less than in Group 2, p<0.005), which indicates the possibility of systemic infection. In this group the surgical treatment was avoided without any fatal consequences. In Group 2, in patients who were undergone to surgical treatment the mean baseline presepsin level was 501.125 pg/ml, which indicates the moderate risk of systemic infection (severe sepsis) and increased risk of adverse outcomes, therefore, surgical treatment was recommended. Thus, the determination of presepsin level can influence on the choice of treatment strategy. Conclusion. The analysis of presepsin level is necessary for the choice of treatment strategy, since the clinical and laboratory data does not always reflect the changes in the kidneys.

Introduction. The globalization observed in the modern world contributes to the increasing rate of the delivery of “exotic” bacterial and parasitic infections from the tropic countries to Russia and the European countries. Aim. To analyze the modern early diagnostic tools of premalignant changes and malignant tumors of urinary bladder of schistosome origin in the residents of endemic areas. Materials and methods. The current study included an analysis of examination and treatment of 181 patients with bladder schistosomiasis who lived in Benguela province in Angola. In 39 cases (21.5%) bladder cancer associated with schistosomiasis was detected. All patients were undergone to surgical treatment. 142 patients (78.5%) were divided into two groups. In Group 1 (n=74) patients had uncomplicated bladder schistosomiasis and in Group II (n= 68) the patients with granulomatous inflammatory changes in the urinary bladder were included. Results. The patients with bladder schistosomiasis (n=142) were undergone to outpatient examination. In 38 cases (26.8%) the cytologic study of urinary sediment (CSUS) revealed the schistosomes eggs. With ultrasound study, the specific granulomatous changes in the mucous membrane of urinary bladder were detected in 28 cases (19.7%) while hydronephrosis, calcifications and thickening of bladder wall was diagnosed in 7 (4.9%), 10 (7%) and 99 (69.7%) patients, respectively. During cystoscopy the granulomatous changes in the bladder were found in 68 cases (47.9%). In Group I patients received «Praziquantel» in combination with oral antibiotic therapy, which resulted in resolution of gross hematuria and dysuria. All patients in Group II (n=68) were also administered antibacterial and antiprotozoal therapy. An additional 35 patients (24.6%) were undergone to transurethral bladder resection. Of 33 patients in Group II (23.2%) who received only antibacterial and antiprotozoal therapy the granulomas persisted in 7 cases (4.9%) and, therefore, TURB was performed. The subsequent studies showed the regression of the lesions in these patients. Conclusion. CSUS and ultrasound study are not sufficient for diagnosis of bladder schistosomiasis. Cystoscopy is recommended for all patients, since it allows to evaluate bladder volume and to determine the indications for TURB in addition to antiprotozoal and antibacterial therapy.

Aim. To develop a rationale treatment strategy for elective isolated and simultaneous interventions in geriatric patients with benign prostatic hyperplasia (BPH) aimed at decreasing of complications rate and grade, based on current approach to indications and contraindications. Materials and methods. From 2000 to 2015 yy. a total of 639 elderly and senile patients with BPH were undergone to isolated simple prostatectomy, transurethral prostatic resection and simultaneous surgery. Two timeframe were allocated, from 2000 to 2006 and from 2007 to 2015 yy. During the first period, the conventional indications and contraindications were used for determination of the type and volume of the the surgery. During the second period, a novel author’s approach to the structure indications and contraindications for the surgical treatment was introduced. Results. For the first time in the geriatric urology a modern structure of the indications and contraindications for elective interventions in patients with BPH has been developed, which allowed to clarify the treatment strategy on the individual basis. The new criteria for absolute and relative contraindications are included as well as, for the first time, temporary, specific and organizational contraindications for the simple prostatectomy and TURP. There is a need for review some conventional contraindications for the TURP in elderly and senile patients, considering that in specialized geriatric urological hospital for patients with severe concomitant diseases (therapeutic, neurologic, etc.), TURP should be the method of choice regardless prostate volume, often exceeding 60 cc. The use of a new structure of indications and contraindications allowed to establish absolute contraindications for the elective surgery in 19%, relative contraindications in 21% and temporary contraindications in 8% cases, respectively. These patients were undergone to palliative surgeries or drug treatment which helped to prevent possible postoperative complications and mortality. Conclusion. In order to determine the treatment strategy in elective isolated and simultaneous interventions in geriatric patients with BPH it is necessary to consider the current general and specific indications as well as absolute, relative, specific, temporary and organizational contraindications. The introduction of the novel structure of the indications and contraindications for the elective isolated and simultaneous surgeries with priority of TURP had a pronounced clinical effect, contributing to the marked reduction of postoperative complications and deaths in geriatric patients with BPH.

Introduction. The relationship of surgical treatment of urethral stricture and such mental deviations as anxiety and depression is still poorly understood. Particularly, there is no reliable data on how mental status is associated to surgical treatment of the urethral stricture and its efficacy. Aim: to study the indicators of anxiety and depression in patients with urethral stricture before and after surgery. Materials and methods. The prospective study involving 30 men aged 20-74 years with urethral stricture of various etiologies and localizations was conducted. The validated questionnaires, HADS-1 and HADS-2 were used to evaluate anxiety and depression, lower urinary tract symptoms (I-PSS-QoL), erectile dysfunction (IIEF-5) before and 3 and 6 months after surgery. Results. Almost all patients with urethral stricture before surgery had an increased level of anxiety and depression, which in 70% cases decreased to normal values by 6 months after successful surgery. Clinically, these changes correlated with the improvement of lower urinary tract symptoms. The restoration of erectile function in patients by 6 months was less pronounced, though it had no influence on the resolution of anxiety/ depression. Conclusion. The determination of psycho-emotional status in patients with urethral stricture before and after urethroplasty should be as important for the evaluation of the efficiency of surgical treatment, as the resolution of lower urinary tract symptoms and restoration of sexual function.

Introduction. For rational planning of laser lithotripsy tactics, determination of pulse settings and laser modes, considering patient’s condition, stone size and composition as well as for more rationale planning of operation theatre loading and the use of high-technology equipment the knowledge of the time required for complete stone fragmentation is needed. It is still assessed subjectively base on the urologist’s own experience. Aim. To determine the specific value of urinary stone’s mass decrease in order to evaluate exact time for complete fragmentation during holmium laser lithotripsy. Materials and methods. Fragmentation time values were derived from in vitro studies in which lithotripsy using holmium laser was compared to other lithotriptors’ types, as well as our own results of time and energy level measurement during urinary stones fragmentation in vivo were used. Results. As baseline data for estimating of the urinary stones destruction using holmium laser lithotripsy we suggest to use not stone volume but its mass which combine in some extent the volume and density. To take into account energy level for stone fragmentation it is suggested to introduce new value, the specific decrease of the stone mass per unit of laser energy (mg/J). It is established that such a value is a constant for a given laser type and fiber size. This value is calculated using stone dimensions, its density in HU and the total laser energy delivered during complete fragmentation. Based on experimental data it is estimated that specific decrease of the stone mass per unit of holmium laser energy during fragmentation in vitro of BegoStone is 0.442±0,083 mg/J (p=0.05). This value, measured in real conditions in vivo during urinary stones lithotripsy using holmium laser Triple («Medoptotech») with 600 μm fiber is 0.40110.12 mg/J (p=0.05). Conclusion. The use of specific decrease of the stone mass per unit of the laser energy during lithotripsy allows to assess complete fragmentation time of the urinary stones, based on their dimensions and density in HU. The absolute error in estimating of stone fragmentation time does not exceed several minutes, which is quite acceptable for calculating the total time of using high-technologic equipment and operative time.

Introduction. Surgical treatment of proximal hypospadias is associated with a number of difficulties and unsuccessful repeated interventions. The changing approaches to the treatment of hypospadias with the revision of the attitude to urethral plate provide new opportunities in resolving this problem. Aim: to improve the results of surgical correction of hypospadias by creating “artificial” urethra that is very close to a native one in its functional qualities. Material and methods. From 2011 to 2017 г. two-stage urethroplasty using Bracka technique was used in 41 patients with a proximal hypospadias aged 1-16 years. From those, 32 patients were undergone to primary intervention (78%), and 9 boys previously had unsuccessful urethroplasty performed by different techniques (22%). Oral mucosa graft was used in 9 patients (22%), and in other 32 cases inner preputial skin was harvested (78%). The classical and modified Bracka technique were performed in 19 and 22 cases, respectively. The urethral plate was preserved in 22 cases and “artificial” urethra was created by its tubularization, which contributes to the reduction of the required length of the harvested prepucial graft. Results. The complication rate in patients after classical Bracka technique was 31.6% (n=6) in comparison with 4.5% in group of the modified urethroplasty (n=1). Thus, the efficiency of modified technique was significantly better than that of the classical intervention (р<0,05). Conclusion. The preservation and use of urethral plate for urethroplasty during the two-stage surgical correction of the proximal hypospadias allows to decrease the total length of “artificial” urethra and to improve the properties of the newly formed urethra.

Bladder stones are usually seen among patients with bladder outlet obstruction, especially in men over the age of 50 years. There are several risk factors for bladder stones, including urinary tract infections, abnormal urinary tract system anatomy, and presence of foreign bodies. In addition, migrating intrauterine contraceptive devices through the wall of the urinary bladder and foreign bodies such as surgical sutures may act as a nidus for developing stone formation. Here in, we report a case of bladder stone associated with surgical non-absorbable suture, used for gynecologic surgery 4years ago, and treated endoscopically. The aim of this paper was to know gynecological association and the management of bladder stones. The patients who had a history of pelvic surgery previously and present with lower urinary tract symptoms such as dysuria, voiding difficulties, weak micturition and hematuria should be evaluated for the foreign body-associated disorders.

In the Russian Federation, a proportion of bladder cancer in the overall structure of malignant tumors is about 2.8% and among oncological diseases of genitourinary system its incidence is second only to prostate cancer. Bladder cancer ranks as ninth most prevalent in males and as eighteens in females. The most important issue is to determine a recurrence rate of non-muscle invasive bladder cancer, which can reach 80%. In this regard, currently, all over the world much more attention is paid to studying and creation of early detection, including non-invasive, which will be reliable in the early stages. It can possibly lead to a reduction the number of cystoscopy and become as “golden” standard of noninvasive diagnosis bladder cancer.

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

In the article the main causes of the development of infective complications after percutaneous nephrolithotomy and their predictors described by the different authors are presented. A review of studies, dedicated to analysis of baseline risk factors of postoperative fever, systemic inflammatory response syndrome and/or sepsis was conducted. It was established that stone size and true bacteriuria are reliable risk factors as well as technical features of PCNL and the duration of the surgery. The staghorn and multiple stones increase the postoperative complications rate by three times. Despite low incidence of postoperative sepsis after PCNL, it is the serious complication and the main cause of mortality in a postoperative period. The use of prophylactic antibiotics with consideration of bacteria, isolated from the urinary tract significantly reduces the incidence of the postoperative infectious complications. The scheme of a single injection of the antibiotic 30 minutes before the surgery is effective.

Penile tuberculosis is a relatively rare disease. However, considering persisting epidemic of the tuberculosis in the several parts of the world, the growth of migration, predominantly, from these regions, it is reasonable to keep in mind this localization of extrapulmonary tuberculosis. Penile tuberculosis can be primary, secondary and iatrogenic, induced by intravesical instillations of BCG-vaccine for superficial bladder cancer. Penile tuberculosis can affect penile skin, glans and cavernous bodies. Any alteration in the penis is suggested to be due to sexual transmitted diseases or malignant process. The diagnosis is confirmed by morphological study, because microbiological study showed mycobacterium only in one case and PCR is positive in no more than one third of cases.

In this article the current data on using of antibacterial drug Fosfomycin for treatment of lower urinary tract infection are reviewed. The distinct features of pharmacodynamics and pharmacokinetics of fosfomycin, as well as the spectrum of its antimicrobial activity are thoroughly discussed. The current information on the resistance of uropathogens, including those that produce extended-spectrum β-lactamase, are presented.

The prevalence rate of overactive bladder symptoms is 16% for men and 16.9% for women. Currently, m-anticholinergics are the first line of therapy. The selective and non-selective antimuscarinic drugs are available in Russian Federation. Some patients refuse long-term use of М-anticholinergics due to either side effects, or insufficient efficacy. This situation prompted world scientific community to search of alternative treatment methods. Mirabegron is a selective β3-adrenoreceptors agonist, which represent a new approach to the treatment of patients with overactive bladder. In this article the studying of adrenoreceptors, properties of mirabegron and the possibilities for its applications are reviewed.

In the article the biography of famous Italian doctor and anatomist Lorenzo Bellini who in his student years described a tubule system in the kidneys is reviewed. An author’s translation of fragments of his work «Exercitatio anatomica de structura et usu renum» with the description of the discovery as well as the works of Marcello Malpighi «Opera posthuma», which stated the priority of this discovery to Bellini and not to Bartolomeo Eustachi, is provided. The evaluation of the medical and scientific activities of Bellini by his contemporaries is given.