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No 5 (2018)


Laparoscopic ileal ureteral substitution. Results of the first 40 operations

Kochkin A.D., Gallyamov E.A., Popov S.V., Biktimirov R.G., Sanzharov A.E., Sergeev V.P., Sevryukov F.A., Orlov I.N., Novikov A.B.


Introduction. Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically. Aim. To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access. Material and methods. From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Ofthem, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on Results. The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years. Conclusions. The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.
Urologiia. 2018;(5):5-12
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The features of the pathologic changes in chronic oxalate stone disease after 16 week of experimental phase

Zharikova G.V., Bryukhanov V.M., Neymark A.I., Zharikov A.Y., Bobrov I.P., Yakushev N.N.


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.
Urologiia. 2018;(5):13-15
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The preparation of patients with urinary stone disease to extracorporeal shock-wave lithotripsy

Neymark A.I., Neymark B.A., Nozdrachev N.A., Sokol I.N., Kirillov I.V.


The treatment of urinary stone disease is one of the most urgent and complex issue in modern urology. Citrate is one of the most important natural urinary inhibitors of stone formation. In this regard, the drugs containing citrate sodium and potassium are being actively used. Aim: to assess the efficiency and safety of Uryklar, dietary supplements. Material and methods: A total of 57 patients with proximal ureteric stones were included in the study (intervention group (n=30) and control group (n=27)). After stenting all patients received antispasmoic, antiinflammatory and antimicrobial therapy. In the intervention group Uryklar was additionally administered (405 mg), 1 capsule TID for 1 month. All patients were undergone to extracorporeal shock-wave lithotripsy with subsequent removing of the stent. In all cases multiplanar CT was done before and 28 days after initiation of drug therapy for determination of stone size, contour and density. 10 days after stent removal the symptoms and stone-free rate were assessed using US, plain X-ray and intravenous urography, blood count, urinalysis, biochemical blood analysis. Results. In patients receiving Uryklar, there was a significant reduction of stone size during the observation, up to complete dissolution.
Urologiia. 2018;(5):16-21
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The role of presepsin in the estimation of disease severity and assesment the treatment efficiency in patients purulent pyelonephritis

Chernova Y.G., Neymark A.I., Momot A.P.


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.
Urologiia. 2018;(5):22-27
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The long-term infective complications in patients after kidney transplantation and photopheresis

Faenko A.P., Zulkarnaev A.B., Fedilina V.A., Kantaria R.O., Faenko I.G., Kildyushevskyi A.V., Vatazin A.V.


Aim: to evaluate the influence of prophylactic use of photopheresis on the risk of long-term infective complications after kidney transplantation. Materials and methods. The open cohort randomized study was conducted. A total of 60 recipients after cadaveric kidney allotransplantation from 30 donors were assessed. The patients were randomized into two groups (n=30). All transplants were paired, and one kidney was transplanted to patient in intervention group and the another one was transplanted to patient in control group. In the intervention group all patients received standard immunosuppression therapy (tacrolimus, mycophenolate, prednisone) and 10-15 sessions of photopheresis during first 6 months after the transplantation. In the control group only the immunosuppression therapy was given. The follow-up period ranged from 2 to 7 years, an average 4.5±2.0 years. Results. The rate infective complications in the both groups gradually decreased as the postoperative period increased exponentially, but it was lower in the intervention group than in the control group. The rate of respiratory infection, asymptomatic bacteriuria and viremia, verified by the genetic amplification was 4, 2 and 1.5 times lower in the intervention group. The risk of clinically meaningful infection was significantly lower in the intervention group than in the control group: IRR 0.3888 (95% CI 0.2754; 0.5445; р<0.0001). 6-year survival in the intervention group was 100% in comparison to 82.8% in the control group (95% CI 51.6; 93.16). Conclusion. The prophylactic use of the photopheresis allows to decrease the risk of infective complications after the kidney transplantation.
Urologiia. 2018;(5):28-34
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Parasitic disease of urinary tract system (on the example of schistosomiasis)

Startsev V.Y., Asfandiyarov P.R., Kolmakov A.Y.


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.
Urologiia. 2018;(5):35-38
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Surgical technique and the first clinical experience of augmentation urethroplasty without dividing of corpus spongiosum (KODAMA technique)

Kotov S.V., Belomitsev S.V., Guspanov R.I., Iritsyan M.M., Surenkov D.N., Semenov M.K., Ugurchiev A.M.


Aim. In case of complex and long urethral stricture a use of augmentation technique is often limited by “critically” narrowing of urethral plate. In such cases, the augmentation anastomotic urethroplasty without division of the corpus spongiosum can be the method of choice, because it allows to perform simultaneous augmentation urethroplasty with maximal sparing of antegrade blood flow in corpus spongiosum. Materials and methods. In urologic clinic of N.I. Pirogov City Clinical Hospital №1 the analysis of 17 patients who were undergone to augmentation anastomotic urethroplasty without division of the corpus spongiosum (Kodama technique), performed by single surgeon from 2013 to 2017 yy was done. The meant stricture length was 3.75 cm (2-6). Penile, bulbar and panurethral stricture was found in 6 (35.3%), 7 (41.2%) and 4 (23.5%) cases, respectively. Results. Technique efficiency was 88.2% and in 2 patients (11.8%) a stricture recurrence developed. The mean maximum flow rate before and after surgery were 5.4 and 23.1 ml/s, respectively (p<0.05). The mean catheterization time was 14 (7-30) days. There were no patients with de novo urinary incontinence and erectile dysfunction. Conclusion. The initial results of augmentation anastomotic urethroplasty without division of the corpus spongiosum showed high efficiency. To our opinion, the antegrade blood flow sparing makes it the method of choice in patients with long non-traumatic urethral stricture (without severe spongiofibrosis), good preoperative erectile function but isolated length of “critically” narrowing of the urethral lumen.
Urologiia. 2018;(5):39-45
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The choice of individual treatment strategy in geriatric patients with benign prostatic hyperplasia with consideration of indications and contraindications for elective isolated and simultaneous interventions

Leschenko I.G., Bratchikov O.I., Shatokhina I.V., Akimov A.I.


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.
Urologiia. 2018;(5):46-52
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The use of nutrient complexes in idiopathic male infertility associated with astenoand/or teratozoospermia: the search of predictors of treatment efficiency (preliminary results)

Bozhedomov V.A., Kamalov A.A., Bozhedomova G.E., Kozlova V.I., Kamarina R.A., Epanchintseva E.A.


Background. Nutrient complexes (dietary supplements) containing various vitamins, minerals, enzymes are popular substances for treatment of male infertility. However, the use of such complexes often does not lead to an improvement of ejaculate analysis and the restoration of fertility. Aim. To determine the predictors of efficiency of treatment with a complex of nutrients. Material and methods. An open, uncontrolled study which included 102 men from infertile couples aged 25-45 years with idiopathic asteno-, and/or teratozoospermia was conducted. All man received the complex of nutrients (4 capsules of 410 mg per day) containing L-arginine (720 mg), L-carnitine (240 mg), L-carnosine (92 mg), coenzyme Q10 (10 mg), glycyrrhetinic acid (6 mg), zinc (4,8 mg), vitamin Е (3,2 mg), vitamin А (0,36 mg), selenium (0,034 mg), which is from 12% to 80% of recommended level of daily intake for these substances. The ejaculate analysis was done in accordance to WHO recommendations, including the assessment of the production of reactive oxygen species (ROS). Results. After 3 months of treatment the proportion of sperm cells with progressive motility increased in 59% patients in the average by 4 % (р<0.05) due to an increase in the proportion of rapidly progressive sperms with grade “A” motility by 4 % (р<0,05) and a decrease in the proportion of non-progressive sperms (-2 %; р<0.05). The improvement was more often observed in patients with baseline lower sperm motility (р<0,05) and had phasic dependence on the ROS level. It was more pronounced (+24 % in relative values for motility “A”; р<0.05) in patients with moderate elevation of ROS level (2-4 IU), and insignificant at the normal (< 2 IU) and marked elevated (4-7 и >7 IU) ROS level. The standardized effect with an increase of ROS for motile spermatozoa of category A was 0.16, 0.47, 0.34 и 0.22, respectively, i.e., it was weak in all cases. The changes of sperm concentration and morphology were insignificant (р>0.05), but the improvement of sperm morphology was more often observed in patients with pathologic forms greater than 95 % (р<0.05). Conclusion. The increase in the proportion of sperm cells with progressive motility while taking nutrient complex had dependence on the baseline level of oxidative stress and it was more pronounced in patients with moderate elevation of ROS level. The further, more powerful studies to assess the influence of dietary of this supplement on the other ejaculate indicators.
Urologiia. 2018;(5):53-59
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The influence of urethral stricture disease and urethroplasty on anxiety and depression in men

Kogan M.I., Amirbekov B.G., Kryuchkova M.N., Mitusov V.V., Krasulin V.V., Sizyakin D.V.


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.
Urologiia. 2018;(5):60-63
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Histopathological evaluation of the evolution of oral mucosa grafts used for augmentation urethroplasty

Kogan M.I., Dementieva I.Y., Mitusov V.V., Glukhov V.P., Krasulin V.V., Sizyakin D.V., Il’yash A.V.


Introduction. The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra. Aim: to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty. Material and methods. A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied. Results. The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium. Conclusion. The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.
Urologiia. 2018;(5):64-68
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The assesment of the fragmentation rate of urinary stones during the holmium laser lithotripsy

Chernega V.S., Tlukpovskaya-Stepanenko N.P., Eremenko A.N., Eremenko S.N.


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.
Urologiia. 2018;(5):69-73
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Experimental verification of thulium lithotripsy

Rapoport L.M., Vinarov A.Z., Sorokin N.I., Dymov A.M., Enikeev D.V., Tsarichenko D.G., Lekarev V.Y., Klimov R.E., Andreeva V.A., Kovalenko A.A.


Aim. Experimental evaluation of the efficacy and safety of lithotripsy using a new pulsed thulium fiber laser operating at a wavelength of 1.94 microns, peak power of 500 watts (maximum average power of 50 watts) by comparing it with a holmium laser operating at a wavelength of 2.1 microns (average maximum power 100 W and 120 W). Relevance. The proportion of minimally invasive surgery in the management of urolithiasis, including retrograde intrarenal surgery, is steadily growing. The most appropriate tool for stone destruction is a laser. To date, the gold standard of minimally invasive surgical treatment of nephrolithiasis is holmium laser lithotripsy, which uses a laser on yttrium-aluminum-garnet activated by holmium ions (Ho: YAG) operating at a wavelength of 2.1 pm. However, in recent years, lasers on a Tm-activated fiber with a wavelength of 1.94 pm have become increasingly popular since the water absorption coefficient for the Tm radiation of a fiber laser is 5.5 times higher than for a Ho: YAG laser and in 2.2 times higher than for the Tm: YAG laser. This difference may translate into greater effectiveness and speed of stone crushing, which in turn leads to shorter operating time. Materials and methods. This article describes physical foundations of holmium and thulium laser radiation, the mechanisms of stone fragmentation, data from a series of experiments comparing the efficiency and safety of ex-vivo lithotripsy using a holmium solid-state laser with a wavelength of 2.1 pm and a thulium fiber laser with a wavelength of1.94 pm. Results. The study findings suggest that the STA IRE-Polyus thulium fiber laser operating at a wavelength of 1.94 microns and a maximum power of 500 watts has several advantages over the holmium laser in the stone fragmentation in urological practice. Conclusion. The results of the experimental work allow us to conclude that the use of a thulium fiber laser operating at a wavelength of 1.94 μm and a maximum peak power of 500 W enables highly effective and safe lithotripsy.
Urologiia. 2018;(5):74-80
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Modification of two-stage technique of bracka with preservation and tubularization of the urethral plate for repair of proximal hypospadias

Kagantsov I.M., Surov R.V.


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.
Urologiia. 2018;(5):81-87
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A rare observation of the giant urinary bladder stone

Kadyrov Z.A., Rahimov D.A., Boboev S.S., Turdaliev S.H., Safarov M.M., Ubaydulloev A.H., Djuraev I.I.


A rare observation of iatrogenic damage of the urinary bladder by the needles used for osteosynthesis, which were encrusted with salts and lead to the formation of a giant bladder stone weighing 720 g, is given. The curiosity of the situation was associated with the long-term observation and the surgical removal of the stone and foreign bodies 19 years after initial detection due to the development of upper urinary tract complications.
Urologiia. 2018;(5):88-91
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Bladder stone secondary to prolene suture after gynecologic surgery

Sungur M., Caliskan S., Lokman U., Savci U., Sahin M.


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.
Urologiia. 2018;(5):92-93
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Laser in laparoscopic urology

Chuhrov D.A., Korolev D.O., Dymov A.M., Lekarev V.Y., Laukhtina E.A., Mynaev V.P., Sorokin N.I., Enikeev M.E., Shpot E.V., Vinarov A.Z., Rapoport L.M.


Nowadays, various laparoscopic instruments for tissue dissection and vessel coagulation are available. However, there are ongoing studies dedicated to “ideal” type of energy suitable for this aim. Laser radiation has been used for many years in medical practice and it is established as reliable and effective method in surgical armamentarium. The ability to provide highly precision and well-controlled action on the tissues, improved hemostasis, easy adaptability to fiber-optic and minimally invasive delivery systems, as well as the possibility of facilitating complex dissection made lasers an important tool for surgeons. The mechanism and methods of laser energy using in urology have been studied since 1980s, but there is still no consensus on the optimal type of laser and its settings during urological surgeries, which determines the importance of further researches dedicated to this promising form of energy.
Urologiia. 2018;(5):94-99
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Current trends in bladder cancer diagnosis

Glukhov A.I., Polotdykova N.V., Gordeev S.A., Vinarov A.Z., Polyakovsky K.A., Rapoport L.M., Tsarichenko D.G., Enikeev D.V., Glybochko P.V.


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.
Urologiia. 2018;(5):100-105
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Modern radiology diagnostics methods for assessment of renal perfusion in patients with urinary stone disease

Aleksandrova K.A., Rudenko V.I., Serova N.S., Gazimiev M.A., Kapanadze L.B.


Urinary stone disease is the current issue for healthcare system worldwide. High prevalence of urinary stone disease (at least 5% of the population of developed countries) determines clinical significance of the studying of its etiology and pathogenesis, improving of diagnostic methods and novel treatment technologies. The development of endoscopic devices, creation of new eswl machines and improvement of endourology interventions under X-ray guidance allowed to solve the problem of surgical treatment. Therefore, one of the actual issue is the choice of X-ray method for predicting and evaluating of treatment efficiency in patients with urinary stone disease. The changes of renal blood flow depend on urodynamic disturbances, stone location and size, the duration of disease, complications, patient’s age. Therefore, for comprehensive studying of renal function the hemodynamics evaluation is needed. In this review the advantages, drawbacks and perspective on developing of different radiologic methods for renal hemodynamic assessment are given.
Urologiia. 2018;(5):106-113
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The role of drug therapy in the management of varicocele

Gamidov S.I., Popkov V.M., Shatylko T.V., Popova A.Y., Korolev A.Y., Ovchinnikov R.I., Gasanov N.G.


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.
Urologiia. 2018;(5):114-121
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Vitamin D and urinary stone disease: the current state of problem

Ali H.M., Saenko V.S., Pesegov S.V., Ali S.H., Vovdenko S.V., Kazilov Y.B.


Disturbances of vitamin D metabolism is one of the factors leading to the impairment of phosphate and calcium homeostasis which plays leading role in the development of urinary stone disease. Vitamin D is necessary for wide spectrum of physiologic processes and good health condition. Until now, in many guidelines on urolithiasis there is an advice to limit vitamin D intake due to concerns of an increase in the stone formation. In vivo studies have shown that 1,25(OH)2D3 can both increase and decrease and not to influence on calcium excretion. The results of the studies assessing the relationship between vitamin D blood/plasma level and urinary stone disease are often inconsistent and even controversial. In patients with urinary stone disease the vitamin D deficiency is often found and currently there is still a lack of studies dedicated to problem of vitamin D deficiency in patients with urinary stone disease and the need for its correction.
Urologiia. 2018;(5):122-127
pages 122-127 views

The infective complications of the percutaneous nephrolithotomy

Guliev B.G., Zaikin A.Y., Ismati O.


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.
Urologiia. 2018;(5):128-133
pages 128-133 views

Frequency and risk factors for the development of infravesical obstructions caused by surgery of benign prostatic hyperplasia

Kriuchkova N.V., Kogan M.I., Glukhov V.P., Mitusov V.V., Sizyakin D.V.


Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.
Urologiia. 2018;(5):134-139
pages 134-139 views

Penile tuberculosis

Kulchavenya E.V.


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.
Urologiia. 2018;(5):140-145
pages 140-145 views

Urate urolithiasis: pathogenesis and possibilities of conservative therapy

Frolova E.A., Tsarichenko D.G., Saenko V.S., Rapoport L.M.


Urolithiasis is a widespread chronic disease; its prevalence has been steadily increasing over the past 50 years. Urolithiasis accounts for a large proportion urologic diseases, exceeded only by urinary tract infections and diseases of the prostate. Urate urolithiasis refers to a type of urolithiasis, characterized by the formation of kidney stones consisting of uric acid or its salts. In populations of industrialized countries, uric acid is the second or third most frequently occurring stone-forming substance. The article summarizes the data on the global prevalence of both urolithiasis as a whole and urate urolithiasis in particular. The authors provide a detailed overview of the formation of the current concept of the urate urolithiasis pathogenesis and the management of the disease. The main focus is placed on the possibilities and the role of litholytic (stone-dissolving) therapy for urate urolithiasis and the mechanisms of the action of citrate preparations.
Urologiia. 2018;(5):146-152
pages 146-152 views

Fosfomycin for treatment of uncomplicated lower urinary tract infection

Al-Shukri S.H., Slesarevskaya M.N., Kuz’min I.V.


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.
Urologiia. 2018;(5):153-159
pages 153-159 views

Quality of life of urological patients

Protoshchak V.V., Paronnikov M.V., Babkin P.A., Kiselev A.O.


Achieving a high quality of life for patients is a paradigm of modern medicine. The doctrine of the quality of life, originated in the 60s of the twentieth century, is currently actively developing in all fields of medicine, including urology. This article reviews the history, terminology, and methods of studying the quality of life. Along with the general questionnaires, disease specific quality of Ufe instruments are gradually emerging in the standards of examination and follow-up of urological patients.
Urologiia. 2018;(5):160-169
pages 160-169 views

New approach to the treatment of patients with overactive bladder. Mirabegron: past, present and future

Korshunova E.S.


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.
Urologiia. 2018;(5):170-174
pages 170-174 views

Retrograde intrarenal surgery: a modern view of the problem

Grigor’ev N.A.


Retrograde intrarenal surgery (RIRS) is a rapidly developing field of endoscopic management of urolithiasis. Previously considered an additional technique in patients with lower calyx stones that do not respond to extracorporeal shock wave lithotripsy, now the RIRS along with percutaneous surgery is gaining a leading position in the management of kidney stones. Currently, it is recommended as the main surgical modality for treating stones less than 2 cm, especially in cases where extracorporeal shock wave lithotripsy is not feasible or not desirable. Retrograde intrarenal surgery has no specific contraindications, except for the active inflammatory process in the urinary tract, and can be used even in patients with various coagulopathies. In this paper, we present information on the history of the emergence and advances of RIRS, indications and contraindications, preoperative patient care, the choice of anesthesia, the surgical technique and features of the ureteral sheaths, strings, and lithoextractors. Recommendations for laser lithotripsy, postoperative care and possible complications with a review of the current literature are presented.
Urologiia. 2018;(5):175-181
pages 175-181 views

Lorenzo Bellini (1643-1704) and his discovery of the renal tubules

Kutia S.A., Razumovskaya E.A., Grigoryants A.V., Sataieva T.P., Shaymardanova L.R.


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.
Urologiia. 2018;(5):182-185
pages 182-185 views
pages 186 views

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