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No 6 (2018)


Russian version of the neurogenic bladder symptom score (NBSS)

Philippova E.S., Bazhenov I.V., Volkova L.I., Moskvina E.Y., Turova E.L., Popova Y.V.


Aim. The Neurogenic Bladder Symptom Score (NBSS) is widely used now for the bladder symptoms assessment in neurogenic low urinary tract dysfunction. It is suitable for all patients, regardless of a bladder management method. NBSS contains 24 questions, which focus on incontinence, storage and voiding symptoms, urinary complications and life quality. With the permission of the authors (Dr.Welk et al.), NBSS had been translated into Russian according to the cultural and lingual adaptation algorithm. Objectives. Validate the Russian version of NBSS for multiple sclerosis patients. Design, setting, and participants. The study included 80respondents: group A - 40 multiple sclerosis (MS) patients with neurogenic bladder, group B - 40 multiple sclerosis (MS) patients without bladder dysfunction, group C - healthy controls. All participants filled out the NBSS two times with an interval of two weeks. They also completed other measurement tools (IPSS,OAB Awareness Tool, WHOQOL BREF).Data were used to determine the internal consistency (Cronbach’s alfa), external validity (Pearson correlation), and test-re-test reliability with interclass correlation coefficient. Results. The mean of the NBSS total in the group A was 22.56±12.6, which significantly (p<0.001) exceeded score in comparable groups B (6.42±2.3) and C (5.31±1.9). The Cronbach’s alfa of the total and the in continence, storage/voiding, and consequences domains was 0.939, 0,965, 0,801 and 0.712 respectively, which confirms the high internal consistency of the Russian version of the NBSS. External validity was verified by the relevant correlations with other questionnaires. Test-retest reliability was excellent. The interclass correlation coefficients were >0.85 (p<0.001) for all subdomains and the overall score. Conclusion. The Russian version of the NBSS demonstrated good validity and reliability and may be recommended for use in clinical practice.
Urologiia. 2018;(6):5-13
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Urodynamics study in patients with urinary incontinence, after surgical treatment of localized prostate cancer

Aboyan I.A., Aboyan B.E., Orlov Y.N., Pakus S.M., Pakus D.I.


Aim. Radical treatment of prostate cancer (PCa) is often associated with the development of urinary incontinence (UI). The etiology of UI after prostatectomy is multifactorial and can be caused by both urethral sphincter deficiency and bladder dysfunction. To date, there are no comparative studies of the development of UI in patients after either organ-preserving treatment or radical prostatectomy (RP). Considering this fact, our aim was to carry out the comparative assessment of urodynamic changes in these categories of patients. Materials and methods. A retrospective study (n=158) was conducted. All patients were divided into three groups, depending on the method of treatment, HIFU (Group 1, n=32), retropubic RP (Group 2, n=46); robot-assisted RP (Group 3, n=80). The mean age was 71.8±3.68, 61.5±4.63 and 60.8±3.4 years in Group 1, 2 and 3, respectively (p<0.01). The average score was ICIQ-SF-14 points. The median follow-up was 2.7 years. In all cases a multi-channel urodynamics study in accordance with ICS standards was performed. Results. Detrusor overactivity (DO) was detected in 22 (68.7%), 24 (52.1%) and 64 (80%) patients in Group 1, 2 and 3, respectively (p<0.001). In 14% of patients with DO (18%, 12% and 12% Group 1, 2 and 3, p<0.05), leakage test with stress provocative maneuver was negative. The decrease in the bladder compliancy was revealed in 75.9% of patients, and in 8.8% cases (n=14) it was associated with anatomical changes (12.5%, 8.6% and 7.5% in Group 1, 2 and 3, respectively, p<0.01). The mean maximum detrusor pressure was reduced in all patients. Bladder outlet obstruction was detected in 46.6%, 21.7% and 12.5% cases (/K0.001). There was no significant difference in the level of maximum urethral pressure in all groups, but it was significant in patients with negative breakdown at the threshold of abdominal pressure and DO (p<0.05, k=0.87). Conclusion. The high incidence of postoperative bladder dysfunction in patients of the studied groups revealed by us differs from the existing literature data, which dictates the need for a detailed assessment of bladder dysfunction when choosing a tactic for treating UI. In connection with the above, we consider it necessary to conduct further studies with a mandatory pre- and postoperative urodynamic assessment of the lower urinary tract in patients after surgical treatment of prostate cancer without UI.
Urologiia. 2018;(6):14-19
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Imidafenacin for treatment of overactive bladder and urgent urinary incontinence: the results of open-label multicenter randomized controlled clinical trial

Al-Shukri S.H., Pushkar D.Y., Apolikhin O.I., Evdokimov M.S., Kogan M.I., Krivoborodov G.G., Kagan O.F., Petrov S.B., Poltoratskyi A.N., Kuzmin I.V., Sharvadze G.G.


Introduction. The analysis of the results of a multicenter, open, randomized comparative phase III clinical trial on the use of imidafenacin for treating patients with OAB was carried out. A clinical study was conducted according to GCP standards in 12 urological centers of the Russian Federation with the support of company AO «R-Pharm». Materials and methods. A total of 296 patients (men and women) aged from 18 to 65 years with OAB and urgent urinary incontinence were included in the study. All patients were randomized into two groups. In Group 1 (n=148) patients received М-cholinoblocker imidafenacin 1 tablet (0,1 mg) twice a day. Group 2 patients (n=148) were prescribed a comparison drug tolterodine 1 tablet (2 mg) twice a day, as well. The duration of treatment was 12 weeks. Results. The analysis of results showed a significant decrease in the OAB symptoms in both groups. In Group 1 a decrease of episodes of urge urinary incontinence was more pronounce compared to Group 2, as well as amount of day-time and night-time of episodes of urge urinary incontinence by the 2nd, 4th, 8th and 12th weeks of treatment in comparison with baseline scores. There were no differences between two groups in the severity of reducing average urinary frequency per day. Reducing the severity of urinary disturbances in patients of both groups was accompanied by an improvement in the quality of life. There was a significant and similar decrease in the average total score of both OAB Awareness Tool and EQ-5D questionnaires. Tolerability of treatment was satisfactory in both groups and there were no differences in the adverse events in Group 1 and 2. Conclusion. Imidafenacin showed high clinical efficacy for treating patients with OAB, which is not inferior, and in some values, is superior in comparison to tolterodine. Both drugs had a similar safety and tolerability profile.
Urologiia. 2018;(6):20-25
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Evaluation bacteriological analysis of urine in patients with long-term bladder drainage

Vasilyev A.O., Govorov A.V., Shiryaev A.A., Bykov P.I., Kim Y.A., Kalinina N.A., Schneiderman M.G., Pushkar D.Y.


Introduction. The experience of comparative evaluation of the effectiveness of various types of urethral catheters in prevention of catheter-associated infection is described in this article. Materials and methods. The study included 69 patients treated at the CCH n.a. S.I. Spasokukotsky in the period from December 2017 to March 2018. The average age of patients was 67.5 years. In all patients, the bladder was drained by a two-way Foley catheter No. 16-18 Ch (100% silicone). In the 1st group (n=18), the bladder was drained with a standard urethral uncoated catheter, in the 2nd (n=16) - with a silver impregnated urethral catheter, in the 3rd (n=15) - with an urethral catheter coated with nitrofuran, in the 4th (n=20) urethral catheter with the possibility of controlled irrigation of the bladder and urethra with antiseptic solutions and (a new model of the urethral catheter developed during cooperative work of the Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov Urology Department and National Medical Research Center of Obstetrics, Gynecology and Perinatology n.a. V.I. Kulakov). Results. The bladder was drained by Foley urethral catheter for ≥ 15 days. A microbiological study of urine (on the example of clinical isolates of conditionally pathogenic microorganisms) with preparation of an inoculum, inoculation of nutrient media, counting cultures of pathogenic bacteria and determining the sensitivity of pathogenic bacteria to antibiotics was carried out. The study showed the effectiveness of the new urethral catheter model in patients with long-term bladder drainage. Conclusions. Conducting multicenter studies evaluating the effectiveness of the proposed urethral catheter model with the inclusion of a larger number of patients will reduce the economic costs, associated with treating patients with prolonged bladder drainage in the long term by reducing the number of nosocomial infection cases and reducing postoperative day.
Urologiia. 2018;(6):26-31
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The changes in urine microflora in patients with urinary stone disease

Dutov V.V., Buymistr S.Y., Rusanova E.V.


Introduction. Since the results of treatment of chronic pyelonephritis (CP) depend on timely and rationally selected targeted antibiotic therapy, when choosing a treatment regimen, it is necessary to rely on the local data obtained by monitoring the state of microflora in a particular hospital. Aim: to monitor the changes in urine microflora in patients with urinary stone disease. Materials and methods. A total of 598 isolated bacteria and yeastlike fungi from patients with urinary stone disease who were treated in the Department of Urology during different time periods (1997-1999, 2010-2014 and 2015-2017 yy) were analyzed. A comparison of the urine microbiota in patients with single kidney stone (n=154) and staghorn stone (n=147) for the period 2015-2017 yy. was carried out. Results. The significant changes of gram-positive and gram-negative bacteria were found with a tendency to decrease in the proportion of the latter (from 80.6% to 50.6%, p<0.05) due to a decrease in the proportion of P. mirabilis and complete absence of Enterobacter spp, Serraciae spp and Citrobacter spp. as well as an increase in the number of gram-positive bacteria (from 18 to 48.7%, p<0.05) owing to increase in the proportion of E. faecium + E. faecalis. During observation period, E. Coli has remained the leading pathogen (26.4+0.32%). During observation period, a permanent fourfold prevalence of gramnegative bacteria in clinically significant concentrations (>104 CFU/ ml) was found: E. coli (36.8+4.1%). The proportion of K. Pneumonia increased from 8.5% to 17.4%, and proportion of P. mirabilis decreased from 20.3 to 10.4%. Despite a significant increase in the proportion of Enterococcus spp. (from 4.6 to 26.6%) in the general population, the incidence of microorganisms in clinically significant concentrations during analyzed period remained unchanged and did not exceed 8.46+4.76%. In patients with single stones and patients with staghorn stones there was no significant difference in the proportion of analyses with clinically significant concentrations of bacteria fer (p>0.05). The percentage of analyses with clinically significant concentration was 70.06%, while in all patients with urolithiasis it was 59.7%. In patients under and over 60 years old, the largest number of bacterial pathogens were represented by E. coli. (29.7% and 32.1%, respectively). Conclusion. E. Coli remains the leading bacterial causative agent of calculous pyelonephritis, both in the general population and in analyses with clinically significant concentrations of bacteria. There were no significant differences in urine microflora in patients with staghorn and single stones.
Urologiia. 2018;(6):32-36
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Comparative characteristics of uropathogenic Escherichia coli strains, allocated in polyclinic and stationary conditions

Kuznetsova M.V., Provorova S.V., Kubarev O.G., Yudin D.S., Karimova N.V., Bajandina N.V., Teplyakova M.A., Demakov V.A.


The etiological structure of urinary tract infections (UTI) is determined by the leading role of uropathogenic Escherichia coli (UPEC). The aim of the work is to study the biological properties and phylogenetic diversity of E. coli strains isolated from UTI in outpatient and inpatient patients. Methods and materials. 198 clinical UPEC strains were studied, 105 of which were designated as polyclinic and 93 as nosocomial (73 are isolated from urine and 20 are from catheter surface 48 hours after hospitalization). UPEC phylogenetic groups were determined by polymerase chain reaction (quadruplex PCR) according to O. Clermont et al. (2013). Results. Among polyclinic cultures, representatives of all eight recognizable phylogroups were found; strains of UPEC phylogroup B2 (37.1%), E (13.3%) and F (8.6%) were most often found. Nosocomial cultures in almost 90% of cases belonged to the phylogroup B2, to which all the catheter-associated strains were assigned. The E. coli of the phylogroup B2, both in the mono-species and in the polymicrobial associations, was authentically more often isolated in the hospital than in the polyclinic (p<0.00001), whereas the bacteria of the phylogroup E, on the contrary, in the polyclinic (p<0.0001) . The hemolytic activity and biofilm-forming ability of UPEC strains did not differ in the two groups, while in the hospital hemolytic E. coli of the B2 phylogroup was significantly more likely than the polyclinic (p<0.001). In addition, B2 strainsformed biofilms in more than 60% cases. Regardless of the source of isolation, the strains were resistant to ampicillin (62.1%), amoxicillin/clavulanate (27.8%), cefotaxime (37.9%) and ciprofloxacin (36.9%). The production of ESBL was detected in fifty-one (25.8%) cultures, with a statistically significant difference in nosocomial strains: urinary
Urologiia. 2018;(6):37-44
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Microbiological analysis as effective tool for optimization of empirical antibiotic therapy in the urological clinic

Pisanenko D.N., Gasrataliev V.E., Gorshkova T.N., Ivaneeva M.V., Abramov D.V., Danilov A.A., Galitsky T.V., Ruina O.V., Stroganov A.B., Atduev V.A.


Aim: to study the features of microbiota in patients of urological departments and to optimize the schemes of antibiotic therapy. Materials and methods. Data of microbiological studies in patients of urological departments in 2017 years were analyzed. Isolation of pathogens was carried out using standard techniques. A disk diffusion test using Mueller-Hinton agar with BioRad disks was used to determine the sensitivity. The statistical analysis was performed using the WHONET 5.4 program. In addition, a comparison with the results of the PCR study was done. Results. A total of 672 etiological pathogens were isolated in whole clinic in 2017 year. From those, 173 pathogens were found in the urological clinic, which accounted for 25.7% of the total number. Gram-negative bacteria predominated and its proportion was 59.23%. Gram-positive bacteria were isolated in 24.4%, and fungi were found in 16.37% of cases. The structure of pathogens isolated from stoma or obtained by catheterization was not significantly different. Most frequently isolated pathogens included @K. pneumonia (22.8%), @E. coli (21.2%), @C. albicans (17%), @P. aeruginosa (11%), @E. aerogenes (6%) and @S. aureus (3 %). @K. pneumonia usually had an unfavorable resistance pattern. E. coli isolated from urine samples had more favorable resistance pattern in comparison to pathogens obtained from stoma. The bacteria which were found in intensive care unit had the increased level of resistance. Conclusion. Gram-negative bacteria predominate in the urological clinic with a relatively high proportion of extended-spectrum beta-lactamase producing organisms. Risk factors for the emergence of multi-resistant pathogens are the treatment in the intensive care unit and the presence of stomas or catheters. The PCR method, carried out in parallel with routine microbiological studies and regular analysis of the overall bacterial spectrum, allows to optimize the starting antibiotic therapy from the first day of the disease. The use of cephalosporins is not justified in the most cases. Aminoglycosides and fluoroquinolones remain effective. The use of either β-Lactamase-protected penicillins or fosfomycin is possible only after obtaining the results of bacteriological study. When prescribing carbapenems, the risk of inefficiency is especially high in patients with stomas/catheters and transferred from the intensive care unit.
Urologiia. 2018;(6):45-51
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Antioxidative activity and clinical efficiency of dietary supplements Nefradoz for treatment of recurrent calcium oxalate urolithiasis

Kamalov A.A., Okhobotov D.A., Proskurnina E.V., Sozarukova M.M., Nizov A.N.


Aim: to evaluate antioxidant properties of dietary supplements Nefradoz, as well as its role in the prevention of calcium oxalate stones. Materials and methods. Our study consisted of two parts, clinical and experimental. In the clinical trial a total of 80 patients with recurrent calcium oxalate urolithiasis of various localization were included. All patients were divided into 2 groups. In treatment group (n=45) patients received Nefradoz 1 capsule 2 times a day. In control group (n=35) no treatment was prescribed. In all patients a biomarkers level (bikunin, osteopontin, nephrocalcin) in urine was determined by ELISA. In addition, Litos-test was performed. Follow-up duration was 6 months. In the experimental part of the study, the antioxidant properties of Nefradoz were evaluated using chemiluminescence method. Results. The antioxidant activity of resveratrol, which is contained in 300 mg Nefradoz (1 capsule), was 23.66±1.18, which corresponds to the moderate activity. After 6 months of therapy a level of bikunin and osteopontin did not significantly changed, which indicates a minimal risk of stone recurrence. According to the Litos-test, the activity of stone formation in Nefradoz group significantly decreased to minimal values in 42 out 45 patients (p<0.05). In the control group an excretion of biomarkers was minimal, which significantly increased the risk of stone formation. Conclusion. Dietary supplement NefraDoz can be used for prevention of calcium oxalate urolithiasis in case of increased stone formation according to the Litos-test. The antispasmodic, uroseptic and diuretic effects allow to maintain the effective level ofbiomarkers which is required for a recurrence-free course of urolithiasis compared to the control. The antioxidant activity, primarily determined by the resveratrol, can sufficiently compensate for oxidative stress and prevent the development of calcium oxalate stone. Further studies are needed to confirm our results.
Urologiia. 2018;(6):52-59
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The evaluation of the impact of quality and microelement composition of drinking water on the incidence of urolithiasis in various regions of Dagestan

Omarova K.M., Magomedova I.H., Ibragimova E.S.


Aim: to study the influence of qualitative and microelement composition of drinking water on the incidence of urolithiasis in different regions of the Republic of Dagestan. Materials and methods. The statistical data of the Ministry of Health of the Republic of Dagestan for 2000-2016 yy. were used. A total of 12123 outpatient and inpatient charts of patients with urinary stone disease were analyzed. The annual average quality of drinking water, as well as the contents of microelements in different climatic and geographical areas of the region were assessed. The results. The high morbidity among the residents of the flat territory was established which was associated with the highest water hardness, high content of microelements and salts of heavy metals that exceeded the acceptable concentrations. The number of patients with urinary stone disease living in mountainous areas is much less (11.8%) than in the flat area (83.08%). A relationship between quality of water, microelement composition and urinary stone disease in this area was found. The stone disease was more common in women (66.3%) than in men (33.7%). Conclusion. Our results can be used for the prevention of urinary stone disease given that the Republic of Dagestan is an endemic region.
Urologiia. 2018;(6):60-65
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Acute uncomplicated cysititis: do we follow the guidelines?

Kulchavenya E.V., Neymark A.I., Borisenko D.V., Kapsargin F.P.


Aim: to evaluate the compliance of prescriptions made by urologists in treatment of patients with lower urinary tract infection, in particular with acute uncomplicated cystitis. Materials and methods. A specially designed questionnaire was filled out by 161 urologists from Novosibirsk, Barnaul and Krasnoyarsk, as well as participants of VII Congress of urologists of Siberia. Results. The survey showed that 34.8%, 27.9%, 22.4% and 14.9% of urologists had 6-10, 11-20, 1-5 and more than 20 patients with acute uncomplicated cystitis a month, respectively. According to results, 91.9% of urologists are familiar to National guidelines on treatment of lower urinary tract infections and 91.2% of doctors consider them to be reasonable. Among those surveyed, 29.2% of urologists believe that National Guidelines differ from European Guidelines; 95.7% of participants adhere to recommendations, but only 47.4% respect it almost always, 16.9% do it in half of cases and the remaining 35.7% comply with them in less than 40% cases. Moreover, 86.4% of urologists started a treatment of acute cystitis with antimicrobial therapy and preferred fosfomycin in 41.0%, nitrofurans in 20.9%, fluoroquinolones in 21.6% and cephalosporins in 16.5% cases, respectively. Almost all respondents (93.8%) are convinced that antibiotic therapy should be accompanied by phytotherapy, and 71.5% of urologists administer Canephron. Conclusion. In the urologic community there are controversies in the treatment of patients with acute uncomplicated cystitis. The choice of therapy is not always optimal.
Urologiia. 2018;(6):66-69
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Efficiency of fosfomycin trometamol for treatment of acute uncomplicated cystitis

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


Introduction. Acute cystitis is the most common type of uncomplicated urinary tract infection. A choice of antibiotics for the treatment depends not only on the spectrum of antimicrobial activity against pathogens, but also on the pharmacokinetic properties, due to high urine concentration after single or double use is needed. In addition, high safety profile and acceptable cost are important. Fosfomycin is one of the drugs whose efficiency in treating of patients with lower urinary tract infection is proved. It has been on the pharmaceutical market for a long time and is widely used in urologic practice. There is a risk of a decreasing of efficiency of fosfomycin, considering sustained downward trend in the sensitivity of uropathogens. This causes a need to monitor the resistance of main uropathogens to fosfomycin. In this article our experience of using of fosfomycin for the treatment of women with acute uncomplicated cystitis is presented. Aim: to evaluate an efficiency of fosfomycin trometamol for treatment of women with acute uncomplicated cystitis. Materials and methods. During the period from September to November 2018, we performed an examination and treatment of 57 women with acute uncomplicated cystitis aged from 19 to 40 years. All patients were prescribed 1 sachet of Fosfomycin Esparma (fosfomycin trometamol) after urination. The examinations were carried out on the 1st, 3rd and 7th day, including an evaluation of urination frequency, urgency, nocturia and pain intensity. In addition, urinalysis and urine culture using solid media with determination of the type of pathogens, sensitivity to antibiotics and the level of bacteriuria were also performed. Results. Baseline, all patients had complaints of pain in the bladder, urethral discomfort and frequent urination, but passing only small amount of urine. All women had leucocyturia and bacteriuria. By the 3rd day after receiving fosfomycin, urinary disturbances persisted in 22.8% patients and 17.5% of women still described pain. Mild leucocyturia was determined in 42% cases. Urine culture was negative. By the 7th day after the start of therapy, all clinical and laboratory data were returned to the normal values in all patients. Conclusion. Based on the results of our study, we recommend the fosfomycin as the first-line treatment of uncomplicated lower urinary tract infection due to broad spectrum, low resistance of uropathogens, high safety profile and good compliancy.
Urologiia. 2018;(6):70-75
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Some epidemiological aspects of urinary tract infections in «Altai regional hospital for veterans of wars»

Sursyakova K.I., Safyanova T.V.


Introduction: Urinary tract infections (UTIs) are among the most common infectious diseases in outpatient and inpatient practice. Aim: to analyze some epidemiological aspects of UTIs in large hospitals of the Altai Territory (AK) for 2007-2017 yy. Materials and methods: a retrospective analysis of UTI incidence, including acute and chronic pyelonephritis, acute and chronic cystitis in the AK for 2007-2017, as well as in large medical organizations (MO) AK (KGBUZ «Altai regional hospital for war veterans» and KGBUZ. «Regional clinical hospital») was done. The main uropathogens in patients who were treated in the MO of AK were determined and the sensitivity of isolated microorganisms to antimicrobial drugs and disinfectants was analyzed. Conclusion: a knowledge of the modern structure of uropathogens and systematic analysis of their sensitivity to antimicrobial drugs is of outmost practical importance and ensures a timely and individualized approach to the empirical antibiotic therapy even before the results of urine culture are known as well as allows to select proper disinfectants in the MO.
Urologiia. 2018;(6):76-79
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The morphologic results of organ-sparing interventions in patients with renal tumor aged up to 40 years and older

Alyaev Y.G., Syrota E.S., Bezrukov E.A., Lerner Y.V.


Aim: to evaluate the features pathologic results of organ-sparing interventions in patients aged up to 40 years and older and assess an influence of patient age on the recurrence-free survival in case of pathologically proven renal cell cancer. Materials and methods. A retrospective analysis of laparoscopic organsparing removal of kidney tumors in 314 patients performed from January 2012 to May 2017 was conducted. The mean patient age was 54.4±10.9 (25- 78) years. There were 178 males (56.7%) and 136 females (43.3%). All patients were divided into two groups. In Group 1 a total of 37 patients aged ≤ 40 years (11.8%) were included and Group 2 consisted of 277 patients (88.2%) over 40 years. In Group 1 there was no family cases of renal cell cancer. Results. In Group 1 malignant tumors were more common (n=33 cases (89.2%)), and benign tumors were diagnosed in 4 (9.8%) cases. Among patients older than 40 years the malignant and benign tumors were determined in 242 cases (87.4%) and 35 cases (12.6%), respectively. It was estimated that there were no differences in neither malignant tumors rate (p=0.75), nor in proportion of different pathologic forms of benign (p=0.68) and malignant neoplasms (p=0.25), nor in proportion of various degrees of anaplasia (p=0.33). A mortality rate was 0.6% (2 patients in Group 2), and there was 3 relapse (1.1%). A proportion of censored cases was 99.4% for overall survival and 98.9% for recurrence-free survival. A point estimate of overall survival after 36-months follow-up was 35.77±0.16 months. The mean disease-free survival was 35.47±0.24 months. The survival differences between two groups were not significant due to absence of relapse and mortality in patients aged ≤ 40 years. Conclusion. During the planning of surgical treatment of patients with kidney tumors aged ≤ 40 years a preference to organ-sparing interventions should be given. The postoperative genetic counselling is recommended to exclude hereditary renal cell cancer. Considering a high risk of local recurrence in all patients aged < 40 years meticulous and regular follow-up is needed.
Urologiia. 2018;(6):80-85
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A prognostic value of level of antiviral antibodies in the development of recurrence of bladder cancer

Kosova I.V., Loran O.B., Sinyakova L.A., Gundorova L.V., Kosov V.A., Pogodina I.E., Kolbasov D.N.


Introduction: Serological diagnosis of virus-associated tumors attracts the attention of many specialists. The changes in the level of antiviral antibodies in tumors of different localizations are proved. In some cases, the authors suggest using these data either for screening of tumors or for controlling the cure. Aim: to evaluate the predictive value of antiviral antibodies for the recurrence of bladder cancer. Materials and methods: a level of antiviral antibodies (IgG, M) against Epstein-Barr virus (EBV), herpes simplex virus (HSV) 1 and 2 types, cytomegalovirus (CMV) of 100 patients with bladder cancer (72 men and 28 women) aged from 38 to 90 years (mean age 65±10) was studied. Multivariate analysis with a construction of classification tree was performed. The recurrence of the bladder cancer was used as the dependent variable. Results: in patients with recurrence of bladder cancer there was an increase in the level of anti-CMV IgG (616.5±501.46 U/ml vs. 339.06±306.61 U/ml, p=0.0017) and anti-EBV IgG-EBNA (246,7±207 U/ml vs. 141,5±163,7 U/ml, p=0.0118). After the construction of the classification tree, anti-CMV IgG, anti-EBV IgG-EBNA, tumor stage and the presence of CMV DNA in tumor tissue were selected. It allowed to classify correctly 20 of 24 patients with recurrence and 58 of 72 patients without relapse. The most significant predictors included anti-CMV IgG level (100%), anti-ЕBNA IgG level (78%) and tumor stage (50%). The sensitivity, specificity, positive prognostic value (probability of tumor detection in patients with a positive test result), negative prognostic value (probability of absence of the tumor in persons with a negative test result) and accuracy were 83.33%, 80.56%, 58.82%, 93.55% and 81.25%, respectively. A multivariate analysis (binary logistic regression) was performed and a reliable model (χ2=22,438, p=0,00043) was created, including the following parameters: anti-CMV IgG more than 670 u/ ml, anti-EBNA IgG more than 130 u/ml, the degree of anaplasia, the presence CMV and/or EBV DNA in tumor tissue. Based on the regression equation, an accuracy test for prediction of tumor recurrence was carried out, which resulted in fairly high predictive results: specificity and sensitivity were 95.2% and 33.3%, respectively. Conclusions: anti-CMV IgG level more than 670 U/ml and anti-EBNA IgG level more than 130 U/ml are reliable predictors for the recurrence of bladder cancer.
Urologiia. 2018;(6):86-94
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A comparative analysis of laparoscopic and retroperitoneoscopic partial nephrectomy depending on the type of temporary and definite hemostasis

Shpot E.V., Mamedkasimov N.A., Alyaev Y.G., Rapoport L.M., Proskura A.V., Mashin G.A.


Aim: to carry out a comparative analysis of treatment results of patients with renal tumors who were undergone to nephron-sparing surgery, depending on the type of temporary and definite hemostasis. Materials and methods: a total of 163 laparoscopic partial nephrectomies were performed by single surgeon from January 2015 to July 2018. The comparative analysis of treatment results of patients with renal tumors based on following parameters: tumor stage, features of the tumor site, the duration of surgery, the amount of blood loss, complications rate and grade as well as functional and oncological outcomes, depending on the type of temporary and definite hemostasis, was conducted. For preoperative planning the generally accepted nephrometric scale R.E.N.A.L. was used as well as 3D-reconstruction of the tumor. Results: Of the 163 patients, 64 were women (39.3%). The mean age of patients was 56.7±11.1 (25-80 years). A clinical stage T1a, T1b, T2 and T3a was diagnosed in 77, 20, 2 and 64 cases, respectively. The average tumor size was 34.8±1.1 (11-78 mm). The mean operative time was 84.5±32.2 min (30-180). Laparoscopic transperitoneal access was used in 90 patients (55.21%), retroperitoneoscopic approach was chosen in 73 cases (44.79%). The tumor had exophytic growth in 110 cases (67.5%) and in 53 cases it was endophytic (32.5%), while in 59 cases it localized in renal sinus (36.2%). The operative time was significantly shorter in the Group of zero ischemia (72.2±29.02 [p<0.001]) and bipolar coagulation of the tumor bed (60.8±31.7 [p<0.001]). The mean volume of blood loss was 160.8±142.7 ml (30-900). A GFR calculated by the MDRD equation (mean level was 75.7 ml/min/1.73 m2) on the next day and 6 months after surgery showed a slight decrease in group of zero ischemia, compared to other groups: next day and 6 months after surgery it was 72.8±21.6 (p<0.001) and 72.01±16.6 (p=0.025), respectively. A simple enucleation was performed in 41 cases, while enucleoresection was done in 70 cases. A collection system was opened in 22 cases (13.5%±9.8). The suturing and clipping were performed in 20 and 2 patients, respectively. In 2 cases a stenting was performed. In 2 cases there was hemoglobin drop requiring blood transfusion (1.2%±3). An embolization due to refractory bleeding was required in 3 cases (1.8%±3.7). There was no conversion to open surgery or nephrectomy. Of the 163 tumors, a malignancy was diagnosed in 151 (92.6%±7.5) cases. There was no positive surgical margin and recurrence of the tumor. Conclusion: Laparoscopic partial nephrectomy can be successfully performed under zero ischemia. The intervention without clamping of renal blood vessels contributes to significant preservation of the renal function.
Urologiia. 2018;(6):95-100
pages 95-100 views

Immediate and long-term effectiveness of combined application of magnetolaser therapy and red light in complex treatment of patients with chronic nonbacterial prostatitis

Kulishova T.V., Neimark A.I., Kryanga A.A., Gazamatov A.V.


The aim of the study was to increase the efficiency of complex treatment of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with the combined effect of magnetolaser therapy (MLT) and red light. Materials and methods. We examined and included in the study 120 men with a verified diagnosis of CP/CPPS (III B), at the stage of exacerbation. By envelope method, patients were divided into two randomized groups. The main group consisted of 60 patients who received a basic treatment complex, including medicamentous therapy, prostate massage, diet therapy, a complex of therapeutic gymnastics, and the combined effect of MLT and red light of 10 procedures per course. The comparison group consisted of 60 patients who received only a basic therapeutic complex. Evaluation of the effectiveness of treatment was carried out in dynamics before complex treatment, immediately after the course of treatment and 6 months later for analysis of long-term results using the questionnaire «System of summary evaluation of chronic prostatitis symptoms», dopplerography of urethral arteries of the prostate, laser Doppler flowmetry in the prostate. Results and discussion. In the main group of patients with CP/CPPS immediately after complex treatment and after 6 months, a positive therapeutic effect was noted in the form of relief of pain syndrome, dysuria, improving the quality of life, improvement of blood circulation in the urethral arteries of the prostate and microcirculation. In the comparison group, the positive effects from the complex baseline treatment were less pronounced. Comparative analysis of the results of the study between the main group of patients with CP/CPPS and comparison group showed the presence of statistically significant differences in all indicators of clinical symptoms of the disease, dopplerography in the urethral arteries of the prostate and microcirculation in the prostate, both immediately after treatment and after 6 months of follow-up. Conclusion. The method of complex treatment of patients with CP/ CPPS with the combined effect of MLT and red light has greater immediate and remote efficacy in comparison with baseline treatment.
Urologiia. 2018;(6):101-107
pages 101-107 views

The features of course of chronic abacterial prostatitis with inflammatory compoment in men of the first period of mature age depending on the somatotype. Part 1: the clinical characteristics

Vinnik Y.Y., Borisov V.V.


Aim: to study the course of chronic abacterial prostatitis with the inflammatory component (CAPIC) depending on the somatotype in men of the first period of mature age taking complex treatment with a use of local and systemic ozone therapy. Materials and methods. A total of 306 men of asthenic, normostenic and pyknic somatotypes with CAPIC were followed-up. Along with standard therapy, all patients received systemic and local ozone therapy. Patients complaints were recorded before and after treatment. Questionnaires for total assessment of the symptoms of CAPIC and male sexual function were used for monitoring of clinical manifestations. Results. Sexual disturbances before and after treatment were less pronounced in patients with normostenic somatotype in comparison to patients with asthenic and pyknic somatotypes. Pain syndrome was less common in normostenic patients (0.83±0.09 points). The most severe dysuric symptoms (р<0.03) was noted in patients with pyknic somatotype, such as weak urine stream, interrupted stream and incomplete bladder emptying (1.33±0.14 points), increased frequency of urination (0.91±0.11 points), dribbling (1.22±0.14 points). In addition, they had a maximum influence of the symptoms of CAPIC on the professional activity (1.50±0.08 points; р<0.02). After treatment, a clinical index (CI) of CAPIC in the severity of clinical manifestations in patients of the normostenic somatotype was insignificant (9.29±0.55 points), while in patients with asthenic and pyknic somatotype it was moderate, almost insignificant (11.71±0.62 and 13.62±0.61 points, respectively). Overall, CAPIC was the most severe in patients with a pyknic somatotype, which was objectively confirmed by the of CI of CAPIC. However, standard therapy with a using of regional and local ozone therapy in these patients were more efficient in comparison with patients with other somatotypes and was accompanied by an almost twice decrease in CI of CAPIC (from 24.32±0.73 to 13.62±0.61 points).
Urologiia. 2018;(6):108-114
pages 108-114 views

The primary purulent paranephritis in children

Solov’ev A.E., Lazutina G.S., Kul’chickiy O.A.


In the article an experience of successful surgical treatment of such a rare pathology in children, acute primary purulent paranephritis is described. In 11 children aged from 2 days to 14 years the standard laboratory, imaging and X-rays studies, including CT and MRI. Upper, posterior, anterior and lower paranephritis was detected in 2, 1, 2, and 6 cases, respectively. The authors concluded that in case of inefficiency of antibacterial therapy the surgical intervention is a main approach to the treatment of acute primary purulent pyelonephritis in children.
Urologiia. 2018;(6):115-117
pages 115-117 views

Is implantation metastasis of colorectal cancer to the kidney possible?

Sushkov O.I., Likhter M.S., Maynovskaya O.A., Saifutdinova K.R., Shahmatov D.G.


Kidney metastasis in colorectal cancer are rare. A number of publications dedicated to this topic is quite limited. In this article a rare observation of metastasis of colorectal cancer to the kidney is described.
Urologiia. 2018;(6):118-121
pages 118-121 views

Left-sided renal cell cacrinoma with vena cava inferior thrombus: totally laparoscopic removal

Perlin D.V., Vorobiev A.A., Zippunnikov V.P., Dymkov I.N.


A surgical treatment of patients with tumor thrombus in the inferior vena cava (IVC) of levels II-III, originating from the left renal vein involves performing thrombectomy, radical nephrectomy and lymph nodes dissection. In most cases it requires major open surgery which leads to complications in 38% of patients and perioperative mortality of 4-10%. In recent years, the laparoscopic radical nephrectomy with thrombectomy have been gradually introduced. However, there are anecdotal reports about performing of such interventions in case of left-sided renal tumor with thrombus in the IVC. A description of technique and own experience of performing laparoscopic radical nephrectomy with thrombectomy from the IVC in 3 patients with tumor thrombus of levels II-III, originating from left kidney are presented. In one case distant metastases were detected preoperatively and in another patient an involvement of tail of the pancreas by the tumor was diagnosed. There was no conversion to open surgery. The maximum tumor size ranged from 5 to 16 cm. The length of tumor thrombus in the IVC was 2.4-7 cm and estimated blood loss was 300-2500 ml. In one case a blood transfusion was required postoperatively. The follow-up period was 4-26 months. One patient died from progression of the disease after 5 months, two other patients are alive without any signs of relapse. The initial experience of laparoscopic radical nephrectomy with thrombectomy from IVC in patients with left-sided renal cell cancer suggests that this technique is reproducible and relatively safe with respecting of basic principles of oncology and vascular surgery. The surgery is not associated with major perioperative complications, significant blood loss and is accompanied by a rather favorable postoperative period. An accumulation of a larger number of cases is needed to assess the oncological results of this technique.
Urologiia. 2018;(6):122-127
pages 122-127 views

Comparison of the International Prostate and Visual Prostate Symptom Scores in Turkish patients

Caliskan S., Sungur M.


Introduction. Benign prostate hyperplasia is one of the most common disease in elderly men. The patients usually present lower urinary tract symptoms including frequency, urgency, nocturia and interittancy. The prostate symptom scores are usually used for daily urology practice. We aimed to compare the International Prostate Symptom Score and Visual Prostate Symptom Score in Turkish patients. Methods. The study protocol was conducted from from February to August 2017. The patients presenting with lower urinary tract symptoms over the age of 45years were included. The age, prostate specific antigen level, education level and symtom scores were recorded. The patients with history of neurological disease, prostatic surgery, radiotherapy and any malignancy were excluded. Results. There were 81 patients in the current study. The mean age and PSA level was 58.86±7.39years and 1,94±1,77 ng/ml. Most of the patients (54.32%) had primary level of education and the patients who were graduated from university (19.75%) followed. The secondary and high school level was 12.34% and 13.58% respectively. The fully complete rate of the symptom scores 37% for IPSS and 9.8% for VPSS and 81% for CSS (p<0.05). In the patients with fully complete; there was no significant difference for patients’ education level and age. Conclusions. The IPSS and VPSS are established symtom scores for patients with benign prostate hyperplasia. The difficulties to understand and translate problems of these questionnaires; new, mother language originated symptom score is needed for Turkish patients.
Urologiia. 2018;(6):128-130
pages 128-130 views

Recurrence prevention for urinary stone disease. Part II. The factors associated with increase in incidence of urinary stone disease. Current views on the mechanisms of stone formation (continuation)

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


Urinary stone disease is one of the most actively progressing diseases, which are associated with metabolic disturbances and are influenced by the genetic, environmental factors and lifestyle \. In the article the current views on initiation factors of stone formation and theories of stone formation are reviewed. The factors that play an important role in the activation and inhibition of nucleation and aggregation of stone -forming substances are discussed. All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.
Urologiia. 2018;(6):131-138
pages 131-138 views

Robot-assisted pelvic floor reconstruction: review and own experience

Sukhikh S.O., Kolontarev K.B., Vasilyev A.O., Pushkar D.Y.


Pelvic organ prolapse (POP) is the most common urogynecological disease in women of middle and older age groups. This disease causes numerous urogenital symptoms and significantly reduces the quality of life of patients. Surgical correction of POP is the optimal method f treatment for this category of patients, however, the choice of surgery and access remains controversial. In recent decades, thanks to the development of robotic technologies, the use of robot-assisted sacrocolpopexy (RAS) has become increasingly popular. Numerous studies have shown the equivalence of results compared with the «gold standard» repair of prolapse - open sacrocolpopexy. This article presents a review of the current literature and our own experience of RAS.
Urologiia. 2018;(6):139-143
pages 139-143 views

Bacterial prostatitis: epidemiology and etiology

Kogan M.I., Naboka Y.L., Ismailov R.S., Belousov I.I., Gudima I.A.


Prostatitis is considered as heterogeneous group of the diseases attracting broad interest of researchers worldwide. The acute and chronic stages of the process, as particular categories of bacterial prostatitis, remain in the realities of modern practical and scientific urology with lively discussions. Despite a large number of domestic and international publications, consensus on many topical issues of bacterial prostatitis is currently not achieved. The true incidence and prevalence of bacterial prostatitis in various regions of the world has not been finally determined. The exhaustive data concerning the etiological structure, mechanisms of development and persistence of the inflammatory process in the prostate tissue are not presented. At the same time, new risk factors that can influence the development and progress of these diseases are identified and discussed. Researchers review algorithms for examining patients, obligate spectrum of diagnostic methods, as well as the desirability of using the newest investment means necessary for the successful verification of the diagnosis taking into account the development of modern medical technologies. This review describes in detail the various aspects of the epidemiology and etiology of bacterial prostatitis, based on an analysis of major literature sources in conjunction with its own scientific facts.
Urologiia. 2018;(6):144-149
pages 144-149 views

Factors predicting the development of urinary tract disorders in prostatic hyperplasia in elderly men

Dudarev V.A., Startsev V.Y.


The review article presents information from foreign and domestic authors on the relevance of studying the incidence of men with bening prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Complex urodynamic studies (CUDS) remains the most informative test of the degree of expression of LUTS and bladder outlet obstruction (ВОО) caused by BPH. The difficulty in interpreting the results, the invasiveness and inaccessibility of CUDS in the routine practice of most medical institutions makes it necessary to perform relatively simpler and more accessible methods of research, which do not always objectively reflect the degree of urinary incontinence in older men. This fact causes a large number of complications and adverse outcomes of surgical treatment with the rapid development of BPH and obstructive symptoms. Taking into account the results of world research, the study of the urine proteome and urinary exosomes will improve the quality of diagnosis in patients with BPH and help in assessing the prognosis of the development of the disease.
Urologiia. 2018;(6):150-154
pages 150-154 views

A role of fesoterodine in treatment of overactive bladder

Kupriyanov Y.A., Kasyan G.R., Pushkar D.Y.


The muscarinic receptors have been used as target in treatment of overactive bladder (OAB) for a long time. ^ese patients have complaints of urgency, increased urinary frequency and nocturia, sometimes with urinary incontinence (involuntary urine leakage which is associated with abrupt and strong desire to void). Fesoterodine is a prodrug that is structurally and functionally associated with tolterodine and it is the novel drug for OAB treatment. As a result of fesoterodine cleavage by non-specific esterase, the active metabolite 5-hydroxymethyl tolterodine (5-НМТ) is formed. Like other antimuscarinic drugs, fesoterodine allows to improve bladder storage function (reducing the frequency of urination) and urgency. For assessing an improvement of the quality of life after treatment by fesoterodine the KHQ questionnaire was used.
Urologiia. 2018;(6):155-163
pages 155-163 views

Prostate cancer prevention. the current trends

Karpov E.I.


The interest in the prostate cancer prevention is associated with high incidence and slow growth of tumor. Despite the lack of clinical guidelines for prostate cancer prevention, more and more studies are carried out dedicated to this topic. Since prostate cancer prevention requires prolonged use, the substances derived from food are seems to be the most appropriate. The two most well-known and studied substances are indole-3-carbinol (I3C), obtained from cruciferous plants, and epigallocatechin-3-gallate (EGCG), contained in green tea. As a source of I3C and EGCG, it is possible to use a dietary supplement ProstaDoz. It also included an extract of fruits of dwarf palm, vitamin E, zinc, selenium. ProstaDoz has virtually no contraindications, has no toxic influence, even with prolonged use, does not cause adverse events and can be considered as a promising preventive and therapeutic agent for prostate cancer and prostatic intraepithelial neoplasia (PIN).
Urologiia. 2018;(6):164-167
pages 164-167 views
pages 168 views

Nikolai Ivanovich Tarasov (to the 85th anniversary)

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Urologiia. 2018;(6):169-170
pages 169-170 views

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