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No 1 (2019)


«LUTS/BPH - who treats?». The results of the epidemiologic study

Pushkar D.Y., Rasner P.I., Aboyan I.A., Asfandiyarov F.R., Kotov S.V., Kogan M.I., Korneev I.A., Medvedev V.L., Neymark A.I., Novikov A.I., Pavlov V.N., Tsukanov A.Y., Shabalkin S.A., Shormanov I.S.


Introduction. In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. Materials and methods: a prospective multicenter epidemiological study «LUTS/BPH - who treats?» was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. Results: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. Conclusion: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.
Urologiia. 2019;(1):5-15
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Justification of a use of additional antioxidant therapy in experimental models of chronic bacterial prostatitis

Bratchikov O.I., Dubonos P.A., Tyuzikov I.A.


Aim. To study the changes of the main parameters of the oxidative status in prostate after standard antimicrobial monotherapy and to justify a use of additional antioxidant therapy in various experimental models of chronic bacterial prostatitis (CBP). Material and methods. A total of 60 outbred adult male healthy rats weighing 180-200 grams were used in the experiment. In a control group, 20 intact rats were included. Two experimental groups of 20 animals each were formed and in each group two subgroups (n=10) were distinguished. Two series of experiments were performed in the episodic and relapse models of CBP (based on the Nickel J.C. (1990) and Goto T. (1991)), respectively, with an evaluation of the efficiency of antimicrobial monotherapy (levofloxacin 12.5 mg/kg/day per os for 20 days) in each of the subgroups. In prostate homogenates the levels of CFUs, active forms of oxygen (ROS), diene conjugates and malonic dialdehyde, as well as an activity of superoxide dismutase (SOD) and succinate dehydrogenase (SDH)) were evaluated. Results. The microbiological efficiency of standard antimicrobial monotherapy in the episodic model of CBP was higher than in the recurrent model (90.0% vs 80.0, respectively, p<0.05). The degree of free radical aggression and a severity of lipid peroxidation in recurrent CBP were significantly higher, and the activity of SOD and SDH was significantly lower than in the episodic model of CBP (p<0.05). In both models, residual oxidative stress persisted in the prostate tissue after antimicrobial therapy, indicating an incompleteness (in the case of episodic model of CBP) or decompensation (in case of recurrent CBP) of the antioxidant defense system. Conclusion. A persisting of residual oxidative stress after a course of etiotropic antimicrobial monotherapy in the prostate has justified a necessity of the additional administration of antioxidants (antihypoxants) for a combined pharmacotherapy of CBP.
Urologiia. 2019;(1):16-22
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Role of biomarkers of acute kidney damage during lithotripsy of high-density stones

Nazarov T.K., Komyakov B.K., Rychkov I.V., Trubnikova K.E., Tursunov A.I.


Aim. To obtain the information about functional state of kidneys in patients with urolithiasis before and after treatment, as well as to study the damaging effect of different types of energy used for fragmentation of high-density stones. Materials and methods. A total of 105 patients aged from 25 to 62 years with high-density stones were undergone to lithotripsy. In Group 1 (n=38), Group 2 (n=32) and Group 3 (n=35) contact laser lithotripsy, contact ultrasound lithotripsy and extracorporeal shock-wave lithotripsy was used, respectively. In all cases the clinical and biochemical blood and urine tests were performed as well as leukocyte migration inhibition test, selective proteinuria, a urine level of inteleukin-18 (IL-18) and urine NGAL (lipocalin-2) were assessed. The first examination was done the day before lithotripsy and the next ones were performed after 3 hours, on the 1st and 5th day after the intervention. Results. In all cases dense unilateral kidney stones of size 0.8-2 cm were detected. The stone-free rate after contact lithotripsy was 92.8%. After ESWL, the stone-free rate after two weeks was 94.9%. The average duration of lithotripsy in the Group 1, 2 and 3 was 40±3.8 min, 35±2.3 min and 32±3.6 min, respectively. Based on the level of biomarkers of AKI, laser lithotripsy allows to achieve stone fragmentation with the least damage. Conclusion. Our study proves that IL-18, NGAL, leukocyte migration inhibition test and selective proteinuria allows to diagnose AKI at early stages, as well as to objectively assess the functional state of the kidneys after lithotripsy. The obtained data proves that laser lithotripsy is the safest method as assessed by damaging effects on the kidney parenchyma.
Urologiia. 2019;(1):23-27
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The features of pathogenesis of urolithiasis in patients with diabetes mellitus type 2

Prosiannikov M.Y., Yanenko E.K., Yarovoy S.K., Golovanov S.A., Konstantinova O.V., Anokhin N.V., Djalilov O.V., Sivkov A.V., Apolikhin O.I.


Introduction. In recent years, a large number of studies has been published that proved a very significant role of diabetes mellitus type 2 for development of urolithiasis. The aim of our work was to conduct a comparative study of biochemical parameters of blood and urine as well as chemical composition of urinary stones in urolithiasis patients in the general population and in patients with diabetes mellitus type 2. Materials and methods. The work was divided into 2 stages. During the first stage an analysis of chemical composition of urinary stones in the general population (n=5669) and in patients with diabetes mellitus type 2 was carried out (n=350). During the second stage an analysis of biochemical parameters of blood and urine in urolithiasis patients in the general population (n=101) and in patients with diabetes mellitus type 2 was conducted (n=350). Results. In the general population calcium oxalate stones was predominated (56.8%), while phosphate (24.9%) and urate (17.4%) stones were less frequent. In a subgroup of patients with diabetes mellitus type 2 uric acid stones were predominated (74.3%), significantly exceeding calcium oxalate (15.1%) and calcium phosphate (10.6%) stones. In the general population of patients with urolithiasis, hypercalciuria, hyperuricosuria, hyperuricemia and hypomagnesiuria was detected in 60.4%, 42.6%, 26.7% and 43.5% of cases, respectively. In patients with concomitant diabetes mellitus type 2, hypercalciuria, hyperuricosuria, hyperuricemia was observed in 9.4%, 26.7% and 42.5%, respectively. In 60.3% of patients with diabetes mellitus type 2 marked acidity of the morning urine was detected (pH<6.0). Conclusion. Correction of metabolic disorders in patients with urinary stone disease and diabetes mellitus type 2 should be aimed at increasing of urine pH and reducing the level of uric acid in the blood and urine.
Urologiia. 2019;(1):28-34
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A comparative analysis of intravesical sodium hyaluronate monotherapy and its combination with oral chondroitin sulfate in patietns with bladder pain syndrome/intersticial cystitis

Aboyan I.A., Aboyan V.E., Pavlov S.V., Zin’kovskaya O.V., Pavlov D.S.


Aim. It is established that intravesical sodium hyaluronate and chondroitin sulfate has high efficacy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). Currently, an oral form of chondroitin sulfate is also available. The aim of study was to compare the efficacy of intravesical hyaluronic acid monotherapy and long-term oral chondroitin sulfate in combination with intravesical therapy in patients with BPS/IC. Materials and methods. A total of 59 patients with BPS/IC were randomized in two groups. In Group 1, 30 women (mean age 57.1 years) received viscoelastic solution of sodium hyaluronate 50 ml 1 time per week for 12 weeks as intravesical monotherapy. In Group 2 (n=29), patients were prescribed to complex therapy, which included the similar intravesical therapy combined with chondroitin sulfate in a dose 0.39 g, 2 capsules 3 times a day, also for 12 weeks. All patients completed visual analogue scale (VAS), interstitial cystitis symptom index (ISCI), interstitial cystitis problems index (ICPI) and voiding diary before and 1 week after the start of therapy. In all cases a cystoscopy and urodynamic study were performed in order to exclude other bladder pathologies. Results. At baseline, a mean VAS score in both groups was 7 points, a mean ISCI score was 17 points in Group 1 and 18 points in Group 2 (p>0.1). The mean ICPI score in both groups was 15 points. A frequency of urination in Group 1 and 2 was 11.4 and 11.6 per day, respectively (p>0,1). A mean volume ofurination was 138+24.6 and 131+18.6 мл, respectively. After 12 weeks of therapy there was significant improvement of VAS, ICSI and ICPI scores in both groups, as well as frequency and volume of urination, but in Group 2 an improvement in almost all parameters studied, except for the volume of urination, was more pronounced. Conclusion. The combined therapy of BPS/IC with intravesical hyaluronic acid and oral chondroitin sulfate provides significantly better results in comparison with intravesical hyaluronic acid as monotherapy.
Urologiia. 2019;(1):35-39
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A comparative analysis of the effectiveness of serenoa repens and serenoa repens in combination with urtica dioiccus for lower urinary symptoms suggestive of benign prostatic hyperplasia associated with chronic inflammation in prostate tissue

Ibishev K.S., Krainy P.A., Mitusov V.V., Sizyakin D.V., Magomedov G.A.


Introduction. Benign prostatic hyperplasia (BPH) is the most common proliferative disease of the prostate gland in the elderly. Materials and methods. The results ofan open, randomized comparative study of the effectiveness of Serenoa repens in the combination with Urtica dioiccus (Prostagut-forte) are presented in the article. All patients were divided into two groups, depending on the therapy. In group I (n=51) Serenoa repens in combination with Urtica dioiccus 160/120 mg twice daily for 3 months was given, while in Group II (n=51) patients were prescribed to Serenoa repens 320 mg once a day, for 3 months. Results. According to the results, herbal preparations, like Serenoa repens, are effective for the medical treatment of BPH, which is confirmed by a decrease in LUTS severity, an increase in Qmax, a decrease in postvoid residual urine volume and an intensity of the inflammatory process in the prostatic tissue. However, in patients with BPH associated with chronic inflammation, it is preferable to use Serenoa repens in combination with Urtica dioiccus.
Urologiia. 2019;(1):40-46
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Lower urinary tract symptoms in young adult men: analysis of prevalence, profile and relationship with metabolic syndrome’ risk factors

Korneyev I.A., Alexeeva T.A., Potapova M.K., Alexeeva N.M., Al-Shukri S.K.


Aim. To evaluate LUTS prevalence and characteristics of lower urinary tract symptoms in young men and to investigate the relationship between LUTS and metabolic syndrome risk factors. Materials and methods. One hundred and one male student (age between 19 and 29, mean 21,2+1,5 years) of St Petersburg universities (63 (62,4%) students of First State Pavlov Medical University and 38 (37,6%) students of National Research University Higher School of Economics) were anonymously questioned. Students were asked about their height, weight, metabolic syndrome risk factors and interviewed by I-PSS and QoL questionnaire. The obtained data was analyzed in order to find significant relationship. Results. Lower urinary tract symptoms (I-PSS>0) were found in 84 (84%) men, mild and moderate LUTS - in 77 (77%) and 7 (7%) men, respectively. 39 (39%) men had both storage and voiding symptoms, storage only and voiding only symptoms were found in 31 (31%) and 14 (14%) students respectively. I-PSS score was higher in men with hypertension, diabetes, chronic stress and unmotivated fatigue (p=0,032, p=0,027, p=0,015 and p=0,003, respectively). In regression model (R2=0,268) I-PSS score was associated with diabetes (p<0,001), chronic stress (p=0,002) and hypertension (p=0,020). Conclusion. LUTS prevalence in young men is high. The relationship between LUTS and metabolic syndrome risk factors in young adult men can be considered as a reason for clinical investigation.
Urologiia. 2019;(1):47-51
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The efficacy of fesoterodine in patients after transurethral resection of the prostate

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


Aim. For a long time, benign prostatic hyperplasia (BPH) was considered as only cause of lower urinary tract symptoms (LUTS) in elderly men. More than 30% of patients underwent surgery by the age of 80. Unsatisfactory outcome of surgical treatment of BPH are observed in 9-27% of cases. Various irritative symptoms, which are typical for detrusor overactivity, persist especially often. Currently, anticholinergic drug therapy (m-cholinoblockers) is the main treatment for detrusor overactivity. The aim of our study was to assess the effectiveness of m-cholinoblockers for the treatment of persisted LUTS in men with BPH who had undergone transurethral resection of prostate (TURP). Materials and methods. The study included 60 patients with BPH who underwent TURP. All patients were divided into two groups. In Group 1, anti-inflammatory therapy for 10 days with 1-month follow-up was prescribed. In Group 2, anti-inflammatory therapy was combined with the drug Toviaz® for 1 month. Evaluation of the treatment effectiveness was carried out 3-5 days, 14-15 days and 1 month after TURP, respectively and included voiding diary, IPSS score, QOL, uroflowmetry, adverse events and acute urinary retention. Results. At baseline, in the Group 1 and 2, average urination frequency was 12.6 and 12.7 times per day, the number of urgency episodes was 9.2 and 9.0 times and number of nocturnal voiding episodes was 5,2 and 5.3 times, respectively. The average IPSS score was 19.8 and 19.7 points and Qmax was 6.5 and 6.7 ml/sec, respectively. By the 14th-15th day of therapy, in both groups positive changes were found. There was a significant decrease (p<0.05) in the urination frequency and nocturnal voiding episodes according to voiding diaries, an increase in Qmax and average IPSS and QOL score. The adverse events rate in group 2 was 16.7%. By the 30th day of therapy in the group 1 there were no significant changes. However, in group 2, urination frequency, number of urgency episodes, average IPSS and QOL score decreased to an average of 5.7 times a day, 0.4 times, 1.2 times, 9.3 points and 1.6 points, respectively. Average Qmax increased to 15.5 ml/sec. No adverse events were detected. Conclusion. According to the results of our study, the use of m-cholinoblockers, in particular Fesoterodine (Toviaz®), in combination with standard therapy in patients with detrusor overactivity after TURP is reasonable and allows to effectively and safely alleviate irritative symptoms.
Urologiia. 2019;(1):52-55
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Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?

Mamedkasimov N.A., Spot E.V., Alyaev Y.G., Rapoport L.M., Sorokin N.I.


Introduction: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. Materials and methods: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D -model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. Results. In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+29.1 ml), than in patients with exophytic and endophytic tumors (142.3+15.2 and 208.2+35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+5.2 min, p=0.005). The amount of blood loss was 179.4 + 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. Conclusion. According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.
Urologiia. 2019;(1):56-62
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Laparoscopic ultrasound guided partial nephrectomy

Guseinov R.G., Popov S.V., Skryabin O.N., Orlov I.N., Vorobiev A.A., Bagrov F.A., Katunin A.S.


Introduction. The choice of method of surgical treatment for endophytic kidney tumors depends on the precise definition of the location and size, the extent of invasion into adjacent tissues and the type of vascularization. Intraoperative ultrasound (IOUS) in combination with 3D-CT allow to receive this information. The aim of this study was to compare the laparoscopic-assisted extracorporeal partial nephrectomy and laparoscopic partial nephrectomy with IOUS and visualization in Full HD, 3D Full HD and 4K modes. Materials and methods. A total of 77 patients aged 43-75 years with endophytic renal tumors were included in the study. They were undergone either extracorporeal partial nephrectomy or laparoscopic partial nephrectomy with IOUS. We compared the rate of positive surgical margins, early postoperative bleeding, de novo renal failure or aggravation of preexisting renal failure and stricture of vesico-ureteric anastomosis. Results. The rate of early postoperative bleeding, chronic kidney failure and pathologically-proven positive surgical margin in patients who underwent extracorporeal partial nephrectomy followed by kidney autotransplantation was 23.1%, 13.4% and 13.4%, respectively. After laparoscopic partial nephrectomy these values were 12%, 16.7% and 8.3%, respectively. The best outcomes were achieved in patients who underwent laparoscopic partial nephrectomy with IOUS and with a use of visualization in Full HD, 3D Full HD and 4K modes.
Urologiia. 2019;(1):63-67
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Comparative analysis of results in laparoscopic radical cystectomy with extracorporeal and intracorporeal neobladder formation

Popov S.V., Skryabin O.N., Orlov I.N., Suleymanov M.M., Kryshevskaya A., Obidnyak V.M.


Introduction: The aim of the study is to compare the results and complications of muscle-invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation. Materials and methods: Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden). Results: In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases-Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis. Conclusion: Due to medical technologies development and endovideosurgical equipment improving, it became possible to perform hightechnological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.
Urologiia. 2019;(1):68-72
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A role of MRI-Ultrasound fusion targeted biopsy of prostate in the diagnosis of prostate cancer

Shestopalova O.Y., Jakovenko A.A., Rumyantsev A.S., Matveev A.V., Nevirovich E.S.


Aim. To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI. Material and methods. The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate. Results. There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason > 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason > 4 + 3) compared to SB (p=0.025). Conclusion. MRF-TB allows to detect more significant PCa (Gleason > 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.
Urologiia. 2019;(1):73-77
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Docosahexaenoic acid in the treatment of idiopathic male infertility

Vinogradov I.V., Gamidov S.I., Gabliya M.Y., Zhukov O.B., Ovchinnikov R.I., Malinina O.Y., Popova A.Y., Chalyi M.E., Bragina E.E., Zhivulko A.R.


Aim: docosahexaenoic acid is one of the most common fatty acids in the cell membranes of sperm. This substance is a structural component of cell membranes, and is responsible for such properties as plasticity and fluidity which are necessary for the implementation of the process of capacitation and acrosome reaction. In addition, docosahexaenoic acid has antioxidant properties. Aim of our study was to assess the effect of dietary supplement docosahexaenoic acid (Brudi PLUS) on such markers of male fertility as the sperm DNA integrity, standard indicators of semen analysis and cryotolerance in infertile men. Materials and methods: a randomized, multicenter, double-blind, placebo-controlled study was conducted. A total of 109 infertile men were recruited to participate in the study. All patients underwent different analyzes, including semen analysis, sperm DNA fragmentation, MAR-test, test ofcryotolerance and electron microscopy analysis ofspermatozoa. In active treatment group patients were prescribed to drug containing 350 mg of docosahexaenoic acid 3 times a day for 90 days. In the control group, patients were administered to a placebo with a similar scheme. All analyzes were repeatedly performed after 3-months of therapy. Results: An increase in the progressive mobility and sperm viability was determined after the test of cryotolerance in the active treatment group. According to electron microscopy analysis of spermatozoa, positive changes were observed in the number ofheads of the normal form with the normal structure of chromatin and acrosome, as well as a decrease in the number of spermatozoa with insufficiently condensed chromatin. Conclusions: the therapy with drug Brudi PLUS in patients with male infertility allows to increase in cryotolerance of sperms as well as decrease in number of sperm ultrastructure defects.
Urologiia. 2019;(1):78-83
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Cytogenetic, kariopathological and morphological abnormalities of spermatozoa and urothelial cells in human granulocytic anaplasmosis depending on polymorphism of the gene of DNA ligase IV

Ilyinskikh N.N., Ilyinskikh E.N., Subbotin A.M., Kostromeeva M.S.


Aim: to assess the role of human granulocytic anaplasmosis (HGA) caused by Anaplasma phagocytophilum in the induction of cytogenetic damage of spermatozoa and karyopathological abnormalities of urothelial cells depending on the polymorphism of the gene of enzyme, DNA ligase IV. Material and methods. A total of 129 male patients with HGA and 84 otherwise healthy donors were examined. The samples of both semen and urothelial cells were obtained from each individuals for microscopic analysis. The diagnosis was confirmed by cytological (microscopic) method, enzyme immunoassay and polymerase chain reaction (PCR). An analysis of the frequencies of damaged spermatozoa and urothelial cells in all participants was carried out. In addition, a molecular cytogenetic study of spermatozoa by fluorescent in situ hybridization (FISH) was carried out using an AneuVysion multicolour for chromosomes 18 and 21 («Abbott», USA) to determine the frequency of aneuploidy in spermatozoa. The level of DNA fragmentation was studied by SCD (Sperm Chromatin Dispertion Test) using a commercial Halosperm kit («Halotech DNA», Spain). Results. The cytological analysis revealed the significant increase in the proportion of spermatozoa with cytogenetic abnormalities and urothelial cells with karyopathological damage in the HGA patients. The most significant damage to nuclear structures of cells was determined in the patients with Ile/Ile genotype. The significant effects of HGA in DNA damage and cytogenetic abnormalities in patients were verified by the increased frequency of spermatozoa with DNA fragmentation, monosomy and disomy in 21 and 18 chromosomes, as well as the appearance oi urothelial cells with karyopathological abnormalities. In addition, the increased frequencies of pathospermia with pathological abnormalities of head, neck and tail of spermatozoa in HGA patients were found. Conclusion. According to our results, the cytological analysis in the patients with HGA demonstrated the significant increase in the frequencies of spermatozoa with head, neck and tail defects and DNA fragmentation, monosomy and trisomy of the 18th and 21st chromosomes, as well as the increase in the frequencies of urothelial cells with karyopathological abnormalities. The genetic polymorphism of the effects of HGA was revealed, and the most significant cytogenetical damage was found in the patients carrying the Ile/Ile genotype of the LIG4 Thr9Ile gene.
Urologiia. 2019;(1):84-89
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Antioxidant therapy improves the results of НВА-test in infertile men during a preparation for assisted reproductive technology (IVF/ICSI)

Popova A.Y., Ovchinnikov R.I., Gamidov S.I.


Introduction. Male infertility accounts for 45-50% of all barren marriages, and in up to 40% of cases an idiopathic male infertility is diagnosed. The introduction of ART programs into clinical practice allowed to restore the childbearing function in various diseases, both in women and men, which were previously considered absolutely unpromising for treatment. Aim: to study an influence of the antioxidant complex (Androdoz) on the results of HBA-test in infertile men during a preparation for assisted reproductive technology (IVF/ICSI). Materials and methods. A total of 80 men aged from 25 to 45 years planning an ART program were included in a comparative, randomized, prospective, controlled study. Sixty men in a main group received an antioxidant complex (Androdoz) for 3 months, while 20 men were allocated to control group. The criterion of efficiency of the treatment was an improvement of HBA-test as well as pregnancy rate in the couples determined by interviewing patients participating in the study. Results. After 3 months of therapy an increase in the number of morphologically normal spermatozoa in the ejaculate was shown in the main group, while in the control group negative changes were noted. There was a decrease in the proportion of spermatozoa with a progressive movement (А+В) in comparison with the control group. A positive influence of antioxidant complex (Androdoz) on the functional properties of sperm was proven by the increase in HBA-test by 13.8%, whereas there were no positive changes in the control group. A pregnancy rate after the first cycle of ART in the main group was 45% compared to 25% in the control group. Conclusion. The use of the antioxidant complex (Androdoz) for the treatment of male infertility in those patients who considers ART program is perspective method which allows to improve the main criteria of sperm analysis and functional tests (HBA-test), and also contributes to an increase in positive outcomes of ART program.
Urologiia. 2019;(1):90-96
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Urogenital tuberculosis in children

Soloviev A.E., Mayorov A.N., Efimov E.A., Kulchitsky O.A.


Aim. To analyze the clinical spectrum of urogenital tuberculosis (TB) in children from 1993-1997 to 2013-2017, who were treated at the FSCU «Kiritsy». Materials and methods. Clinical forms of urogenital tuberculosis were diagnosed in 195 children (stage 1) and 158 children (stage 2). Conventional methods of TB diagnosis, including clinical, laboratory, imaging studies, tuberculin skin test and urine culture for BCG were used. In all cases, standard treatment for TB in combination with physiotherapy were performed. Results. When comparing the clinical spectrum of urogenital tuberculosis in children in 1993-1997 yy. (stage 1) and 2013 and 2017 yy. (stage 2), who were treated at the children's tuberculosis clinic "Kiritsy", the authors concluded that during the last 5 years the number of children with urogenital tuberculosis had decreased by 1.5 times (195 children in 1 stage, 158 in 2 stage) and proportion of children with a destructive form of urogenital tuberculosis decreased by 4 times (15 children in stage 1, 4 in stage 2). The contemporary diagnostic methods (urine culture, Diaskintest, ultrasound, instrumental methods) contributed to improved diagnosis of urogenital tuberculosis. Novel powerful antituberculous antibiotics allowed to significantly improve treatment outcomes. Results. 1) The incidence of urogenital tuberculosis in children over the past 5 years has decreased by 1.5 times compared with 90th years of the the last century. 2) At the current stage, the use of urine culture, Diaskintest, ultrasound, x-ray and instrumental methods contributes to the diagnosis of urogenital tuberculosis in children. 3) Multidisciplinary team consisted of pediatricians, pediatric urologists, phthisiopediatric as well as sanitary and educational work in the foci of infection allow to identify the urogenital tuberculosis in children.
Urologiia. 2019;(1):97-101
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Successful treatment of an infant with a rare anomaly: iliosacral dystopia of the right kidney and obliteration of the left distal ureter

Imamverdiyev S.B., Abdurahimova V.Y.


In the article a rare case of structural anomaly of ureter, namely obliteration, in 1-year-old infant is reviewed. The obliteration was located in the distal part of the left ureter. There was urine leakage through dilated and inflamed wall of the ureter towards right gluteal region with a formation of retroperitoneal abscess. A diagnosis was established based on preoperative MRI and intraoperative antegrade pyeloureterography. Extravesical Lich-Gregoir ureterocystoneostomy was successfully performed.
Urologiia. 2019;(1):102-104
pages 102-104 views

Methanaphylaxis of urolithiasis. Part 3. The factors associated with increase in incidence of urinary stone disease. Current views on the mechanisms of stone formation

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


All theories of stone formation are based on the common condition, which is the supersaturation ofstone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.
Urologiia. 2019;(1):105-112
pages 105-112 views

A role of fructose in urinary stone formation

Pavlova Z.S., Golodnikov I.I., Kamalov A.A., Nizov A.N.


Obesity is one of the actual problems of modern medicine. The comorbid conditions in patients with obesity and metabolic syndrome have no less important value, attracting the attention of scientists and clinicians. Renal stone disease is one these diseases. We are interested in its development, which is directly related to the effect of excess amounts of such a monosaccharide, as fructose. For quite a long time, this carbohydrate was considered to have only positive properties, including its role in carbohydrate metabolism in general, and, in particular, in diabetes mellitus. Over the years, a pathological effect of excess fructose was detected. Since fructose was used to replace glucose, and accordingly, its amount in food, and especially in diabetic foods, was growing. In addition, the industrial production of corn-based fructose has become much less expensive than the production of sucrose, which has also contributed to the increased use of this monosaccharide in the food industry. In this article, the mechanisms leading to the development of pathologies which are associated with the excessive use of fructose, increase in the level of uric acid with subsequent formation of uric acid stones, are reviewed. Thus, the study of the effect of fructose on the pathogenesis of renal stone disease is interesting and extremely relevant, since for many specialists, it is animal protein that is associated with the development of kidney stone disease and the role of fructose is not only unobvious, but is also a revelation.
Urologiia. 2019;(1):114-118
pages 114-118 views

Safety of tadalafil in patients with cardiovascular comorbidities

Nikitina I.L., Gaysina G.G., Galimov S.N., Bulygin K.V., Galimova E.F., Pavlov V.N.


Tadalafil is a drug from the phosphodiesterase-5 inhibitors (PDE-5) group, which is used to treat erectile dysfunction (ED), lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and ED with LUTS in patients with BPH. The efficacy and safety of tadalafil were reviewed. The focus was on cardiovascular safety of tadalafil due to frequent cardiovascular comorbidities in patients with ED. We concluded that tadalafil is well tolerated and safe in patients with cardiovascular comorbidities and, in addition, has a beneficial effect on the cardiovascular system.
Urologiia. 2019;(1):119-125
pages 119-125 views

Molecular basis of intratumoral heterogeneity of urinary tract urothelial carcinoma

Osmanov Y.I., Gaibov J.A., Kogan E.A., Rapoport L.M.


In the article the main mechanisms of molecular pathogenesis of urinary tract urothelial carcinoma are presented. Two different molecular pathways that determine the development of non-invasive and invasive urothelial carcinoma, the immunohistochemical spectrum of stem markers and aspects of the carcinogenesis of multifocal and recurrent tumors are considered.
Urologiia. 2019;(1):126-130
pages 126-130 views

Good urodynamic practice: consensus on the terminology

Pushkar D.Y., Gadgieva Z.K., Kasyan G.R., Krivoborodov G.G., Kupriyanov Y.A., Rosier P.F.


In this publication a summary of the published manuscript “Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study” developed by a working group under the guidance of the Standardization Steering Committee of International Continence Society (ICS)1 is presented. The members of the working group were: Werner Schaefer, Gunnar Lose, Howard B. Goldman, Michael Guralnick, Sharon Eustice, Tamara Dickinson, Hashim Hashim and Peter F.W.M Rosier.
Urologiia. 2019;(1):131-136
pages 131-136 views
pages 137-137 views

Yuriy Antonovich Pytel: to the 90th anniversary of his birth (1929-1998)

Alyaev Y.G., Aslamazov E.G., Gadgieva Z.K.
Urologiia. 2019;(1):138-140
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