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No 3 (2019)


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Treatment of patients with lower urinary tract symptoms in Moscow

Pushkar D.Y., Rasner P.I., Kotenko D.V., Gerasimov A.N., Shabalkin S.A.


Introduction. In recent years, there has been a persistent tendency to a decrease in surgical treatment of patients with lower urinary symptoms (LUTS). This fact can be explained by variety drugs which have acceptable safety and high efficiency for treatment of urinary disorders. As part of our survey of men in Moscow region, the trends in prescribing the different drugs for the LUTS was studied. In addition, the duration of therapy and patient adherence were analyzed. Materials and methods. A prospective multicenter epidemiological study “Characteristics of lower urinary tract symptoms in men in the Moscow region” was carried out using data obtained from April 1 to May 31, 2017 with anonymous survey of 525 men with mean age of 64.2±9.93 years, living in Moscow and went to the urologist with urinary disorders. All respondents answered questions from specially designed questionnaire consisted from 140 items. All medical data were analyzed, including received drugs, the duration of the therapy and subjective assessment of efficiency. Results. A total of 419 patients from 525 (79.8%) received any kind of therapy. The most commonly used drugs were а-blockers, which consisted 65% of all prescriptions. Other drugs were administered significantly rarely. It is surprisingly, that 85.6% of respondents in Moscow region received the original а-blockers, not generic drugs. Satisfaction rate was 74.3%. Most of patients (58.3%) had received а-blockers for 1-3 years and 33.3% administered these drugs for more than 3 years. Combined drug therapy was the second most popular (25.5%). The most commonly used combination included а-blockers and inhibitors of 5а-reductase. In 90.6% cases the appointment was made by urologist. Conclusion. Drug therapy is the most popular treatment in patients with LUTS. Our data suggest that а-blockers as monotherapy or in combination with inhibitors of 5а-reductase is the most often prescribed therapy. These results are in concordance with the main conclusions of international studies dedicated to this issue.
Urologiia. 2019;(3):7-12
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Prediction of the effectiveness of the therapy of LUTS/BPH by Serenoa repens extracts

Sivkov A.V., Golovanov S.A., Zhukova L.V.


Introduction. For the treatment of LUTS/BPH is used a wide range of drugs that patients have to take for a long time. Therefore, it is important to develop methods for predicting long-term results of therapy. The purpose of this work is to evaluate the possibility to predict long-term results of drug therapy of LUTS/BPH using mathematical modeling on the example of treatment with Serenoa repens extract (ESR - Permixon). Materials and methods. For prediction using the methods of predictive analytics of the therapeutic ESR effect in the long term, materials from the open study «Clinical and biological long-term tolerance of a lipidosterolic extract of Serenoa repens (Permixon) in patients with symptomatic benign prostatic hypertrophy» (No. P0048 95 GP 401) were used. The study took place in 1995-1999 in 3 Moscow medical centers: Research Institute of Urology of the Ministry of Health of the Russian Federation, Urological Clinic of the Moscow Medical Academy named after Sechenov and the urology department of Moscow Clinical Hospital No 60. The study included 155 patients aged 52 to 87 years (65.3) who received the drug in 320 mg capsules per day for two years. The target indicators of the prognosis identified key clinical parameters: a decrease IPSS of>25% or>3 points and an increase in Qmax>25% at 12 and 24 months of treatment. When evaluating the results, a binary approach was used: improvement achieved (1), not achieved (0). Results. Using the methods of predictive analytics, mathematical models were built to predict the long-term results of treatment according to the most significant 7 initial criterias (predictors): IPSS; Qmax; average urine flow rate; urination volume, urination time, residual urine volume, prostate volume. For each target field and time interval, mathematical models were built using ensembles from 7 selected machine learning algorithms with the best predictive qualities: BNet; C5.0; SVM; KNN; NNet; CHAID; C&RT. Verification of models on internal randomized samples showed their high prognostic properties: sensitivity 82.4-99.0; specificity 75.0-96.1; AUC 0,864-0,965. Conclusion. The potential for effective prediction by the methods of predictive analytics and data mining of the separated results of drug therapy of LUTS / BPH according to the main clinical criteria was demonstrated. It is necessary to continue training and testing the model with the inclusion of new clinical observations in the data set. This approach is applicable to the creation of similar models for predicting the effect of other drugs.
Urologiia. 2019;(3):14-22
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Diagnosis and treatment of abacterial category III CP/CPPS, associated with herpes viruses

Evdokimov V.V., Kovalyk V.P., Malinovskaya V.V., Shuvalov A.N., Kushch A.A.


Introduction. The etiology of abacterial CP/CPPS (category III) has not been studied enough. Currently, there is no gold standard of diagnostic study and optimal treatment algorithm. Aim. The aim of our study was to study three human herpes viruses (HHV) in clinical samples from patients with inflammatory diseases of urogenital tract and to evaluate the efficiency of proposed treatment algorithm for abacterial CP/CPPS. Materials and methods. The biological samples from the urogenital tract (urethral swab, ejaculate and expressed prostatic secretions) from 101 patients with category III CP/CPPS were studied. Quantitative analysis of HHV DNA (CMV, EBV and HHV-6) was performed by PCR. Results. HHV DNA was detected in 38/101 patients (37.6%) in Group 1. Among the detected viral types, HHV-6 was the most common (52%). Analysis of biological samples form the three sources revealed that viral DNA was determined in urethral swab in concentration of3,703,900 copies/ ml. In Group 2, viral DNA was not detected in 63 patients. Evaluation of results of the standard treatment in HHV-negative patients (n=63) and antibiotic-free scheme, including the immunoregulatory drug Viferon®, in HHV-positive patients (n=38) showed that the number of HHV-positive samples after treatment decreased by 54.3%. In addition, severity of all symptoms according to NIH-CPSI scale significantly decreased in both groups (p<0.0001). There was an improvement in all clinical symptoms in Group 1 by 47.9%, especially for pain + urination (52%). It should be noted that a positive response to treatment, which was confirmed by the changes in total score of NIH-CPSI scale, was noted in all patients in Group 1. Conclusion. Detection of herpes viruses in the urogenital tract of patients with abacterial CP/CPPS suggests possible role of viral infections in its etiology. The comparative analysis of the results of standard treatment including antiviral, immunomodulatory and antioxidant drugs showed that the use of complex therapy without antibiotics allowed to eliminate or significantly reduce the concentration of viruses in urogenital tract, as well as significantly reduce the clinical manifestations of abacterial CP/CPPS.
Urologiia. 2019;(3):23-30
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Use of cytomedins in case of prostatic involvement in chronic prostatitis according to UPOINT classification

Ergakov D.V., Martov A.G., Turin D.E.


Background: chronic prostatitis is a common disease that significantIy influence on the quality of life. Aim: Our aim was to assess the prevaIence of particuIar domains of UPOINT cIassification and determine the efficiency of prostate- selective cytomedins in complex therapy of chronic prostatitis with the predominance of organic component. Materials and methods: a total of 96 patients aged from 24 to 48 years were treated in City clinical hospital named after D.D. Pletnev in 2017-2018 yy. with a previously diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The mean duration of the disease was 18.0±6.2 months. The total NIH-CPSI score was 24±7.3 (pain score 9±4.9, urinary score 7±2,7, quality of life 8±2.3), Qmax was l6±4.2 ml/s, prostate volume - 34±12 cc. Leukocyturia in post-massage urine was found in 52 patients (54%). Positive urine culture after prostate massage or positive bacterial semen study were found in 22 patients (23%). Prostate-specific therapy consisted of 20 days of rectal suppositories Vitaprost-forte® followed by oral therapy by Vitaprost® tablet of the same duration. Results: Follow-up examination of 72 patients (75%) was performed after 3 months of therapy. The total NIH-CSPI score decreased to 15.6±5.1 (pain score 6.3±3.8, urinary score 4.6±2.2, quality oflife 4.7±2), Qmax was 16±3.8 ml/s and mean prostate volume was 24±6 cc. The normalization of laboratory parameters was achieved in all cases. Conclusion: using the UPOINT classification allows to optimize the treatment of patients with chronic prostatitis. Use of prostate-specific cytomedins (Vitaprost®) is highly effective in case of prostatic involvement according to the UPOINT classification.
Urologiia. 2019;(3):31-35
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The experience of using drug Afalaza for treatment of lower urinary symptoms in treatment-naive patients with benign prostatic hyperplasia

Kupriyanov Y.A., Rasner P.I., Rokhlikov I.M., Akrikidi A.A., Soloviev V.V., Markov A.A., Nozdrin E.V., Logvinov L.A., Vasilevskiy R.P., Skrupskiy K.S., Pushkar D.Y., Putilovskiy M.A., Epstein O.I.


Introduction. Benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 50 years. The prevalence of the BPH increases with age, and pathologic features of BPH are found in about 90% of men over 80 years. Aim. The aim of the study was to study the efficacy and safety of Afalaza for the treatment of lower urinary tract symptoms (LUTS) in treatment-naive patients with BPH. Materials and methods. A multicenter study of using Afalaza for the treatment of LUTS in treatment-naive patients with BPH was carried out in 9 urological centers in Moscow. A total of 80 treatment-naive patients with BPH were enrolled. The improvement in the total score of IPSS, IIEF-5 and QoL after 30 weeks of therapy was evaluated as well as changes in prostate volume and maximum urinary flow rate (Qmax). Results. After 30 weeks of therapy, there was a significant decrease in the total IPSS score. A decrease in the total IPSS score by 5.5 points (+37.9%) from 14.5+4.0 at the baseline to 9.0+4.1 at the visit 9 was seen. The QoL decreased by 1.8 (-38.3%) points from 4.7+1.0 at the baseline. The Qmax also changed from 12.7+4.6 to 16.4+5.7 (+28.3%) after 30 weeks of therapy. At the visit 9, the total IIEF5 score increased by 3.4+4.4 (+19.9%) from 17.1+4.3 at the baseline. In addition, prostate volume decreased from 42.7+11.1 at baseline to 41.0+9.8 cc post-treatment (-5.15%). A reduction of post-void residual urine volume from 26.0+25.3 at baseline to 17.7+24.2 (-31.9%) post-treatment was also shown. Conclusion. The results of a multicenter study demonstrate the efficacy of Afalaza for treatment of treatment-naive patients with LUTS/BPH. Afalaza reduces prostate volume and improves an erectile function.
Urologiia. 2019;(3):36-42
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Clinical value of herbal terpenes after extracorporeal shock-wave therapy

Rudenko V.I., Rapoport L.M., Demidko Y.L., Demidko L.S., Inoyatov G.S., Allenov S.N.


Background. Rowatinex is a combined drug based on plant terpenes which provides diuretic, anti-inflammatory and antispasmodic effect. A use of herbal preparation Rowatinex in patients with urinary stone disease after extracorporeal shock-wave therapy (ESWL) is analyzed in the article. Aim. To clarify the efficiency of the drug Rowatinex in patients with urinary stone disease after ESWL. Materials and methods. All patients were divided into two groups depending on therapy administered after ESWL. In main group (n=150) patients received Rowatinex, while in control group (n=70), antispasmodics were administered. Spontaneous passage offragments was observed in 104 patients in main group (69.3%) and 30 patients in control group (42.9%). Results. When studying the effect of therapy on the changes of complete blood count, biochemical panel and daily excretion of some substances (magnesium, uric acid, calcium, etc) there were no significant differences between main group and control group. All values were normal. It was estimated that increase in diuresis during use of Rowatinex contributes to effective and rapid passage of stone fragments. In addition, there was a decrease in leukocyturia in both groups. Conclusion. Drug Rowatinex allows to reduce the time to spontaneous passage of fragments after ESWL, intensity of pain syndrome and leukocyturia as well as to increase in daily diuresis. This is not accompanied by the development of complications and side effects which allows to administer Rowatinex for a long time as part of complex medical expulsive therapy and use it for recurrence prevention of urinary stone disease. Effect of Rowatinex didn’t depend on the stone composition.
Urologiia. 2019;(3):43-49
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Adjunctive technologies in treatment of patients with urogenital tuberculosis

Shevchenko S.Y., Kulchavenya E.B.


Introduction. Currently, the limits of therapeutic efficiency in urogenital tuberculosis have been achieved. The etiological therapy should be supplement by pathogenetic drugs. Aim: to determine the efficiency of deoxyribonucleate sodium in the complex treatment of patients with urogenital tuberculosis. Material and methods. Single-center open-label randomized comparative prospective study was carried out. A total of 62 patients with active urogenital tuberculosis were included. All patients received therapy in accordance with National clinical guidelines for urogenital tuberculosis. In the main group, patients additionally received pathogenetic therapy in form of deoxyribonucleate sodium via intramuscular injection of 75 mg every 48 hours. Whole one-month course consisted of 15 injections. Pathogenetic therapy was started immediately after the choosing of anti- tuberculosis drugs and confirmation of good tolerability. The efficiency of treatment was evaluated after one and three months. The assessed criteria included the intensity of pain and severity of dysuria, signs of inflammation, bacterial isolation and changes in the quality of life. Conclusion. The addition of deoxyribonucleate sodium in the form of intramuscular injections of 75 mg every 48 hours for 1 months resulted in a significant increase in the efficiency of treatment. Quality of life in patients receiving deoxyribonucleate sodium improved twice (from 11.1 to 21.5 points), while in the control group this value was twice as low (from 10.8 to 15.9 points).
Urologiia. 2019;(3):50-53
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Calcium kidney stones: comparative evaluation of diagnostic value of calcium level in serum, urine and hairs

Gres A.A., Nitkin D.M., Gres N.A., Juraha T.M., Said Hamad Mahmud -.


Aim: to study the calcium level in the urine, serum and hairs and to assess the diagnostic value of the calcium level in various biosubstrates in patients with calcium and non-calcium stones. Materials and methods: a total of 99 patients with urinary stone disease were included in the study. A diagnostic value of calcium level in biosubstrates according to the chemical analysis of stone composition performed using qualitative chemical reactions and microcrystalloscopy was evaluated. Results: Urinary level of calcium and oxalate is proved to have high diagnostic value in patients with calcium nephrolithiasis (specificity 93.9% and 96.9%, and positive predictive value 88.2% and 97.2%, respectively). The specificity and positive predictive value of the calcium level in the hairs was 81.2% and 87.2%, respectively. Conclusion: A comprehensive study of the elemental spectrum in urine, hair, and serum increases the diagnostic value of the evaluation of calcium, determined by the type of studied biosubstrate and stone type in patients with nephrolithiasis.
Urologiia. 2019;(3):54-59
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Remote monitoring of urinalysis parametres during treatment of patients with uric acid stones by citrate-containing compounds

Prosiannikov M.Y., Shaderkin I.A., Konstantinova O.V., Anokhin N.V., Voytko D.A., Nikushina A.A.


Introduction. Oral dissolution therapy has been successfully used in urologic practice since 1950s. However, many doctors attempt to improve efficiency of this approach. Use of different medical personalized digital devices which are increasingly used in clinical practice, represent one of the solutions of this problem. Aim. Our aim was to assess efficiency of oral dissolution therapy with drug Blemaren in patients with uric acid stones using of portable urinary analyzer with system of remote monitoring. Materials and methods. A total of 12 patients with uric acid stones were followed. All of them had kidney stone with a density less than 500 HU according to CT-urography. Oral dissolution therapy was performed with the drug Blemaren for 8-9 weeks. All patients were advised to maintain urine pH of 6.5-7.0. With aim of dynamic monitoring of urine parameters, a portable urine analyzer “ETTA AMP-01” was given to all patients for 2 months. Results. Complete dissolution was achieved in 10 (83.3%) patients. In one case (8.3%) oral dissolution therapy was complicated by acute pyelonephritis. A stenting was performed and dissolution therapy was continued with a positive effect. In another case (8.3%) partial dissolution was seen, however, extracorporeal shockwave lithotripsy was decided to perform. Doctor who remotely monitored different parameters of urinalysis (n=11) followed urine pH, density, leukocytes, erythrocytes, level of nitrite, which provided a more comprehensive assessment of patient’s current state. If necessary, the specialist contacted the patient and adjusted the therapy. Conclusion. The possibility of remote monitoring of urinalysis and simple communication with urologist allows to titrate drug dose more convenient compared to conventional approach when outpatient urologist controls pH diaries based on dip-stick test. Moreover, such approach gives an opportunity to quickly identify complications and correct the therapy in a timely manner.
Urologiia. 2019;(3):60-65
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Experience of application of hormonal and probiotic therapy in the complex treatment of women in periand postmenopausal with chronic recurrent bacterial cystitis in the background of vulvovaginal atrophy

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


Introduction. Lower urinary tract infections (LUTI) are one of the most common diseases among women. The risk of LUTI increases with the onset of peri- and postmenopause. Vulvovaginal atrophy occurs in 30% of women aged 55 years and 75% of women aged 70 years. Currently, local hormone therapy is the main method of its treatment. However, different variants of complex therapy are also used. Materials and methods. The study included 60 women aged with the diagnosis: «Postmenopausal atrophic vaginitis. Chronic recurrent bacterial cystitis in the acute stage». The patients were divided into 2 groups of 30 people. In group 1 was carried out etiotropic antibiotic therapy in combination with local use of single-agent preparation or estriol for 3 months. In group 2, the patients received antibiotics in combination with Triozhinal for 3 months. The effectiveness was monitored on the 1st and 7th day of therapy, as well as 3 months after the start of treatment. Results. At admission in both groups there were signs of vulvovaginal atrophy and exacerbation of chronic cystitis. Complex therapy with Triozhinal, containing lyophilized culture of lactobacilli L. casei rhamnosus Doderleini, contributed to the normalization of PH, restoration of vaginal biocinosis, and, consequently, reduce the severity of complaints of dryness and burning in the vagina, dyspareunia. Thus, despite the reduction of symptoms in the majority of women, the proportion of such patients in group 2 was higher and amounted to 96.7% against 83.3% in group 1. Supportive reception of the drug for 3 months. it allowed to preserve the normocinosis of the vagina until the restoration of its trophic, as well as to reduce the frequency of bacteriuria and leukocyturia by 20% compared with the results of group 1, and to significantly reduce the number of relapses of infection (p<0.05). Conclusion. Triozhinal improves the results of treatment of recurrent urinary infection in women with vulvovaginal atrophy in peri- and postmenopausal and can be recommended for use in combination therapy.
Urologiia. 2019;(3):66-71
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Micropercutaneous laser nephrolithotripsy

Martov A.G., Dutov S.V., Popov S.V., Emelyanenko A.V., Andronov A.S., Orlov I.N., Adilhanov M.M., Kozachihina S.I.


Introduction. The least invasive technique of PCNL is micropercutaneous nephrolithotripsy (micro-PCNL). A possibility of kidney puncture under direct endoscopic control with the creation of a working channel sized of 8-4.85 F is a characteristic feature of this system. Aim. To study the possibilities of micro-PCNL and to determine its role in the treatment of kidney stones. Materials and methods. A total of 74 patients aged 49.8+16.3 years were included in the study. In majority cases an isolated kidney stone was diagnosed (86.4%). The most common stone localization was pelvis (51.5%), followed by lower pole (35.9%). Considering the technical aspects of microPCNL, all patients were divided into 2 groups depending on the stone burden. In 46 patients (62.1%), the stone size was < 1.5 cm, while in 28 patients (37.9%) stones were bigger than 1.5 cm. Prestenting was performed in 54.0% due to renal colic or obstructive pyelonephritis. For the purpose of passive flushing of stone fragments during the lithotripsy, in most patients with a stone size > 1.5 cm, as well as in some prestented patients a ureteral access sheath with a diameter of 10/12 F (56.7%) was placed under x-ray control. In most patients with stones less than 1.5 cm, a 4.85 Ch sheath was utilized. In patients with larger stones, working sheath of 8 Ch was put. For stone disintegration, 50 W and 100 W holmium lasers, as well as the Russian innovative thulium fiber laser were used. Results. The average duration of surgery from the puncture was 30.6+11.6 minutes. The effectiveness was determined by use of a noncontrast computed tomography, performed one month after the surgery. An overall stone-free rate after one-session was 89.1%, and it was 93.4% and 82.4%, respectively, in patients with stones sized less and more than 1.5 cm. In 32.4% cases the stenting was placed due to the large number of small residual fragments and risk of obstruction. In one case, a conversion into a mini-PCNL was done. Two patients (2.7%) required stenting because of renal colic caused by the migration of stone fragments into the ureter. There was no bleeding. In 8.1% of cases, acute pyelonephritis was developed that was treated conservatively. In 9.4% of patients, ESWL was required due to residual stones diagnosed one month after the surgery. Conclusion. Micro-PCNL is highly effective and safe method for treatment of kidney stones. Placing of ureteral access sheath of size 10/12 F contributes to the passive flushing of fragments during lithotripsy, which, together with the use of the 8 F working sheath, makes it possible to effectively perform micro-PCNL in patients with kidney stones larger than 1.5 cm.
Urologiia. 2019;(3):72-79
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A comparison between enucleation of the prostate using holmium and thulium laser in volume over 80 cc: retrospective clinical study with 12-months follow-up

Popov S.V., Orlov I.N., Martov A.G., Malevich S.M., Sushina I.V., Grin E.A., Obidnyak V.M., Dovganskiy D.V., Topuzov T.M.


Aim: The aim of our study was to evaluate efficiency of thulium laser enucleation of the prostate (ThuLEP) for the treatment of benign prostatic hyperplasia (BPH). Materials and methods: A retrospective analysis of 112 patients with BPH who underwent ThuLEP (n = 60) or holmium laser enucleation of the prostate (HoLEP) (n = 52) at our institution from January 2017 to June 2017 was carried out. The perioperative data and complication rate were assessed. Severity of lower urinary tract symptom (LUTS) was evaluated after 1, 6 and 12 months using International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]. To shorten learning curve, we modified the technique and simplified the intervention. To reduce noise during surgery, we performed ThuLEP using Vela XL. Results: There were significant differences in pre- and perioperative parameters, including operative time (113.15 ± 12.14 vs. 118.08 ± 15.76 min, p=0.46), decrease in serum sodium concentration (3.49 ± 0.83 vs. 3.48 ± 0.84 mmol/L, P = 0.97), hemoglobin drop (1.37 ± 0.18 vs. 1.43 ± 0.38 g/dL,p = 0.65), catheterization time (2.15 ± 0.38 vs. 2.27 ± 0.39 days, p=0.52) and hospital stay (6.95 ± 0.82 vs 7.56 ± 1.36 days, p=0.25) between the two groups (ThuLEP and HoLEP). Compared with the HoLEP group, intraoperative noise was lower in ThuLEP group (47.22 ± 10.31 vs. 59.45 ± 9.65 db,p < 0.05). At 1-, 6- and 12 months follow-up, the LUTS severity (I-PSS, QoL score and Qmax) were significantly improved in both groups in comparison with the baseline values. Furthermore, there was no difference in LUTS severity between two groups (p > 0.05). Conclusion: ThuLEP is comparable to the holmium laser in terms of efficiency, safety and indications and represent minimally invasive treatment option for patients with LUTS secondary to BPH.
Urologiia. 2019;(3):80-83
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An adaptation of the CLAVIEN-DINDO classification of complications for contact ureterolithotripsy

Mamedov E.A., Dutov V.V., Bazaev V.V., Podoynicyn A.A., Buymistr S.Y.


Aim: to study an adaptability of the Clavien-Dindo classification of complications for contact ureterolithotripsy. Materials and methods. A total of 506 patients with ureteric stones who were undergone 545 endoscopic interventions in the Urologic Department of “MONIKI” named after M.F. Vladimirsky were included in retrospective analysis. Results. Complications of grade 1, II, IIIa and IIIb were noted in 39 (7.1%), 24 (4.3%), 15 (2.8%) and 14 cases (2,6%), respectively. Among the complications of grade IVa, an acute pyelonephritis was complicated by the septic shock. The complication of grade IVb developed in 1 case (0.2%). There were no complications of Grade V. The Clavien-Dindo classification allows to grade only postoperative complications and attempts to adapt it for the assessment of intraoperative complications can lead to the distortion of study results. Conclusion. The uncontrolled use of the Clavien-Dindo classification in all areas of surgery can lead to a decrease in its accuracy, thereby reducing its value as fairly universal tool. In our opinion, a further work aimed to the development of strict criteria for the different grades of complications of the Clavien-Dindo classifications is needed. We believe it is possible and necessary to develop a single tool for the assessment of complications of typical interventions within a single surgical area.
Urologiia. 2019;(3):84-88
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Morphological study of lymphoid organs at early stages of experimental prostate carcinogenesis

Lomshakov A.A., Astashov V.V., Kozlov V.I., Ryzhakin S.M., Uloga M.V., Medyantseva D.A.


Aim. the aim of our study was to identify of structural transformations in the thymus and lymph nodes at the early stages of the development of an experimental prostate cancer. Materials and methods. Experiments were performed on 60 adult male CBA mice weighing 28-30 g. An experimental model of a prostate cancer was created by inoculating a diluted cell strain of Ehrlich Ascites Carcinoma cells into the prostatic parenchyma through midline laparotomy under ether anesthesia. The animals were divided into three groups of 20 each: 1) control (intact animals) 2) animals on the 5th day of experimental prostate tumor growth and 3) animals on the 18th day of experimental prostate tumor growth. The pathological examination of the prostate, thymus, and pelvic lymph nodes was performed. The selection of structural components and cellular elements in the thymus and lymph nodes was carried out according to the International histological nomenclature. Results. According to the results, there was an increase in the percentage of connective tissue elements and glandular tissue increased in the thymus and the number of immunoblasts increased on the 5th day of the experiment. However, disorganization of the thymus structure was detected on the 18th day as well as an increase in the cortical substance, the number of epithelial reticular cells and decrease in the number of immunoblasts. On the 5th day, paracortical hyperplasia, sinus histiocytosis and activation of the blast transformation were detected in lymphatic nodes. On the 18th day, metastases, follicular reaction and activation of the transport function were determined. Conclusion. Our data suggest that the accidental thymus involution and impairment of transport and immune functions of pelvic lymph nodes in experimental prostate cancer. The severity of disturbances depends on the stage of prostate carcinogenesis.
Urologiia. 2019;(3):89-94
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Fatty acid-binding protein in the serum and sperm

Sosnin D.Y., Gal’kovich K.R., Zubareva N.A., Krivtsov A.V., Pozdin N.V.


Introduction. a composition of seminal plasma reflects a state of reproductive organs that are involved in sperm production. Aim: to study a concentration of fatty acid-binding protein (FABP) in blood serum and sperm samples with normal and altered characteristics. Materials and methods: a total of 82 men with mean age of 33.1+4.7 years old who were examined to clarify the cause of infertility were included in the study. The main group (n=21) consisted of men with oligozoospermia, while control group (n=33) consisted of healthy men with normal sperm analysis. In addition, patients with high viscosity of sperm were included in the comparison group (n=28). There were no changes in complete blood count and biochemical blood panel in all participants. The content of FABP in blood serum and seminal plasma was determined. Results: the average content of FABP in seminal plasma was 1.347+0.26 ng/ml and exceeded the serum concentration of this compound (p<0.000001), which was 0.305+0.193 ng/ml. The concentration in seminal plasma did not depend on its serum concentration (R=0,068194), as well as the sperm volume and viscosity, but it was correlated with sperm concentration (R=0,66387). The concentration of FABP in seminal plasma was highest in the control group (1.47+0.33 ng / ml) and it was higher compared to the main group (1.22+0.09 ng/ml; p=0.000057) and the comparison group (1.29+0.19 ng/ml; p=0.010822). There was no difference between groups in serum concentration of FABP (p=0.9814). Conclusion: the obtained data suggest that a reduced level of FABP in seminal plasma can be considered as unfavorable criterion indicating a reduced fertility.
Urologiia. 2019;(3):95-100
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The incidence of AZF deletions, CFTR mutations and long alleles of the ar CAG repeats during the primary laboratory diagnostics in a heterogeneous group of infertily men

Mikhaylenko D.S., Sobol I.Y., Safronova N.Y., Simonova O.A., Efremov E.A., Efremov G.D., Alekseev B.Y., Kaprin A.D., Nemtsova M.V.


Aim: microdeletions in the AZF region ofY-chromosome, compound heterozygotes of severe and mild CFTR mutations, and long CAG-repeats in the androgen receptor gene (AR) as marker of predisposition are frequently studied as genetic causes of male infertility. A simultaneously testing of the panel including biochemical, immunological, cyto- and molecular genetic markers is often performed during the complex laboratory diagnostics in infertile men. The aim of our work was to identify molecular genetic alterations, which are advisable for simultaneously testing in a man with currently uncertain form of infertility, to increase the informativeness of laboratory diagnostics. Materials and methods: a retrospective study of 885 infertile men was conducted. AZF deletions were determined by multiplex PCR using 10 STS-markers (sY83, sY84, sY86, sY127, sY134, sY143, sY152, sY157, sY254, sY255) and two control loci SRY and AMEL with detection in polyacrylamide gel. Mutations in the CFTR gene (F508del, CFTRdel2.3(21kb), I507del, 1677delTA, 2143delT, 2184insA, 394delTT, W1282X, G542X, N1303K, R334W and 5T) were detected by PCR and SNaPshot. For determination of length of the AR CAG-repeat a fragment analysis of fluorescently labeled PCR products on the 3500xl capillary sequencer was performed. Results: AZF deletions were detected in 8.2% of cases. The largest number of deletions was found in the AZFc subregion (58.9%), while a frequency of deletion in AZFa, AZFb or combined deletions of two and three subregions was 5.5%, 12.3% and 23.3%, respectively. Heterozygous carriage of severe CFTR mutations was detected in 4.7% patients. The most frequent mutation was F508del (83.3%), followed by CFTRdel21kb (7.1%) and W1282X (4.8%). The frequency of the mild splicing 5T mutation was 5.3%, and its incidence was significantly higher than in the previously published control group (p=0.002). AR genotyping revealed that the most prevailing allele was 21 (CAG) (21.5%). Long alleles with 27 or more CAG-trinucleotides were identified in 7.5% of the tested cases. In addition, 7 CAG heterozygotes with Kleinfelter syndrome were found. Conclusion: during primary complex laboratory diagnostics in a heterogeneous group of infertile men, it is advisable to detect AZF deletions and the most frequent CFTR mutations, including F508del, CFTRdel21kb, 1677delTA, 2143delT, W1282X and 5T. The more comprehensive analysis of CFTR mutations is justified only in patients with verified obstructive infertility. Sequencing of panels associated with infertility genes using NGS technology is promising.
Urologiia. 2019;(3):101-107
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Use of local baroimpulse therapy in the treatment of patients with chronic abacterial prostatitis / chronic pelvic pain syndrome and erectile dysfunction

Churakov A.A., Bezrukov E.A., Dolgov A.B., Butnaru D.V., Martirosyan G.A., Zakharova N.B., Popkov V.M.


Aim. To study the efficiency of local baroimpulse therapy (BIT) in the complex treatment of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) and erectile dysfunction (ED). Materials and methods. A total of 112 men with confirmed diagnosis of CP/CPPS and ED, who received drug therapy according to the standards and guidelines were included in the study. In the main group (n=68) all patients additionally received local BIT in the form of rectal pneumovibromassage (PVM) of the prostate (totally, 10 procedures). In the control group (n=44) only standard treatment was provided. The efficiency of therapy was assessed based on the complex clinical examination, laboratory tests and imaging methods. Results. At the visit 2 (1 month after the start of therapy) there were significant differences in clinical (resolution of symptoms of CP/CPPS and improvement of erectile function), laboratory and imaging criteria between 2 groups. The rectal PVM using apparatus MKV-01 “Inavita” resulted in decrease the activity of inflammation process and levels of pro-inflammatory cytokines, increase of flow rate and intrapro static blood flow. According to the analysis of long-term results, after 6 months of therapy the remission was seen in the most of patients in the main group (79.4%), which was 40.8% higher than in the control group. Conclusion. The use of local BIT by mean of rectal PVM allows to increase efficiency of complex treatment of patients with CP/CPPS and ED.
Urologiia. 2019;(3):108-113
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Long-term results of the first treatment of men with May-Thurner syndrome and varicose veins of pelvic organs

Kapto A.A., Vinogradov I.V., Kharpunov V.F., Mamedov R.E., Smyslova Z.V.


Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.
Urologiia. 2019;(3):114-121
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Penile prosthesis implantation through subcoronal approach with graft-free corporoplasty in patients with Peyronie disease with concomitant erectile dysfunction

Akhvlediani N.D., Pushkar D.Y., Bernikov A.N., Chernushenko A.S., Reva I.A.


Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.
Urologiia. 2019;(3):124-127
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The current status of surgical treatment of benign prostatic hyperplasia with volume over 80 сс

Biktimirov R.G., Martov A.G., Biktimirov T.R., Kaputovskij A.A.


According to European Association of Urology (EAU), an open simple prostatectomy, holmium laser and bipolar enucleation represent current standard methods for surgical treatment of benign prostatic hyperplasia (BPH) with volume over 80 ml. The transurethral resection of prostate, thulium laser enucleation and laser vaporization are second-line methods. In addition, some novel interventions are currently being developing. The aim of our work was to systematize all current procedures for more convenient use in clinical practice.
Urologiia. 2019;(3):128-133
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Super-selective prostatic artery embolization for bph treatment

Karpov V.K., Kapranov S.A., Shaparov B.M., Osmolovskiy B.E., Kamalov D.M., Kamalov A.A.


Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system. BPH prevalence increases in men with advancing age, highlighting the necessity of minimally invasive surgical procedure including super-selective prostatic artery embolization (PAE). The current role of the PAE for BPH treatment according to recent national and international publications is discussed in this review. The data from the largest studies are structured and presented along with our experience in PAE. In addition, a need to continue research on this topic is underlined.
Urologiia. 2019;(3):134-141
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Fusion biopsy of the prostate

Okishev A.V., Govorov A.V., Vasilyev A.O., Bormotin A.V., Pushkar D.Y.


Aim. to compare the prostate cancer (PCa) detection rate, accuracy and safety of prostate image-guided fusion biopsy methods (cognitive fusion, software-fusion and HistoScanning-guided biopsy) on the basis of published studies in patients from 48 to 75 years with suspected prostate cancer during primary or repeat biopsy. To identify the limitations of these methods and improve the efficiency of fusion biopsy of the prostate in a further clinical trial. Materials and methods. search was carried out in the PubMed, Medline, Web of Science and eLibrary databases using following requests: (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy); (prostate cancer OR prostate adenocarcinoma) AND (PHS OR Histoscanning) AND (targeted biopsy) and (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy) AND (cognitive registration), targeted prostate biopsy, prostate histoscanning, histoscanning, cognitive prostate biopsy. Results. a total of 672 publications were found, of which 25 original scientific papers were included in the analysis (n=4634). According to the results, PCa detection rate in patients with an average age of62.5 years. (4875) and an average PSA of 6.3 ng/ml (4.1-10.8), who underwent cognitive fusion biopsy under MRI control (MR-fusion) was 32.5%, compared to 30% and 35% for histoscanning in combination with a systematic biopsy and combination of methods (MR-fusion biopsy and histoscanning-guided biopsy), respectively. The accuracy of cognitive MR-fusion biopsy was 49.8% (20.8%-82%), the accuracy of the software MR-fusion biopsy was 52.5% (26.5%-69.7%), the accuracy of histoscanning-guided targeted biopsy was 46.8% (26%-75.8%). The highest values were observed in the patients undergoing primary biopsy (75.8%). Discussion. Currently, imaging methods allow us to change the approach to the diagnosis of PCa by improving the efficiency of prostate biopsy, the only formal method for verifying PCa. A common method for PCa diagnosis in 2018 is a systematic prostate biopsy. However, due to the its drawbacks, fusion biopsy under control of MRI or ultrasound has being introduced into clinical practice with superior results. So far, there is a lack of sufficient scientific data to select a specific technique of the fusion biopsy of the prostate. According to the analysis, it was concluded that the incidence of complications didn’t increase when performing targeted biopsy in addition to the systematic protocol. Conclusion. The efficiency ofcognitive MR-fusion biopsy is comparable to software MR-fusion biopsy. Histoscanning-guided biopsy has lower diagnostic value than MR-guided target biopsy using software. The lack of solid conclusions in favor of a particular prostate fusion biopsy technique stresses on the relevance of further research on this topic.
Urologiia. 2019;(3):142-149
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Herbal preparations and microelements as alternative therapy in benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction

Kamalov A.A., Nizov A.N., Okhobotov D.A.


The aim of the work is to provide a current view on the efficiency of the components of dietary supplement Antiprost for the treatment of urological diseases. The study results on the influence of the dietary components of supplement Antiprost are presented in the article in according to principles of evidence-based medicine. Antiprost can be used in the routine urological practice in specific situations, e.g., if patient refuses from the conventional treatment in BPH/LUTS/ED for any personal reasons, or in case of individual intolerance of standard drugs. Randomized clinical trials should be performed for further studying of the efficiency of dietary supplement Antiprost.
Urologiia. 2019;(3):150-155
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Urinary stone disease. Part V. Drugs used for metaphylaxis of urinary stone disease

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


The stages of postoperative metaphylaxis, drugs used for correction of metabolic disturbances are reviewed. In addition, the basic principles of drug metaphylaxis in various types of stone formation are described.
Urologiia. 2019;(3):156-165
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The impairment of the blood flow in renal parenchyma in patients with urinary stone disease after different treatment methods

Kutluev M.M., Safiullin R.I.


Disturbances of urinary flow result in an increase in intrapelvis pressure and a decrease in the kidneys’ ability to filter urine. The impairment of the blood flow in renal parenchyma represents one of the causative factors. Compensatory mechanisms in case of prolonged occlusion include collecting system dilation as well as pyelorenalis reflux. These changes lead to urine circulation via glomerular and tubular apparatuses, the interstitial tissue and lymphatic vessels and lead to the pyelovenous reflux. The results of studies dedicated to impairment of blood flow in the kidney parenchyma during the ureteral occlusion and in different types of the surgical treatment of urolithiasis are presented in the article.
Urologiia. 2019;(3):166-169
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