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No 5 (2019)


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Results of treatment and risk factors for recurrence of iatrogenic urethral strictures in men

Zhivov A.V., Tedeev R.L., Koshmelev A.A., Karpovich A.V., Yudovskyi S.O., Pushkar D.Y.


Aim. Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. Materials and methods. A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. Results. Average stricture length was 5,8±4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length >5,5 cm. Conclusion. Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods ofthe US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.
Urologiia. 2019;(5):7-13
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Experimental evaluation of inflammatory process in the prostate caused by transurethral transmission of uropathogen in low counts

Kogan M.I., Naboka Y.L., Todorov S.S., Ismailov R.S.


Background. According to the literature, bacterial count of uropathogens isolated from expressed prostate secretion and urine which is sufficient for a diagnosis of bacterial prostatitis I and II categories, remains contradictory. Undoubtedly, the identification ofmicroorganisms from affected organ in high titers indicates the presence of a relevant infectious-inflammatory process. In turn, there is no consensus on the development of bacterial prostatitis at lower titers of uropathogens. Thus, the aim of our study was to identify and compare the potential features of the development and occurrence of an infectious inflammatory process in the prostate during the reproduction of bacterial prostatitis in an animal model using a low titer of causative uropathogens. Materials and methods. A total of 16 «New Zealand» mature male rabbits aged 24±2 weeks old with weight of 3.5+0.3 kg were examined. Inoculation was performed via transurethral route, according to the developed experimental technique. E. coli was used as bacterial agent with a count of 1 x 103 CFU/ml, 1 x 105 CFU/ml and 1 x 107 CFU/ml. All animals were randomized into 4 groups of 4 individuals depending on the titer of the inoculated microorganisms (groups 1-3, respectively), group 4 - control (with inoculation by Sol. NaCl 0.9%). Sacrification and vivisection were performed on days 1, 3, 7 and 14 of the control days. Biopsy specimens from the lower urinary tract and internal genital organs of laboratory animals (bladder, urethra, prostatic complex - 6 biopsies #1A-1D, 2A, 2B) were evaluated morphologically and bacteriologically. Analytical evaluation of the experimental data was presented using descriptive statistical methods. Results. In experimental groups (Groups 1-3), bacteriological examination of prostatic complex biopsies showed growth of microflora in all samples in titers of 10x-107 CFU / ml. In group 1, the maximum concentration of uropathogen was observed on day 7, compared to day 1 in both groups 2 and 3. In all observed cases, the highest degree of bacterial contamination was noted in the biopsy specimens from paraprostatic tissues and distal part of the prostate, which was 4.0+1.7 lg CFU/ml and 3.5+1.9 lg CFU/ml, respectively, and the smallest in proximal prostatic loci (1C) and bladder neck (2B) - 3.0+1.2 lg COE / ml and 3.0+1.7 lg COE / ml, respectively. According to the morphological study, a relevant progression of the suppurative and destructive inflammation (with foci of colliquation necrosis) was identified in group 1 in the biopsies from the prostate with a maximum degree of changes on day 7 with subsequent formation of loose connective tissue proliferation areas by 14 days. This indicates the conversion of the inflammatory process to the chronic stage. These changes corresponded with the results of histopathological studies in groups 2 and 3 where higher titers of bacterial agent were used. In group 4 (control) the commensal flora was bacteriologically determined in the biopsies, but there were no signs of inflammation, according to the results of the morphological study. Conclusion. In experimental model, we found that E. coli 103 CFU / ml induces the development of a phasic inflammatory process in the structures of the prostatic complex. These processes resulted in the formation of irreversible proliferative changes. As a consequence, it shold be recommended to consider these signs of contamination when evaluating the results of bacteriological examination of expressed prostate secretion/urine samples during planning treatment strategy.
Urologiia. 2019;(5):14-21
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Prostate cancer and dogs’ sense of smell: opportunities of noninvasive diagnostics

Protoshchak V.V., Andreev E.A., Karpushhenko E.G., Slepcov A.V., Ovchinnikov D.V., Alent’ev S.A., Lazutkin M.V., Mamaenko A.V., Mamaenko T.V.


Introduction. A screening of prostate cancer is an important problem of healthcare system worldwide. Aim. To evaluate a possibility and efficiency of Belgian Malinois dogs’ sense of smell in diagnosis of prostate cancer. Materials and methods. Urine samples from 176 men were assessed. Of these, 112 samples were taken from patients with biopsy-proven prostate cancer, and 64 from healthy young men. The study with two Belgian Malinois dogs consisted of two stages. The first stage was to train the dogs to distinguish the urine of patients with prostate cancer. A total of 66 urine samples were used at this stage (from 42 patients with prostate cancer and 24 healthy people). At the second detection stage, urine samples of patients with prostate cancer was identified. A total of 110 urine samples were evaluated (70 patients with prostate cancer and 40 healthy people). Results. The first dog correctly identified 68 samples from patients with prostate cancer, and in 37 cases it indicated the absence of disease (sensitivity 97.1%, specificity 92.5%, accuracy 95.4%). The second animal correctly identified 69 and 39 samples, respectively (sensitivity 98.6%, specificity 97.5%, accuracy 98.2%). Conclusion. A possibility of training dogs to identify patients with prostate cancer has been demonstrated. Further studies dedicated to the detection of volatile organic compounds in the urine using specialized analyzers of “electronic nose” type, as well as gas chromatography in combination with mass spectrometry, are of both scientific and practical interest.
Urologiia. 2019;(5):22-26
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Experience of using fosfomycin for the treatment of acute uncomplicated cystitis in women in postpartum period

Kutluev M.M., Safiullin R.I.


Aim. To determine whether fosfomycin can be used in treatment of women with acute uncomplicated cystitis in the postpartum period. Materials and methods. The results oftreatment ofacute uncomplicated cystitis in 51 patients in the postpartum period were retrospectively evaluated. All patients received a single dose 3 g of fosfomycin. Results. In order to determine clinical efficiency, in all cases laboratory tests were performed prior to and 3 days after treatment. A degree of pain syndrome, the number of voids and urgent episodes were also evaluated. Urine culture was studied before and 7 days after taking fosfomycin. There was a decrease in the number of leukocytes and erythrocytes in urine, number of voids, including urgent episodes. A normalization of urine flora after a single dose of the fosfomycin was noted. Discussion. In our research in the repeated analysis of urine culture, the number of bacteria was lower than 104 in all cases, and there was also decrease in the number of voids and intensity of pain syndrome. Conclusion. The treatment of acute uncomplicated cystitis in women in the early postpartum period has its own characteristics. A single dose of fosfomycin allows to avoid long-term use of the antibiotic and to continue breastfeeding, which is required for the treatment of this disease in lactating women. One of the medicine used in AAC is Fosfomycin Esparma, which has a high safety profile. The use of high-quality antibacterial therapy in these patients to give possibility to avoid complications.
Urologiia. 2019;(5):27-30
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Dual-energy computed tomography in the diagnostics of urolithiasis

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


The aim. To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones «in vivo». Materials and methods. A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). Results. In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. Conclusions. Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.
Urologiia. 2019;(5):31-36
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Clinical value of CT-perfusion in patients with ureteric stones

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


Introduction. Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions. Aim: to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion. Materials and methods. From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system. Results. In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis. Conclusion. CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.
Urologiia. 2019;(5):38-43
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Specific features of the treatment of stress urinary incontinence in patients with III-IV stage of anterior vaginal prolapse

Mgeliashvili M.V., Buyanova S.N., Schukina N.A., Petrakova S.A., Erema V.V.


Aim: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. Materials and methods: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. Results: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didn’t affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. Discussion: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. Conclusion: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.
Urologiia. 2019;(5):44-47
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Nephroprotective effect of calcium channel blocker lercanidipine in treatment of patients with urolithiasis and urinary tract obstruction and monitoring of the serum cytokine profile

Khotko A.I., Khotko D.N., Zakharova N.B., Tarasenko A.I., Popkov V.M., Alekseev A.V.


Objective: to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage. Material and methods. 66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage. Results. In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MSP-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy. Conclusion. The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.
Urologiia. 2019;(5):48-52
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Use of volumetric dynamic voiding multispiral computed cystourethrography in diagnosis and evaluation of treatment efficiency of congenital and acquired pathology of the urogenital area

Istranov A.L., Shchekoturov I.O., Bakhtiosin R.F., Serova N.S., Adamyan R.T., Matevosyan A.V.


Aim. The aim of this study was to determine the possibilities of volumetric dynamic voiding multispiral computed cystourethrography (VDMMCT) for assessment of the lower urinary tract during voiding. Materials and methods. VDMMCT was performed in a series of 22 patients with various urethral pathologies using 320 detector rows (640 unique slices; row width 0,5 mm). This method allows to cover the scan area of 16 cm per one rotation of the X-ray tube. In all patients, the cross-sectional area of the various urethral parts was estimated and the urinary bladder volume and average urine flow rate during all voiding phases were calculated. Results. VDMMCT was performed for dynamic evaluation of bladder volume’s changes and analyzing a passage of contrasted urine throughout the urethra. The average volume of the urinary bladder was 356.3+179.9 ml, while the voiding volume was 299.5+154.8 ml. The average pre-and postoperative urine flow rate was 4.1+1.1 ml/s and 7.9+5.1 ml/s, respectively. The maximum urine flow rate was 19 ml/s. The average urethral diameter according to the VDMMCT after urethroplasty was 7.6+2.1 mm. The minimum length of urethral strictures was 17 mm, while the maximum length was 32 mm. Conclusion. Our results demonstrate the efficiency of the VDMMCT for assessing of the urethra throughout its length. VDMMCT can multidimensionally and dynamically represent the change of the bladder volume and the urine flow rate.
Urologiia. 2019;(5):53-58
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Specific features of the immune status and blebbing of the plasmatic membrane of lymphocytes patients with urolithiasis complicated by the pyelonephritis

Berezhnoy A.G., Sevrukov F.A., Vinnik Y.S., Kapsargin F.P., Vinnik Y.Y.


Introduction. According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role. Aim. To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis. Materials and methods. A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes’ plasmatic membrane was evaluated by phase contrast microscopy. Results. It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes’ blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.
Urologiia. 2019;(5):60-63
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Treatment of acute uncomplicated cystitis in women with antibiotic allergy or intolerance

Davidov M.I., Voitko D.A., Bunova N.E.


Aim: A comparative evaluation of the efficacy and safety of Canephron N and Cystone as monotherapy in women with acute uncomplicated cystitis and antibiotic allergy or intolerance was performed. Materials and methods. A prospective, randomized, controlled study of drug Canephron N as monotherapy for acute uncomplicated cystitis in 51 women with a history of antibiotic allergy or intolerance was carried out in 3 urological centers in Perm from 2016 to 2019. In the main group, patients received Canephron N for 30 days, while in comparison group, Cystone was prescribed. The Acute Cystitis Symptom Score (ACSS), microscopic study of urine sediment, urine culture and other methods were used. Results were evaluated 3, 6, 30 days and 1 year after the start of treatment. Results. In the main group, monotherapy with Canephron N for 30 days resulted in a decrease in the total ACSS score from the baseline 12.9 to 0.3 points, while in Cyston group, changes of ACSS score were less pronounced, from baseline 12.8 to 1.4 points (p<0.01). Clinical cure rate in the main and comparison group was 88.5% and 68%, respectively. In another 3.8% and 1% of patients in the main and comparison group, an improvement was seen. The number of patients with leukocyturia in the Canephron N group decreased to 11.5% compared to 28% in Cyston group (p>0.05). Bacteriuria rate in the main group was 7.7%, which was less than in the comparison group (20%, p> 0.05). Number of sick days in the main group was 4.9+0.4, compared to 7.4+0.6 days in Cyston group. In the Canephron N group, 1-year recurrence rate was only 7.7%, while in the Cyston group the recurrence was seen in 16% of patients. Conclusion. According to the results, Canephron N is an effective and safe drug as monotherapy for acute uncomplicated cystitis, and can be considered as drug of choice for the treatment of women with antibiotic allergy or intolerance.
Urologiia. 2019;(5):64-71
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Results of analysis of the structural and functional state of the kidneys by the method of mathematical processing of contrast-enhancing MD-CT data in patients with urolithiasis

Fiev D.N., Khokhalchev S.B., Borisov V.V., Saenko V.S., Demidko Y.L., Chernenlyi M.M., Proskura A.V., Puzakov K.B., Lartcova E.V., Potoldykova N.V., Inoyatov G.S., Alyaev Y.G.


Introduction and Objectives: to date there have been several hypotheses on the causes of kidney stone formation. Compromised intrarenal blood flow might play one of major roles in stone formation. Advances in software and 3D technologies have unveiled the nature of contrast medium flow in the intrarenal structures. Mathematical analysis and 3D rendering of computed tomography (CT) scans was utilized for inrarenal contrast medium flow assessment in patients with stone kidney disease. This study aimed at assessing split glomerular filtration rate (sGFR) in patients at the initial stage of stone kidney disease (SKD). sGFR was measured by means of mathematical analysis of 3D rendering abdominal contrast enhanced CT scans. As well as that, possible correlations between irregular inrarenal contrast medium flow and causes of stone formation were considered. Materials and Methods: 23 patients of both sexes with stone kidney disease (SKD) were recruited. They underwent US/Dopler investigation of the kidneys and the bladder, plain X-ray, histopathological evaluation of the tissues (those patients who were operated on), spectroscopic analysis of the stone(s). Mathematical analysis of 3D rendering of CT scans was utilized for sGFR assessment (sGFR reference value: 0,55% of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size less than 1,5-2,0 cm 3) stones that do not block urine flow 4) non-operated young patients; 5) patients free of comorbidities. Inclusion criteria were set to mitigate the effects of other factors that might influence on intrarenal blood flow and conduct the study per se. Results: Mathematical analysis of 3D rendering of CT scans allowed to elucidate changes in sGFR in 22 (95,6%) patients out of23. HypErfiltration (hyperF) was detected in 10 (43,5%) patients, hypOfiltration (hypoF) was detected in 11(47,8%) patients. sGFR values were statistically significantly different in these groups both on the left (p=0,000142) and on the right (p=0,00068). No significant gender differences were observed (hypoF group aged 25-67 years with the mean age of 43,5 years; hyperF group aged 17-57 years with the mean age of 39 years (p=0,563). Ultrasound Doppler renal resistive index in renal arteries was within the normal range in both groups with no statistically significant difference between the groups. However, 1 patient demonstrated no sGFR changes. Another patient had hyporfiltration on the left (0,48%) and hyperfiltration on the right (0,62%) Conclusions: sGFR alterations (hypo- or hyperfiltration) were detected in the majority of the patients with SKD (95,6%). This in turn might be suggestive of compromised intrarenal blood flow. Further studies are needed to elucidate the optimal management of these patients.
Urologiia. 2019;(5):72-78
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Impact of germline BRCA2 and CHEK2 mutations on time to castration resistance in patients with metastatic hormone-naive prostate cancer

Matveev V.B., Kirichek A.A., Filippova M.G., Savinkova A.V., Khalmurzaev O.A., Lyubchenko L.N.


Introduction: as shown in previous studies, mutations in the BRCA1/2 and CHEK2 genes are associated with worsened long-term results of the definitive treatment for localized prostate cancer (PCa). Aim: to evaluate the prognostic value of germline BRCA1/2 and CHEK2 mutations on time to castration-resistance in patients with metastatic PCa (mPCa), receiving hormonal therapy in the first-line systemic treatment. Materials and methods: A total of 76 patients with mPCa receiving hormonal therapy with luteinizing hormone-releasing hormone analogue (LHRHa) in N.N. Blokhin National Medical Research Center of Oncology were recruited in our prospective study. All patients were genotyped for germline mutations in the BRCA1/2 and CHEK2 genes by real-time polymerase chain reaction using a set “OncoGenetics” (LLC “Research and Production Company DNA-Technology”, Russia, registration certificate № 2010/08415) and the Sanger sequencing using a set “Beckman Coulter enomeLab GeXP”. In addition, a histologic grade and volume of metastatic disease were evaluated. Results: Pathogenic and possibly pathogenic mutations in the BRCA2 and CHEK2 gene were identified in 19 (25%) patients. No cases of BRCA1 mutations were detected. Median time to castration resistance was significantly lower in BRCA2 and CHEK2 mutation carriers (7.93 mo, 95% confidence interval (CI) 2.62-13.25), than in non-carriers (48,66 mo, 95% CI 31.05-68.26, p<0,001). Cox analysis confirmed three independent unfavorable prognostic factors. Discussion: The results of our study and other publications have confirmed limited efficacy of standard approach to treatment hormone-sensitive mPCa in germline mutation BRCA2 and CHEK2 carriers. However, the main objective of studies was to assess the survival rates in these patients at the stage of castration-resistant mPCa. Conclusion: Our results demonstrated that germline BRCA2 and CHEK2 mutations are independent unfavorable predictors in patients with mPCa which are associated with decreased time to castration resistance (HR 3.04, 95% CI 1.63-5.66, p<0.001), particularly in subgroup with low volume metastatic disease (HR 4.59, 95% CI 2.06-10.22, p<0,001). An evaluation of a prognostic value of mutations in other DNA repair genes requires additional research.
Urologiia. 2019;(5):79-85
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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 2: laboratory and imaging 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. Clinical, laboratory and imaging characteristics were recorded before and after treatment. In addition, hemodynamic parameters in the prostate, prostatic part of the urethra and skin projection of the prostate were evaluated. Results: In patients with pyknic somatotype (from 34.12+0.51 cm3 to 29.08+0.64 cm3) the most significant reduction in prostate size during the treatment with CAPIC was observed, while the improvement of microcirculation parameters were seen in patients with asthenic somatotype. Changes in the microcirculation in the mucous membrane of the prostatic part of the urethra and skin projection of the prostate during the treatment of CAPIC are somatotype-dependent. The highest values of tissue perfusion were found in patients of the normostenic somatotype, while pyknic patients had the smallest values. Along with somatotyping, this allows to use in clinical practice the abovementioned methods for early diagnosis and subsequent monitoring of the effectiveness of CAPIC therapy.
Urologiia. 2019;(5):86-93
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Paternity rates among men who have not undergone varicocelectomy in childhood or adolescence

Sizonov V.V., Sichinava Z.A., Kravtsov Y.A., Kogan M.I.


Introduction: Feasibility of prophylactic varicocelectomy in adolescents is under discussion, which determines the importance of studying the frequency of paternity among men who were actively monitored. Aim: to evaluate a paternity rate in a group of adult men who have not undergone varicocelectomy in childhood or adolescence. Materials and methods: The paternity rate was evaluated using a questionnaire-based survey carried out in 2018 among men who were actively monitored for unilateral varicocele with ipsilateral testicular hypotrophy during adolescence in 1999-2004. A total of 202 questionnaires were sent out checking whether the recipients were willing to have children. Median age at the time of the varicocele diagnosis was 15 years [Q1; Q3] (13-17). At the time of diagnosis, varicocele of grade III was found in 114 (93.4%) boys, and in 8 (6.6%) children, varicocele of grade II was seen. Results: A total of 142 respondents were enrolled. Median age of the participants was 31 (29; 34). 20 men were excluded from the survey, due to prophylactic varicocelectomy (n=8, 5.6%), other reproductive diseases (n=4, 2.8%), previous radiotherapy or chemotherapy (n=2, 1.4%) and reproductive pathologies in the spouses (n=6, 4.2%). 16 (13.1%) participants were not planning to have children. Among the remaining, 9 respondents (6.6%) had no children. Varicocelectomy was carried out in 17 (16.3%) patients due to infertility, and 14 (82.3%) subsequently became fathers. 83 (78.3%) patients had one or more children as a result of spontaneous pregnancy. Paternity frequency in the surveyed group was 91.5%. Conclusion: Our results demonstrate high paternity frequency among men with asymptomatic left-sided varicocele accompanied by ipsilateral testicular hypotrophy during childhood and adolescence who were actively monitored without surgical treatment.
Urologiia. 2019;(5):94-97
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Predictors of perioperative complications in children with obstructive uropathy

Morozova O.L., Morozov D.A., Lakomova D.Y., Severgina L.O., Maltseva L.D., Morozov K.D.


Aim: To identify predictors of perioperative complications in children with obstructive uropathy. Materials and methods: A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using «Vector - Best» (Russia, Novosibirsk) (IL-8), «Bender Medsystems» (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA). Results: The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed. Conclusion: Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
Urologiia. 2019;(5):98-104
pages 98-104 views

Computer tomography and magnetic resonance imaging of perirenal non-hodgkin’s lymphoma

Kotlyarov P.M., Pavlov A.Y., Gvarishvili A.A.


A description of specific features of CT-MRI in rare patient with perirenal non-Hodgkin’s lymphoma is presented in the article. CT scan was used to determine the accumulation of contrast medium and pathological vessels along the right kidney’s border. Diffusion weighted MRI revealed the low values of the measured diffusion coefficient (MDC) and high accumulation index of the paramagnetic in the tumor tissue (0.59-0.62). The specific features of perirenal non-Hodgkin’s lymphoma on CT/MRI, an evaluation of the tumor’s volume and stage, and signs of malignancy are described.
Urologiia. 2019;(5):105-108
pages 105-108 views

Laparoscopic uretero-pyeloanastomosis in iatrogenic trauma of the upper pole ureter in a duplex kidney

Guliev B.G., Komyakov B.K.


In case of stricture of the lower third of ureter in patients with duplex kidney, ureteroneocystostomy or transureteroureterostomy can be used. Anastomosis of the injured ureter of the upper pole with the pelvis of the lower pole is considered nontypical. In this clinical observation, a 46-year-old patient with iatrogenic trauma of the pelvic part of the upper pole of a duplex kidney successfully undergone laparoscopic ureteropyelostomy. There were no complications; the stent was removed after 4 weeks. During the follow-up examination, the function of both kidneys was within normal range and there were no disturbances in the urine passage in the upper urinary tract. Thus, laparoscopic ureteropyelostomy provided an adequate urine passage from the duplex system kidney through the healthy ureter.
Urologiia. 2019;(5):109-111
pages 109-111 views

Priapism as first clinical manifestation of chronic myeloid leucosis

Rustamov M.N., Huseynov G.R., Ahmedov I.S.


Blood disorders, in particular chronic myeloid leukemia (CML), are among the rare etiological factors of priapism. A clinical observation of ischemic priapism lasting 18 hours, which developed in patients with previously not diagnosed CML, is presented in the article. The CML was subsequently diagnosed based on the results of blood analyses and bone marrow aspiration. Treatment strategy consisted of immediate aspiration of blood from the cavernous bodies (19G) followed by the intracavernous injection of phenylephrine solution. After resolving priapism, CML therapy was carried out, which allowed to avoid a recurrence of priapism.
Urologiia. 2019;(5):112-113
pages 112-113 views

Bilateral acute purulent destructive pyelonephritis after retrograde ureteroscopy and lithotripsy

Bazaev V.V., Dutov V.V., Urenkov S.B., Mamedov E.A., Romanov D.V., Podoynicyn A.A.


The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patient’s condition may require nephrectomy.
Urologiia. 2019;(5):114-118
pages 114-118 views

Partial segmental thrombosis of upper part of the corpus cavernosum

Koshmelev A.A., Baranova E.O., Trebushenkov A.Y., Dudarev V.A., Zhivov A.V., Pushkar D.Y.


Diphallia is an uncommon deformity, withglans duplication being its rarest form. We discuss here a case of a 6-year-old boy who presented due to excess prepuce malformation that, on examination, revealed a “penile nodule” that proved to be glans duplication. Our patient had only one urethra present and no congenital anomalies. Surgical uneventful penile reconstruction involving radiofrequency ablation (RFA) resolved the issue.
Urologiia. 2019;(5):119-123
pages 119-123 views

A rare case of partial glans duplication

Vlachos A., Plataras C., Christianakis E., Alexandridi V., Bourikis G., Velaoras K., Alexandrou I.


Diphallia is an uncommon deformity, withglans duplication being its rarest form. We discuss here a case of a 6-year-old boy who presented due to excess prepuce malformation that, on examination, revealed a “penile nodule” that proved to be glans duplication. Our patient had only one urethra present and no congenital anomalies. Surgical uneventful penile reconstruction involving radiofrequency ablation (RFA) resolved the issue.
Urologiia. 2019;(5):124-125
pages 124-125 views

Diagnostic utility of positronic emission tomography in recurrences of prostate cancer

Petrovskiy N.V., Glybochko P.V., Dolgushin M.B., Krupinov G.E., Shariya M.A., Meshcheryakova N.A.


An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.
Urologiia. 2019;(5):126-131
pages 126-131 views

Detrusor ischemia. Clinical effects

Berdichevsky B.A., Berdichevsky V.B.


Three basic theories of the development of an overactive bladder that have experimental and clinical evidences have been described, including neurogenic, myogenic, and urothelial. Based on the results of the literature anaIysis, the authors suggested the existence of detrusor ischemic disease as a result of compressive impairment of its blood flow due to incomplete or short-term reIaxation under overactivity or hydrauIic compression of the vessels by excessive urine volume in case of hypoactive bladder.
Urologiia. 2019;(5):132-135
pages 132-135 views

The role of viral infection in the development of recurrent lower urinary tract infections

Ibishev K.S., Lapteva T.O., Krachotkin D.V., Ryabenchenko N.N.


This review is dedicated to the problems of diagnosing recurrent lower urinary tract infections caused by viruses. The literature search was conducted using the Medline, PubMed, EMBASE, CNKI, and WANG FANG databases. Further study of virobiota and microbiome of urine both in normal and in pathological conditions are warranted.
Urologiia. 2019;(5):136-139
pages 136-139 views

Genetic aspects of primary hyperoxaluria: diagnostics and treatment

Filippova T.V., Svetlichnaya D.V., Rudenko V.I., Alyaev Y.G., Shumikhina M.V., Azova M.M., Subbotina T.I., Gadzhieva Z.K., Asanov A.Y., Litvinova M.M.


Primary hyperoxaluria is a group of inherited metabolic diseases characterized by increased formation of calcium-oxalate stones in kidneys with development of nephrolithiasis and chronic kidney disease. The article summarizes the modern information on the diagnostics and treatment of the disorder depending on genotype of the patient (AGXT, GRHPR, HOGA1 genes). The evaluation of the molecular genetic aetiology of the kidney stone disease contributes to the personalized treatment and prevention of the pathology in the patients and their relatives.
Urologiia. 2019;(5):140-143
pages 140-143 views

Immune disturbances in acute pyelonephritis. Part I

Shatokhin M.N., Konoplya A.I., Kholimenko I.M., Besprozvanniy V.I., Mavrin M.Y.


In the part I of a literature review of modern national and foreign publications dedicated to the problem of immune disorders in acute pyelonephritis, information on the role of innate and adaptive immunity in the pathogenesis of acute pyelonephritis is summarized and systematized. The relationship between the pathogens and immune system, in particular the ability of pathogens to overcome the protective immune mechanisms are discussed. The role of neutrophilic granulocytes as well as cellular immunity in the pathogenesis of acute pyelonephritis is shown. The changes in level of pro- and anti-inflammatory cytokines are separately highlighted. In conclusion, perspective directions for the studies in the area of immune disorders in acute pyelonephritis are proposed.
Urologiia. 2019;(5):144-149
pages 144-149 views

Current aspects of the treatment of urogenital atrophy (based on the consensus of britain society of menopause)

Balan V.E., Tikhomirova E.V., Tsarkova A.V., Gadgieva Z.K.


The symptoms of genitourinary syndrome of menopause are considered as typical for late menopausal period. However, these symptoms are increasingly diagnosed in perimenopausal and early menopausal period. Women seldom seek medical care, since autonomic menopausal symptoms are usually more bothersome. In many cases, doctors are not sure in necessity of any hormonal replacement. Moreover, a confusion still exists between systemic hormone replacement therapy (HRT) and local estrogen preparations. Besides moisturizers and local intravaginal estrogens, novel treatment modalities have emerged that extend therapeutic armamentarium.
Urologiia. 2019;(5):150-154
pages 150-154 views

Efficacy of 5a-reductase inhibitors in the treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia

Nizov A.N.


In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5a-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.
Urologiia. 2019;(5):156-160
pages 156-160 views
pages 161-162 views
pages 163-166 views

Alexey Georgievich Martov (on the 60th anniversary)

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Urologiia. 2019;(5):167-168
pages 167-168 views

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