No 6 (2019)

Aim: to study a correlation between clinical stage of pelvic organ prolapse (POP), a histological structure and results of immunohistochemical study of the vaginal wall were evaluated. Materials and methods. A total of 60 peri- and postmenopausal women (average age 61.9±8.4 years) with POP of stage II-IV, according to the POP-Q classification, or with stress urinary incontinence and cystocele of stage I-II, who undergone to surgical treatment, were included in the study. During a procedure, a biopsy from the anterior vaginal wall was taken. Depending on the stage of POP, patients was divided into two groups. In the group 1, 30 patients with stage I and II of POP were included, while group 2 included 30 women with POP of stage III and more. The control group (group 3) consisted of 20 patients without POP (mean age 63.4±11.0 years) who underwent a hysterectomy due to to other indications. A histological and immunohistochemical studies of vaginal wall tissue was performed in order to determine the tissue content of collagen type I and III; matrix metalloproteinases 1 and 2 (MMP-1 and MMP-2), a tissue inhibitor of metalloproteinases 1 (TIMP-1), vimentin and smooth muscle actin. Results. In contrast to two other groups, in group 2 there were significant changes in the connective tissue. Collagen has a form of fibrous mass with areas of reduced content. In addition, scarring areas with an increase in the content of type III collagen, a decrease in the amount of type I collagen and elastic fibers with significant fragmentation, were seen. Moreover, in patients with severe POP (III-IV), degradation of collagen fibers with a decrease in connective tissue strength and elasticity was detected. Women with POP had a low ratio of type I:III collagen. Analysis of the collagen content in the vaginal wall in patients with mild POP (I-II) revealed a significant increase in the level of collagen type I (p=0.0003) and a decrease in the content of type III (p=0.045), compared to patients with more severe POP (III-IV). The level of MMP-1 and MMP-2 in women with POP was higher, than in control group by 1.7 times (p<0.05). The content of TIMP-1 in the group 1 was significantly lower by 1.5 and 2.2 times, compared to group 2 and 3, respectively. An analysis of MMP-1 and MMP-2 concentration in patients of groups 1 and 2 revealed a significant (p=0.04) decrease in their activity in severe POP (III-IV). In women of the group 2, biopsy of the vaginal wall showed that expression of vimentin and smooth muscle actin in the connective tissue was significantly higher, than in group 1 and 3 (p<0.05). Vimentin expression in the group 2 was 1.4 and 2.6 times higher than in the group 1 and 3, respectively. In the control group, the expression of these markers in the vaginal wall was minimal and focal. Conclusion. Our data indicate that fibrosis and degradation of the connective tissue in the vaginal wall predominate in POP, and these changes are a consequence, but not a cause of PG. The aggravation of degenerative changes in the connective tissue leads to the progression of POP.

Introduction. Barren marriage is an important medical and social problem. Up to 20-60% of cases of male infertility are associated with inflammatory diseases of the reproductive system. Chronic prostatitis constitutes up to 50% cases. In this regard, a search of methods aimed at improvement of detection rate of pathogens in inflammatory prostatic diseases of the prostate is still relevant. Aim: To study the influence ofbovhyaluronidaze azoximer (Longidaza®) on the diagnostic sensitivity of semen culture in infertile men. Materials and methods: a total of 87 infertile men were included in the study. The main group consisted of 41 patients who received Longidaza® 3000 IU, one suppository every two days, for a total of 5 suppositories, prior to semen culture. In the control group, 46 patients had semen culture without any interventions. When evaluating the result of semen culture, clinically significant bacterial count was >103 CFU/ml. Results. In the main group, bacterial growth was seen in 19 (46.3%) patients, which is 2.7 times higher than in the control group (n=8; 17.4%; X2=4.47, p=0.0346). A total of 36 patients in the control group with negative semen culture at baseline undergone to repeat analysis, according to the protocol in the main group. As a result, in 12 more patients in the control group (33% men with initially negative semen analysis) a bacterial growth was shown. The detection rate of bacteria in the ejaculate in the control group after repeat analysis was similar to those in the main group (43.5 и 46.3%, respectively, р=0.87). Conclusion. The preliminary use of bovhyaluronidaze azoximer rectal suppositories (Longidaza®) in infertile men, when they undergone diagnostic evaluation, contributes to increase in diagnostic sensitivity of semen culture and allows to improve the quality of diagnosis of the inflammatory diseases of reproductive system.

Introduction. Acute cystitis is the most common manifestation of uncomplicated urinary tract infection. One of the drugs whose effectiveness in the treatment of patients with INMP has been proven is fosfomycin, which has been on the pharmaceutical market for a long time and is widely used in urological practice. despite the good results of etiotropic therapy, the problem of recurrent UTI remains unresolved, which occurs in about 30% of women within a year after the first episode of cystitis. alternative prophylactic agents, such as probiotics, cranberry preparations, phytopreparations, etc. are increasingly used in prolongation of the inter-relapse period. One such remedy is D-mannose. Objective: to evaluate the effectiveness ofD-mannose and the combined drug Ecofomural containing fosfomycin and lactulose in the complex treatment of women with uncomplicated lower urinary tract infection. Materials and methods. 60 women with acute uncomplicated cystitis were examined and treated. By random sampling, all women were divided into 2 groups of 30 people. In group 1, antibiotic therapy with Ecofomural once 1 sachet after urination was prescribed. The product contains 3G of fosfomycin and 1.5 g of prebiotic lactulose. In group 2, a similar antibacterial therapy with the enrichment of the diet with a source of D-mannose (Ecocystin) 1 sachet 1 time per day for 6 months. Evaluation of the effectiveness of antibacterial therapy was carried out on the 3rd and 7th day. It included analysis of dysuric symptoms according to diaries of urination, assessment of pain intensity, laboratory tests. Long-term results of therapy were evaluated within 6 months after taking the antibacterial drug. The examination included a comparative analysis of the frequency of relapses of the disease, filling diaries of urination and laboratory tests. Results. When treated, all women showed signs of acute cystitis. On the 3rd day of therapy in both groups there was a statistically significant (p<0.05) positive dynamics of the studied parameters. By the 7th day in both groups marked relief of dysuric phenomena and pain. The number of white blood cells in the urine of all patients was within normal values. During a further 6-month follow-up, relapses of the disease were detected in 7 (23.3%) patients in group 1 and in 1 (3.3%) in group 2. Bacteriological examination in group 1 revealed the same pathogen in 5 (16.7%) cases as in the first treatment. The other women had different pathogens. Conclusion. The results of the study demonstrated the high efficacy and safety of complex therapy with Ecofomural containing fosfomycin and lactulose, in combination with long-term enrichment of the diet with D-mannose (Ecocystin) b in order to prolong the inter-relapse period of uncomplicated lower urinary tract infection.

Introduction. Early diagnosis of renal cell carcinoma (RCC) is extremely difficult, due to the late development of clinical manifestations. The study of the aberrant expression of tumor-associated antigens and a production of autoantibodies to these proteins seems promising and novel method for RCC diagnosis. Aim: To evaluate the possibility of using arrestin-1 (Arr-1), recoverin (Rec) and autoantibodies against arrestin-1 (AAA1) and recoverin (AAR) as a kidney tumor biomarker. Materials and methods: Primary kidney tumors and metastases of 62 patients were investigated. For immunohistochemical studies, tissues were incubated with polyclonal antibodies against Rec and Arr1 as the main antibodies. Detection of AAR and AAA-1 in the serum of patients was performed using Western Blot analysis according to a standard protocol. Results: Among 62 tumors, renal cell carcinoma (RCC) constitutes 50 cases (86.4%), and oncocytoma was diagnosed in 12 patients (19.4%). In 11 (22%) cases of RCC, distant metastases were detected. Positive expression of Rec was observed in almost 71% of all types of kidney tumors. In 61.3% of patients with RCC, Arr-1 expression was seen. In the serum, AAR was found only in 1 patient (1.6%) with RCC. However, unlike AAR, AAA-1 in the serum of patients was observed much more often (75.8%). Conclusion: According to our data, the presence ofAAA1 in the serum, unlike AAR, can be considered as an early kidney tumor biomarker. The high expression of recoverin and arrestin-1 in kidney tumors suggests the use of these proteins in future as a marker for the diagnosis or even as a potential target for immunotherapy.

Aim: to carry out a multicenter prospective analysis of the results of the ERAS protocol in patients undergoing radical cystectomy in real-life clinical practice. The aims of the study were to assess the complication and mortality rate after radical cystectomy using the ERAS protocol and to assess how often ERAS protocol was implemented. Materials and methods: a multicenter study was carried out in 4 clinics in Russia. A total of 134 patients who underwent radical cystectomy in 2017 were prospectively analyzed. Open and laparoscopic radical cystectomy was performed in 35 (26.1%) and 99 (73.9%) patients, respectively. Bricker procedure prevailed as a method for urine derivation (91.7%). Complication and mortality rate, and each principle of ERAS protocol was analyzed both in the general sample of patients and separately for open and laparoscopic radical cystectomy. Results: length of hospitalization before the radical cystectomy was 1 (1-2) day. The median duration of surgery was 260 (205-300) minutes, median blood loss was 300 (200-400) ml. The median of the patient’s time in ICU was 1 (0-2) day. A total of 95 (70%) complications were recorded in the 90-day period after the surgery, including Clavien I-II category in 52 (38.8%) cases and Clavien III-IV in 43 (32%) cases. Of these, gastrointestinal tract complications were predominated. Gastroparesis requiring a nasogastric tube was observed in 16 (11.9%) patients. Ileus developed in 43 (32.1%) cases, and 22 patients (16.4 %) were managed conservatively; however, 21 patients (15.7%) undergone to reoperation. A 90-days mortality reached 5.2% and the main causes included multiple organ failure as a complication of peritonitis, acute heart failure after myocardial infarction and massive bleeding. Re-hospitalization rate was 9.7% (n=13). Length of stay was 12 (9-16) days. According to univariate and multivariate analysis, an absence of antibacterial prophylaxis, a history of coronary heart disease and the patient’s age more than 75 years were predictors of an increased complication rate. A 30 -days mortality rate is 5.2%, and re-hospitalization was required in 9.7% (n=13) cases. An average length of stay was 12 (9-16) days. Frequency of implementation of ERAS protocol in each of the participating clinic varied. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. Conclusion: 1. Despite the use of the ERAS protocol, radical cystectomy has a high frequency of complications (up to 70%); most of them are Clavien I-II. A 30-days mortality rate is 5.2%, and re-hospitalization is required in 9.7% cases. 2. Univariate and multivariate analysis showed that an absence of antibacterial prophylaxis, a coronary heart disease and the patient’s age more than 75 years are predictors of an increased complication rate. 3. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. 4. To obtain more convincing data on the ERAS protocol after radical cystectomy, long-term studies are required.

Background: The aim of this study was to clarify period prevalence (PP) and incidence associated to urinary system cancers in Isfahan Province/Iran. Methods: Data from 2011 to 2015 was obtained from the Isfahan Cancer Registry. The location of cancers was distinguished by the related established topography code (C64-C68). Period prevalence (PP) was calculated and expressed per 100000persons. Results: There were 2117 patients with urinary system cancers. The mean age ± SD was 63.6±14.9 years old, that in 62% ranged between 20 and 70years old. For total population the PP was calculated as 42. 5 per 100000persons. This value was corresponded to PP of 66.4 for males and 17.9 for females (p<0.001). The total PP was corresponded to values of 33.2 for bladder, 8.1 for kidney, 0.42 for renal pelvis, 0.36 for ureter and 0.38 for other unspecified related organs. Of these populations the estimated living cases corresponded to the 368females and 1513 males. Conclusion: The PP for urinary system cancers in male population was 3.7 times higher than females. There was a 23.2% increase in the Irs over the study period. These findings highlighted the advantage of further strategy base-research toward pharmacotherapy and surgery management of such patients.

The purpose of the study is to assess the risk of pathozoospermia with the combined effect of bisphenol A, triclosan and 4-nonylphenol. Materials and methods. 84 samples of sperm were studied in men with normo-and patozoospermia. In seminal fluid, the concentrations of bisphenol A, triclosan and 4-nonylphenol were simultaneously determined by gas chromatography with mass spectrometry (GC-MS). The spermiological study was carried out according to the WHO recommendations (2010) taking into account the assessment of the number of spermatozoa, their motility and morphology, as well as sperm damage. The results were subjected to statistical processing using the Mann-Whitney U-test and the multiple logistic regression method. Results were considered statistically significant at p<0.05. Results.Bisphenol A was found in 100% of the ejaculate samples with a median concentration of 0.150 ng/ml. Triclosan and 4-nonylphenol were detected in 84.3% and 98.1% of ejaculate samples with a median concentration of 0.11 ng/ml. and 0.16 ng/ml, respectively. The comparison groups were statistically significantly distinguished by the concentrations of bisphenol A and triclosan (p<0.001; p=0.018), respectively, as well as the DNA index of spermatozoa fragmentation (p=0.002). Bisphenol A, by increasing the concentration in seminal fluid by 0,1 ng/ml, increased the chance of developing pathosospermia by 24.9 times. The effect of triclosan and 4-nonylphenol on pathosospermia was not statistically significant. In a multiple logistic regression equation describing the joint effect of EDs on patozoospermia, as well as the ratio of the chances of its occurrence with a change in the concentration of one of the endocrine disruptors per unit while fixing the other variables, the coefficients of triclosan and 4-nonylphenol on the patozoospermia were also not statistically significant. In addition, the confidence interval for the odds ratio included one. Conclusion. The development of pathozoospermia is primarily associated with the effect of bisphenolA in seminal fluid in men. It should be assumed that there is no synergistic effect of endocrine disruptors on patozoospermia.

Aim: to study the microstructure of the urethral plate in patients with a proximal form of hypospadias to justify the use of tissues from the ventral penile surface when creating an artificial urethra. Materials and methods. A histological study of surgical specimens from 10 patients with proximal hypospadias was carried out. The urethral plate, a strip of tissue from the ectopic external urethral orifice located in the penoscrotal angle, to the coronary sulcus, was completely excised and processed by various techniques. A staining with hematoxylin and eosin, picrofuchsin according to Van Gieson, as well as immunohistochemical typing of CD 34, collagen (type I, III, and IV), fibronectin, and smooth myocytes using alpha-smooth muscle actin was performed. Results. All elements which are present in a healthy urethra, such as epithelial cells, blood vessels, normal collagen fibers, smooth muscle cells and complexes of glands, were found in the microstructure of the urethral plate. Conclusion. The cytoarchitectonic features of the ventral penile tissues are similar to the microstructure of the healthy urethra, which provides a rationale to consider the urethral plate as a material with optimal bioresistant properties for urethroplasty.

Post-radiation fistulas are one of the most severe complications of radiotherapy performed for pelvic malignant tumours. A method of coaxial nephrostomy with a putting an occlusive balloon has been proposed for palliative treatment, preparation to surgical treatment or improving the quality of life of patients with contraindications for surgical procedures. A clinical case of a patient with multiple post-radiation vesicovaginal and vesicorectal fistulas who was successfully treated using the proposed method, is presented in the article.

Suture granuloma is very rare complication of surgical procedures developing from the non-absorbable sutures. The development of suture granuloma is a chronic process and includes multinucleated giant cell formation. It has two step process including the initial reaction of tissue inflicted the passage of the needle and specific inflammatory reaction of the suture material. There is no pathognomonic imaging modality fort he diagnosis of suture granuloma. Surgery is used to for the diagnosis and eradication of the inflammation. A 59 year old man presented with 3*2 cm sized palpable, firm painless nodular mass in the right scrotum. The patient was treated with high orchiectomy before 3 weeks. The mass was excised and reported as silk suture granuloma.

Bladder cancer ranks 7th in the world among all malignant tumors in men and 11th in both sexes. Radical cystectomy is the gold standard of muscle-invasive bladder cancer treatment in most countries of the world. A large number of fundamentally different options for urine derivation is developed. Therefore the choice of the method of urine derivation is one of the most important and difficult in the treatment of such patients. This review covers current international articles on this topic for 2015-2018.

In modern clinical practice, antimicrobial resistance creates a significant problem for the effective metaphylaxis of various infectious and inflammatory diseases of the urinary system. Annually, researchers note an increasing number of mutations in the genomes of bacteria that cause infectious diseases, which leads to the appearance of more aggressive strains. The inefficiency of antibiotic therapy requires to a search for alternative methods for treatment and prevention of infectious diseases. use of viruses that infect bacteria (bacteriophages) represent one of such methods. A literature review of recent publications indicates that phage therapy has been gained significant increase. The general aspects of phage therapy, mechanism of action, as well as the existing possibilities and limitations of phage therapy in treatment and prevention of infectious diseases of the urinary system are highlighted in this article.

The significance of diabetes is not only due to its high prevalence, but also to its serious complications. Urinary disturbances, which are referred as diabetic cystopathy, are among the most common complications of diabetes. The current data on the prevalence, manifestations, and possible pathogenesis of diabetic cystopathy are presented in the review of literature.

Delayed ejaculation is a form of sexual disorders, which is characterized by constant or intermittent delays or absence of ejaculation and orgasm, despite normal sexual arousal and erectile function. Delayed ejaculation is one of the most studied and rare types of male sexual dysfunctions, which leads to depression, anxiety, and often is a reason of low selfesteem, reduced satisfaction of a man with his partner, and worsening of relationships between partners. In some cases, delayed ejaculation and anejaculation cause infertility. Current views on epidemiology, diagnostics and treatment strategy of delayed ejaculation are presented in the article.

Implantation of three-piece penile prosthesis is a gold standard in patients with severe erectile dysfunction. Currently, three surgical approach (scrotal, suprapubic and subcoronal) are used for prosthetic implantation. A method of implantation for three-piece penile prosthesis is still under discussion. The literature dedicated to an influence of surgical approach on the results of implantation for three-piece penile prosthesis in patients with severe erectile dysfunction is reviewed. The advantages and drawbacks of each technique are mentioned.