No 1 (2020)

Aim. To determine the frequency of occurrence of opрortunistic pathogenic bacterial flora and viral pathogens in the urine of healthy people with the establishment of the association between them. Materials and methods. 40 healthy sexually active women and men were examined, which are divided by gender into equivalent groups: Group I - healthy women (n=19), Group II - healthy men (n=21). The age of the subjects ranged from 20 to 25 years, the average age was 22.4±1.2 years. In both groups, the average portion of morning urine was taken for a study after a proper hygienic procedure with self-urination of the subjects in a sterile plastic container (Sterile Uricol for urine sample collection «HiMedia»). In addition to the nutrient media regulated by the Clinical Guidelines, additional HiMedia chromogenic media were used to cultivate facultative anaerobic (FAB) and non-clostridial anaerobic bacteria (NAB). Detection of viruses was performed by PCR with detection in «real time». DNA isolation was carried out by the sorption method using the AmpliPrime DNA-Sorb-B («NextBio») kit from urine samples, with preliminary concentration. Results. In all 40 cases, normative leukocyturia was detected in the urine. According to the results ofbacteriological examination ofurine, healthy men and women in all cases found aerobic-anaerobic associations. Coagulase-negative staphylococci (CNS) and Corynebacterium spp. Dominated in the cluster of aerobic taxa of microbiota. (75.0%, 55.0% respectively). The spectrum of CNS was represented by five species: S.epidermidis (30.0%), S.haemolyticus (27.5%), and S.warneri (25.0%), S.saprophyticus and S.lentus (15.0%). Enterococcus spp. were recorded in the urine in 32.5% of cases. Representatives of the Enterobacteriaceae family were represented by 4 taxa: E. coli (10.0%), Klebsiella spp., Proteus spp. (5.0% each), Enterobacter spp., Citrobacter spp. (2.5%). In a cluster of anaerobic bacteria in the urine, Eubacterium spp. (60.0%) and almost half of healthy individuals recorded Lactobacillus spp. and Peptococcus spp. (42.5% each). When analyzing the frequencies of detection of various microbiota taxa, it was found that women significantly more frequently recorded urine Corynebacterium spp., Eubacterium spp. and Lactobacillus spp., as well as Enterococcus spp. and Peptococcus spp. Peptostreptococcus spp. and Veillonella spp. were significantly more often determined (p<0.05) in the urine of men. HHV6 (10.0%), HPV18 and B19 parvovirus (2,5%) were determined in the urine of healthy people. It should be noted that the studied viruses were more often recorded in men, in particular, HPV18 and parvovirus B19 - only in men, and HHV6 - more often in men (7.5%), less often in women (2.5%). Significant associations of some genera of microorganisms with the sex of the participants were revealed for E. faecalis and Lactobacillus spp., which were more often found in the urine of healthy women Reliably significant associations were found for three taxa: viruses HPV6, HPV18 and parvoviruses B19 (16.7%) were determined in the presence of Bacteroides spp., Bifidobacterium spp., and Prevotella spp., in urine. Accordingly, in 83.3% of cases, these viruses were detected in the absence of the above-listed taxa of microorganisms in the urine. Conclusions. The normal urinary microbiota of healthy women and men has differences: Lactobacillus spp and Candida spp are absent in the urine of men while Streptococcus spp in urine of women. HHV6, HPV18, parvoviruses B19 are found in urine of healthy people and more often in men. Data about the virobiota and microbiota of urine in healthy people can highlight on the pathogenesis of urinary tract infections of various localization and develop targeted approaches in personalized therapy of this group of diseases.

Aim: to evaluate the efficiency of dietary supplements Renotinex® for the complex treatment of patients with urinary stone disease who undergone to extracorporeal shock wave lithotripsy (ESWL). Materials and methods: a total of 60 patients with uncomplicated form of the urinary stone disease with the first stone episode (of size up to 1 cm) were evaluated. Patients were divided into two groups of 30 people and treated by ESWL. In the first group, patients additionally received Renotinex®. In the second group, standard complex therapy (antispasmodics, analgesics, non-steroidal anti-inflammatory drugs) was prescribed. The urinary level of β2-microglobulin and serum level of tocopherol were considered as markers of damage and inflammation. Pain intensity was assessed using visual analogue scale. Follow-up studies were carried out on the 1st, 7th and 14th day of therapy. Duration of treatment and follow-up was 1 month. The average number of ESWL sessions was 2.6 in both groups. Results: according to the study, it was established that components of Renotinex® had antiseptic, antispasmodic, anti-inflammatory effects on the genitourinary system, enhancing renal blood flow and decreasing the permeability of the kidney capillaries. In addition, Renotinex® has diuretic effect and nephroprotective effect, and improves renal function, alleviating aggressive therapeutic influence of ESWL. Antioxidant and nephroprotective effect are among the main mechanisms of action of Renotinex®. Conclusion: In patients who received Renotinex® as dietary supplements fragments after ESWL pass twice as fast, while in patients who did not receive Renotinex®, there was more pronounced damage to the kidney parenchyma diagnosed by urine level of β2-microglobulin. The serum concentration of vitamin E increases, while taking Renotinex®, which may prevent the peroxidation of polyunsaturated lipids in cell membranes and enhances the nephroprotective effect of Renotinex®.

Objective: the aim ofthis study was to evaluate the effect ofextracorporeal shockwave therapy on CPPS due to non bacterial prostatitis. Methods: There were two groups in the study. 78 patients in the first group received 6 sessions of Low intensity-shokwave therapy (Li-ESWT) in three weeks. 40 patients from group «2» were receiving diclofenac sodium in the form of suppositories. Results: Patients in the first group showed significant improvement of pain and quality of life in comparison to the control group, which experienced less significant improvements. Conclusion: Low intensity-shokwave therapy (Li-ESWT) is effective in chronic pelvic pain syndrome treatment.

Background: endoscopic enucleation is a conventional minimally invasive method of surgical treatment for large prostates. Aim: The aim of the study was to analyze preoperative, intraoperative, immediate postoperative outcomes and 12-month functional results of endoscopic enucleation of the prostate. Materials and methods: a total of 120 endoscopic enucleations were performed in the Department of Urology, City Clinical Hospital named after D.D. Pletnev in 2016-2017. Bipolar electroenucleation was performed in 63 cases, while laser enucleation was done in 57 patients (28 holmium and 29 thulium). Three-lobe, two-lobe and en-block electroenucleation was performed in 23, 24 and 16 patients, respectively. The technical advantages of laser enucleation included lesser need for mechanical traction during enucleation of the adenoma from the prostatic capsule and the predominant use of two-lobe technique (33 cases). En-block laser enucleation was done in 7 patients, while three-lobe technique was used in 17 patients. Both groups were comparable in terms of I-PSS, QoL, prostate volume, maximum urination rate, and residual urine volume. Results: weight of the removed adenoma after electroenucleation was 105+24 g and 98+18 g after laser enucleation; the operation time was 118+10 and 132+25 min, duration of the catheterization 48+16 and 51+10 h, length of stay 3.6+1.2 and 3.8+1.3 days, respectively. Closed prostate perforation more often occurred after electrosurgical enucleation (6 vs. 1). There were no significant differences in the outcomes in both groups one year after the surgery. After removal of the urethral catheter, incontinence developed in 9% (6/63 and 5/57, respectively) of cases. During the period from 6 to 12 months, urinary incontinence persisted only in one patient, who subsequently was underwent to injection therapy with a partially positive effect. All 22 patients with urinary disturbances that occurred after enucleation had a short distance from the top of the verumontanum to the external sphincter (less than 1.5 cm; risk ratio (RR) = 3.5) and intravesical protrusion of more than 1 cm (RR=2.1). Conclusion: endoscopic bipolar and laser enucleation is an effective and safe treatment method for large BPH. It should be noted that postoperatively there was an increased frequency of irritative symptoms, which disappeared by 6 months.

Aim: To study an importance of new 2016 WHO histologic grading system for prostate cancer in evaluating the risk of progressing after conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy. Materials and methods. A total of 53 patients with prostate acinar adenocarcinoma were undergone to conformal external beam radiation therapy, brachytherapy 125I and androgen deprivation therapy. Age of patients was 54-80 years (68.11+4.7 years). T3 and T2prostate cancer was diagnosed in 42 (79.3%) and 11 (20,7%) patients, respectively. Baseline PSA level ranged from 5.5 ng/ml to 311 ng/ml (39.7±7.9 ng/ml). According to the new grading system (the WHO classification, 2016), all patients were divided into five risk groups. Results. Median follow-up was 64.9 months. The biochemical progression was seen in two patients, while three patients had metastatic disease. All patients with progressing prostate cancer were from IV and V prognostic groups. The 5-year progression-free survival rates for patients of IV-V and I-III groups were 44, 4% and 100%, respectively. Conclusions. According to the results of combination treatment (conformal external beam radiotherapy, brachytherapy 125I and hormonal therapy), progression-free survival rate in patients of IV (Gleason 4+4=8) and V (Gleason 4+5=9 or 5+5=10) groups, according to new WHO grading system were significantly lower, in comparison with patients of I (Gleason 3+3=6), II (Gleason 3+4=7) and III groups (Gleason 4+3=7). Our study showed that new WHO classification allows to predict the progression of prostate cancer not only after prostatectomy, but also after conformal external beam radiation therapy, combined with brachytherapy 125I and androgen deprivation therapy.

Aim. To evaluate the results of different methods of urine derivation in patients with postrenaI anuria due to upper urinary tract (UUT) obstruction, caused by fungal bezoar. MateriaIs and methods. The resuIts of treatment of postrenal anuria in 8 patients without congenitaI obstructive anomaIies of UUT in 5 cIinics from 2004 to 2018 were anaIyzed. All patients from the birth received continuousIy two or more antibiotics for diseases not reIated to kidneys and the urinary tract. Median of gestational age was 32 weeks [31.5; 38.5]. There were 4 boys (50%), and 4 girls (50%). The duration of anuria at the time of hospitalization was 2 days [1.5; 5]. Creatinine level at admission was 218 μmol/l [164.5; 392.5] and urea was 17.9 μmol/l [13.2; 24.95]. In all cases, candida albicans was revealed in urine. Postoperative complications were graded according to the Clavien-Dindo classification. ResuIts. AII patients received systemic antifungaI therapy; UUT drainage was performed in 7 (87.5%) cases. Ureteral catheter was placed bilaterally in 2 (28.6%) patients (4 renal units). There were 5 complications (CIavien-Dindo grade IIIb). BiIateraI percutaneous nephrostomy was performed in 3 (42.8%) patients (6 renal units), and there were 2 complications (Clavien-Dindo grade Illb and V). Open pyelostomy was performed in 2 (28.6%) patients (one bilateral, one on the right side; a total of 3 renal units). There was only one complication of Clavien-Dindo grade V. The average number of surgical procedures required to alleviate UUT obstruction per one renal unit was as following: 2.25 for ureteral catheterization; 1.17 for percutaneous nephrostomy; 1 for open pyelostomy. Regardless of the drainage method, diuresis tended to be normalized and azotemia decreased during the first postoperative day. In one case, the obstruction was eliminated by antifungal therapy without drainage of UUT. Mortality rate was 25% (n = 2). Conclusion. Ureteral catheterization is a minimally invasive, safe method for decompression of UUT obstruction, caused by fungal bezoar, which is non-inferior to nephrostomy tube or open pyelostomy. Ureteral catheterization can be used as a primary method of urine derivation in children with UUT obstruction caused by candida bezoar

A clinical case of scrotal atavism in the form of bone plate, which simulated neoplasm of scrotal organs and has not been previously described, is presented in the article. In our opinion, the tumor is a vestige of Bakulyum, an organ, which disappeared in Homo sapiens. The patient was successfully operated in the outpatient surgical department with good functional and long-term results. After 1-year follow-up, there were no complaints or recurrence. The patient had normal sexual function.

An analysis of the frequency of residual lower urinary tract symptoms after surgical treatment is presented in this literature review. A special attention is paid to prognostic criteria for persistence ofirritative symptoms after the surgery. The analysis of modern approaches to the treatment of urinary disturbances has been performed. The possibility of the combined use of various classes of drugs to improve the efficiency of the treatment is highlighted.

A review of modern literature on the study of microbiota of the genitourinary system by methods of chromatography-mass spectrometry and sequencing of urine specimens is presented in the article. The sequencing method is used to analyze microbiota of different organs. Obtained results of the genomic analysis have revealed cases of infection by potential pathogenic microorganisms, which are often not diagnosed during standard urine culture due to specific requirements for culture media.