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No 3 (2020)


Assessment of the psychological status of urologists during the COVID-19 pandemic

Krasavtseva Y.V., Kiseleva M.G., Kasyan G.R., Pushkar D.Y.


The aim of this study was to analyze the symptoms of depression, anxiety, and stress in urologists during the COVID-19 pandemic. Materials and methods. 90 urologists aged 25 to 60 years (M=37.27, S.D.=9.53), 93% of them were men, participated in the online survey. They answered questions about their attitude to their job as doctors and the impact of COVID-19. They filled out the Depression, Anxiety and Stress Scales (DASS-21), the Ten Item Personality Inventory (TIPI) and answered questions assessing their sense of control. Results. The greatest concern among urologists is the risk of getting infected with COVID-19 (for 30% of the doctors). 43% of urologists state that their profession interesting. A positive attitude to work, as well as the Big Five traits (Conscientiousness, Emotional Stability and Agreeableness) are associated with lower levels of depression, anxiety, stress and lack of control. Working with COVID-19 patients reduces stress and increases the sense of control. Age and high levels of Emotional Stability predicted lower levels of anxiety, depression and stress. Discussion. Working with COVID-19 patients allows doctors to feel more control over what is happening. A sense of control, in turn, and a positive attitude towards work are associated with a lower levels of depression, anxiety and stresssymptoms. Conclusion. The results of this study can be used in selection of therapeutic targets for psychotherapy, administered to doctors; in prevention of symptoms of anxiety, stress and depression among doctors; and in professional selection of doctors for working in crisis situations.
Urologiia. 2020;(3):5-9
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Lower urinary tract urodynamics after reconstruction of the pelvic part of the ureter

Komyakov B.K., Ochelenko V.A., Al-Attar T.H., Mhanna H.M., Shevnin M.V.


Introduction. The problem of impaired urodynamics of the lower urinary tract after reconstructive surgery of the pelvic ureter remains almost unexplored in modern literature. There are only a few publications about the effect of operations in the area of the ureterovesical segment on bladder function. Aim. To study the function of bladder after replacing the pelvic ureter with bladder flap, small intestine or appendix. Materials and Methods. We performed a retrospective analysis of reconstructive operations of the distal ureter, which were performed in 273 patients. Boari flap or its modifications were used in 142 (52%) cases; ureteroappendicocystanastomosis - 23 (8.4%) patients, and replacement of the pelvic ureter with small intestine in 105 (38.5%) cases. A followup urodynamics was carried out on the 10-14th day of the postoperative period, after 3 months, then after 6 and 12 months. We evaluated: uroflowmetry, cystometry, and pressure-flow study. Results. In 75 (53%) of 142 patients who underwent Boari flap or its modifications, varying degrees of disturbance of bladder urodynamics were observed. After isoperistaltic intestinal ureteroplasty in 2 (2.5%) of 79 patients, detrusor hyperactivity was observed, which was regressed following conservative therapy. Urodynamics of bladder did not suffer after appendicoplasty. Conclusion. Deformation, denervation and devascularization of detrusor are the main causes of bladder dysfunction after flap operations. Ileal ureter substitution with isoperistaltic position of the graft provides physiological passage urine from the kidney to the bladder, following good bladder function. The inclusion of antiperistaltic ileal loop in the urinary tract negatively affects the urodynamics.
Urologiia. 2020;(3):10-14
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Efficiency and safety of phenazopyridine for treatment of uncomplicated urinary tract infection: results of multi-center, randomized, placebo-controlled, clinical study

Petrov S.B., Slesarevskaya M.N., Chibirov K.H., Topuzov M.E., Kagan O.F., Voronova E.N.


Aim: to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. Materials and methods. A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6±7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53±8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. Results. All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was “significant improvement” (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups. Conclusion. The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.
Urologiia. 2020;(3):15-21
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Current approaches to the diagnosis of acute cystitis and to evaluation of treatment efficiency

Kulchavenya E.V., Neymark A.I., Tbiukanov A.Y., Yarin G.J.


Introduction. Lower urinary tract infections are common infectious diseases. Although there are international valid questionnaires for evaluating a number of urological diseases (prostatitis, BPH, erectile dysfunction), a unified questionnaire for cystitis was absent until recently. Our aim was to evaluate the efficiency and ease of use of the Acute Cystitis Symptom Score (ACSS) in the daily urological practice. Materials and methods. A total of 47 women aged 24 to 46 years with typical complaints for acute cystitis were included into multicenter open, non-comparative prospective population-based study. All of them completed the ACSS questionnaire during the first consultation and after 7-10 days at the follow-up visit. The diagnosis of acute cystitis was valid with a total score of 6 or more points. Clinical and laboratory studies were used to diagnose the cystitis. Results. Self-completion of the questionnaire by the patient and its analysis by the physician took about four minutes. The average baseline score for the «typical» domain was 9.8±1.3, while a score for the differential diagnostic domain was 1.2±0.4. The mean baseline quality of life was 6.4±0.8 points. The total score averaged 17.4±1.9. All 47 patients had leukocyturia, and 12 (25.5%) had hematuria. A microbiological study was done in 36 (76.7%) patients and revealed an increased concentration of uropathogens in all cases. Thus, acute cystitis diagnosed on the ACSS scale was confirmed, and 41 (87.2%) patients had acute uncomplicated cystitis, and in 6 cases (12.8%) various complications developed. Conclusion. The specificity of the ACSS questionnaire was 100%. The questionnaire can be considered as a necessary tool for studies on LUTS in order to standardize obtained data and ensure their comparability.
Urologiia. 2020;(3):22-25
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Prevention of infectious and inflammatory complications after percutaneous nephrolithotomy

Perepanova T.S., Merinov D.S., Kazachenko A.V., Khazan P.L., Malova Y.A.


Introduction. Given the increase in antibiotic resistance of uropathogens, one of the urgent problems is a development of optimal antimicrobial prophylaxis for surgical interventions, as well as an adequate regimen of antibiotic therapy after percutaneous nephrolithotomy (PCNL). Aim: to determine an effective perioperative antimicrobial prophylaxis for PCNL in patients with kidney stones. Material and methods. A total of 90 patients with staghorn or multiple large kidney stones who underwent PCNL were included in the study. Before PCNL, urine culture was performed in all patients in order to determine the sensitivity not only to antibiotics, but also to bacteriophages. In addition, urine was taken for additional microbiological studies after the puncture of the collecting system, as well as on the 3rd and 7th day after PCNL. All patients were divided into three groups of 30 patients depending on the regimen of perioperative prophylaxis. In group 1, patients were prescribed ciprofloxacin 1000 mg i.v. intraoperatively, then 1000 mg i.v. q.d. for 3-5 days. In the group 2, patients received one dose of cefotaxime + sulbactam (1.0 g + 0.5 g) 2 hours before PCNL i.m. In the group 3, a polyvalent pyobacteriophage purified was given orally 1 hour before PCNL in a dose of 40 ml and the same dose was used t.i.d. for 3-5 days postoperatively. Results. In all three groups of patients, the following infectious complications were evaluated: acute pyelonephritis, systemic inflammatory response syndrome (SIRS) and urosepsis. There were no serious infectious and inflammatory complications in the early postoperative period among all patients. SIRS developed on days 1-3 after PCNL in 26.6%, 20% and 20% ofpatients in group 1, 2 and 3, respectively. However, by days 4-7 after PCNL, there was normalization of blood cells count (leukocytes, neutrophil band cells), temperature and general condition. Conclusion. Different regimens of antimicrobial prophylaxis for PCN L have the same efficiency. The development of SIRS on days 1-3 after PCNL is correlated not only with the antimicrobial agents used and the route of their administration (intravenously, intramuscularly and orally). Most likely, the development of SIRS is more associated with surgical trauma.
Urologiia. 2020;(3):26-33
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Frequency of occurrence and risk factors for acute kidney injury after radical cystectomy

Tarasenko A.I., Alekseev A.V., Kabirov I.R., Urmantsev M.F., Abdrakhimov R.V.


Introduction. Various studies have revealed the negative impact of surgery or related factors on the risk of acute kidney injury (AKI). The risk factors and 6 -months outcomes in patients with clinical or subclinical manifestations of AKI after radical cystectomy were analyzed. Materials and methods. This prospective study included patients with normal renal function who underwent radical cystectomy. Urine and serum samples were collected to measure the level of neutrophil gelatinase-associated lipocalin (NGAL). Results. Of the 186 patients, 43 (23.1%) had AKI in the postoperative period. The most reliable predictor was the concentration of NGAL in the urine 12 hours after surgery (threshold value of 156.87 ng/ml). In 53 (28.5%) patients with NGAL higher than this value, subclinical AKI was diagnosed. Patients with clinical AKI and patients with subclinical AKI were allocated to the AKI group. Independent risk factors for postoperative AKI were age and obesity. After 6 months the glomerular filtration rate (GFR) in the group with AKI was significantly lower than in the control group, although the baseline GFR was similar. Conclusion. Determination of NGAL concentration in urine is recommended for early diagnosis of postoperative AKI, as well as for predicting the functional state of the kidneys 6 months after oncourological procedures. A significant proportion of patients developed subclinical AKI; in this group there was a worse renal outcome in comparison with the group without AKI.
Urologiia. 2020;(3):34-38
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Method of complex therapy of chronic cystitis

Sitdykova M.E., Nikolsky E.E., Birchuk O.A., Sayapova D.R.


Aim. To assess the effectiveness of hydroxyethyldimethyldihydropyr imidine (trade name Xymedone) in the treatment of chronic recurrent cystitis in women. Materials and methods. The study included 30 patients (the main group) with a confirmed diagnosis of chronic cystitis (HC) with a recurrence rate of at least 3 times a year, the average age of the patients was 46.0+2.7 years. The control group consisted of 30 age-comparable patients with a similar diagnosis, who underwent standard treatment for this disease. The article presents the results on the effectiveness of the use of hydro xyethyldimethyldihydropyrimidine (Xymedone) in the treatment of HC after anti-inflammatory and local treatment with collargol instillations, and the terms for the regeneration of the bladder mucosa are determined. To patients of the main group Xymedone was prescribed in a dose of 500 mg 3 times a day for 30 days after the completion of local treatment. Control cystoscopy was performed 15 and 30 days after the start of the drug, 3 days after its withdrawal. Results. The planned treatment was completed by all 30 patients of the main group. After 15 days from the date of administration of Xymedone most of patients had no low urinary tract symptoms (LUTS), in comparison with the control group. Cystoscopy performed at this time allowed to establish a positive trend while taking Xymedone in the process of restoring the bladder mucosa after influence of collargol. Hyperemia in the neck and triangle area persisted in most patients, and only in 8 (26.6%) it decreased. Treatment with Xymedone was continued. After 30 days of drug intake laboratory parameters were according to normal values, a significant increase in functional capacity of the bladder (189,5+19,8 ml) and volume of urination (147,9+26,7 ml.) was detected, the thickness of the bladder wall in a state of filling in the averages was 3.5+ 0.3 mm, which corresponded to the norm. Cystoscopy, performed 3 days after canceling of the drug, showed a slight hyperemia in the bladder neck area only in one patient. Recurrence of HC in the control group occurred within 6 months after completion of treatment in 15 (51%) women. In the main group there were no relapses during two years of dynamic follow-up. Conclusions. Hydroxyethyldimethyldihydropyrimidine, included in the therapy of HC, accelerates the regeneration of the bladder mucosa after local treatment of recurrent cystitis and shortens the period of its recovery, significantly lengthens the period of persistent remission.
Urologiia. 2020;(3):39-45
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A prevalence and risk factors for development of urinary tract infections in women of reproductive age

Gaybullaev A.A., Abdurizaev A.A., Gaybullaev O.A.


Aim: to study the prevalence and identify risk factors for development of urinary tract infections (UTI) among women of reproductive age in Tashkent. Materials and methods: a cross-sectional epidemiological study of the prevalence and risk factors of UTI in women was performed. The case-control study was conducted according to the nest-typological method. A total of 1028 women were examined, of which 654 were of reproductive age. To evaluate the impact of various risk factors on the development of UTI, social-economic status, medical and obstetric history and complaints were analyzed. Results: The prevalence of UTI in women of reproductive age was 8.71%. The causative agent of UTI in 99% of cases was E. coli, and S. aureus was isolated only in 1% of cases. The most significant risk factors for UTI were vaginal discharge (odds ratio (OR) 2.32, 95% confidence interval (CI) 1.16-4.64), a history of pelvic inflammatory diseases (OS 1.99, 95 % CI 1.01-3.91), as well as the use of daily pads (OS 1.92, 95% CI 1.03-3.57). Conclusion: Vaginal discharge, a history of pelvic inflammatory diseases and the use of pads are significant risk factors for the development of UTI in women of reproductive age.
Urologiia. 2020;(3):46-49
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Combination of a1-blockers and phosphodiesterase type 5 inhibitor in patients with benign prostatic hyperplasia and erectile dysfunction: results of observatory prospective multicenter study

Borisov V.V.


Aim. To evaluate the efficacy and safety of combination therapy with a1-blocker and phosphodiesterase type 5 inhibitor (PDE5) in patients with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Materials and methods. The observational multicenter program involving 18 medical institutions in Moscow included 315 men aged 40-65 years with BPH and ED. The inclusion criteria were a total IPSS score more than 8 points, QoL score of more than 3 points and clinical manifestations of ED (< 20 points on the IIEF-5 score). All patients received combined pharmacotherapy with Alfuprost® MP 10 mg/day and Viatail® 50 mg/day (if necessary, the dose was increased to 100 mg/day) for 3 months. Results. The combination therapy showed a high clinical efficiency and a favorable safety profile. Lower urinary tract symptoms improved by more than 60%, QoL increased by 64% and erectile function improved in more than 80% of patients. At the end of treatment, the average patient satisfaction score on the Likert scale was 4.2 (high and very high satisfaction), while doctor’s satisfaction with the clinical response of patients to the treatment was 4.35 points, which also corresponds to high and very high efficacy of therapy. Conclusion. Combination of Alfuprost® MP 10 mg/day and Viatail® 50 mg/day (100 mg, if necessary) can be considered as one of the best options for non-surgical treatment of patients with BPH and ED.
Urologiia. 2020;(3):50-55
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New opportunities of using gialuronidase in chronic prostatitis

Kulchavenya E.V., Shevchenko S.Y., Cherednichenko A.G., Breusov A.A., Vinitskiy A.A.


Introduction. The use of hyaluronidase contributes to improvement in microcirculation, destruction of biofilms and reducing of congestion in patients with chronic prostatitis. Based on this mechanism, the use Longidaza* for the diagnosis of latent bacterial prostatitis was suggested. Aim. To evaluate diagnostic and treatment capabilities of the long-acting enzyme preparation Longidaza* (rectal suppositories with an activity of 3000 IU), prescribed to patients with chronic prostatitis in routine clinical practice. Materials and methods. A total of 39 men with chronic prostatitis of categories II and IIIa were included in open, prospective, noninterventional, comparative, single-center study. A microbiological study of expressed prostate secretion (EPS) was performed three times, at baseline, after using two suppositories Longidaza 3000 IU and after 7 weeks of therapy. From the 1st to the 10th suppository, Longidaza* was used every 48 hours, then, from the 11th to the 20th suppository, it was prescribed every 72 hours. The isolation of the pathogen was an indication for the antibiotic therapy. The treatment outcome was evaluated by using NIH-CPSI scale and laboratory and microbiological analysis of EPS. Results. Diagnostic stage. Initially, pathogens were isolated in 27 (69.2%) patients. The number of leukocytes in EPS averaged 25.9±2.3. The use of two suppositories Longidaza* increased the number of patients with isolated pathogens to 33 (82%). In 7 out 12 patients with an initial diagnosis of abacterial prostatitis, the use of two suppositories of Longidaza* contributed to isolation of the pathogen in EPS (58.3%). The number of leukocytes in the EPS after enzymatic provocation increased by 50.2%. Treatment stage. The number of patients with isolated pathogens decreased from 33 to 7 (17.9%). The pain intensity decreased on average to 2.2±0.4 points, and in 27 (69.2%) men dysuria resolved. The quality of life significantly improved up to 1.3±0.2 points. The total score on NIH-CPSI scale decreased on average from 17.3±1.9 to 3.9±0.3 (p<0.05). An increased number of white blood cells in EPS was seen only in 5 (12.8%) men. Conclusion. In many cases, bacterial prostatitis remains undiagnosed. Rectal suppositories Longidaza* can be recommended for the diagnosis of the latent bacterial chronic prostatitis, since this drug contributes to detection of pathogen and inflammation.
Urologiia. 2020;(3):56-62
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Transurethral endopyelotomy using thulium fiber laser

Martov A.G., Golubev M.Y., Ergakov D.V., Golubev P.M., Baykov N.A., Andronov A.S., Abdullaev D.A.


Introduction. Transurethral endopyelotomy is an alternative treatment method for short stricture of ureteropelvic junction (UPJ). Aim: to evaluate the efficiency of transurethral thulium laser endopyelotomy. Materials and methods. A total of 94 patients with UPJ obstruction during the period from December 2016 to December 2018 were prospectively enrolled in the study. Pelvic size did not exceed 3 cm in 31 patients, and it was in the range from 3 to 4 cm and more than 4 cm in 35 and 28 cases, respectively. Depending on the treatment, all patients were divided into 2 groups. The main group included 48 patients who underwent retrograde thulium fiber laser endopyelotomy. In the control group (n = 46), patients underwent Anderson-Hynes laparoscopic pyeloplasty. In the main group, there were significantly more patients with more preserved ipsilateral kidney function, with short (less than 1 cm) and recurrent UPJ strictures and less severe hydronephrosis compared to the control group. In addition, there were no patients with crossing vessel in the main group. Postoperatively, an internal stent of 6-8 Fr was put in all patients for a period of 6-8 weeks. After stent removal, all patients underwent a followup examination, including an ultrasound examination and, if pelvic size was more than 3 cm, contrast-enhanced CT-urography was performed. Results. In all patients, after stent removal, a decrease in the pelvic size was noted. The operation time in the main and control group was 24±14 minutes and 82±26 minutes, respectively. In all cases, ureteropyeloscopy was performed prior to laparoscopy to determine the exact length of stricture and to exclude narrowing of other parts of the ureter. After follow-up of 24 months, an examination in 36 patients of the main group and 29 patients of the control group was performed. There was 1 recurrence after laparoscopic pyeloplasty and 1 recurrence after endopyelotomy. In other patients of both groups, there were neither stricture, nor impaired renal function. Conclusion. The first experience of using a thulium fiber laser for transurethral endoscopic treatment of UPJ obstruction is presented in the article. Indications for the transurethral thulium endopyelotomy are the presence of primary or secondary UPJ obstruction (with a decrease in kidney function by no more than 40%), length of up to 1 cm, absence of an additional vessel and pelvic dilatation of no more than 4 cm.
Urologiia. 2020;(3):63-68
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Clinical, morphological and microcirculatory criteria of local recurrence of the prostate cancer after HIFU therapy

Neymark A.I., Tachalov M.A., Neymark B.A., Levin V.P.


Aim: to study the clinical, morphological and microcirculatory criteria for treatment efficiency and prognosis of local recurrence after HIFU. Materials and methods. On the basis of the urological department of Clinical Hospital «Russian Railways - Medicine» in Barnaul (the clinical base of the Department of Urology and Andrology with a course of Specialized Surgery of FGBOU VO «Altai State Medical University») for the period 2011-2018, a comprehensive examination and treatment of 240 patients with prostate cancer (PCa) by means of HIFU using «Ablatherm» was performed following transurethral resection of the prostate (TURP). The indication for HIFU was morphologically-proven PCa (stage T2a-cN0M0) in patients with contraindications due to comorbidities or those who refused from radical prostatectomy. Results. A decrease in PSA to 0.5 ng/ml or less was observed in 74% of patients. A stable PSA level for 3 years was observed in 76% of patients. PSA levels differed depending on the PCa risk group. In the low-risk PCa, negative biopsy was seen in 89.6% of cases, in comparison with 72.2% and 69.4% in intermediate and high-risk PCa, respectively. There was a significant decrease in the volume of the prostate in all patients with low-risk PCa. The largest decrease in prostate volume was observed 12 months after HIFU. Regarding recurrence-free survival after HIFU therapy, during followup of 3 years or more, 77% of patients didn’t have any signs of recurrence. A 3-year overall survival after HIFU was 83%. In addition, an increase in postoperative PSA levels, change in parameters of Doppler study and laser Doppler flowmetry at the area of the prostate during the period of 6-36 months after HIFU was associated with a significant increase in the risk of recurrence of PCa at biopsy. Conclusion. HIFU therapy is an effective treatment method for inducing prostate necrosis with minimal collateral damage to the surrounding tissue. The best results were achieved in patients with low-risk PCa. There were minimal adverse events after HIFU. In addition, in case of relapse after HIFU therapy, there is an opportunity for an early assessment of the efficiency and prognosis.
Urologiia. 2020;(3):69-76
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Complications of the «acute scrotum syndrome» in children

Shormanov I.S., Shedrov D.N., Morozov E.V., Pisareva M.V., Garova D.Y.


Aim. To establish causes of complications and repeated surgical procedures in patients with acute scrotal pathology during the short- and long-term follow-up. Materials and methods. The treatment results of 3315 patients aged 0 to 18 years with various forms of acute scrotal pathology were analyzed. Results. A total of 43 complications were documented, 32 of them required surgical intervention. The most common complication is testicular necrosis due to incorrect judgement of viability after torsion with performing an organ-preserving procedure, which is dictated by the surgeon’s desire to preserve a testicle. Such a decision is made without objective data and in all cases leads to repeated procedure due to testicular necrosis. Inappropriate surgical hemostasis is often associated with improper surgical technique and underestimation of inflammatory tissue changes. Purulent complications are the most common in acute epididymitis and are caused by the presence of an inflammatory focus in the scrotum. Wide revision of the scrotum in case of testicular appendage’s pathology is not justified, since the second appendage is rarely found, while the invasiveness of the procedure increases. Conclusion. Complications were more common in the early postoperative period (88.4%). Purulent complications are directly dependent on the duration of the disease and are exacerbated by the secondary inflammatory process. Most of complications are treatable; performing of preventive measures helps to avoid them.
Urologiia. 2020;(3):77-80
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Molecular and genetic technologies for the diagnosis of monogenic forms of urinary stone disease: clinical cases

Litvinova M.M., Filippova T.V., Svetlichnaya D.V., Morozov S.L., Chugunov I.S., Nuralieva S.Z., Rudenko V.I., Gadzhieva Z.K., Subbotina T.I., Shumikhina M.V.


Kidney stone disease (KSD) is an actual problem of modern health care. By now, more than 80 monogenic forms of urolithiasis have been described. To diagnose such forms of KSD different molecular genetic technologies are used. In the current article 5 clinical cases of KSD among the patients aged 1-9 years old are presented. All of them underwent comprehensive instrumental, clinical, laboratory and molecular genetic investigations. DNA analysis was carried out by Next Generation Sequencing method (NGS) (target NGS-panels and Whole Exome Sequencing). In all cases the molecular genetic cause of the disease was found - idiopathic infantile hypercalcemia type 1 (gene CYP24A1 - 3 cases) and cystinuria (gene SLC7A9 - 2 case). Several unknown genetic variants were found in CYP24A1 (c.1379G>T, c.1156A>T, c.1286T>C) and SLC7A9 (c.920T>A). The importance of genetic testing and the role of genetic counseling for patients with KSD were shown.
Urologiia. 2020;(3):81-86
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Autologous kidney transplantation after ureter avulsion during ureterolithotripsy

Grinev K.M., Dutov V.V., Podoynitsyn A.A., Romanov D.V., Mamedov E.A., Dadashov M.T.


Currently, when performing ureterolithotripsy in patients with proximal ureteral stones, urologist should be ready for intraoperative complications and be able to use various methods to diagnose them. Ureteral avulsion is an extremely rare, but the most serious complication of endoscopic procedures. Clinical observation of autologous kidney transplantation performed after ureteral avulsion with good functional and clinical results is presented.
Urologiia. 2020;(3):87-90
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Renomedullary interstitial cell tumor: review of a rare clinical case

Todorov S.S., Kogan M.I., Deribas V.Y., Kazmin A.S.


Autopsy study of a 49-year-old patient demonstrates a rare kidney tumor that had a structure of a mesenchymal renomedullary interstitial tumor (RIO), which had specific characteristics. They include a predominance of the cellular component in the tumor, represented by cells with processes elements (fibroblasts, myofibroblasts), which were surrounded by collagen fibers of interstitium. Apparently, these cells can be involved in the regulation of renin and bicarbonates, the exchange of components of connective tissue (collagen fibers, proteoglycans) and hormones (estrogen, progesterone). Since these tumor cells regulate the synthesis and secretion of the substances, numerous clinical manifestations of RIO can be explained. Most likely, these include increased blood pressure, water-electrolyte disorders, hormonal disorders due to the presence of estrogen receptors, progesterone in the tumor tissue and metabolic disorders (diabetes mellitus). However, these assumptions require further clinical, morphological and immunohistochemical studies.
Urologiia. 2020;(3):91-93
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Urethral diverticulum in female

Gvozdev M.Y., Arefyeva O.A., Vasilyeva M.A., Dzhuraeva M.D.


Urethral diverticulum is one of the rarest female urological diseases, which is characterized by various manifestations, ranging from an asymptomatic to severe urinary disorders, pain and dyspareunia. The aim of this work is to present a clinical observation of female urethral diverticulum with a description and discussion of its etiology, diagnosis, and treatment. Clinical observation is dedicated to 40 -year-old woman with complaints of pain in the urethral area. The patient underwent ureteral stenting followed by a diverticulectomy. Vaginal diverticulectomy is the gold standard for treatment. The specialist performing such interventions should be aware for possible intraoperative complications. It seems appropriate to perform the surgical treatment of female urethral diverticulum in specialized centers with an experience in female urethral reconstruction.
Urologiia. 2020;(3):94-97
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«Adherent Perinephric Fat»: a prognosis and influence of perioperative results of organ-sparing procedures in localized kidney parenchyma tumors

Syrota A.E., Rapoport L.M., Bezrukov E.A., Tsarichenko D.G., Syrota E.S., Vovdenko S.V., Alyaev Y.G.


The results of recently published articles on the etiology and pathogenesis of “Adherent Perinephric Fat” (APF) are presented in the review. The current possibilities for predicting the presence of APF based on clinical data and imaging methods are highlighted, as well as the to an influence of ARF on perioperative results of organ-sparing procedures using various surgical approaches in patients with localized kidney parenchyma tumors.
Urologiia. 2020;(3):98-103
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Adjustment of urine PH as effective tool for successful metaphylaxis of urinary stone disease. phytotherapy

Saenko V.S., Lachinov E.L., Zhantlisov D.A., Gorbachev M.I., Soltanov A.A.


Urinary stone disease constitutes significant burden for healthcare system worldwide. Metaphylaxis after removal or spontaneous passage of urinary stone may be an effective measure for the prevention of recurrent stone episodes. An adjustment of urine pH, based on the type of urinary stone plays a key role in the metaphylaxis of urolithiasis. The use of combined preparations based on herbal plants, which has antioxidant, anti-inflammatory, antimicrobial activity and diuretic effect, and also affects pH level of urine without impairment of the body microbiome, is very promising for the metaphylaxis of urinary stone disease.
Urologiia. 2020;(3):104-110
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Epidemiological studies of the male reproductive potential: sperm quality as a marker of reproductive health

Osadchuk L.V., Osadchuk A.V.


Currently, the global demographic crisis in industrialized countries, including Russia, is accompanied by a decrease in the reproductive potential of human populations. In different regions of the world, a decrease in male fertility has been observed that expressing in poor semen quality, increasing in the proportion of male factor in infertile couples and the growth of congenital anomalies of the male reproductive system, resulting to infertility. The observed negative trends in a range of male reproductive problems highlighted the global problem of maintaining men’s health, as well as raised the question of the causes of this phenomenon. Taking into account the increasing risks associated with reproduction of humanity, epidemiological studies of male fertility have been started in various countries of the world. The purpose of this review is to analyse epidemiological studies of male fertility, regional and ethnic differences in biological indicators of male fertility. The review provides information on regional and ethnic differences in male fertility in Western Europe, the United States, China, Japan and other countries. Based on our review of epidemiological data we can conclude that the region of residence and ethnicity are important determinants of the male reproductive potential, which can have a significant impact on its variability. Traditional methods of population studies of male fertility are considered, based on which time trends, regional and ethnic differences in the male reproductive potential are studied, and adequate information about the prevalence and causes of male infertility and subfertility can be obtained.
Urologiia. 2020;(3):111-120
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Simple renal cysts and peripelvic cysts

Gerasimenko N.A., Zhmakin V.A., Krupinov G.E., Amosov A.V.


The topic of renal cystic lesions is described in the article. The localization and structure of solitary, parapelvic and multiple sinus cysts are discussed. The Bosniak classification (1986) is presented, as well as the updated Bosniak classification, in which a number of modifications in 2019 were made. The contemporary diagnostic methods are mentioned, as well as factors that allow to select patient for active surveillance. Current surgical procedures are presented.
Urologiia. 2020;(3):121-127
pages 121-127 views

Use of D-mannose in the prevention of recurrent lower urinary tract infection in women

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


Lower urinary tract infections (LUTI) currently retain the status of one of the most urgent problems of urology. According to extensive microbiological studies of UTIAP I and II, «DARMIS» the most common pathogens that are detected in the urine of women with LUTI are gramnegative bacteria of the Enterobacteriales family, in particular E. Coli. Antibacterial therapy demonstrates high effectiveness in the treatment of uncomplicated LUTI. However, the problem of recurrent infection remains unresolved. Taking into account known side effects of continuous antimicrobial prevention, as well as data on the high frequency of relapses after its cancellation, it is necessary to identify alternative LUTI prevention strategies. The use of D-mannose can be one of these strategies. D-mannose use for the prevention of relapses of INMP is indicated in the clinical recommendations of the American (AUA) and European (EUA) urological associations. D-mannose is a monosaccharide that is extracted from a larch rod. It is relatively quickly absorbed and reaches the peripheral organs in about 30 minutes, after which it is excreted in the urine. The structure of d-mannose allows it to bind to mannose-sensitive E. Coli fimbriae and prevent their adhesion to the urinary tract mucosa. Several studies demonstrated high safety profile and effectiveness of longterm D-mannose treatment in preventing LUTI. The data presented in the literature allow us to recommend patients with recurrent LUTI long term D-mannose intake helps to reduce the severity of symptoms in acute episodes and prolong relapse-free period. As a source of D-mannose, we can recommend Ecocystin 1 sachet 1 time a day.
Urologiia. 2020;(3):128-132
pages 128-132 views

Multimodal approach to the treatment of staghorn stones in modern clinic

Popov S.V., Orlov I.N., Asfandiyarov F.R., Skryabin O.N., Suleymanov M.M., Sytnik D.A.


This lecture is dedicated to increasing stone free rate (SFR) in patients with staghorn renal stones by using a multimodal approach. Percutaneous nephrolithotomy (PCNL) is the “gold standard” for the treatment of this group of patients. Depending on a stone size and complexity, SFR for PCNL varies from 55 to 98%. Due to low SFR, which is a main criterion for the effective procedure, various approaches currently are being suggested. In this lecture, we highlighted the following approaches: multi-access PCNL, a use of a ureteroscope in case of antegrade stone migration, a use of flexible instruments, ureterorenoscopy in combination with PCNL. Various lithotripsy techniques are briefly described. The advantage of ultrasound-guided puncture of the kidney is also discussed.
Urologiia. 2020;(3):133-136
pages 133-136 views

In memory of professor L. Kasper - urologist-innovator and prominent scientist (on the 160th anniversary of his birth and the 60th anniversary of the death)

Morgoshiia T.S., Sasova V.D., Belyaeva D.O.


The main dates of life and scientific and practical activity of Leopold Kasper are presented. The scientific views and thoughts of the scientist are analyzed. It is shown that after graduating in 1883 from the University of Berlin he specialized in urology under supervision of G. Thompson, P. Freyer, F. Guyon, I. Albarran and L. Dittel. L. Kasper was the founder of a large German urological school, the author of a large number of scientific works, including study dedicated to cystoscopy, endoscopic procedures, functional diagnosis of renal disorders, treatment of renal tuberculosis and urolithiasis, prostate diseases, transurethral galvanocaustics of bladder tumors, etc. He designed a special catheterization cystoscope (1895), which allowed for the first time to study differential functional ability of each kidney. It greatly facilitated the recognition and treatment of surgical pathologies of kidneys and upper urinary tract. In addition, L. Kasper improved and implemented into practice a functional renal test with fluoridzine and cryoscopic examination of urine obtained from each kidney separately after ureteral catheterization.
Urologiia. 2020;(3):137-138
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