No 2 (2020)

Background. Chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome IIIa (CP/CPPS IIIa) are separate nosologies defined diagnostic verification criteria according to the NIH-NIDDK classification (1995). The identification of enterobacteria in the prostatic secretion (PS) has long been a criterion for the diagnosis of CBP, while PS in patients suffering CP/CPPS IIIa was considered as “sterile”. However, the introduction of various methods of PS's in-depth analysis and UPOINTS classification (2010) development with the allocation of site I (infection) allows us to consider the infectious factor as an etiological predictor of the initiation of inflammation in the prostate with CP/CPPS IIIa. Thus, the determination of the features of the taxonomic composition of microbiota in СBP and CP/CPPS IIIa can act as a differentiating factor of these conditions. Aims/Objective: performing a comparative analysis of the PS microbiota in patients suffering from CBP and CP/CPPS IIIa. Materials and methods. Feature: full-scale, prospective, comparative, uncontrolled study. During the study, a staged PS's bacteriological study was performed in 101 patients (aged 20-60 years) with prostatitis-like symptoms lasting more than 3 months and identified leukocytosis in PS (> 10x'). Stage I of the PS's study: a standard nutrient medium and culturing conditions were used. Two comparison groups were formed according to the results of the initial bacteriological study: 49 patients were included in group 1 (CBP), in which E. coli, Klebsiella spp., Proteus spp. were identified in PS (causative uropathogens in CBP), in group 2 (CP/CPPS IIIa) included 52 patients, with no growth of the above microorganisms' taxa in the biomaterial and/or primary negative results of the study. Stage II of the PS's study: an extended set of selective media and special cultivation conditions were used for accessory verification of bacteria in biomaterial. Biochemical identification of bacteria was carried out using test systems. Statistical processing of seeding rates was carried out using Statistica 10.2 package (StatSoft Inc., USA). In both groups, we used descriptive statistics methods and the Mann-Whitney U test to process the results of bacteriological studies. The significance of differences between the studied parameters was considered at the level of p<0.05 and p<0.01. Results. Usage of an expanded set of selective media and special cultivation conditions (as compared with the results of the primary bacteriological culture of the exprimate) made it possible to collectively verify in PS to 28 species / genera of microorganisms in both groups (25 in group 1 and 24 in group 2). The taxonomic composition of the PS's microbiota was almost identical in both groups and presented mainly in the form of multicomponent microbial associations. According to the results of analysis of the bacteria's identification frequency in PS, it was found that in group 2 (CP/CPPS IIIa) significantly more often than in group 1 (CBP) discovered some representatives of the non-clostridial anaerobic flora (NAB: Peptococcus sp., Propionibacterium spp. and others), coagulase-negative staphylococci (CNS: S.haemolyticus, S.warneri) and certain taxa of gram-positive microorganisms (Corynebacterium spp. and Str. agalacticae). In turn, when analyzing the PS contamination, it was found that integrally in group 1 (CBP) in the samples of the biomaterial a higher titer of microorganisms was determined with a wide range of quantitative values, in relation to group 2 (CP/CPPS IIIa), where the titer indices were somewhat lower and had a smaller variation relative to the average. Conclusion. Identification in patients of both groups in PS of different mixed microbial associations, similar in the taxonomic spectral composition of microbiota, suggests that CP/CPPS IIIa in some cases is unverified CBP, which in turn necessitates a review of diagnostic and therapeutic strategies to achieve positive clinical result.

Aim: to evaluate the level of nerve growth factor (NGF) in the blood and urine and mast cell infiltration of the bladder wall in a model of interstitial cystitis/bladder pain syndrome (IC/BPS) and to analyze their relationships. Materials and methods. IC/BPS modeling was performed on 38 female rabbits, which were divided into 4 groups. In the group 1, IC/BPS was simulated by an instillation of 70% alcohol into the bladder, while in group 2 and 3 animal’s own urine and normal saline were injected into the bladder wall. The group 4 consisted of intact animals. The NGF level was determined by ELISA. To determine the concentration of mast cell in tissues, each cross-section was divided into 10 sections. The severity of mast cell infiltration was evaluated in each area using the following scale: 0 - no mast cells; 1 - less than 20 cells; 2 - 20 -45 cells; 3 - more than 45 cells. The points of all 10 areas were added up, divided by 30 (the maximum possible score) and multiplied by 100. Results. An increase in the NGF level in the blood and urine was seen in different models of IC/BPS, but it was significantly more pronounced in the group 2 (toxic model). Mast cells were determined only in the group 1 (0.25±0.707) and 2 (14,200+5,796). In animals with the urinary toxicity model, mast cell activity was significantly higher in comparison with those in the model with an instillation of 70% alcohol (p<0.001). The level of NGF in blood and urine correlated in different directions. Mast cell proliferation and activation was determined in case of impairment of the bladder wall integrity by the injection of urine. Conclusion. Our animal model of IC/BPS, which was created by instillation of 70% alcohol into the bladder and the injection of urine into the bladder wall, showed an increase in the level of NGF in urine and blood and the concentration of mast cells. These findings, as well as relationship between these values indicate the development of neuroimmune inflammation in this pathological condition. Considering the involvement of many factors in the pathogenesis of this syndrome, further researches are required.

The purpose of the study: a retrospective analysis of the results of patients treatment with ureteral strictures by evaluating the effectiveness of various methods of laparoscopic operations. Materials and methods: a retrospective analysis of the treatment of 30 patients operated in the Central Hospital of Civil Aviations from 2013 to the present time with strictures of all departments of the ureters, except the pelvic-ureteral segment (LMS), was performed. The study included 18 women and 12 men. The age ofpatients was 54+8.1 years (29-79 years) for men and 51+8.5 years (28-74 years) for women. According to the results of x-ray examinations, the length of ureter stricture was determined, after that selected the tactics of surgical treatment. The study included patients who underwent intestinal plastics of the ureter, the operation Boari, ureterocystoanastomosis, ureteroureterostomy. All stages of surgical interventions were performed laparoscopically. Results: 23 patients (76.66%) had a smooth postoperative period. A month after the operation, ureteral stents were removed. Attacks of acute pyelonephritis, relapses of the disease were not observed during the follow-up period from 7 months to 3 years. Possible complications are analyzed. In one case, after intestinal plastic surgery of the ureter in the postoperative period, the phenomena of small bowel obstruction were noted, which required surgical treatment in the volume of applying a bypass eunoascendoanastomosis «side by side». In 7 cases, anastomosis strictures were diagnosed in the postoperative period. In the 5 cases, after examination (CT of the urinary tract with contrast, antegrade ureteropyelography), the anastomosis was recognized compensated. Conclusion: It is shown that all the necessary range of operations can be performed by laparoscopic method while preserving all the advantages of low-trauma access.

Aim: to compare the results of treatment of patients with acute obstructive calculous pyelonephritis, who underwent to retroperitoneoscopic procedure, with patients, who underwent to drainage of the collecting system by means of ureteral stent or nephrostomy tube as the first stage. Materials and methods. A total of 121 patients were treated from 2011 to 2019. Of these, 78 patients were included in the main group. The stones were located in the ureteropelvic junction (n = 20) and the upper and middle ureter (n = 58). The average size of the stone was 12.9 ± 4.8 mm. Preliminary upper urinary tract drainage was not carried out and the stone was removed completely. The group 2 consisted of 26 people. The stones were located in the upper (n = 18) and the middle ureter (n = 8); the average size was 9 ± 2.8 mm. Renal drainage was done using ureteral stent and when pyelonephritis resolved, ureterolithotripsy was performed. The group 3 was represented by 17 patients. All stones were located in the ureteropelvic junction. The average size was 20.3 ± 10.7 mm. Renal drainage was done using percutaneous nephrostomy; when there were no inflammatory changes, percutaneous nephrolithotripsy was performed. Results. In the main group, normalization of body temperature and resolution of inflammatory changes in the blood and urine occurred earlier. The stone was removed completely and there were no residual fragments. Period of rehabilitation was are also significantly shorter than in groups 2 and 3. The retroperitoneoscopic method was more effective and safer for the treatment of patients with acute obstructive pyelonephritis caused by large stones located in the upper or middle ureter and ureteropelvic junction.

Objective: To evaluate histopathological outcomes and biochemical recurrence (BCR) free survival in patients after nerve-sparing radical prostatectomy (nsRP). Materials and methods: Prospective study group comprised 313 patients who underwent uni- or bilateral nsRP from 2014 to 2018; control group included 592 patients with clinically localized prostate cancer who underwent non-nsRP from 2014 to 2018. Mann-Whitney U-test was performed to assess continuous variables; chi-squared test was used for comparative analysis of categorical data. BCR free survival was evaluated with Kaplan-Meier method, log-rank test was used to compare survival outcomes. Results: Adverse histopathological findings were lower in the study group: extracapsular extension was found in 9,4% and 18,75% (p<0,001), grade group upgrade in 23% and 29,3% (p=0,04), positive surgical margins (PSM) in 15% and 22,1% (p=0,01). Subanalysis according to cancer risk groups showed lower PSM rates in high-risk patients (15,6% and 30,3%, p=0,017) and tendency for higher PSM rates in low-risk patients in the study group with no significant difference (12,6% and 7%, p=0,16). BCR free survival after 12 months was 100% and 88,2%, after 20 months - 92,3% and 86,4%, p=0,04. PSM ratesin the study group were notsignificantly different depending on the type of surgery: 13,9% in robotic-assisted approach and 15,4% in retropubic approach, p=0,75. Conclusions: Relatively favorable histopathological outcomes and BCR free survival can be achieved after nsRP. However, obtained results could not be considered optimal and clearly indicate the need for further improvement of preoperative planning and intraoperative quality control of surgical treatment.

Introduction. Undifferentiated connective tissue disease (UCTD) is genetically-determined systemic process. First clinical manifestations occur in childhood or adolescence. Varicocele is an example of varicose veins transformation and represents one of most significant “minor criterion” of the UCTD. Aim. To determine a correlation between presence of typical features of UCTD and varicocele or varicose vein dilatation of other locations. Materials and methods. Clinical data and biopsy results of 70 patients aged 3-44 years (children, adolescents and adults) were analyzed. All patients were divided into three groups. In main group, there were patients with left-side varicocele, while control group 1 included patients with varicose veins of lower extremities and control group 2 consisted of male with combined symptomatic hemorrhoids. Histological examination of vein walls and/or excised hemorrhoidal nodes was performed in all cases. In addition, patients were interviewed using the survey “Diagnostic coefficient and informative coefficient of connective tissue dysplasia”, developed up by T.I. Kadurina, which included 39 phenotypic sings. Results. The majority of all patients (58.57%) had more than 5 sings of UCTD. In 10 boys and adolescents with varicocele and 9 out of10 children with varicose veins of lower extremities, five and more sings of UCTD were revealed. Adult patients had fewer number of UCTD sings, which suggest genetic predisposition of UCTD. Most common and significant signs which were found in all groups, included pes planus, long second-toe syndrome, scoliosis of 1-2 stage, joint hypermobility. Conclusion. In our opinion, it is advisable to conduct a survey in children and young patients with preclinical stage of the varicocele, especially in boys with varicocele in the first-degree relatives, in order to identify signs of UCTD and ensure an individualized treatment approach.

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an “ideal” stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

The pathophysiological role of obesity as one of the most significant and actual metabolic non-infectious diseases and the key component of the metabolic syndrome based on results of modern epidemiological and clinical-experimental studies is discussed in the review. General information on the prevalence of obesity and its negative effect on the quality oflife of men is presented. The endocrinology of adipose tissue and associated hormonal and metabolic disorders are discussed in more detail. The analysis of pathophysiological mechanisms explaining an influence of obesity on prostate metabolism, which leads to the initiation and progression of the benign prostatic hyperplasia, is carried out. Currently, there is a large body of evidence that obesity and benign prostatic hyperplasia have a lot of common interacting pathogenetic mechanisms. An opinion that, considering a global increase in the prevalence and severity of obesity in men and its negative effects on the prostate, treatment for obesity in men can be considered as an effective primary preventive measure, and in patients with benign prostatic hyperplasia as an effective secondary preventive measure.

The active development of minimally invasive procedures on retroperitoneal organs using endoscopic technology raises the question of the most rational approach. The studies dedicated to the comparison of transperitoneal and retroperitoneoscopic approach are analyzed in the article. The advantages and the most common complications, as well as the factors limiting the widespread use of retroperitoneoscopic approach, are reviewed.

The use of the combined herbal preparation Cystenium II for the prevention of recurrent lower urinary tract infections, including those in children and pregnant women, is described in the review. The etiological component of infectious and inflammatory diseases of the lower urinary tract and specific features of the interaction of microorganisms with bladder mucosa were studied. A detailed analysis of pharmacodynamic effects of Cystenium’s II components is provided. The specific features of the treatment of acute cystitis in pregnant women and children older than 7 years are presented.