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No 2 (2020)


Validation of the Russian version of the ureteral stent symptoms questionnaire (USSQ) for the evaluation of quality of life and stent-related symptoms

Bazaev V.V., Shibaev A.N., Joshi H.B., Urenkov S.B., Zenkov S.S., Pavlova Y.V., Mamoyov A.L.


Introduction: Ureteral stents are frequently used in urology practice and have a significant impact on health-related quality of life (QoL). In 2003 Н. Joshi et al. developed the specific questionnaire for evaluation of QoL and stent-related symptoms, namely Ureteral Stent Symptoms Questionnaire (USSQ). USSQ consists of 40 questions and 2 visual analog scales (VAS), divided into 6 domains. Over the past decade, this questionnaire has been translated into 9 languages. A Russian version of the questionnaire has not been developed yet. Aim: To perform linguistic validation of the Russian version of the USSQ. Material and Methods: Linguistic validation of the original USSQ was performed through a standard process including translation, back translation and pilot study. A total of 103 patients undergone ureteral stent placement and successfully filled in the Russian USSQ at weeks 1 and 4 after stenting, and at week 4 after stent removal. In addition, 30 healthy people filled in the same questionnaires twice at 3-week intervals, as a control group. To evaluate reliability, validity and sensitivity to change of the Russian USSQ, statistical analysis was performed. External criteria included validated questionnaires (EQ-5D, IPSS and pain VAS). Results: Content validity was approved by experts and proved during patients’ interviewing. Reliability test-retest was satisfactory for urinary symptoms, body pain, general health, and work performance domains (p<0,001 between test and retest evaluation). USSQ domains showed good correlations between each other (correlation coefficient was 0,80- 0,94). Cronbach's alpha coefficient of internal reliability was 0.73 0.95. Correlation between other instruments and corresponding USSQ domains was good (p<0,001), proving criterial validity. Sensitivity to changes after stenting and stent removal was also good for most domains (p<0,001). Conclusion: Russian version of USSQ is a valid, reliable and sensitive instrument for the assessment of QoL and stent-related symptoms and is ready for application in the routine clinical practice.
Urologiia. 2020;(2):5-15
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Prostatic secretion microbiota: a comparative analysis of the chronical prostatitis II and IIIA category

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


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.
Urologiia. 2020;(2):16-22
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Phenotypic and molecular genetic properties of Escherichia coli clinical strains isolated from patients with urological diseases

Slukin P.V., Svetoch E.A., Aslanyan E.M., Astashkin E.I., Ershova M.G., Poletaeva E.D., Shepelin A.P., Fursova N.K.


Objective. Microbiological and molecular genetic characterization resistance profiles of Escherichia coli strains isolated in a pilot singlecenter clinical study from patients of the urological department in Yaroslavl in 2016-2017. Materials and methods. Clinical strains of E. coli (n=18) were isolated from the urine of women aged 23-84 years. The mobility of bacteria, colicinogenicity, and sensitivity to lactobacilli antagonism, biofilm formation, and susceptibility to antimicrobials were evaluated. The antibiotic resistance genes were identified. Results. The E. coli strains had a wide heterogeneity in mobility, colicinogenicity, and biofilm formation. They were sensitive to Lactobacillus acidophilus antagonism, as well as to nitrofurantoin, meropenem, fosfomycin and the main functional classes of disinfectants and antiseptics, but are resistant to beta-lactams, fluoroquinolones and aminoglycosides. The mcr-1 gene providing resistance to colistin was identified in two strains. Conclusions. Analysis of genetic antibiotic resistance determinants revealed the genetic diversity of clinical E. coli strains. The obtained data on the strain sensitivity to antibacterials and disinfectants can be used by clinicians in choosing the optimal antibiotic therapy and treatment of abiotic surfaces in urological departments.
Urologiia. 2020;(2):23-30
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Experimental evaluation of interaction of the nerve growth factor and mast cells in patients with interstitial cystitis/ bladder pain syndrome

Sholan R.F.


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.
Urologiia. 2020;(2):31-34
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Systemic enzyme therapy for treatment of women with chronic recurrent bacterial cystitis

Kuz'menko A.V., Kuz'menko V.V., Gyaurgiev T.A.


Introduction. In most cases, treatment of infectious and inflammatory diseases, including lower urinary tract infections, includes antibacterial drugs. However, their efficiency decreases every year. The absence of new groups of antibiotics makes it necessary to develop alternative treatment schemes and methods for improving efficiency of existing drugs. Systemic enzyme therapy is one of the promising directions in the treatment of lower urinary tract infections, which was shown to be effective for treating a number of diseases. Aim: to evaluate the results of complex treatment of women with chronic recurrent bacterial cystitis using a drug for systemic enzyme therapy. Materials and methods. The examination and treatment of 60 women aged 19 to 45 years with an exacerbation of chronic recurrent bacterial cystitis, who were randomly divided into two groups of 30 patients, was performed. In the group 1, patients received standard antibiotic therapy. In the group 2, women additionally received Phlogenzym. An evaluation of the efficiency was carried out on the 1st, 7th and 14th day and included analysis of lower urinary tract symptoms, according to bladder diaries, assessment of pain intensity and laboratory tests (C-reactive protein [CRP], IL-6, IL-1|3, TNFa. During long-term follow-up (6 months after completion of treatment), the relapse rate was evaluated in both groups. Results. At admission, all women had clinical and laboratory signs of cystitis. By the 14th day, there was normalization of evaluated parameters in both groups. However, in patients receiving systemic enzyme therapy a more rapid relief of the inflammatory process (a decrease in the frequency of urination, urgency, nocturia, severity of inflammatory changes in the blood and urine) by the 7th day of treatment was observed. During a further 6-month follow-up, relapses were detected in 9 (30%) and 4 (13.3%) patients in group 1 and 2, respectively. Conclusion. The results of the study demonstrated the high efficiency of systemic enzyme therapy. Its use for complex treatment provides more rapid relief of lower urinary tract symptoms and pain, as well as reduces the number of relapses in women with chronic recurrent bacterial cystitis.
Urologiia. 2020;(2):35-40
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Methods of the videoendoscopic correction of the ureters strictures

Zabrodina N.B., Gallyamov E.A., Kovalenko A.V., Sysoev A.M., Bechteva M.E., Ivantsov K.A.


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.
Urologiia. 2020;(2):41-45
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The application of superselective embolization of renal vessels in case of bleeding after percutaneous nephrolithotomy

Zyryanov A.V., Borzunov I.V., Danilov V.O., Makaryan A.A.


Background. Bleeding, injures to surrounding organs and pleura are serious complications of percutaneous nephrolithotripsy. The inefficiency of hemostatic therapy is an indication for superselective embolization of the renal vessels. This technique demonstrates the high efficiency in case of postoperative bleeding. Aim. To develop a treatment algorithm and to evaluate an efficiency of superselective embolization of the renal vessels, based on the results of treatment ofpostoperative complications, which are associated with bleeding. Materials and methods. A retrospective analysis of 1375 patients treated from January 2011 to December 2018 for large (over 1.5 cm) and staghorn renal stones was performed. A number of patients had various complications in the early postoperative period, which were graded according to the Clavien-Dindo classification, including bleeding due to intraoperative damage to renal vessels, which required additional interventions. The treatment strategy was based on the assessment of volume and severity of blood loss as well as the hemodynamic stability. Results. Based on the severity of bleeding and hemodynamic stability, the treatment algorithm was developed. The analysis of the results of superselective embolization of renal arteries demonstrates the high effectiveness of this technique in case of postoperative bleeding. Conclusion. Superselective embolization is an effective method of hemostasis in case of postoperative bleeding. The proposed algorithm allows for early coordination of therapeutic measures depending on the severity ofbleeding and the patient’s condition in order to evaluate the risk of continued bleeding and the determine the optimal treatment strategy.
Urologiia. 2020;(2):46-50
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Retroperitoneoscopic approach for treatment of acute obstructive calculous pyelonephritis. Alternative or a method of choice?

Lebedeva A.A., Neymark A.I., Ilyinskaya E.V.


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.
Urologiia. 2020;(2):51-55
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Psycho-emotional, vegetative-vascular and nephrological determinants of maladaptive stress in persons undergoing nephrectomy for renal cell carcinoma

Shormanov I.S., Los M.S., Kosenko M.V.


Operational stress is a combination of syndromes that can affect renal function in patients undergoing nephrectomy and affect the course of both the early and late postoperative periods. Objective: to assess the relationship of psycho-emotional and autonomic stress with changes in the functional state of the kidney in patients undergoing nephrectomy for kidney cancer. Materials and methods: The clinical study involved 75 patients (mean age 64±3 years, stage 1 CKD) who underwent nephrectomy for localized kidney cancer. In patients of the study group (n=45) before surgery and in the early postoperative period on the 1st, 7th and 14th day, somatic and psychoemotional statuses were studied using the Zung scale, Kerdo index, and glomerular reaction rate estimates. Group control (n=30) of patients who underwent nephrectomy 12 months ago, with the results of clinical studies, as a result of which there were no clinical, laboratory and radiological diseases of a single kidney. The results of biochemical, autonomic and functional tests in this group of patients were taken as the conditionally normal rate characteristic of patients undergoing nephrectomy. Results. In the course of the correlation analysis, when comparing the degree of anxiety of patients after nephrectomy (estimated by SBT according to the Tsung Anxiety Scale) with the calculated Kerdo vegetative index (VIC), a statistically significant positive relationship was found between them, especially pronounced during the first 7 days of the early postoperative period. At this time, the vegetative mediated by vasculogenic factors adaptation progressively worsened (VIC increased), while the GFR of a single kidney significantly decreased. Conclusion. Operational stress, together with all other predictors, may be a risk factor for the development of acute renal failure in the early postoperative period and the progression of CKD in the late period after surgery
Urologiia. 2020;(2):56-59
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Oncological safety of nerve-sparing radical prostatectomy: evaluation of histopathological outcomes and recurrence-free survival

Sokolov E.A., Veliev E.I., Bogdanov A.B., Veliev R.A., Goncharuk D.A.


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.
Urologiia. 2020;(2):60-65
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The effect of polymorphisms C677T and А1298С gene MTHFR on the reproductive function of men

Kulchenko N.G., Myandina G.I., Alhejoj H., Tarasenko E.V.


References. Disturbances of spermogram parameters are associated with infertility in men and are determined by polymorphisms of many genes involved in spermatogenesis. Folate metabolism plays an important role in spermatogenesis, as it is involved in the synthesis, repair and methylation of DNA. Objective: the distribution of C677T (rs1801133) and A1298C (rs1801131) polymorphisms of the MTHFR gene among infertile and fertile men in the Moscow region and to identify a possible Association of these polymorphisms with the risk of pathospermia. Materials and methods: the study included 127 infertile men with different forms of pathospermia and 68 fertile men (with one or more children). Genotyping of polymorphisms (C677T and A1298C) gene MTHFR was performed by real-time polymerase chain reaction (PCR-RV). Results. Analysis of the distribution of MTHFR genotypes (C677T and A1298C) revealed no significant differences in the distribution of genotypes in groups of infertile and fertile men. The frequency of minor allele 1298S in asthenospermia was 52%, in teratospermia was 36% and in men with azzospermia - 33% (х2=8.67; p=0.003). Discussion. To date, there are no published results on the study of the Association of polymorphisms of folate-metabolizing enzyme genes with the development of pathospermia among men in the Moscow region. The results of our study demonstrate that А1298С polymorphism of the MTHFR gene may be involved in the etiology of male infertility in patients of the Moscow region. Conclusion. Comparative analysis of gene and genotype frequencies by the studied polymorphisms in infertile men with different forms of pathospermia showed an associative relationship of allele 1298C of MTHFR gene with the risk of asthenozoospermia (p<0.05).
Urologiia. 2020;(2):66-70
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Clinical manifestations of undifferentiated connective dysplasia disease as predictors of varicocele

Severgina L.O., Studennikova V.V., Rapoport L.M., Tsarichenko D.G., Korovin I.A., Markaryan D.R., Shilova M.A.


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.
Urologiia. 2020;(2):71-75
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Modern pharmacotherapy of uncomplicated infections of the lower urinary tract: the position of antibacterial and herbal preparations

Zyryanov S.K., Butranova O.I., Al-Ragawi A.


Lower urinary tract infections (UTIs) are one of the most common types of infections in women. The existing high risk of recurrent forms, including relapses and reinfection, suggests the paramount importance of the pharmacotherapy strategy chosen by the doctor for the primary episode of lower urinary tract infection, especially acute cystitis, determining the degree of rehabilitation. Current data on the resistance of the main pathogens of UTI to many broad-spectrum antibacterial drugs, on the one hand, and the risk of subsequent resistance formation with the use of reserve antibiotics, such as fluoroquinolones, cephalosporins of 3-4 generation, on the other hand, make the search for optimal antibiotic therapy an urgent task for clinical pharmacologists, urologists and therapists. The article presents an analysis of current data on the prevalence and resistance of major pathogens and provides an review of international and Russian clinical recommendations for the management of patients with lower UTIs, especially acute cystitis, including an analysis of the positions of antibacterial and herbal drugs.
Urologiia. 2020;(2):76-84
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Design and materials for ureteral stents: past, present and future

Martov A.G., Popov S.V., Obidnyak V.M., Gadjiev N.K., Guseynov R.G., Gorelov D.S., Akopyan G.N., Gadzhieva Z.K., Spiridonov N.Y., Petrov S.B.


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.
Urologiia. 2020;(2):85-93
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The perspectives of adjuvant chemotherapy of urethral stricture

Salyukov R.V., Banaru A.M.


A review of preclinical, clinical and postclinical (comparative) studies dedicated to adjuvant therapy for urethral strictures in the form of injections and instillations is presented in the article. The focus is on studies, carried out over the past decade. An information on new antifibrotic drugs used in other areas of medicine that could potentially be used in urology is also provided.
Urologiia. 2020;(2):94-100
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The role of obesity in the pathogenesis of benign prostatic hyperplasia

Bratchikov O.I., Tyuzikov I.A., Artishchev S.O., Shumakova E.A.


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.
Urologiia. 2020;(2):101-106
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Percutaneous nephrolithotomy in patients with solitary kidney

Guliev B.G., Talyshinslyi A.E.


Percutaneous nephrolithotomy (PCNL) is the method of choice for large and staghorn renal stones, including those in patients with solitary kidney. The aim of the literature review was to analyze the results of PCNL in patients with large stones in the solitary kidney. The literature search was conducted in databases Embase, Medline, Google Scholar, Scopus for the period from 2010 to 2019. A total 94 articles were selected, of which 16 papers were included in the review after analyzing the abstracts. Data was pooled and analyzed using SPSS Statistics 22.0. The primary stone-free rate for PCNL in these patients was 68.3+14.2%, and the final stone-free rate increased by 86.5+4.9%. The average duration of the operation was 86+25 (43.7-138.3) min, the length of stay was 5 (2-6) days. The baseline creatinine level was 137 (110-200) mmol/L, compared to 142 (122-183) mmol/L postoperatively. The mean difference between the baseline and postoperative Hb level was 7.8 (1.3-17.5) g/l. The estimated glomerular filtration rate (GFR) before PCNL was 62.3+7.5 ml/min/1.73 m2, and it did not exceed 62.5+9.3 ml/ min/1.73 m2 postoperatively. The overall complication rate ranged from 10.6 to 68.8%, averaging 29.9%. In most cases, there were grade I and II complications, according to Clavien-Dindo classification, which didn’t require additional interventions. PCNL is a highly effective treatment method for patients with large stones in solitary kidney. Complications rate is relatively low, which is achieved by an individual approach, with a consideration of the condition and all risk factors.
Urologiia. 2020;(2):107-112
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Retroperitoneoscopic technologies in retroperitoneal procedures

Lobanov Y.S., Shapovalov K.G., Lobanov S.L.


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.
Urologiia. 2020;(2):113-117
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Immune response to lower urinary tract infections

Vasil'ev A.O., Zaycev A.V., Shiryaev A.A., Prilepskaya E.A., Kim Y.A., Kalinina N.A., Pushkar D.Y.


Urinary tract infections are one of the most common and widespread infectious diseases. A certain role in etiopathogenesis may play genetic predisposition, as well as a decrease in antiadhesive properties and an increase in urothelium permeability due to incompetence of bladder glycosaminoglycan layer. The prevalence of infectious diseases increases significantly with age, as well as in patients with chronic diseases. The introduction of modern biotechnology has allowed clinicians to greatly expand therapeutic armamentarium, while having a number of advantages, including minimal frequency of complications and adverse events, the possibility for long-term use, accessibility, and etc. Priority research areas include the study of toll-like receptors, which are transmembrane proteins that provide pathogen recognition and activate the immune response. The role of these receptors in the development of the immune response to urinary tract infections was evaluated in our study, which allows to predict the course of the disease and to increase treatment efficiency.
Urologiia. 2020;(2):118-121
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Combined prophylaxis of recurrent lower urinary tract infections in children and pregnant women

Kotov S.V., Perov R.A.


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.
Urologiia. 2020;(2):122-126
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