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No 3 (2021)


Antiadhesive strategy for non-antibacterial prophylaxis of recurrent lower urinary tract infections

Kuz’min I.V., Slesarevskaya M.N., Al-Shukri S.H.


Introduction. The importance of recurrent lower urinary tract infection (LUTI) is associated with its high frequency, a significant decrease in the quality of life and insufficient efficiency of currently available treatment methods. Due to the high antibiotic resistance of uropathogens, the role of alternative therapeutic strategies increases, including substances with antiadhesive properties. Aim: to evaluate the efficiency of a biologically active additive (BAA) «Ecocystin» containing D-mannose and inulin for the prevention of recurrent LUTI in women. Materials and methods. A total of 74 women aged 21 to 75 years (mean 47.4+13.6 years) with recurrent LUTI were included in the study. After the initial treatment of LUTI all the patients were divided into two groups. Patients of the main group (n=44) received BAA «Ecocystin», containing D-mannose with antiadhesive properties and inulin, which is a prebiotic, to prevent recurrence of LUTI. Ecocystin was prescribed 1 sachet packet 2 times a day for the first 3 days, and then 1 sachet packet 1 time a day for 6 months. The Ecocystin sachet contains 1.5 g of D-mannose and 1.5 g of inulin. In the control group (n=30) were not prescribed Ecocystin. Clinical indicators were assessed on the 3rd day, as well as after 3 and 6 months from the beginning of the study. Results. During the first 3 months, recurrent LUTI were diagnosed in 51.7% of patients in the control group and only in 15.9% of patients in the main group (p=0.002). By the 6th month of follow-up, relapses were seen in 75.9% and 29.5% of patients, respectively (p<0.001). In the main group a significant increase in the time interval before the onset of recurrence was found. During the first three months of follow-up, the recurrence of LUTI in the main group developed on average after 43.4+14.3 days compared to 28.2+13.5 days in the control group (p=0.026). In addition, severity and duration of recurrent LUTI in patients of the main group were less pronounced than in the control group. Conclusion. Our results showed that Ecocystin is an effective drug for the prevention of recurrences in patients with recurrent LUTI. Considering antiadhesive properties of D-mannose, which is part of Ecocystin, this drug can be recommended as a pathogenetically justified alternative to the antibacterial drugs.
Urologiia. 2021;(3):5-12
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Laparoscopic substitution of the proximal ureter using buccal mucosa

Guliev B.G., Komyakov B.K., Avazkhanov J.P.


Introduction. In patients with long ureteral strictures, bowel substitution of the ureter or kidney autotransplantation can be performed, which are technically demanding. For recurrent uretero-pelvic junction obstruction (UPJO) and proximal ureteral strictures, substitution of the ureter using buccal graft may be an alternative. Aim: to study the results of laparoscopic ureteral substitution in patients with long proximal ureteral strictures using buccal graft. Material and methods. Laparoscopic ureteral substitution of the ureter using buccal graft was performed in 10 patients with long proximal ureteral strictures, 7 of them were men. The average age was 43.5 years. In 6 patients there was a recurrence after previous pyeloplasty, while 3 patients had ureteroscopy due to upper ureteral stone and one patient had ureteral trauma during laparoscopic excision of the kidney cyst. Three patients were admitted to the hospital with nephrostomy tube, seven with a ureteral stent. Using a laparoscopic approach, an affected part of the ureter was dissected along its length, then a stent was placed antegrade and the ureter was substituted with buccal graft using the onlay technique. Results. All patients underwent laparoscopic intervention. There were no intraoperative complications. The duration of the procedure ranged from 170 to 340 minutes. There were no cases of anastomotic leakage. Fever was observed in one patient without nephrostomy drainage (Clavien grade I). On intravenous pyelography and computed tomography, the neoureter was wide and patent. In patients with PUJO, a severity of dilation of the collecting system was decreased over time. Clinically, all procedures were successful, as patients were free of nephrostomy tube and symptoms of upper urinary tract obstruction. Conclusion. Ureteral substitution using buccal graft may be the method of choice in patients with long proximal ureteral strictures. It is relatively easy, since it does not require extensive dissection of the ureter and provides for the possibility of using buccal graft of the desired length.
Urologiia. 2021;(3):13-19
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Phenazopyridine and fosfomycin for the acute cystitis treatment: results of multicenter randomized study

Davidov M.I., Meltsina M.N., Bunova N.E., Metelkin A.M., Prussakov O.R., Lunev A.A.


Aim. To evaluate the analgesic effect, efficacy and tolerability of phenazopyridine in combination with fosfomycin for the treatment of acute uncomplicated cystitis in working-age female. Material and methods. A total of 152 women with acute uncomplicated cystitis were included in multicenter, randomized, open-label study which were carried out in 5 polyclinics of the Perm Territory. All the patients were divided into 2 groups of 76 people each, depending on the treatment. In the main group, women received oral phenazopyridine 200 mg 3 times a day for 2 days (a total dose 1200 mg) and fosfomycin trometamol in a dose of 3 g once. In the control group, patients received a single dose of fosfomycin trometamol (3 g) and drotaverin 80 mg 3 times a day for 2 days. A visual analogue scale (VAS) was used for evaluation of pain intensity. The symptoms of cystitis were assessed using the ACSS scale. In addition, urinalysis, urine culture and other methods were done. The results were evaluated after 6, 12, 24, 48 hours, 3 and 6 days. Results. In the main group, the severity of pain according to the VAS decreased from the initial 7.2±0.5 points to 1.6±0.2 points after 12 hours, to 0.4 ± 0.05 points after 24 hours. Pain syndrome completely disappeared in all patients after 48 hours. In the control group, at all time points, a significant less pronounced analgesic effect was seen (p<0.001). The overall ACSS score in the main group decreased from the 12.0±0.5 points to 2.1±0.3 after 3 days and to 0.28±0.04 points after 6 days (p<0.001), which indicated a more rapid resolution of symptoms compared to the control group. The symptomatic effect of phenazopyridine (relief of pain, dysuria and discomfort) provided a more pronounced improvement in the well-being in the main group in comparison to the control group, which was confirmed by Dynamics domain of the ACSS scale (p<0.001). The combination of fosfomycin and phenazopyridine was more effective than the combination of fosfomycin and drotaverine. The clinical and microbiological cure rate in the main group was 97.4% and 96.9%, respectively. Leukocyturia was resolved earlier, and the duration of treatment decreased by 30.1%. An undesirable effect of phenazopyridine (nausea) was detected only in 1 (1.3%) patient. Conclusion. Phenazopyridine has a pronounced analgesic effect and is proved to be an effective and safe drug in patients with acute uncomplicated cystitis.
Urologiia. 2021;(3):20-27
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Kanefron N in the treatment of non-diabetic glucosuria in patients with recurrent upper urinary tract infection

Berdichevsky B.A., Berdichevsky V.B., Shidin V.A., Cologne A.A., Naletov A.A., Khilkevich S.V., Novoselov V.G.


Aim. Purpose to analyze the effectiveness of the herbal preparation Canephron N in the relief of nondiabetic glucosuria in patients with recurrent upper urinary tract infection (UTI). Materials and methods: the study included 100 patients, 53 of them were women (median age of all patients 42 (35; 58) years) with recurrent UTI. Patients were referred to the urology department to exclude the obstructive component and concomitant chronic diseases. Upon further examination, all patients were found to have nondiabetic glucosuria. Fifty patients received standard etiotropic treatment, in 25 patients it was simultaneously supplemented with the herbal drug Canephron N, and 25 patients, after standard treatment, continued monotherapy with this phytopreparation. Clinical and laboratory dynamics was assessed in the course of various treatment regimens. Results. The study found that the recurrent course of chronic UTI may be associated with nondiabetic glucosuria. In patients who received standard therapy in combination with the herbal preparation Kanephron N, a decrease in the intensity of nondiabetic glucosuria with more effective eradication of the bacterial pathogen was noted. At the same time, monotherapy of manifestations of IVMP, which are refractory to etiotropic therapy, with Kanefron N also proved to be quite effective. Conclusion: the combination of standard therapy for refractory manifestations of UTI with the herbal preparation Kanephron N is accompanied by the leveling of nondiabetic glucosuria (1.3+0.4 and 0.6+0.4 mmol/L, p<0.05), coinciding with a decrease in leukocyturia (25.5+4.5 and 9.5+1.5 in field of vision, p<0.05)
Urologiia. 2021;(3):28-32
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Characteristics of pathogenesis and manifestations of nephrolithiasis in patients with chronic cardiovascular diseases

Yarovoy S.K., Royuk R.V.


Aim. To study the pathogenetic and clinical features of nephrolithiasis in patients with concomitant chronic cardiovascular diseases (CVD), particularly the chemical composition of renal stones, the frequency of relapses, as well as the daily dynamics of the urine specific gravity and acidity level as the main factors of stone formation. Materials and methods. A total of 270 patients were treated in the Department of the urology No. 1 of the "Main Military Clinical Hospital named after N. N. Burdenko" of the Ministry of Defense of the Russian Federation during the period from 2008 to 2018. The main group included 184 patients suffering from nephrolithiasis, of which 72 had hypertension in combination with coronary heart disease, and in other 112 patients chronic heart failure (CHF of stage I, IIA and IIB in 55, 37 and 20 patients, respectively) was previously diagnosed. Data on the CVD were obtained from medical records; ifnecessary, patients were referred to an internist and/ or cardiologist. The CHF was staged in accordance with the Strazhesco-Vasilenko (1935) classification. In the control group there were 86 patients with urolithiasis without any cardiovascular disorders. A retrospective analysis of the stone composition was performed using a NICOLET iS10 spectral analyzer. The urine specific gravity and acidity (pH) was determined using a semi-automatic analyzer CLINITEK Status Plus three times a day (both during hospital stay and 3 months after discharge). Statistical analysis was done using the SPSS program v.19. The absolute values (M±m) were calculated, as well as Min, ME, Mo, Max. Relative values, including Fischer criterion, were evaluated, taking into account the Bonferroni correction. Differences were significant if p-value was < 0.05. Results. There was no difference between groups in age (32; 64; 83). In both groups men were predominated (~ 75-78%). According to chemical analysis, stone composition in the control group was as following: oxalates (76.6%), uric acid (9.3%), phosphates (8.1%); mixed stones (6.7%). Independent of stage of CHF, respective figures were 51.4, 23.6, 8.3 and 16%, respectively. The follow-up of patients for 5 years showed that patients were admitted to the urological hospital with a stone recurrence on average 1.8 times, compared to 3 and 3.8 times with concomitant CVD and CHF, respectively. The most concentrated (specific gravity of 1035) and the most acidic (pH =5.5-5) urine in patients with CHF was found in the evening. Conclusion. Chronic CVD has a significant impact on the clinical manifestations of urinary stone disease. The most pronounced changes are associated with CHF. Features of nephrolithiasis in patients with a CVD include the predominance of uric acid and urate stones, more frequent recurrences, shift in the peak of acidity and urine specific gravity from morning to evening hours.
Urologiia. 2021;(3):33-38
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Overactive bladder: urodynamic characteristics of detrusor overactivity due to the etiology of low urinary tract dysfunction

Philippova E.S., Bazhenov I.V., Ziryanov A.V., Zhuravlev V.N.


The aim of the study was to detect features of detrusor overactivity as an urodynamic phenomenon in patients with different etiology of low urinary tract dysfunction. Materials and methods. The study included 283 patients (61% females and 39% males) aged 18-82 years (49.2+13.5) with neurogenic overactive bladder (n=197), idiopathic overactive bladder (n=41), radiation cystitis (n=8) and chronic pelvic pain (n=37). All patients underwent an urodynamic study (UDS) in Sverdlovsk Regional Clinical Hospital in the period from 2017 to 2020. Results. Detrusor overactivity was detected by UDS in 63.4% patients with idiopathic, 94.2% with neurogenic overactive bladder (OAB) and 2.7% in patients with pelvic pain. Maximal amplitude of detrusor pressure during involuntary bladder contraction was significantly higher in neurogenic dysfunction than in idiopathic (25.76+26.21 cm Н2О and 10.1+3.4 cm Н2О respectively, p=0.003). According to the ROC-analysis, detrusor pressure amplitude has a high predictor value in the diagnosis of a neurogenic origin of overactive bladder (AUC=0.863, p=0.045). The sensitivity of pressure more than 9.5 cm Н20 was 88%. Bladder volume at the time of first involuntary contraction was 137+120 ml and 218+120 ml (p=0.07) for neurogenic and idiopathic OAB respectively. Neurogenic detrusor overactivity followed by urgency incontinence more often than idiopathic (59.5% vs 19.2%). Conclusion. Neurogenic detrusor overactivity is characterized by larger amplitude and higher rate of urgency incontinence.
Urologiia. 2021;(3):39-44
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Cystoscopic and morphological features of chronic recurrent papillomavirus cystitis

Ibishev K.S., Krakhotkin D.V., Lapteva T.O., Todorov S.S., Ryabenchenko N.N., Mantsov A.A., Kogan M.I.


Introduction. Chronic recurrent cystitis (CRC) is a common disease in the female population and a serious medical problem. There are not enough data about etiology of this desiase and effective treatment. Objective. To increase the accuracy of the differential diagnosis of bacterial and papillomavirus chronic recurrent cystitis. Materials and methods. Analysis of endoscopic and morphological diagnostic methods of 118 patients with CRC, which, depending on the etiological factor, were divided into two groups. Group I (n=65) patients with CRC of HPV etiology and Group II (n=53) - CRC of bacterial etiology (E. coli). All patients were examined according to the EAU and RSU recommendations, and an endoscopic examination of the bladder (cystoscopy) was additionally included, followed by morphological examination of biopsy specimen of the urinary bladder. Results: The endoscopic picture of bacterial CRC usually is caused by hyperemia of the mucous membrane of the bladder, hyperemia and injection of vessels with the participation of (small-puncture/diapedesic) hemorrhages without signs of proliferative changes. The endoscopic picture in papillomavirus CRC in all patients presented by focal or diffuse, slightly elevated, exophytic, often polypoid formations of a whitish or whitish-gray color, usually localized in the Leto triangle. Morphological analysis of biopsy tissue of the urinary bladder in patients with bacterial cystitis in the mucous and submucous layer showed edema, thickening of the urothelium, capillary abundance, inflammatory infiltration, represented by lymphocytes, plasma cells and leukocytes, among which neutrophilic macrophage leukocytes were predominant. Morphological analysis of the bladder mucosa in all examined patients with signs of HPV-related lesions showed a thickening of the urothelium, squamous metaplasia of the urothelium, chronic inflammation, microcirculatory vascular reaction and edema. An important distinctive pathomorphological sign of HPV within urinary bladder was the presence of koilocytic transformation of urothelium cells due to the cytopathic effect of the virus. Conclusions: Papillomavirus CRC has characterized by an infectious-inflammatory process in the bladder paries, with lymphocytic-plasmatic infiltration and coylocytic transformation of the urothelium.
Urologiia. 2021;(3):45-49
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Diagnosis of infected kidney cysts in patients with autosomal dominant polycystic kidney disease and end-stage renal disease

Lubennikov A.E., Shishimorov A.A., Trushkin R.N., Isaev T.K., Kotenko O.N., Krupinov G.E.


Aim: to improve the differential diagnosis of infected cysts in patients with ADPKD and to reduce false-positive rate of MR-urography. Materials and methods: a total of 33 patients with ADPKD who underwent bilateral nephrectomy from 2015 to 2020 were included in the retrospective single-center study. In the group 1 (n=17) patients with histologically confirmed infected cyst (s) were included, while in the group 2 (n=16) there were patients without infected cysts. The frequency of symptoms (pain in the loin area, fever), the level of leukocytes in blood and urine, C-reactive protein (CRP) and the results of kidney MRI were compared. Results. Pain, fever, leukocytosis, leukocyturia, and increased CRP levels were significantly associated with infected cysts. The sensitivity and specificity of MRI was 88.2% and 43.8%, respectively. The infected cysts were characterized by a significantly (p=0.004) lower value of the apparent diffusion coefficient (ADC): 0.67±0.21x10-3 mm2/s (95% confidence interval (CI) 0.56-0.79), versus 1.2±0.59*10-3 mm2/s (95% CI 0.89-1.5) in group 2. According to ROC analysis, the ADC value at the cut-off point was 0.83*10-3 mm2/s. The frequency of infected cysts during histological examination increased when the volume of the cyst was more than 13 ml. In multivariate analysis, only the CRP level was a reliable predictor of the presence of infected cysts. ROC analysis showed that the CRP level at the cut-off point was 83 mg/L (sensitivity 70.6%, specificity 75%). Conclusion: In case of fever, pain in the loin area and high CRP level in patients with ADPKD, it is necessary to exclude infected cysts. MRI of the kidneys with the determination of the ADC level in cysts with limited diffusion on diffusion-weighted images is a highly informative method that allows to clarify the content of cysts.
Urologiia. 2021;(3):50-55
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Extravesical reimplantation of heavily-dilated ureters according to Bradic technique

Kogan M.I., Belousov I.I., Krasulin V.V., Gusev A.A.


Introduction. Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Gregoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradic technique (1975) for the first time in the literature is presented. Materials and methods. The authors’ modification of the Bradic technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width. Results. No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring. Conclusion. The Bradic technique along with the Hodgson’s ureter reconstruction provides superior results for heavily-dilated ureters in adults.
Urologiia. 2021;(3):56-60
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Multicenter randomized study of bovhyalu-ronidase azoximer (Longidaza®) in men after transuretral resection of the prostate

Kotov S.V., Bolotov A.D., Belomyttsev S.V., Surenkov D.N., Vorobyova A.V.


Introduction. Transurethral resection of the prostate (TURP) is the gold standard of BPH surgical treatment. It is of current interest to search for medications that can reduce the incidence of complications after TURP. Aim. To evaluate the efficiency of Longidaza® (rectal suppositories of 3000 IU) as part of combined therapy in order to prevent complications after TURP. Materials and methods. The study included 202 patients who underwent TURP in 3 hospitals. The patients were divided into 2 groups: main group - 96 men taking standard postoperative therapy with Longidaza® rectal suppositories N 20; control group - 106 men - taking standard postoperative therapy (tamsulosin 30 days; fluoroquinolone 5 days). Follow-up included IPSS, urinalysis, urine culture, ultrasound examination of the prostate volume (PV), post void residual urine, uroflowmetry at 1,2,3,6 months after surgery. Average preoperative indices: IPSS 27 [23; 30], Qol 5 [4; 6], prostate volume (PV) 71±19cc (30-272 cc), Qmax 7.5±2.5ml/s (1,3-18,7 ml/s). Results. There was a significant improvement in IPSS, QoL, Qmax, PV, post void residual urine (PVR) compared to preoperative values during the entire observation period. There was no statistical difference between the main and control groups for these indexes in 6 months. In the main group had statistically lower incidence of bacteriuria at 3 (11% vs 17%) and 6 months (7% vs 17%), and leukocyturia at 3 (31% vs 46%) and 6 months of follow-up (20% vs 44%). Overall incidence of infectious complications and additional antibacterial drugs prescription was lower in the Longidaza® group compared to the control group (17,7% vs 20,7%). Urethral strictures developed in 7 men in the main group, and 8 in the control group. Conclusion. Our results show that prescription of Longidaza® significantly reduces the incidence of leukocyturia and bacteriuria postoperatively, decreasing the rate of infectious complications in men after TURP.
Urologiia. 2021;(3):61-69
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The use of bioregulatory peptides in the treatment of men with benign prostatic hyperplasia and chronic prostatitis

Kuzmenko A.V., Vinnik Y.Y., Kuzmenko V.V., Gyaurgiev T.A.


Introduction. Benign prostatic hyperplasia (BPH), and chronic prostatitis (CP) are considered to be among the most common causes of lower urinary tract symptoms (LUTS) in men. The combination of BPH with CP raises many questions when choosing the right treatment strategy. For a long time, bioregulators isolated from the prostate gland of cattle have been successfully used in the treatment of CP. Objective: to evaluate the effectiveness of bioregulatory peptides, in particular vitaprost, in the treatment of men with benign prostatic hyperplasia and chronic prostatitis. Materials and methods. The study included 60 patients with BPH and CP, who were divided into two groups of 30 people. In the comparison group (CG), complex therapy with drugs from the group of alpha-blockers and fluoroquinolones was performed. In the main group (MG), a similar complex therapy was performed in combination with vitaprost tablets. The effectiveness of the treatment was evaluated after two weeks (visit 2) and after 4 weeks (visit 3). Results. In the MG, a more effective reduction in the severity of LUTs and manifestations of the inflammatory process was noted than in the HS. After 2 weeks of therapy in OG, the average score on the IPSS, QOL and NICH-CPSI questionnaires was lower by 2.4 points, 1.2 points and 2.5 points, respectively, the number of white blood cells in the prostate secret was on average 1.5 times less, and Qmax was higher by 1.4 ml/sec. The revealed differences were statistically significant (p<0.05). This trend continued after 4 weeks of therapy. Conclusion. Thus, the use of bioregulatory peptides, in particular the drug vitaprost, in patients with BPH and CP helps to reduce the severity of LUTs and pain in a shorter time, has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life of patients in this category.
Urologiia. 2021;(3):70-74
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Type of vascular anastomosis and early outcome after kidney transplantation

Tadayon F., Shariati A., Tolou_Ghamari Z.


There are usually two main techniques of vessel anastomosis called as; end-to-end or end-to-side. The aim of this study was to investigate surgical vascular anastomotic and its’ correlation with early outcome after kidney transplantation. Data including gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, preference of artery or vein in addition to biochemical variables were noted analysed by SPSS. The study population was comprised of 84 females and 176 males (174 living versus 86 deceased donor). Surgical vascular anastomic techniques were based on; first artery second vein (FASV; n=209) or first vein second artery (FVSA; n=51). Vascular anastomic were performed as follow; group 1 (FASV with end-to-end; n= 52%), group 2 (FASVwith end-to-side; n=29%), group 3 (FVSA with end-to-end; n=15%) and group 4 (FVSA with end-to-side; n= 5%). Comparison of groups showed that; deceased/living donor (group 1 versus group 3; p=0.02), ATN (group 1 versus group 2; p=0.002, group 1 versus group 4; p=0.03). Despite the higher use of deceased donors, those with vascular anastomic technique based on FASV (end-to-end) revealed a lower rate of ATN when compared to other techniques. Further studies in this direction recommended.
Urologiia. 2021;(3):75-81
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Two-layer posterior reconstruction of the vesicourethral anastomosis during robotic-assisted radical prostatectomy

Kodzokov M.A., Spot E.V., Proskura A.V., Gazimiev E.S., Damiev A.D., Gazimiev M.A.


Aim. To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP). Material and methods. A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA. Results. One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast. Conclusion. The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.
Urologiia. 2021;(3):82-86
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Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone

Kochkin A.D., Gallyamov E.A., Medvedev V.L., Biktimirov R.G., Novikov A.B., Sanzharov A.E., Sevryukov F.A., Sergeev V.P.


Objective: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. Materials and methods: Retrospective multicentral comparative study. Group “Combo” was presented by patients with the mentioned combined pathology (n=15). Group “Standart” (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: Results: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+3,8 vs 15,9+4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for “Combo” & “Standart” respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. Conclusion: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.
Urologiia. 2021;(3):87-91
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Comparative analysis of clinical features of robotic-assisted and laparoscopic partial nephrectomy

Plekhanova O.A., Mono P., Martov A.G., Golubev M.Y., Grigoriev N.A., Kyzlasov P.S., Abdullaev D.A.


Introduction. Kidney cancer (mostly renal cell carcinoma) is one of the ten most commonly diagnosed malignant tumors among men and women. Due to the widespread use of computer tomography and magnetic resonance imaging, the proportion of early-stage kidney cancers has increased. Currently, treatment options for stage 1 kidney cancer are radical nephrectomy, partial nephrectomy, and active surveillance. Among organ-preserving intervention, three main techniques can be distinguished: open surgery, minimally invasive surgery and ablation methods. To date, robotic-assisted procedures have occupied their place among minimally invasive interventions.Aim. To carry out a comparative analysis of two methods of organ-preserving treatment of kidney tumors, namely robot-assisted and laparoscopic partial nephrectomy.Materials and methods. A retrospective comparative analysis of two groups of patients with kidney tumors who underwent robotic-assisted or laparoscopic partial nephrectomy during the period from 2012 to 2019 was performed.Results. There were no differences between two groups in age, mean score on the RENAL nephrometry scale, preoperative creatinine levels, tumor size, and duration of warm ischemia. However, duration of surgery, the volume of blood loss, serum creatinine after surgery, the length of stay, the use of the technique of early unclamping of the renal artery, the use of technique "off-clamp" and the proportion of exophytic tumors with growth were significantly different between patients of two groups.Conclusion. We believe that the robotic system is intuitively convenient for performing partial nephrectomy, allowing the treatment of potentially more complex cases and expanding the indications for organ-preserving procedures
Urologiia. 2021;(3):92-97
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Clinical and morphological assessment of the results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of Retzius-sparing technique

Golubtsova E.N., Veliev E.I., Sokolov E.A., Paklina O.V., Knyshinsky G.V.


Objective: To compare the perioperative, functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. Materials and methods: A prospective analysis was performed of two groups of patients (n=54) who underwent nerve-sparing robot-assisted radical prostatectomy (period from 2017 to 2018). The first group included 29 patients who underwent nerve-sparing robot-assisted radical prostatectomy with Retzius-sparing technique, the second - 25 patients operated on according to the standard method of bilateral nerve-sparing radical prostatectomy. All patients were comparable in baseline characteristics. In all cases, patients had histologically verified localized prostate cancer pT2a-2c. Results: In cases with use Retzius-sparing technique there is no statistically significant difference in the operation time (243.60 min vs 236.64 min, in groups 1 and 2, p>0.05) and intraoperative blood loss (131.20 ml vs 122.57 ml , in groups 1 and 2, p>0.05). Regarding the dynamics of the urinary continence recovery, the Retzius-sparing technique demonstrates advantages in speed and frequency at all follow-up periods (54.13% vs 41.81%; 68.12% vs 59.21%; 94.15% vs 90 , 63%; 98.54% vs 97.12%; 98.62% vs 97.31%; 98.83% vs 97.82% - in one week after removal of the urethral catheter, 1, 3, 6, 9, and 12 months in the first and second group, respectively). The frequency of erectile function recovery after 12 months was 82.17% and 71.14% in the first and second groups, respectively. Conclusions: Retzius-sparing robot-assisted prostatectomy superior to standard operation in the speed and timing of recovery of urine continence and erectile function.
Urologiia. 2021;(3):98-103
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Long-term results of radical surgery treatment of patients with bladder cancer

Komyakov B.K., Sergeev A.V., Fadeev V.A., Al-Attar T.H., Stetsik E.O., Ulyanov A.Y., Savashinsky Y.S., Kirichenko O.A., Rodygin L.M.


Purpose. To investigate long-term results after radical cystectomy in patients with bladder cancer. Materials and methods. Since 1997 to 2020 yy. we have performed 404 radical cystectomy with different methods of derivation for patients with bladder cancer in our clinic. There were 342 (86,4%) men and 62 (13,6%) women. Laboratory study, ultrasound, X-ray, CT. MRI investigations were performed in all patients. Results. Mortality rate was 2,9%. Early and late postoperative complications have occurred in 136 (33,6%) and 98 (41,8%) cases, respectively. Local recurrence has occurred in 33 (8,5%) patients. 10-years overall and cancer-specific survival were 43,4% and 47,2%, respectively. In lymph-negative patients 2-years and 5-years overall survival were 81,2% and 67,2%, respectively. In lymph positive patients 2-years and 5-years overall survival were 46,9% and 13,9%, respectively. In lymph-negative patients 2-years and 5-years cancer-specific survival were 83,6% and 70,7%, respectively. In lymph positive patients 2-years and 5-years cancer-specific survival were 51,0% and 15,1%, respectively. Overall and cancer -specific survival decreased according to increasing pT-stage and histopathologic grade. Conclusions: pT-stage (pT), lymp nodes status (pN), histopathologic grade ( pG) have a significant independent influence on overall and cancer-specific survival of bladder cancer patients after radical cystectomy.
Urologiia. 2021;(3):104-109
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Improvement of oncologic results of transurethral resection in the treatment of non-muscle-invasive bladder cancer

Zubkov A.Y., Nuriev I.R., Sitdykova M.E.


Aim: To evaluate the efficiency of additional methods of intraoperative control during transurethral resection (TUR) for the treatment of nonmuscle invasive bladder cancer. Material and methods. A total of 138 patients (92 men and 46 women) with non-muscle-invasive bladder cancer (Ta-T1N0M0) were treated in the urological clinic of Kazan State Medical University. The median age was 59 years. In 28 patients TUR was performed as monotherapy, in 28 patients TUR with photodynamic therapy (PDD) was done and other 26 patients undergone TUR under dynamic transurethral ultrasound control. In 29 patients, TUR was combined with a single intravesical instillation of a chemotherapy drug, and in 27 patients, TUR was combined with long-term intravesical chemotherapy. The frequency and type of relapses was evaluated depending on the treatment method during five-year follow-up period. Analysis of postoperative complications and their severity was performed according to the Clavien-Dindo classification. Statistical analysis was performed using the Statistica 7.0 and Microsoft Excel 2003 software package. Survival was assessed using the Kaplan-Meier method. Differences in survival between groups were determined using a log-rang test. Results. The total 5-years recurrence rate in the group 1 was 60.71% (n=17). There were 6 recurrences in the resection area (21.43%) and 8 recurrences outside the resection area (28.57%). The progression rate was 10.71% (n=3). In the group 2, the overall recurrence rate was 25% (n=7), including 2 (7.14%) and 4 (14.29%) recurrences in and outside resection area, respectively. The progression rate was 3.57% (n=1). In the group 3, where TUR was performed in combination with transurethral ultrasound, 7 recurrences were diagnosed over a five-year period (26.92%), including 1 recurrence in the resection area (3.84%) and 6 recurrences in other parts of bladder (23.07%). There was no progression of bladder cancer. In the group of patients who received a single intravenous chemotherapy after TUR, there were no significant differences with the group of patients where TUR was performed as monotherapy. The total number of recurrences was 55.16% (n=16). There were 4 recurrences in the resection area (13.79%) and 9 recurrences in other parts of bladder (31.03%), as well as 3 case of disease progression (10.34%). At the same time, in the group of patients where prolonged course of adjuvant intravesical chemotherapy was performed, a significant decrease in the recurrences rate in the resection area (7.4%; n=2) and progression (3.7%, n=1) was found. The number of recurrences outside the resection area was comparable with the group 1 (22.22%; n=6). Conclusions. According to our data, we recommend to perform TUR in combination with PDD and transurethral ultrasound in order to improve the oncological results. Long-term intravesical chemotherapy is an effective alternative in case of inability to use additional intraoperative control and it should be included in the treatment scheme of patients with a high risk of recurrence.
Urologiia. 2021;(3):110-113
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Risk factors of developing lymphogenic complications after radical prostatectomy with pelvic lymph node dissection

Kotov S.V., Prostomolotov A.O., Nemenov A.A.


Introduction. Prostate cancer (PCa) is very common and real problem in oncourology. The main treatment for localized and locally advanced prostate cancer is radical prostatectomy (RP). Performing RP with pelvic lymph node dissection (PLND) in patients with intermediate and high cancer risk may be associated with an increased risk of developing lymphogenic complications, such as: lymphedema, prolonged lymphorrhea, and the formation of lymphatic cysts (LC). Purpose: to assess the impact of risk factors on the development of lymphogenic complications after RP with PLND. Materials and methods. From January 2017 to March 2020 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department were performed 203 RPs with PLND, of which retropubic RPs (RRP) without the formation of peritoneal flap in 101 patients, RRP with the formation of peritoneal flap in 51 patients, laparoscopic RP (LRP) also in 51 patients. All operations were performed by different surgeons. Univariate comparisons and multivariate logistic regression analysis were used to compare and define independent risk factors for lymphogenic complications. Results. 85 patients (41,9%) out of 203 developed lymphogenic complications, such as symptomatic LC developed in 13 (6,4%), and asymptomatic LC in 38 (18,7%), prolonged lymphorrhea was observed in 25 (12,3%), lymphedema in 9 patients (4,4%). The incidence of lymphogenic complications was higher in the group with RRP without the formation of peritoneal flap in 53 patients compared to RRP with the formation of a peritoneal flap in 18 patients and LRP in 14 patients (53 compared to 32; p=0,028). Extended PLND compared with standard PLND was also one of the risk factors for the development of lymphogenic complications (55 compared to 30; p<0,001). Patients with lymphogenic complications had a larger number of lymph nodes removed (17 compared to 13; p=0,004). Age, body mass index, prostate volume, pTN, Gleason score, time of surgery, blood loss during surgery, the presence or absence of percutaneous drainage did not show a significant statistical difference. In a multivariate analysis extended PLND, the number of lymph nodes removed, and RRP without the formation of peritoneal flap remained the independent predictors of lymphogenic complications. Conclusions. In our study, RRP without the formation of peritoneal flap, extended PLND, and the number of lymph nodes removed, are significantly associated with a high risk of developing lymphogenic complications.
Urologiia. 2021;(3):114-121
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Varicocele and reproductive function: epidemiology and infertility risk (the eamination of 3632 patients)

Bozhedomov V.A., Shomarufov A.B., Bozhedomova G.E., Okhobotov D.A., Kamalov D.M., Kamalov A.A.


Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. The study objective: to evaluate the quantitative correlation between varicocele and reproductive function with a large sample. Design: a cross-sectional and case control study. Materials and methods: 3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel. Results: we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (р<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (р<0.001), 0.11 for DNA fragmentation (р<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% и 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (р<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05). Conclusion. In varicocele, the sperm count decreases but in ¾ of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is ≤1.13).
Urologiia. 2021;(3):122-128
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Renal abscess in children

Kagantsov I.M., Sizonov V.V., Dubrov V.I., Svarich V.G., Shidaev A.K., Orlov V.M., Moskal A.A.


Introduction .Renal abscesses are relatively rare in children, but they can lead to prolonged hospital stay and life-threatening complications. Scrutiny of the literature over the past two decades indicates the absence of a unified tactic for the treatment of purulent-destructive forms of pyelonephritis in children, while more and more articles are appearing in terms of a low -key approach to the treatment of renal abscess in children. Materials and methods. From 2005 to 2019, we treated 59 children with the renal abscess. Among the patients were 22 (37.3%) boys and 37 (62.3%) girls. The location of the abscess on the right was determined in 30 (50.8%) children, on the left, in 29 (49.2%). The average age of the patients was 109 months. The median size of kidney abscess among all patients was 29 [21; 42] mm (range from 12 to 69 mm). Results. The results of treatment were evaluated in the period from 3 months to 5 years. In 27 (45.8%) patients, conservative treatment gave a positive effect, while in 32 (54.2%) abscess puncture was performed under ultrasound guidance. The median hospitalization in patients after an abscess puncture was 15 [14; 18] days, against 13 [9; 17] days for children receiving only antibiotic therapy. The duration of hospital stay was significantly longer in the group of patients who underwent puncture (p=0.019). The effectiveness of conservative therapy was a lot lower in patients with a kidney abscess of more than 3 cm, 60% versus 31% (p=0.026). All 59 patients recovered completely, and none of them required an open surgery to drain a suppurative focus of a kidney or nephrectomy. Conclusion. Conclusion. Our experience confirms the literature data, indicating the need to use a conservative approach to the treatment of patients with the renal abscess as a first-line therapy. Identification of an abscess with a diameter of more than 3 cm in patients considerably increases the likelihood of using an abscess puncture with the absence of the efficacy of a conservative approach.
Urologiia. 2021;(3):129-135
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Management of pediatric patients with urachal remnants

Poddubny I.V., Isaev Y.A.


Background. Management ofthe patients with urachal remnants (URs) has been under discussion for a long time. The traditional approach with surgical removal of all urachal remnants, has been changed to a more conservative, which is preferred by many surgeons, especially in asymptomatic patients. Aim. The purpose of this study was to optimize the treatment of patients with URs, primarily for asymptomatic children. Results. Our previous screening study showed that real incidence of the URs in childhood is significantly higher than it was previously stated. Based on our data and the results of literature review, we propose an algorithm for the workup and treatment of children with URs. Conclusion. We assume that the risk of developing complications (primarily, malignancy) was previously significantly overestimated. In this regard, we recommend conservative tactics in in most asymptomatic cases.
Urologiia. 2021;(3):136-139
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Sources of bacterial penetration into the kidney (review - part II)

Kogan M.I., Naboka Y.L.


Kidney and upper urinary tract infections are a serious general medical problem that is the subject of ongoing experimental and clinical research. However, etiological factors and the pathophysiological mechanisms of acute infectious renal inflammation are poorly understood. This also applies to the problem of sources of bacterial penetration into the kidney. The existing hypotheses on this score have «blank spots». This review comprehensively examines the pathways of invasion of microorganisms into the kidney, causing the development of acute inflammation in it. The proofs in favour of the existing views and their criticism are presented. Also, weaknesses in the inference system are determined.
Urologiia. 2021;(3):140-144
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The closed injury of a kidney and posttraumatic arterial hypertension: condition of study of a problem

Chiglintsev K.A., Zyryanov A.V., Chiglintsev A.Y., Zhuravlev V.N.


The article summarizes the world’s information on the history of the study, classification, management tactics of patients with closed kidney injury, analysis of the development of post-traumatic arterial hypertension (AH). In a research of renovascular and renoparenchymal mechanisms of a syndrome of AG there is no consensus of dependence on severity of injury of a kidney, a type of treatment, about the temporary period between getting injured and emergence of a complication that defines relevance of further studying.
Urologiia. 2021;(3):145-148
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Reflux nephropathy in children: pathogenesis and prognosis. Part 1

Morozova O.L., Lakomova D.Y., Zakharova N.B., Maltseva L.D., Manasova Z.S., Morozov D.A.


The purpose of this review is to analyze the modern literature about renal damage caused by vesicoureteral reflux (VUR). VUR is the most common urodynamic pathology in children and reflux nephropathy (RN), as its main complication, ranks first among the causes of chronic kidney disease (CKD). The risk factors for the appearance and progression of RN are presented in the first part of the review. In the framework of this issue, the main methods of treatment of VUR and associated urinary tract infection are described. The possibilities of conservative and surgical methods for the elimination of reflux for prevention of RN and prognosis of its course are considered. The main morphological aspects of RN formation are described.
Urologiia. 2021;(3):150-154
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Surgical treatment of patients with urogenital tuberculosis

Kholtobin D.P., Kulchavenya E.V.


Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.
Urologiia. 2021;(3):155-161
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Use of intelligent analysis in urology

Harbedia E.K., Rapoport L.M., Gridin V.N., Tsarichenko D.G., Kuznetsov I.A., Sirota E.S., Alyaev Y.G.


The main methods of intellectual analysis (IA) used in modern medicine are described in the review. The main areas for IA application in the healthcare are diagnostics, treatment, prognosis of the course and efficiency of treatment in various diseases. The IA is based on mathematical methods and algorithms. The basic concepts of IA along with examples of its use in urological practice are presented in the review.
Urologiia. 2021;(3):162-166
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