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No 4 (2021)


Evaluation of the effectiveness of surgical treatment of recurrent urethral stricture

Kotov S.V., Iritsyan M.M., Yusufov A.G., Abdulkhalygov E.K., Klimenko A.A., Korochkin N.D.


Introduction. The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. Purpose of the study. To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. Materials and methods. At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n= 43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Q max - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. Results. The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multistage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6±0.9 points. The average value of Qmax at the time of observation was 19.4±7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. Conclusions. Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.
Urologiia. 2021;(4):5-11
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A comprehensive approach to the treatment of urethral strictures caused by lichen sclerosus

Usupbaev A.C., Kurbanaliev R.M., Akylbek S., Kolesnichenko I.V., Sadyrbekov N.Z.


Aim: to evaluate the correctness of the diagnosis of lichen sclerosus with an evaluation of complications in the form of urethral strictures and to ensure long-term monitoring of patient management in order to avoid recurrence of fibrous complications and ascending infection in case of lower urinary tract obstruction. Material and methods: a total of 55 men aged from 17 to 85 years with lichen sclerosus complicated by urethral stricture who were treated from 2005 to 2020 were included in the study. All patients underwent a comprehensive urological examination. From them, 18 (32.7%) patients had previously undergone various types of urethral procedures and were admitted with recurrent urethral stricture for repeated surgery. Results: an examination of patients with lichen sclerosus complicated by urethral strictures is presented, including a morphological assessment of the resected tissue and analysis of etiopathogenetic factors. In addition, the results of complex treatment of patients with urethral strictures associated with sclerosus were evaluated. An increase in the maximum urine flow rate and a decrease in post-void residual volume by almost three times was noted 1-3 months after urethroplasty. After 6 months, a recovery of an adequate micturition and complete absence of residual urine were revealed. The morphological picture in patients with urethral strictures associated with lichen sclerosus is characterized by focal atrophy of the epidermis, replacement of the columnar epithelium with a stratified epithelium with signs of hyperkeratosis and acanthosis, histiolymphocytic infiltration, and the formation of microcalcifications under the basement membrane. Conclusion: the correctness of the diagnosis verification and the choice of the treatment strategy in patients with urethral strictures caused by lichen sclerosus significantly contributes to the favorable outcomes. Based on comparative analysis, we can conclude than complex approach to the treatment of patients with urethral strictures associated with lichen sclerosus is highly effective.
Urologiia. 2021;(4):12-18
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Characteristics of the pathogenic potential of Escherichia coli isolated from patients with calculous pyelonephritis

Pashkova T.M., Morozova N.V., Kuzmin M.D., Kartashova O.L., Popova L.P.


Objective: Comparative phenotypic and genetic assessment of the pathogenic potential of E. coli strains isolated from patients with calculous pyelonephritis. Materials and methods. 78 strains of E. coli isolated from urine of patients with calculous pyelonephritis in the acute phase (n=58) and in the remission phase (n=20). Escherichia were investigated for the presence of virulence genes papA, pap EF, papGII; afa, bma E, iutA, fyuA, feoB, kspMTII, usp multiplex PCR using selected primers. Phenotypically determined the ability to biofilm formation, antilysozyme, antihemoglobin, anticytokine, adhesive and sIgA-protease activity E. coli. Results. The virulent potential of Escherichia coli at the pheno- and genotype levels was characterized. In strains of E. coli isolated from the urine of patients in the remission phase, the ability to form biofilms was more often and with high values of the trait; and in strains isolated in relapse - adhesive activity, the ability to inactivate pro- and antiinflammatory cytokines, antihemoglobin activity, and genes encoding aphimbrial adhesin (afa), responsible for the synthesis of siderophore aerobactin (iutA), transporting bivalent iron (feoB). Conclusion. The revealed differences in the pheno- and genotypic profiles between the cultures of Escherichia coli isolated from patients with calculous pyelonephritis in the phases of exacerbation and remission make it possible to differentiate the isolated strain and predict the course of the infectious-inflammatory process.
Urologiia. 2021;(4):19-24
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Cluster analysis of the main parameters of homeostasis with kidney injury

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


Introduction. Damage to the structure of the kidney in blunt trauma leads to disruption of angioarchitectonics and microcirculation. Objective: to establish the dependence of renal function and circulatory system on the severity of injury and the type of blunt renal trauma. Materials and Methods. The clinical and laboratory homeostasis tests were carried out in 127 patients with the kidney parenchyma contusion and ruptures in the nearest posttraumatic period. Results. Five factors and five clusters of signs were revealed. Tissue level reactions predominate in case of contusion injury of less than half of the organ. Trauma of more than half of the kidney and parenchyma rupture involve the circulatory system in the response reaction. Conclusion: the volume/area and type of damage are predictors in the level of the functional response of the organism - organ or organismal.
Urologiia. 2021;(4):25-29
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The efficiency of probiotics in the prevention of recurrent lower urinary tract infections and bacterial vaginosis

Dobrohotova Y.E., Korotkikh I.N., Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A.


Introduction. The literature data indicate that bacterial vaginosis (BV) increases the risk of development oflower urinary tract infections (LUTI). Thus, it is reasonable to assume that the use of probiotics, in particular Lactoginal, can be effective in preventing relapses of LUTI. Aim. To study the efficiency of probiotics, particularly Lactoginal, for the prevention of recurrent LUTI and BV. Materials and methods. A total of 120 women with chronic recurrent bacterial cystitis in the acute stage and concomitant bacterial vaginosis were randomized into two groups of 60 patients. In group 1, standard antibacterial therapy was used according to guidelines of professional societies. In group 2, vaginal probiotic Lactoginal was prescribed after standard treatment. Results. The results obtained in this study correspond to the literature data. The additional use of probiotics in the complex therapy of chronic lower urinary tract inflammation contributed to the normalization of the lactobacilli concentration in 93% of cases, in contrast to standard antibacterial therapy, after which the normal flora was preserved only in 40% of cases. In addition, a reduction in the number of relapses of BV was seen. Moreover, it was found that in the group of patients treated with Lactoginal, there was 18.3% less recurrence of cystitis within 6 months than in the control group (p<0.05). Conclusion. The use of probiotics, in particular, Lactoginal vaginal capsules, in women with BV after antibacterial therapy contributes to a faster recovery and longer preservation of the normal vaginal flora, which allows to the prolongate the relapse-free period of both chronic bacterial cystitis and BV.
Urologiia. 2021;(4):30-34
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The effectiveness of Alloferon in the complex therapy of chronic recurrent papillomavirus cystitis

Ibishev K.S., Krakhotkin D.V., Mamedov V.K., Palenyy A.I.


Introduction: Chronic recurrent cystitis (CRC) for women is one of the most pressing and unresolved problems of modern urology. Purpose of the research: To study the effectiveness of Alloferon (Allokin-alpha) in the complex therapy of chronic reactive papillomavirus cystitis. Materials and methods: 46 patients with CRC PV-etiology were examined, which, depending on the therapy, were randomized into two groups. Patients of group I (n=22) received combination therapy supplemented with Alloferon, which was injected subcutaneously every 1 day, for a course of 6 injections. Group II (control) (n=24) - combination therapy without study drug. The effectiveness of treatment was assessed immediately after treatment, after 1, 3, 6 months, from the beginning of therapy. Results: When analyzing the results of treatment, a significant improvement in clinical indicators was noted in patients of group I who received complex therapy, which included Alloferon, after 1 month from the start of treatment, there was a significant decrease in pain symptoms and LUTS, an improvement in the quality of life of patients compared with group II. When evaluating the dynamics of laboratory data, in the general analysis of urine, a significant decrease in the level of leukocytes and erythrocytes in the general analysis of urine was noted. In addition, the analysis of the data of cytological examination of urine revealed a decrease in the specific sign of papillomavirus lesions of the bladder -coylocytosis: after 6 months. From the start of therapy, no coylocytes were detected in group I, while in group II, coylocytes in urine were detected in 8 (33.3%) patients. Conclusions: The use of Alloferon (Allokin-alpha) in the complex therapy of patients with CRC PV etiology improved clinical and laboratory parameters after 1 month. after starting therapy, while the undoubted advantage of the drug is a faster reduction in pain, which significantly increased the quality of life.
Urologiia. 2021;(4):35-40
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Whole-body PET/CT scan with 18F-FDG glucose for a clinical assessment of renal parenchyma viability

Berdichevskyy B.A., Berdichevskyy V.B., Bichenova A.G., Barashin D.A.


Aim: to perform a comparative analysis ofthe results of morphofunctional and morphoanatomical studies for the clinical assessment of the viability of the renal parenchyma. Materials and methods. Based on a random sampling method, the results of whole-body PET/CT scan with 18F-FDG glucose in 134 patients with various non-urological disorders were analyzed. However, 13.3% of the participants had concomitant chronic kidney diseases without exacerbation. At the same time, the morphoIogicaI and anatomicaI manifestations of chronic kidney disease were studied in 32 patients of the same age and sex in order to evaluate the severity of structural changes in nephron. Results. It was found that among individuals undergone to whole -body PET/CT scan with 18F-FDG glucose for various diseases without a urological history and patients with chronic kidney disease, the parenchyma tropism to energy-intensive labeled glucose molecules had certain differences that correlated with morphoanatomical manifestations of structural changes in the nephron in chronic kidney disease. Conclusions. The modern morphofunctional PET/CT study of the whole-body viability with 18F-FDG glucose, including the kidneys, is an advanced diagnostic tool that may supplement the results of morphoanatomical studies and monitor the efficiency of treatment.
Urologiia. 2021;(4):41-46
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The use of neural algorithms when choosing a method of surgical treatment of urolithiasis

Ershov A.V., Neymark A.I., Kapsargin F.P., Berezhnoy A.G., Vinnik Y.Y.


Aim: to assess the possibility of using neural network algorithms in choosing a method for surgical treatment of urolithiasis. Materials and methods: treatment results of 625 patients with kidney stones were analyzed in the study. Information about each patient was presented in the form of a multidimensional vector characterized by following preoperative investigations: questionnaires, clinical examination, instrumental and laboratory studies. A register was created where information on more than 50 parameters for each patient was added. Each example has an output parameter representing a predefined treatment strategy (extracorporeal shock-wave lithotripsy [ESWL] - 1, percutaneous nephrolithotomy [PCNL] - 2, pyelolithotomy or nephrolithotomy - 3). The initial database served as the basis for training the neural network estimation technique. Results. A prospective trial was conducted to assess the clinical efficiency of the recommendations of neural network. A cohort of 150 patients admitted to the urology department was divided into two groups of 75 people. In the group 1, patients received treatment according to the standard recommendations. In group 2, treatment strategy was chosen based on the results of neural network analysis. In the group 1, ESWL was performed in 40 (53.3%) patients. The average number of sessions was 1.8. At the discharge, residual fragments were diagnosed in 12 (30%) cases. In 4 patients, acute pyelonephritis developed, which required performing ureteral catheterization and subsequent treatment. In group 1, the efficiency of ESWL was 75%. In the group 2, where the neural network assessment technique was used, the average number of sessions was 1.4. At the discharge, 7 (15.6%) patients had residual fragments: 4 in the kidney, in 3 in the lower ureter ("steinstrasse"). In 4 cases, a conversion for PCNL was performed. ESWL efficiency was 91.1%. Stone-free rate for ESWL in the second group was significantly higher due to the greater number of stone fragmentation. In addition, number of shock waves was lower (the average number of sessions was 0.4 less). Improvement of treatment tactics through the use of neural network algorithms led to a decrease in hospitalization times, as well as to an improvement in the quality of treatment. The low efficiency of ESWL, as the first-line method, led to a change in treatment tactics in 25% of patients in group 1 and only in 8.9% of patients in group 2. Using these algorithms, it was possible to reduce hospitalization time, need for changing treatment strategy, number of auxiliary procedures, readmission rates, the incidence of inflammatory complications, and the number of residual fragments after ESWL. Conclusions. The possibility of using the neural network prediction technique at the preoperative stage in patients with kidney stones has been shown. This technique allows practicing urologist to make a decision on the choice of the optimal treatment method on an individual basis, thereby minimizing the risk of early postoperative complications.
Urologiia. 2021;(4):47-52
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Protection of the prostate in conditions of chronic pelvis varicose

Tsukanov A.Y., Rudchenko N.V., Mozgovoy S.I., Maslyukov A.V.


Introduction. Chronic prostatitis is the most common urological disease. The morphological outcome of chronic inflammation is sclerosis, leading to the loss of functional active tissue. Venous congestion of the small pelvis can act as a trigger factor in the development of prostate sclerosis. Venotonics in combination with antioxidants may be considered for organoprotection of the prostate in pelvic varicose veins. Purpose: to evaluate the protective effect of an antioxidant, venotonic and their combination on the process of formation of connective tissue in the prostate gland against the background of pelvic varicose veins in a chronic experiment. Materials and methods. The experiment was carried out on a proven model of chronic venous congestion of the small pelvis and was carried out on 64 sexually mature rabbits weighing 2.6-3.2 kg. 5 groups have been identified. In the first group (n=15), an assessment of the effect of isolated antioxidant (resveratrol) was carried out. In the second group (n=15), an assessment of the effect of isolated venotonic (diosmin) was studied. In the third group (n=15), the effect of a combination of an antioxidant (resveratrol) and venotonic (diosmin) was evaluated. An aqueous solution of the preparations was injected daily for 180 days. In the fourth group (n=15), changes in the prostate were assessed against the background of venous congestion without exposure. In the fifth group (n= 4), animals performed to provide data on normal anatomy. The animals were taken out of the experiment at 30, 90, 180 days. Prostate tissue was collected for histological examination and morphometry. In prostate samples, the concentration of hydroxyproline, a marker of connective tissue development, was investigated. Results: the isolated administration of resveratrol, as well as diosmin, does not sufficiently compensate for the changes in the hemodynamics of the small pelvis and the toxic effect of metabolic products. With morphometry on day 180, the proportion of glandular tissue in the gland / fibrosis ratio was significantly higher, and fibrosis was lower in Group 3 (79.36 / 9.08 (p<0.01) than in Group 1 (63.1 / 22.74) and Group 2 (65.52 / 21.0) .Quantitative study of hydroxyproline showed lower concentrations in the samples of Group 3 18.44 mg% (p<0.01), relative to Groups 1 and 2 (39.7 and 34.44 mg%) There were no statistically significant differences in the studied parameters between Groups 1 and 2. Conclusion: the use of a combination of diosmin and resveratrol against the background of chronic venous hyperemia allowed, in the course of the presented experiment, to reduce the lesion volume and the growth of fibrous tissue in the prostate gland. The approach itself requires further study.
Urologiia. 2021;(4):53-60
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Monitoring of nocturnal penile tumescence in healthy volunteers by the “Androscan MIT” registrar to establish reliable normal physiological values in a multicenter study

Erkovich A.A., Aliev R.T., Nasedkina T.V., Demidenko E.S., Khabarova O.I., Notov I.K., Andreev U.G., Raff L.S.


Aim. To evaluate the normal numerical and graphic values of nocturnal penile tumescence (NPT) test using Androscan MIT in healthy males in order to use the collected data as reference standard. Materials and methods. NPT monitoring was carried out in 38 healthy male volunteers by fixing a sensor designed for 20 measurements on their penis. During the NPT test the following parameters were recorded: 1) total sleep time; 2) minimal penis diameter (PD) in the flaccid state recorded by the apparatus; 3) maximum PD during effective penile tumescence; 4) absolute PD increase during effective erections; 5) increase in PD in %; 6) the overall time of the rigid-erection phase; 7) the number of penile rigidity episodes; 8) the average duration of each effective erection; 9) the percentage of rigid erections during the whole monitoring period. Results. Based on the data collected by Androscan MIT, we have specified the numerical values which characterize normal physiological NPT indices in healthy male volunteers. The number of tests performed and similar inclusion criteria contribute to the objectiveness of the presented data. Normal sleep time was from 7.3 to 9.5 hours. Monitoring during sleeping reflected the upper and lower limits of the minimal PD value recorded by Androscan MIT, which was from 23.5 mm to 30.2 mm. The maximum PD increase during the most effective erection varied from 35.3 mm to 44.3 mm. Total PD increase was from 10.6 mm to 15.4 mm (from 35.6% to 59.2%). In all cases a significant difference in PD increase between flaccid state and effective erection during sleeping was seen. The number of penile rigidity episodes varied from 3 to 7 a night. The overall time of effective erections was from 62.3 to 206.7 minutes, while the minimum duration of a single erection episode was 16.4 minutes and the maximum duration reached 35.8 minutes. The ratio of effective NPT to the total sleep time (the percentage of penile rigidity episodes) varied from 11.9% to 41.3%. Conclusion. Our results allowed to define reference qualitative and quantitative values of NPT in healthy male volunteers recorded by Androscan MIT which can be considered as normal and physiological and used for differential diagnostics of erectile dysfunction.
Urologiia. 2021;(4):61-67
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Electronic microscopy assessment of immunological disorders in the secret of the prostate in patients with chronic recurrent bacterial prostatitis

Krainii P.A., Ibishev K.S.


Introduction. Chronic recurrent bacterial prostatitis (CRPD) is an urgent problem of modern urology and andrology. Objective: To study the immunological features of the secretion of the prostate by electron microscopy in patients with chronic recurrent bacterial prostatitis. Materials and Methods. The analysis of the morphometric study of neutrophils in the secretion of the prostate was carried out in 90 patients with chronic bacterial prostatitis, who were divided into two groups. Group I (study) (n=51) with chronic recurrent bacterial prostatitis (CRBP) and group II (control) (n=39) with chronic primary diagnosed bacterial prostatitis (CPDBP). Results. At electron microscopy of ALE in most patients with CRBP of the group, the cytological picture of ALE was represented by inactive neutrophils with pathology of phagocytosis. The cells are of the correct rounded shape, without pseudopodia, with light cytoplasm. The cytological picture of ALE in CPDBP is characterized by the absence of impaired local immunity. The normal process of phagocytosis is recorded, where many pseudopodia of the segmented neutrophil completely complete the process of opsonization of microorganisms in the area of the inflammatory process. Conclusions. In patients with CRBP, in 100% of cases, dysfunction of immunocompetent prostate cells was noted, which is the basis for the appointment of immunoactive therapy for CRBP.
Urologiia. 2021;(4):68-72
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Predictors of fertility recovery in subfertile men after varicocelectomy

Shomarufov A.B., Bozhedomov V.A., Akilov F.A., Mukhtarov S.T., Shavakhabov S.S., Abbosov S.A., Kamalov A.A.


Introduction. Varicocelectomy does not always lead to semen improvement and male fertility recovery. Objectives. Analysis of total progressive motile sperm count (TPMSC) predictive role in fertility recovery of subfertile man after varicocelectomy in combination with other predictors. Materials and methods. This prospective, open, multi-center study comprises 93 men from infertile couples with clinical varicocele who underwent microsurgical (inguinal or subinguinal) varicocelectomy. The changes in the standard semen analysis studied according to WHO 2010 Standards. We also evaluated spontaneous pregnancy rates. A discriminant analysis was carried out with step-by-step selection to identify reliable predictors of pregnancy after varicocelectomy. An increase in TPMSC by at least 12.5 million was considered as a good effect of varicocele repair (reference values for the number and progressive sperm motility according to WHO 2010: 39 million x 0.32 (32%) progressively motile). Patients were divided into 3 groups in regards of direction and degree of semen changes: group I included 48 patients with increase of TPMSC>12.5 million, group II comprised 20 patients with mild increase in TPMSC (0.1 - 12.5 million) and the III group comprised patients without any effect (TPMSC did not change, or became less than preoperative one) after varicocelectomy. The initial clinical characteristics of patients in the groups were compared. Results. A significant effect was observed in 52% of cases (n=48), a mild favorable effect in 21% (n=20), and no effect in 27% (n=25). Spontaneous pregnancy rates (in 1 year after varicocele repair) were higher in patients of group I than that of groups II and III: 46%, 10% and 12%, respectively (p<0.05). The initial clinical characteristics between groups were comparable (p>0.05). In group I, the initial semen analysis parameters were significantly better than in group II and worse than in group III: the median and 25% -75% of the quartiles for TPMSC were 15 (1-44), 0 (0-8) and 54 (19-100) million, respectively (for all p<0.001). According to discriminant analysis significant predictors of pregnancy after varicocelectomy were an increase of TPMSC, male age and the initial total sperm motility. The predictive accuracy of the prognostic model with these three predictors was 84%, specificity was 87%, and sensitivity was 76%. Conclusions. The odds of fertility recovery after varicocelectomy has a U-shaped relationship: it is higher in patients with moderate semen quality impairment and it decreases in patients with initially low, and, conversely, high sperm count and motility. An increase in TPMSC by 12.5 million or more is a highly significant indicator of fertility recovery, because in this case the odds of spontaneous pregnancy can reach 50%. Predictors of fertility recovery after varicocelectomy are an increase of TPMSC, male age and the preoperative total motility.
Urologiia. 2021;(4):73-78
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Penile glans amputation during circumcision: causes, treatments and preventive measures

Rudin Y.E., Runenko V.I., Marukhinenko D.V., Aliev D.K., Rudin A.Y.


Introduction. Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. Materials. Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. The results. The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). Conclusion. Visual control of the glans position during circumcision will prevent the amputation. «Guillotine» techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.)
Urologiia. 2021;(4):79-86
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Kidney transplantation from Covid-19 positive deceased donor: what are the consequences for recipients?

Perlin D.V., Alexandrov I.V., Shmanev A.O., Dymkov I.N., Perlina A.V.


Introduction. In recent months, with the spread of COVID 19, the number of kidney transplants from deceased donors has declined significantly in most countries. One of the reasons is the possibility of infection of the recipient with SARS-CoV-2. Determining the risk of transmission of COVID 19 with a donor organ is very important for developing a kidney transplantation policy during a pandemic. Material and method. We present cases of kidney transplantation from COVID 19 positive deceased donor to two dialysis patients in single center. Deceased donor: a 45 years old man with diabetes, who had a major hemorrhagic stroke resulting in brain death. He had normal urine output and serum creatinine level for last 24 hours before kidney harvesting. For a few hours after organ harvesting, the donor was diagnosed COVID 19 (retrospective nasopharyngeal swab rRT-PCR which was confirmed by morphological examination and RNA-PCR of specimens from the trachea and bronchus). Recipient 1: a 49 years old man with polycystic kidney disease had been on hemodialysis for 28 months. He was in urgent list because of problems with vascular access. So non identical ABO (0-donor, B-recipient) kidney transplantation from this deceased donor was done in May 2020. Recipient 2: a 45 years old man with polycystic kidney disease on continuous ambulatory peritoneal dialysis (CAPD). Не was registered on urgent waiting list because of low transport capacity of peritoneum. Kidney transplantation from the same deceased donor was done at the same time. In both cases we completely abandoned any antilymphocytic agents for induction, despite non ABO identical transplantation in one of the recipients and the delayed graft function. Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone and a mycophenolic acid. Results. In first case cold ischemia time was 22 hours. The recipient had delayed graft function with increasing of urine output on day 8 post-transplant. No other deviations from the usual course were seen during hospital stay. The patient was discharge from hospital with serum creatinine level 122 mkmol/L. The cold ischemia time was 21 hours in another patient. Graft function was immediate with a decrease serum creatinine to 92.5 mkmol/L at discharge. Both patients had no febrile and no other symptoms of acute respiratory disease during all hospital stay. No abnormalities on chest X-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs rRT-PCR were negative during all the period. Both recipients were discharged for 5 weeks after surgery to prevent out-of-hospital contamination of COVID 19, which would be difficult to differentiate from transmission infection. After 9 months both patients are doing well with no clinical or laboratory signs of COVID-19. Conclusion. Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-Cov-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level. Avoiding the use of anti-lymphocyte drugs for induction of immunosuppression may also reduce the risk of developing COVID19 after transplantation. A careful collection and analysis of such dates is necessary to develop modern practical recommendations for transplant centers.
Urologiia. 2021;(4):87-92
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Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis

Kholtobin D.P., Shevchenko S.Y., Kulchavenya E.V.


Introduction: Late diagnosis ofrenal tuberculosis leads to complications that cannot be eliminated by treatment. Clinical case. A clinical observation of patient Ch., born in 1976, who was admitted to TB Research Institute of Ministry of Health of Russia on 17.02.2020. A diagnosis was cavernous renal tuberculosis. Tuberculosis of the ureter. MBT (-). Right ureteral stricture (obliteration), complicated by ipsilateral hydronephrosis. Right nephrostomy tube (2018). Clinical cure of disseminated pulmonary tuberculosis. He underwent planned laparoscopic bowel substitution of the right ureter on 10.03.2020. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. Conclusion. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.
Urologiia. 2021;(4):93-96
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Rationale for the choice of an antibiotic for urinary tract infections with an emphasis on the environmental safety of therapy

Yakovlev S.V., Suvorova M.P.


Difficulties in prescribing antibiotics for lower urinary tract infections (UTI) are associated with a fact that such patients can be treated not only by urologists, but also by general practitioners, internists, pediatricians, and gynecologists. Therefore, it is important to adapt the practical recommendations for the treatment of cystitis for different medical disciplines. When creating clinical guidelines, experts take into account the different factors in choosing antibiotic therapy. First of all, pharmacokinetics is of importance and drugs with renal excretion should be preferred. Secondly, the natural activity of the antibiotic against the pathogens, which cause cystitis, has to be considered. In uncomplicated infections, E. coli predominates, while in complicated and recurrent infections E. coli and other enterobacteria are commonly isolated, as well as Enterococci. In addition, local resistance pattern is reviewed. In the Russian Federation E. coli has minimal resistance to nitrofurans and fosfomycin. Lastly, antibiotics can negatively affect the gastrointestinal and urinary tract microbiota and contribute to the increase of antibiotic resistance and the selection of antibiotic-resistant strains, therefore the environmental safety of therapy should be considered. The effect of antibiotics on the resident flora of the gastrointestinal tract, urinary tract and vagina is called collateral effect, or concomitant (parallel) damage, and it may exceed the therapeutic effect of some antibiotics. Cephalosporins and fluoroquinolones can cause ecologically unfavorable effects with the risk of selection of resistant strains; therefore, these drugs are currently considered as second-line agents for UTI. When choosing an antibiotic, preference should be given to drugs with the narrow spectrum and minimal collateral damage, i.e., the principle of "minimum sufficiency” is of importance. Nitrofurans and fosfomycin trometamol are the optimal drugs in terms of efficiency and environmental safety in UTI. WHO experts consider nitrofurans as the most environmentally safe antibiotics with a minimally sufficient spectrum of activity. The environmental safety of antimicrobial therapy is an important component of preventing antibiotic resistance at the global and local levels.
Urologiia. 2021;(4):97-105
pages 97-105 views

Sperm retrieval techniques in patients with non-obstructive azoospermia

Akhvlediani N.D., Reva I.A., Chernushenko A.S., Pushkar D.Y.


Patients with non-obstructive azoospermia (NOA), which accounts for up to 10-15% of all cases of male infertility, until recently could only become parents using donor sperm or through adoption. Modern technical capabilities of sperm extraction in combination with the use of assisted reproductive technologies, make it possible to effectively overcome infertility in this group of patients. A number of highly effective techniques have been proposed for spermatozoa retrieval. However, surgical intervention is associated with certain risks, and therefore, the choice of the optimal treatment method is under discussion. A total of 52 articles were analyzed using the MEDLINE database (PubMed) to form an overview of the current principles of examination and preparation ofa patient with NOA for the surgical sperm retrieval. This review is dedicated to the role of diagnostic testicular biopsy. In addition, a comparative information on the efficacy and safety of percutaneous, fine-needle aspiration, open multifocal and microdissection (micro-TESE) testicular biopsies is presented. Of the currently available sperm retrieval techniques in the urologic armamentarium, micro-TESE seems to be both the most effective and the safest. Micro-TESE can be a cumbersome procedure, however, it provides successful treatment in situations previously associated with zero chance of pregnancy.
Urologiia. 2021;(4):106-113
pages 106-113 views

The use of vascularized scrotal and penile flaps in reconstructive surgery of the urogenital region

Kamalov A.A., Adamyan R.T., Ekhoyan M.M.


The aim of the work is to present a modern view on the clinical application of urogenital flaps, such as autologous scrotal flap and foreskin. This plastic material has such characteristics as acceptable extensibility, good blood supply, accessibility and the absence of significant defects in the donor area. The use of urogenital flaps is an actual and promising direction in reconstructive urology. Unfortunately, currently there is not much literature data on the efficiency of using this type of flaps. Recent literature, both national and foreign studies, dedicated to using urogenital flaps, including comparative data with flaps of other localizations, are reviewed in the article. The review consists of several parts, corresponding to certain groups of nosologies, for the treatment of which urogenital flaps of different localization were used.
Urologiia. 2021;(4):114-120
pages 114-120 views

Surgical treatment of autosomal dominant polycystic kidney disease

Biktimirov T.R., Martov A.G., Biktimirov R.G., Baranov A.V., Miloserdov I.A., Kaputovskij A.A., Khitrikh A.M.


The significance of the problem of autosomal dominant polycystic kidney disease (ADPKD), one of the most common hereditary diseases, is due to the specific features ofits course, simultaneous damage to several organs, the lack of etiotropic treatment, and rapid progression into chronic kidney disease. The only effective treatment for patients with ADPKD at the stage of end-stage chronic renal failure is chronic hemodialysis and kidney transplantation. The role of nephrectomy during the preparation for kidney transplantation in patients with ADPKD is an important and controversial issue. On the one hand, the large size of the kidneys, technical difficulties during dissection, and the invasiveness of the procedure results in a high incidence of complications during and after nephrectomy (3540%) in this population. On the other hand, immunosuppressive therapy in the early and late periods after transplantation puts patients with ADPKD on an extremely high risk of septic complications if own kidneys are preserved. According to the world literature, the use of laparoscopic techniques has significantly reduced the incidence of complications of nephrectomy in patients with ADPKD (up to 9.5%).
Urologiia. 2021;(4):121-125
pages 121-125 views

Theoretical basis of the uropatogens interactions with the host-organism in case of occurrence and development of acute pyelonephritis (review - part III)

Kogan M.I.


The formation and development theories of bacterial inflammation in organs and tissues have been studied in detail and confirmed by experimental and clinical data. However, the development ofinflammation in each organ has its characteristics associated with its structures and functions. This fully applies to acute pyelonephritis. The peculiar structure of uropathogens, their virulence, the reaction of the host organism in response to bacterial invasion, namely, factors of innate and acquired immunity, are analyzed in detail in the review. It reflects both the basic mechanisms of development of acute pyelonephritis and proteomic and genetic factors involved during inflammatory lesions.
Urologiia. 2021;(4):126-131
pages 126-131 views

Bidirectionality of cardiovascular risk factors in patients with urolithiasis: current state of the problem

Murkamilov I.T., Aitbaev K.A., Fomin V.V., Murkamilova Z.A., Yusupov F.A., Schastlivenko A.I.


The most common risk factors for cardiovascular disease and urolithiasis are presented in the article. Data on the prevalence of urolithiasis are discussed, as well as the pathogenetic mechanisms of stone formation in patients with metabolic syndrome, dyslipidemia, and arterial hypertension. The bi-directional relationship of cardiovascular risk factors and urolithiasis is generalized. The role of calcium, uric acid, citrate, changes in urine pH and an increase in body weight in the formation of kidney stones is shown
Urologiia. 2021;(4):132-137
pages 132-137 views

Treatment of the chronic prostatitis: current state of the problem

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


A review of the literature on the urgent problem of urology, which is therapy of chronic prostatitis (CP) is presented. Despite numerous studies dedicated to the prevention and treatment of CP, it has not yet been possible to reduce the CP incidence. Therapeutic approaches aimed at improving the quality of life are not always effective due to the lack of a clear understanding of the etiology and pathogenesis of the disease. Leading Russian urologists recommend introducing into the complex therapy of CP a domestic drug from the cytomedin, namely Vitaprost, which causes a significant decrease in the severity of trophic disorders, inflammatory and congestive processes, improves microcirculation in the prostate, stimulates cellular and humoral immunity, all of which increase the effectiveness of CP therapy.
Urologiia. 2021;(4):138-144
pages 138-144 views

Reflux nephropathy in children: pathogenesis and prognosis. Part 2

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


The second part of this review is devoted to the issues of modern and promising diagnosis of RN in children. The advantages and limits of the available methods for recording the structural and functional state of the kidneys in childhood are considered. Particular attention is paid to possibilities non-invasive methods for diagnosis and prediction of the disease course. Data on promising biomarkers of the early stages of RN formation and progression are presented. For the purpose of a comprehensive and adequate assessment of morphological changes in the kidneys, the necessity of studying various combinations of cytokines in biological media with the subsequent determination of the optimal spectrum is shown. The sensitivity and specificity of molecular indicators of renal damage reviewed as potential targets for renoprotective therapy in the nearest future.
Urologiia. 2021;(4):145-151
pages 145-151 views

The role of male factor in pregnancy loss

Korshunov M.N., Korshunova E.S., Kastrikin Y.V., Efremov E.A., Darenkov S.P.


Currently fertility specialists pay close attention to miscarriage. Spontaneous abortion and recurrent pregnancy loss in an early period of gestation are a frequent complication of pregnancy. Etiology of miscarriage includes genetic abnormalities, immunological disorders, endocrine abnormalities, infections and lifestyle factors. About 40% of cases of pregnancy losses remain unexplained. The role of male factor in miscarriages is considered in the review. The influence of advanced paternal ages, sperm DNA fragmentation, chromosomal abnormalities on pregnancy loss in natural conception or by assisted reproductive technique are described.
Urologiia. 2021;(4):152-157
pages 152-157 views

Review of biomarkers for early diagnosis of acute kidney injury in patients with concomitant trauma

Makhov M.K., Miziev I.A.


Modern methods for the early diagnosis of acute kidney injury using high-precision biomarkers in various pathological conditions, including patients with combined trauma, is reviewed in the article. The pathological processes of cell damage underlying the etiology and pathogenesis of acute kidney injury require a quick and early start of preventive measures. As a consequence, the problem of early diagnosis of acute kidney damage and search of ways to optimize it are still relevant. In case of a possible acute kidney injury, in addition to situations when the renal tissue is already damaged, it is very important to determine level of acute kidney injury biomarkers in biological fluids. The results of our clinical study carried out in the clinic of the Department of Faculty and Endoscopic surgery of the KBSU named after H.M. Berbekov, dedicated to the early diagnosis of acute kidney injury in patients with combined trauma using the serum biomarker cystatin С, are also presented
Urologiia. 2021;(4):158-163
pages 158-163 views
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