No 5 (2021)

Aim: to study the role of P2 receptors in impaired bladder contractility in patients with lower urinary tract obstruction. Materials and methods: in pharmacological studies, tissue samples from the bladder wall of 30 patients were used, obtained during planned surgical interventions for benign prostatic hyperplasia (transvesical simple prostatectomy without placement of cystostomy tube). Based on these tissue, isolated smooth muscle specimens were prepared. Their mechanical activity and the efficiency of ligands of purine P2 and other receptors were evaluated. With this aim, the following P2-receptor agonists were used: adenosine triphosphoric acid (ATP), adenosine diphosphoric acid (ADP), uridine-5'-triphosphoric acid (UTP), alpha, beta-methylene-ATP, 2-methylthio-ADP, as well as antagonists of P2-disulfonate receptors acid (PPADS), suramin, NF023, MRS2500. In addition, the efficiency of ligands of other receptors, including carbacholine, epinephrine, histamine, serotonin, atropine was evaluated. Results: the most effective agonist was alpha-beta-methylene-ATP, while ATP and 2-methylthio-ADP were significantly less active. In our experiments, ADP and UTP did not show an effect on human bladder. The influence of P2 receptor agonists was inhibited by P2 receptor antagonists PPADS and suramin, as well as MRS2500, although to a lesser extent. Carbacholine caused a strong concentration-dependent contractile response of the bladder, which was inhibited by atropine. Histamine resulted in mild bladder contractions only at high concentrations. Epinephrine and serotonin did not cause significant changes in the contractile activity of the bladder. Conclusion: The main subtype of P2 receptors involved in the contractile activity of the human bladder is P2X1 receptors. P2Y1 receptors also have some influence on the contraction, while other subtypes of P2 receptors are not detected by pharmacological methods.

Introduction. Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the "patient-doctor" format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed. Aim. To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation. Materials and methods. A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer "ETTA AMP-01" on dipstick. Data transmission was performed through a mobile application, which is part of the "NetHealth" information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used. Results. By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high. Conclusion. A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.

Urethral pain syndrome (UPS) is characterized by the occurrence of persistent or recurrent pain in the urethra in the absence of a confirmed infection and other obvious local pathological changes. The study of its pathogenetic aspects is important first of all for understanding the causes of the disease, to prescribe effective treatment, specific recommendations for the prevention and treatment of this disease are also absent. This paper presents the advanced experience of our research group on the study of the urethral state by the in vivo cross-polarization optical coherence tomography (CP OCT) method, and also the results of the microbiota analysis in the urethral tissues. The purpose of the study is to search for the risk factors for UPS and the character of changes in the urethral tissues, using the data of: 1) concomitant pathology, 2) structural changes in the urethral wall in UPS in comparison with chronic cystitis of bacterial etiology 3) studying the microbiota of urethral tissues. Materials and methods: The condition of the urethra was studied in 109 patients: 55 of them with UPS (group «OTS»), without clinical manifestations of inflammation; 41 - with chronic inflammation of the lower urinary tract of various origins (group «Inf»); in 14 patients with stones of the upper urinary tract without pyelonephritis, the urethra was taken as the norm (group «N»). All performed a clinical minimum of studies, also cystoscopy with the study of the bladder triangle, the neck of the bladder and the urethra by the method of in vivo tissue imaging - CP OCT. The device «OCT-1300U» with wavelength of 1300 nm is used. To determine the possible role of UPS disease background, the analysis of concomitant pathology preceding the development of UPS was performed. To analyze the relationship of changes in the urethral tissues with the composition of its microbiota, a PCR study of biopsies from the proximal segment of the urethra was performed in 13 patients with UPS. Results: Qualitative comparison of the thickness and character of the OCT signal of the urethral wall layers observed using CP OCT in the studied groups of patients allowed us to establish that the state of the epithelium and connective tissue structures of the mucous membrane in patients with UPS is not the norm, changes are similar to those in chronic inflammation. Changes in the character of the OCT signal were recorded in all parts of the urethra, but in the middle third they are most pronounced and most critical. In UPS, there is a brightly pronounced reorganization of the connective tissue stroma components. Pronounced fibrosis of subepithelial structures (increased signal brightness in the cross-channel compared to the norm) with their thickening was recorded in 48.2% of cases, and thinning/lack of visualization of the epithelial layer was detected in 20.5%, and in chronic inflammation 55.5% and 40.6% of cases, respectively. According to the results of PCR, only one patient had significant total bacterial contamination of the biopsy (ТВС=1047). In all other cases, the total bacterial mass of the biopsies was at the level of negative control. Conclusions. In patients with UPS, the presence of several concomitant, often chronic, diseases was revealed, which may be a premorbid background and one of the risk factors for the occurrence and maintenance of UPS. Pilot PCR studies of biopsies from the proximal segment of the urethra indicate that low values of bacterial contamination in the majority of patients with UPS do not exclude the possible role of bacteria in the development of the disease in some patients. The CP OCT method used in this study is currently the only one in vivo method of visualization of the urethral mucosa, which provides real-time images of structural changes in the epithelial (atrophy or hyperplasia) and connective tissue (active or latent inflammation with cellular infiltration or fibrosis) layers of the urethra, allowing better understanding of the pathogenesis of the disease and monitoring of therapy.

Aim. To assess the morphological and functional characteristics of spermatozoa and DNA stability in patients with normal seed parameters and with an ITZ exceeding the threshold value. Patients and methods. 85 males were studied for semen quality parameters. The morphological anomalies of head, middle piece, and tail of spermatozoa were estimated and presented in illustrations. Due to results elaborated the index of teratozoospermia was calculated. Then the Comet assay was performed. Results. It has been found that spermatozoa from patients with high teratozoospermia index possessed decreased motility as compared to ones from patients with low index of teratozoospermia. It was not found any difference in concentration of spermatozoa between groups of males which possess low and high index ofteratozoospermia. The spontaneous frequency of DNA damage estimated by means of single cell gel electrophoresis followed by silver staining in spermatozoa from healthy donors did not exceed 3,1±0,6. The frequency of DNA damages in sperm of patients with abnormal index of teratozoospermia exceeded 39,6±7,4% (p<0,01). Conclusions. Our results suggest that minor morphological changes in spermatozoa do not affect their motility, while significant morphological abnormalities with ITZ exceeding threshold values are closely associated with impaired DNA stability and dramatically reduce the quality of patient’s seed. Summary. In the initial assessment of patient fertility the attention should be focused on a comprehensive study of sperm DNA morphology and stability.

Aim: to evaluate the relationship between the use of energy drinks and the decline in male reproductive function. Materials and methods: The analysis ofscientific publications dedicated to the issue was carried out. The results of the study, which involved 60 patients aged 22 to 40 years, are presented. The directions for further scientific search are suggested. Results: According to our study, there is a correlation between energy drinks consumption and decreased ejaculate quality. Conclusion: systematic use of energy drinks has a negative impact on male reproductive function.

Long strictures of the upper third of the ureter are most often recurrent and occur after endourological and reconstructive procedures. The lack of native tissues and an impossibility of substitution by bowel segment in some cases dictates the use of alternative surgical techniques. Our first experience of laparoscopic onlay ureteroplasty using buccal graft for long stricture of the upper third of the ureter is described in the article. The length of the stricture was 6 cm. The operation time was 210 minutes, while blood loss volume was less than 100 ml. The patient did not have any surgical complications. Drains were removed in timely manner. The patient was discharged from the hospital in a satisfactory condition on the 8-th day. The ureteral stent was removed after 4 weeks. Kidney ultrasound was performed on a monthly basis. According to IVU after 4 months, the anastomosis was completely patent. This method can be considered as an alternative to more complex procedures in selected patients.

The data presented in the review showed that the coronavirus affects not only the lungs, but also the organs of the urinary system. The new virus causes a mosaic, multi-organ disease with severe consequences after the egg and has a wide organotropism. The role of SARS-CoV-2 in the development of lower urinary tract symptoms (LUTs), which are manifested by frequent, imperative urges, dysuria, nocturia, is not entirely clear. It is assumed that biologically active substances, the activation of which is caused by a virus, play a certain role in the development of SNMP, namely the expression of angiotensin converting enzyme 2 (ACE2), cytokines, activation of tolllike receptor 4 (TLR4), etc. An increase in cytokines that are released into the urine and / or expressed in the bladder and the presence of SNMP in patients with coronavirus infection have been called de novo urinary symptoms or COVID-19 associated cystitis (CAC) in the literature. Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. Despite the unusual manifestation of coronavirus infection, similar mechanisms of damage to urothelial cells in viral and bacterial infections give us the right to think about the use of pathogenetically justified prevention of the development of an inflammatory reaction in the urinary tract, as well as short-and longterm consequences of this disease. For this purpose, it is necessary to recommend drugs that have a multifactorial effect: diuretic, anti-adhesive, anti-inflammatory and regulate the local immunity of the bladder mucosa. We assume that against this background, we can expect a decrease in the number of complications from the organs of the urinary system, and more successful rehabilitation of patients with coronavirus infection and in the post-ovarian period. Final conclusions and recommendations will be available after well-planned clinical trials have been conducted.

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common disorder in older men. The mainstay of conservative treatment for BPH is a1-adrenoblockers. A review of the literature on silodosin, a selective α-adrenergic blocker, is discussed in the article. In clinical studies, there was a significant improvement in IPSS scores and maximum urinary flow rate in patients who received silodosin at a daily dose of 8 mg compared to those receiving placebo. It should be noted that silodosin has demonstrated long-term safety and early onset of efficacy. Compelling literature data to support the clinical benefit of silodosin for the treatment of LUTS associated with BPH is presented.

The article is devoted to the multiparametric ultrasound techniques for prostate biopsy targeting. This literature review illustrates the variety of ultrasound-based targeting procedures and presents data concerning the diagnostic value of each. A special attention is given to every targeted technique limitations and the opportunity for the MTI-fusion.

The articIe anaIyzes the scientific and practicaI activities of the prominent French urologist Professor Joachim Albarran (1860-1912). It is noted that a student of the founder of French uroIogy F. Guyon I. Albarran in 1906 was elected in his place Professor of urology and head of the Department of the Necker hospitaI (HopitaI Necker) in Paris. It is shown that in 1891 he published a work on bladder tumors, creating a new progressive classification of them. This paper presents well-known monographs by I. Albarran on the mechanism of origin ofhydronephrosis, tubercuIosis, and kidney tumors. He deveIoped a method for studying the functionaI activity of the kidneys and proposed the method of «experimental polyuria» (1905). It is also noted that I. Albarran invented the catheterization cystoscope and this made ureteraI catheterization a method widely available in practical surgery. I. Albarran’s extensive operational experience was described in his manual of operative surgery of the urinary tract (1909), which stiII has not Iost its vaIue. I. AIbarran created a briIIiant scientific schooI, from which came a whoIe gaIaxy of outstanding cIinicians and uroIogists.