No 6 (2021)

Introduction. Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients. Purpose of the study. To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs). Materials and methods. 85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the x2 test, Fisher’s test. Multivariate analysis was performed using logistic regression. Results. Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1;p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications. Conclusion. Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

Introduction. Urolithiasis is one of the most common urological diseases, which affect at least 3% of the population. Aim. To study the epidemiology of urolithiasis in the European part of the Russian Federation and to determine the composition of urinary stones in order to understand the pathogenetic mechanisms of urinary stones formation. Materials and methods. Urinary stone were obtained from 2888 patients with urolithiasis and the composition of kidney stones was analyzed using the method of infrared spectroscopy. Results. The predominance of oxalate stones was seen in kidney stones with mixed composition (83%) and the prevalence of uric acid stones (54%) was revealed in “pure” kidney stones. Urinary stones with a predominance of oxalates had significantly less impurities (12,4%) than stones with a predominance of uric acid, phosphates and carbonates with average amount of impurities more than 24%. Conslusion. The analysis of stone composition with a consideration of pathogenic factor showed that disorders of calcium metabolism in the population of the European part of the Russian Federation prevailed (88%).

Background: Stones consist of the organic, inorganic and amorphous part. The factors that affect the formation of stones can be divided into two categories; 1). Those that are in the urine and form the crystalline nucleus, agglomeration, which includes proteins, salts, glycoprotein’s, phospholipids, and 2). Changes in cell surface leading to crystal adhesion to epithelial cells. Objective: The purpose of this study was to determine the composition of uroliths (stones), nucleus, envelope, core component and stone layer component. Material and Methods: The research was conducted with patients of the Urology Clinic, University Clinical Center of Kosovo, in Prishtina. The work was prospectivein our research were included 102 patients. After the intervention: endoscopic or surgery, we took the stone and did the chemical analysis of the stones with the method: X-ray diffraction and infrared spectroscopy. This will determine the components of the stones and their types. From the statistical parameters, the structure index, arithmetic mean, and standard deviation were calculated. Qualitative data testing was done with X2-test or Fisher test. Quantitative data testing with T-test., Test verification was done with a reliability rate of 99.7% (p<0.01) and a reliability of 95% (p<0.05). Results: Our study included66.7% male and 33.3%female. With X2-test we gained a difference with statistically significant significance in the number of cases by gender (X2=11.3, p=0.001). The age group most attacked is 40-49years. The chemical component of stone patients was: 58.8% Calcium oxalate monohydrate, 14.7% Calcium Phosphate, 10.8% Magnesium ammonium phosphate, 5.9% Calcium oxalate dihydrate, 4.9% Uric acid, 2.9% Cystinic, 1.0% Ammonium hydrogen urate and brush 1.0%. We have the group of children who are 8 cases or 7.84%. The chemical composition; Calcium oxalate monohydrate 2.94%, Cystinic; 1.96%, Calcium Ox.Dihydrate; 0.98%, Magnesium ammonium phosphate; 0.98%, uric acid; 0.98%. Conclusion: X-ray diffraction analyzes the crystalline components of the stone, while infrared spectroscopy is more sophisticated to identify non-crystalline materials, including amorphous substances and fat. In our adult research, calcium oxalate monohydrate, calcium phosphate stones appear more often, while in children, calcium oxalate monohydrate. The most common stone nucleus analysis is Ammonium hydrogen urate.

Introduction. Despite the low invasiveness of percutaneous nephrolithotripsy, this surgery is not without complications. One of the most important stages of the operation, on which depends not only the success of the patient completely getting rid of calculus, but the likelihood of complications, is the puncture of the pelvic-pelvic system. Purpose. Determination of the effectiveness and security of the new less-traumatic puncture needle MG under experimental conditions. Materials and methods. A series of pork kidney punctures with a new less-traumatic needle MG and standard Chiba and Troakar needles (Coloplast A/S, Denmark) were performed under experimental conditions, followed by a comparative morphological assessment. The staining of the slides was performed with hematoxylin and eosin. For the purpose of additional assessment of the structures of the kidney punctured with a low-traumatic MG needle, a morphological assessment of the parenchyma stained with picrofuchsin according to Van Gieson was performed. Results. On parenchymal slides with punctures with Chiba and Trocar needles, the passage places with multiple large fragments of desquamated (damaged) epithelium are visualized. On preparations of the parenchyma punctured with a less-traumatic needle MG, the place of passage of the needle is presented with clear contours. The damaged epithelium in the lumen of the formed defect is practically absent. With additional staining according to Van Gieson (magnification x200), the integrity of the full-blooded vessel adjacent to the limited focus of the needle MG was visualized. Output. The new less-traumatic puncture needle MG is an innovative development in urology. The design of the needle with an atraumatic mandrel-bulb atraumatic mandrel-bulb on a spring basis made it possible to significantly reduce the trauma to the structures of the kidney and perirenal tissues due to the bougienage effect.

Introduction. Currently, empiric antibiotic therapy is considered the standard for acute cystitis. However, additional treatment may be required to alleviate the patient's condition and shorten the time to subjective recovery. Aim. To evaluate the efficiency of the combined administration of fosfomycin trometamol and herbal drug Canephron® N in comparison with a single oral dose of fosfomycin trometamol in women with uncomplicated bacterial cystitis. Materials and Methods: A randomized, comparative, open-label study was carried put between January 2018 and June 2019. The study included 112 women with symptoms of acute uncomplicated cystitis, who were randomized between two groups in a 1:1 ratio. In the main group, patients received a single oral dose of fosfomycin in combination with Canephron N (2 tablets t.i.d. for 2 weeks), while in the control group patients received only a single dose of fosfomycin (3 g). Symptoms were assessed using the Russian version of the Acute Cystitis Symptom Score (ACSS), completed daily for a week. Also, all patients underwent urine analysis on the 1st, 3rd, 5th and 7th days of therapy. The mean time to complete recovery based on the ACSS questionnaire and the time to resolution of pyuria were compared using the Mann-Whitney U test. Comparison of the proportion of patients with complete cure, according to the questionnaire, or with the elimination of pyuria was carried out using the chi-square test. Results: The final analysis included 46 patients who received fosfomycin in combination with Canephron and 47 patients who received fosfomycin as monotherapy. In the group of combination therapy, patient-reported complete recovery (assessed by the ACSS questionnaire) was seen on average after 1 day, while in patients treated with monotherapy, the median time to subjective recovery was 3 days (p=0.00012). A significant difference between the groups in the proportion of patients with complete resolution of symptoms of acute cystitis was observed on days 1, 2, and 3 (p<0.05). The therapy was well tolerated in both groups. The most frequent adverse events were dyspepsia (8.7% in the combination group compared to 6.4% in the control group) and headache (in 4.3% and 6.4% of patients, respectively). Conclusion: the combined use of fosfomycin trometamol and the herbal drug Canephron® N allows to reduce the duration of symptoms in patients with acute cystitis, thereby accelerating return to their usual lifestyle patterns.

Introduction. Treatment of tuberculosis involves long-term intake of several antimicrobial drugs, including that with a wide spectrum of action, which may affect the microflora of the urinary tract. Aim. To determine the effect of long-term combination of antibiotic drugs on the microbiome of male urethra. Materials and methods. A total of 75 men were included in an open, prospective, non-comparative study, including 63 patients with pulmonary tuberculosis who received anti-tuberculosis therapy for at least 3 and no more than 5 months without urinary tract infections (main group) and 12 patients with non-infectious urological diseases (urolithiasis, benign prostatic hyperplasia) and normal urinalysis (comparison group). All patients underwent urethral swab with a sterile cotton after cleaning of genital area. The identification of pathogens and the quantitative assessment of composition of the microbiota in the obtained samples was performed by the method of real-time polymerase chain reaction (RT-PCR). The quantitative results are presented in the number of genomic equivalents in 1 ml (GE/ml), which are proportional to the microbial contamination of the samples. Results. «Classical» pathogenic microflora in the urethral swab was detected in 1/3-1/4 patient with tuberculosis. Enterobacteriaceae spp./ Enterococcus spp. in a titer of 103-104 GE/ml was identified in 16 (25.4%) patients. Staphylococcus spp. was found in the titer of 103-106 GE/ml in 20 males (31.7%). In the comparison group, Staphylococcus spp. was present in half of the cases (n=6), and Enterobacteriaceae spp./ Enterococcus spp. were isolated in every third patient (n= 4) with a titer of 103-105 GE/ml. In patients with tuberculosis, Corynebacterium spp. was most commonly detected (n=31, 49.2%), while in the comparison group this pathogen was isolated only in 3 (25.0%) patients. At the same time, the detection rate of Candida spp. in urethral swab was not significantly different between two groups (7.9 and 8.3%, respectively). Conclusion. Patients with tuberculosis receiving combination of chemotherapeutic drugs for at least 3 months, and male without signs of urinary tract infections have significant differences in the spectrum of the urethral microflora.

Introduction. Currently, there is a large selection of a-blockers on the pharmaceutical market, while they have comparable effectiveness, slightly differing only in safety profile. However, even small differences are of fundamental importance for comorbid patients, especially for those patients who are prone to developing cardiovascular diseases in adulthood. The choice of a-blockers, which is able to minimize the risks of cardiovascular complications, is important. Materials and methods. Outpatient cards of 120 patients with BPH and concomitant high blood pressure or stage 1-2 hypertension, who had been taking Alfuprost® MR for at least 12 weeks, were analyzed. All patients were divided into two groups of the same number. In group 1, 60 patients with LUTS/BPH and concomitant high blood pressure did not take any antihypertensive drugs, while 60 patients with LUTS/BPH and stage 1-2 hypertension in group 2 received antihypertensive drugs (according to the recommendation of an internist or cardiologist). Based on the analyzed data, the efficacy of the drug Alfuprost® MR, its safety profile, including the effect on blood pressure and pulse, and the recorded adverse events after 4 and 12 weeks were assessed. Results. An analysis of the results of a retrospective study showed an improvement in LUTS in both groups, starting from 4 weeks of treatment, followed by positive dynamics by 12 weeks of therapy with Alfuprost® MR. The data obtained correspond to those presented in the literature. During 3 months of therapy, it was recorded: a decrease in the average score on the IPSS scale by 30%; an increase in the average urine flow rate by 20.6%; a decrease in the average amount of residual urine to normal values; an improvement in the quality of life of patients, according to the results of filling out the QoL questionnaire, by an average of 1.8 points. Patients in both groups had clinically insignificant fluctuations in systolic and diastolic blood pressure, less than 1 mmHg (in both groups) during 12 weeks of therapy; changes in heart rate during 3 months of therapy with Alfuprost® MR were also clinically insignificant and averaged no more than 1 beat per minute In the medical records of patients, no adverse reactions were registered during therapy with Alfuprost® MR, which confirms the high safety profile of the drug in clinical practice. Conclusion. Thus, Alfuprost® MR is an effective means for the treatment of LUTI in BPH, with minimal vasodilating effects, which allows the drug to be prescribed to comorbid patients with concomitant high blood pressure or hypertension, including those taking antihypertensive drugs.

Objective: Evaluation of the effectiveness and safety of the drug PPR-001 (lyophilizate) in comparison with placebo in men with impaired spermatogenesis. Materials and Methods: This study was a randomized, double-blind, placebo-controlled, prospective, multicenter, parallel-group research. Results: It was found that the drug has clinical efficacy and a positive effect on the concentration of spermatozoa in the ejaculate, the percentage of progressively mobile forms and the number of morphologically normal forms of spermatozoa was increased in the group of PPR-001. The primary end point was defined as a proportion of patients who had a therapeutic response (TO) at Visit 3. TO meant at least 20% increase in the concentration and/or progressive motility of spermatozoa compared to the baseline level. The hypothesis of Superiority of PPR-001 over placebo based on primary end point was confirmed (the limit of Superiority was more than 27%). In total, AEs were identified in 65 patients out of 100 (34 patients in the PPR-001 group and 31 patients in the placebo group). When assessing the number of patients who had AEs, there were no statistically significant differences between the groups. All identified AEs were of mild severity; during the study. No negative dynamics was found according to the results of the assessment of vital functions, biochemical and clinical blood tests, clinical urinalysis, ECG indicators. Conclusion: The study demonstrated the superiority of PPR-001 over placebo in terms of increasing concentration and motility of spermatozoa in the ejaculate. A significant increase in the number of morphologically normal forms of spermatozoa in the PPR-001 group was also revealed.

Aim. To analyze the diagnostics results and surgical outcomes in girls with congenital urogenital sinus. Materials and methods. A total of 9 girls with urogenital sinus were evaluated and treated in the clinical base of the Department of Hospital Pediatric Surgery with a course of oncology at TashPMI during the period from 2009 to 2019. Results. The results of diagnostics and treatment of 9 patients with various forms of urogenital sinus are presented. In 6 cases the anterior sagittal (transanal) approach was used. The karyotype in 8 girls corresponded to 46,XX, while another girl has karyotype of 46;X0, which is typical for Turner syndrome. Severe degree of virilization was found in 2 patients, which required clitoroplasty. Conclusion. Traditional methods of surgical correction and modified procedures provide an optimal approach and facilitate the urethral dissection from the vagina with subsequent advancement to the perineum, significantly reducing the indications for the performing a preliminary colostomy.

This article presents its own experience of using suppositories with oxidised dextran in the treatment of a patient with recurrent bacterial prostatitis complicated by prostate calcifications, these are the positive effects on the use of suppositories with oxidised dextran: a decrease in the size of calcified areas, a stable elimination of opportunistic microflora and the achievement of long-term remission of the disease.

Non-gonococcal urethritis (NGU) is a common disease in men. The main cause of NGU is sexually transmitted infections, which can cause various complications, including reproductive ones. Chlamydia trachomatis and Mycoplasma genitalium are the most common causes of NGU, but no known viral or bacterial pathogens are detected in 28-50% of cases. Traditional research methods revealed a higher load of specific pathogens in patients with urethritis compared to the control, but these studies do not allow us to determine the total bacterial load in the urethra. Using the 16S rRNA sequencing method to characterize the urine and urethral microbiota reveals a diverse bacterial microbiota in both asymptomatic men and patients with NGU, which has a high diversity. The revealed microbiota in both healthy and patients with urethritis still has an ambiguous interpretation and requires further study.

The increase ininfections caused bymultidrug-resistantmicroorganisms is currently one of the most serious medical issues. In fact, antimicrobial resistance is viewed by the World Health Organization as one of the most serious threats to health worldwide. The problem is exacerbated by the lack of new antibiotics with respective benefits for the treatment of multidrug-resistant bacteria. While new compounds are being developed a number of «old» antibiotics used in clinical practice for several decades may acquire new indications for use.

Urinary tract infections, especially recurrent cases, are caused by uropathogens, which, after repeated courses of antibiotic therapy, can develop antibiotic resistance, which requires a search for an alternative treatment strategy. In this regard, the restoration of nonspecific protective factors that normally prevent the adhesion and colonization of pathogens is of interest for clinicians. To date, scientific data has been accumulated about the anti-uropathogenic and antiadhesive activity of many plant extracts. However, studies on the specific action of herbal components are limited. Data on the chemical composition, mechanisms of action, in vivo and in vitro efficacy of medicinal plants growing on the European continent and used for the prevention or treatment of acute and chronic (recurrent) urinary tract infections are presented in the review.