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No 2 (2022)


Bradic’s anti-reflux uretero-cysto-anastomosis in children with recurrent obstructive megaureter

Kogan M.I., Sizonov V.V.


Introduction. Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research. Purpose. Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradic’s technique for children with recurrent obstructive megaureter (OM). Materials and methods. The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradic’s extravesical reimplantation. Results. During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the presurgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings. Conclusions. The simplicity of Bradic’s extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradic’s surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.
Urologiia. 2022;(2):5-10
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Therapeutic efficacy and safety of monotherapy Alfuprost® MR 10 mg/day in clinical practice

Novikov A.I., Shpilenya E.S.


Corresponding author: Novikov A.I. - Ph.D., MD, professor at the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Head of the Department of Oncourology of State Budgetary Healthcare Institution «Saint-Petersburg clinical scientific and practical center for specialised types of medical care, Saint Petersburg, Russia; Introduction. Alpha-blockers are the first-line therapy for men with BPH/LUTS. They have similar efficiency, but different uroselectivity. Therefore, when choosing α-blockers, their safety and adverse events should be taken into account. Aim. To evaluate the efficiency and safety of using Alfuprost® MR 10 mg/day for 12 months in clinical practice. Materials and methods. A total of 55 men aged 55-80 years with BPH/ LUTS were included in the study, which was carried out on the basis of 6 outpatient clinics in St. Petersburg from June 2020 to September 2021. Along with standard methods, the examination included an assessment of male sexual function, hemodynamic parameters, and satisfaction with the treatment of patients and physicians using the Likert scale. The follow-up scheme included 7 visits (every 60±5 days) and lasted 12 months. Results. After 2 months of therapy with Alfuprost® MR, a significant decrease in the number of patients complaining of pain was observed. The proportion of patients with urgency and difficulty with urinating decreased by 50% and 30%, respectively. By the end of the treatment, the total IPSS score decreased by 1.9 times and averaged 9.98 points, the quality of life improved by 2.5 points, the average maximum urine flow rate significantly increased by 1.4 times, reaching 17.4 ml/sec, and the post-void residual volume decreased to 12.5 ml (3.8 times). By the last visit, there was a decrease in prostate volume by 4.3%. Moreover, the proportion of patients with an initial level of total PSA 2.5-4 ng/ml decreased by 25.4%. The level of PSA after treatment less than 2.5 ng/ml was seen in 70.9% of cases. All patients were satisfied with the treatment after 2 months, as well as investigators at visit 5. There was a significant improvement in all components of the sexual function, especially erectile function. In addition, there were no significant changes in ejaculation. Conclusion. Long-term therapy with Alfuprost® MR 10 mg/day has high therapeutic efficacy and safety in elderly patients with LUTS/BPH, regardless of comorbidities.
Urologiia. 2022;(2):11-17
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Evaluation of the results of sodium fumarate, furosemide, and mannitol on the initiation and outcome of renal warm ischemia in an experimental study

Popov S.V., Guseynov R.G., Skryabin O.N., Sivak K.V., Perepelitsa V.V., Davydov A.V., Barhitdinov R.S., Katunin A.S., Mirzabekov M.M.


While performing surgical treatment of the localized form of renal cell cancer by means of open or laparoscopic partial nephrectomy, renal warm ischemia is an important issue. Using renal warm ischemia allows to prevent parenchymal bleeding, to optimize conditions for resection of the tumor and to increase significantly the efficiency of hemostasis. However, an important problem is the probability of ischemic hypoxic damage of the remaining part of the kidney tissue during renal warm ischemia and renal functional impairment in the postoperative period. Aim. To compare nephroprotective activity of sodium fumarate, mannitol and furosemide using experimental model of 30- and 60-minute renal warm ischemia in rabbits. Materials and methods. The experiments were carried out on 360 conventional male-rabbits of the “Chinchilla” breed weighed 2,6±0,3 kg which were allocated into 10 groups. The control group №1 included intact animals, the control group №2 included the rabbits in which renal artery was not clamped. For the animals from the trial groups (№3-№10) the experimental model of 30- and 60-minute renal warm ischemia was used. In groups №3 and №4 no drugs were provided. Other rabbits undergone renal warm ischemia with a protection by sodium fumarate (groups №5 and №6 - 1,5 ml/kg IV), lasix (groups №7 and №8 - 3,0 mg/kg IV) and mannitol (№9 and №10 - 1,0 g/kg IV). The influence of renal warm ischemia on the renal tissue ultrastructure and the levels of NGAL, Cystatin-C and creatinine in blood and urine were studied. Results. During experimental pharmacologically uncorrected 30-minute renal warm ischemia in animals, edema of the terminal part of microvilli of the proximal tubules’ epithelium, an increase of lysosome number in the hyaloplasm of epithelial cells, appearance of flaky content of medium electronic density in the lumens of distal tubules and collecting tubules, as well as sharp peak-like increase of NGAL and cystatin-C in blood and urine were observed. Increasing the time of ischemia up to 60 minutes was accompanied by more severe disturbances. In groups where sodium fumarate, lasix and mannitol were used the observed ultrastructural disturbances were expressed to lesser extent, whereas sodium fumarate demonstrated the best nephroprotective activity. After using mannitol the severity of disturbances was less than in the groups where mannitol, lasix or sodium fumarate were not given. Lasix and sodium salt of fumaric acid showed a higher nephroprotective activity. The best results were received in the animals received sodium fumarate. Conclusions. The studied drugs provided a nephroprotective effect regarding ischemia of rabbit kidney. The effect of sodium fumarate was the most pronounced, followed by furosemide and, to a lesser extent, mannitol. Use of sodium fumarate allows to protect and stimulate the kidney tissue effectively during oxygen deprivation under ischemic state.
Urologiia. 2022;(2):18-26
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Pathogenesis and treatment of postcoital cystitis: are our approaches correct?

Komyakov B.K., Tarasov V.A., Ochelenko V.A., Shpilenya E.S., Shevnin M.V.


Aim. To study the pathogenetic factors in the development of postcoital cystitis and the efficiency of extravaginal transposition of the urethra. Materials and methods. Literature data and our point of view on the causes of postcoital cystitis are described. Case histories of 438 patients aged 18 to 61 (mean 24±1.3) were analyzed. The efficiency of extravaginal transposition of the urethra for the prevention of recurrence of postcoital cystitis was evaluated. Results. The long-term results of operations in 315 patients were studied. A positive effect was noted in 297 (94.3%), which means the complete recovery or reduction in the frequency of cystitis to 2 or less times a year, while complete recovery occurred in 214 patients. In 18 (5.7%), the surgical procedure was ineffective, which required repeated interventions. Discussion. According to our observations, the external opening of the urethra is located in patients with postcoital cystitis and in healthy women at the same level - before the introitus. During sexual intercourse, everyone experiences vestibulo-vaginal frictional dislocation of the urethra, however, exacerbations of the inflammatory process in the bladder occur only in some females, which is associated with the multifactorial nature of the disease. Conclusion. Postcoital cystitis develops as a result of a complex of factors, the most significant ofwhich are the state of the vaginal microflora, the virulence of uropathogenic bacteria, the anatomical features of the urethra and vagina, its narrowness with a mismatch with the penile size, the intensity and duration of sexual intercourse, severe, complicated childbirth and surgical procedures in this area. Performing extravaginal transposition of the urethra according to Komyakov demonstrated high efficiency in the prevention of recurrence of postcoital cystitis.
Urologiia. 2022;(2):27-32
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Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city

Davidov M.I., Anikin D.N., Petrunyaev A.I.


The purpose of the study: to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm. Materials and methods. The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests. Results. During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies. Conclusion. As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.
Urologiia. 2022;(2):34-42
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The use of a complex of natural antimicrobial peptides and cytokines for treatment of male infertility and chronic prostatitis

Ovchinnikov R.I., Popova A.Y., Vtorushina V.V., Muradyan A.A., Gamidov S.I.


Introduction. Chronic prostatitis (CP) has long been considered one of the common causes of male infertility. The influence of therapy for CP on spermatogenesis is well studied. However, recently, especially in the era of the new coronavirus infection (COVID-19), much attention has been paid to the effects of cytokines on the pathogenesis of the inflammatory process, and their impact on male fertility. Aim. To study the effect of a complex of natural antimicrobial peptides and cytokines (Superlymph) on ejaculate, MAR test, oxidative stress (OS), and sperm DNA fragmentation (SDF) in men with infertility and a history of CP. In some patients, the level of cytokines before and after treatment was determined. Materials and methods. A total of 583 infertile men with a history of CP, aged 18-75 years, were screened according to the inclusion/ exclusion criteria. In group I, patients received antioxidant stimulation of spermatogenesis (triovit, trental, mexidol) in combination with a complex of natural antimicrobial peptides and cytokines (Superlymph) one suppository 25 IU at night for 20 days for 1-3 weeks and for 6-8 weeks for 2 months. In group II, antioxidant stimulation of spermatogenesis was prescribed along with suppositories for the prevention of CP for 2 months. The evaluated criteria included sperm analysis, MAR test, oxidative stress in spermatozoa (reactive oxygen species (ROS)) and SDF. The levels of seminal plasma cytokines were also measured before and after treatment in 32 patients using the Bio-Plex Pro panel for the simultaneous determination of 17 human cytokines, the Human Cytokine 17-plex Assay. Statistica-10 software was used for statistical analysis (p<0.05). Results. Of 135 eligible patients, results were collected from 125 men (mean age 31.7 ± 13.4 years). In group I, there was a more pronounced increase in motility by 42.3%, a decrease in the MAR-test level by 64.7%, oxidative stress in spermatozoa by 56.1%, and SDF by 25.6%, compared to group II (30.4 %, 10.5%, 45.7%, 21.9%), respectively. All these changes were significant with the exception of a decrease in the level of SDF. In group I, there was a predominant increase in the activity of anti-inflammatory cytokines (IL-4, 10, 13), a decrease in the level of pro-inflammatory cytokines ((IL-2, 12). In group II, there was a significant decrease in both pro-inflammatory (IL-2, 6, 8), and anti-inflammatory cytokines (IL-4). The remaining changes were insignificant. Among mild side effects, there were a change in the color of the sclera in 4 (3.2%), anal pain in 3 (2.4%), a decrease in libido in 2 (1.6%) patients. No differences between groups in the frequency of side effects were recorded (p>0.05). Conclusion. Antioxidant stimulation of spermatogenesis in infertile men and CP is an effective and safe. The addition of a complex of natural antimicrobial peptides and cytokines (Superlymph) leads to a more profound increase in sperm motility, a decrease in the MAR-test, oxidative stress in sperm cells, which potentiates the effects of therapy. The use of Superlymph is accompanied by a more pronounced positive effect on pathospermia, an increase in anti-inflammatory and a decrease in pro-inflammatory cytokines. In the contrary, in control group, where patients received antioxidant stimulation of spermatogenesis, only a decrease in the level of main cytokines was observed. The effect of a complex of natural antimicrobial peptides and cytokines (Superlymph) on the level of SDF, as well as the relationship with fertility and childbirth rates, requires further study.
Urologiia. 2022;(2):43-53
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Radio wave electrotherapy with a radiofrequency of 448 khz for the treatment of patients with organic erectile dysfunction: a prospective, randomized, blind, Sham-controlled, parallel-group study

Chuvalov L.L., Korolev D.O., Azilgareeva C.R., Taratkin M.S., Olefir Y.V., Fiev D.N., Lumpov I.S., Gorobets Y.P., Enikeev D.V., Rapoport L.M., Enikeev M.E.


Aim. To evaluate the efficiency of radio wave electrotherapy (448 kHz) for the treatment of patients with organic erectile dysfunction (ED). Materials and methods. A prospective, randomized, blind, sham-controlled clinical trial was carried out. Inclusion criteria were as following: 1) patients with 5 to 20 points on the IIEF-5 score; 2) patients with proven organic erectile dysfunction lasting at least 6 months; 3) patients with penile arterial insufficiency and/or venous insufficiency, confirmed by doppler study of penile vessels with pharmacological stimulation (peak systolic velocity (PSV) <25 cm/s, end-diastolic blood flow velocity (DPV) >5 cm/s, resistance index (IR) < 0.8). The participants were randomized into two groups (experimental and control) in a 1:1 ratio. The full treatment course lasted 9 weeks. Patients underwent an assessment of erectile function based on questionnaires (IIEF-5, SEP, Schramek), as well as Doppler ultrasound of the cavernous arteries before inclusion in the study as well as a after treatment. Results. The study included 61 men (experimental group [n=31], control group [n=30]. There was a significant difference in the IIEF-5 scores after treatment between the experimental group and the control group (19.5±3.2 vs. 15.1±5.4, p=0.017, respectively). Significant differences were also noted in mean total score of the SEP questionnaire: an increase to 3.6±1.0 in the treatment group compared to 2.4±1.1 in the control group (p=0.004). The results of the Schramek questionnaire also demonstrated a significant increase in the mean score in the experimental group compared to the control group: 4.2±0.6 vs. 3.2±1.0 (p=0.011). The response time to the drug and the detumescence time also significantly differed between the two groups: 11.9±4.0 min vs. 15.5±4.1 min, p=0.001 and 126.6±60.7 min vs. 66.2±40.9, p<0.001, respectively. Neither complications nor any adverse events were recorded during treatment or after its completion. Conclusions. Radio wave electrotherapy with a radiofrequency of448 kHz can improve the IIEF-5, SEP and Schramek scores, as well as the indicators of ultrasound Doppler ultrasonography in patients with organic ED. To assess the feasibility of this method in patients with organic ED of different stages, further studies are needed.
Urologiia. 2022;(2):54-58
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Dynamics of sperm indicators in men with chronic prostatitis associated with secondary infertility based on the use of «ANDROEXPERT SV1» suppositories

Novikova E.G., Troitsky A.V., Selyatitskaya V.G., Ukah H.U., Notov K.G., Tityaev I.I., Tikhonov I.V.


Introduction. Chronic prostatitis (CP) is the most common cause of a disorder of not only sexual, but also reproductive functions in men, which is caused by a decrease in the quality of the ejaculate and is confirmed by a deterioration in spermogram parameters, up to oligoasthenoteratozoospermia and azoospermia. In such a situation, the onset of pregnancy in the natural cycle is impossible - even with a completely preserved reproductive function in a woman. As an active substance in the recovery of men with chronic prostatitis associated with secondary infertility, we proposed oxidised dextran in the form of a pharmaceutical composition, which was developed at Federal Research Centre for Fundamental and Translational Medicine, Novosibirsk, Russia; and produced by ANDROEXPERT Research and Manufacturing Company LTD, Novosibirsk, Russia. The purpose of the study was to evaluate the dynamics of spermogram parameters as a result of the use of suppositories with oxidised dextran «ANDROEXPERT SV1» in men with chronic prostatitis associated with secondary infertility. Material and methods. The study included 52 patients with chronic prostatitis associated with secondary infertility. The mean age of the patients was 32+2.2 years. The examination of patients was carried out in accordance with the algorithm recommended by the Russian Society of Urology, the European Urological Association and the standard of primary health care for chronic prostatitis (Appendix to the order of the Ministry of Health of Russia No. 775n of 09.11.2012). The patients were divided into two groups: the 1st group of patients received oxidised dextran rectally once per day for 10 days, then 20 days every other day; The 2nd (comparison group) received a placebo in the form of rectal suppositories consisting of cocoa butter in a similar way. Results. The volume of ejaculate among patients of the 1st group increased from 2.54+0.15 to 3.13+0.18 (ml), which amounted to 23.23%; p<0.05. The sperm concentration indicator increased from 26.40+4.18 to 41.12+5.37 (million/ml) - by 55.75%; p<0.05, which led to an increase in the total number of spermatozoa in the ejaculate by 88.5%, from 65.47+8.41 to 123.41+12.33 (million pieces); p<0.05. The number of leukocytes in the same group decreased by 2.8 times: from 1.25+0.17 to 0.44+0.10 (million/ml) - by 64.80%; p<0.05. The indicator of the severity of sperm agglutination decreased by 3 times: from 0.52+0.07 to 0.17+0.03 - by 0.35 arb. units, which was 67.31%; p<0.05. The indicators of the spermogram in patients with chronic prostatitis of the second group did not change in the course of treatment. Conclusion. Assessing the dynamics of spermogram parameters as a result of the use of «ANDROEXPERT SV1» in men with chronic prostatitis associated with secondary infertility, there is a decrease in the number of leukocytes and a significant improvement in the parameters of the ejaculate, both its general properties and the main characteristics of spermatozoa. Thus, ANDROEXPERT SV1 suppositories show high clinical efficacy and safety in monotherapy and may be promising when choosing the management tactics for this group of patients.
Urologiia. 2022;(2):59-65
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Correlation adaptometry as a method of renal assessment and organismic interaction with closed kidney injury

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


Introduction. The kidney concussion causes damage to intraorganic angioarchitectonics, microcirculatory disorders, as a consequence - a decrease in functional capabilities of the organ, affecting inter-system interrelationships in the organism. Purpose of the study: to evaluate the interaction of renal functions and hemodynamic homeostasis by the method of correlation adaptometry in groups of victims after closed kidney injury with different areas of organ damage. Materials and methods. The study involved 114 patients with isolated comotional kidney injury Grade I-III, with the involvement of the 1st organ segment - 30 (26.0%), 2 segments - 26 (22.8%), 3 segments - 58 (51.2%). A radionuclide study was performed, the parameters of hemodynamic homeostasis were determined, and the functional stress index (IFN) was calculated. The assessment of the contingency of the analyzed parameters was carried out on the basis of correlation analysis, and the degree of connectivity of the parameters was estimated using the correlation graph. Results. It was found that with an increase in the number of damaged segments of the kidney, the main physiological parameters of the organ regress together with an increase in functional deficit. Vector decrease of functional capabilities ofthe organism by IFN was noted: from satisfactory adaptation (when kidney segment 1 was injured); through tension of adaptation mechanisms (2 segments); to unsatisfactory adaptation (3 segments), when homeostasis was preserved with significant tension of regulatory systems. The correlation graph was recorded at the level of 11,96 and 11,57 in trauma of the 1st and 2nd segments of the kidney. In case of damage to 3 segments of the organ, the weight of the correlation graph increases - 16,97, which indicates pronounced structural and functional maladaptive disorders in the activity of the organ. Conclusion: assessment of the conjugacy of indicators of renal and organism interaction, indicates the greatest tension of the reserves of functional potential of the organism in case of damage of 3 segments of the kidney.
Urologiia. 2022;(2):66-70
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Kidney carboxycryoablation. Pilot study

Damiev A.D., Akopyan G.N., Spot E.V., Kharchilava R.R., Kodzokov M.A., Gasanov E.N., Lerner Y.V., Krivov M.M., Gazimiev M.A.


Aim: The aim of this experimental study was to evaluate the effect of low temperatures of carbon dioxide on a “living” blood-supplying organ (pig kidney), to determine the possibility of performing cryoablation of kidney tissue with carbon dioxide (carboxycryoablation), as well as to establish experimentally modes of carboxycryoablation of the kidney. Materials and methods. To carry out this experimental study, a female of the mini-pig line was used. We performed laparoscopic access to the kidney for carboxycryoablation. During the freezing of the kidney, three modes were compared: 60, 90, and 120 s on one kidney of one animal. Immediately after the completion of cryoablation, nephrectomy was performed, and the removed kidney was sent for histological examination. According to the histological study, the results of the use of carbon dioxide during cryoablation of porcine kidney tissue were evaluated. Results. Cryoablation based on carbon dioxide (carboxycryoablation) leads to irreversible death (necrosis) and destruction of the affected tissue. A direct relationship between the exposure mode and the size of the cryonecrosis zone was noted. Thus, the most extensive zone of necrosis with a diameter of 10 mm was achieved when performing cryoablation in the exposure mode of 120 s. Conclusion. This experiment showed that carbon dioxide-based cryoablation remains a feasible procedure that leads to irreversible death (necrosis) and destruction of the affected tissue. However, further studies on the safety and efficacy of cryoablation of kidney tissue with carbon dioxide are required.
Urologiia. 2022;(2):71-76
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Urethral diverticulum in a patient with two stones after combined treatment of prostate cancer with metastasis to the left cavernous body of the penis

Polyakov N.V., Serebryany S.A., Galitskaya D.A., Penkov P.L., Kachmazov A.A., Alekseev B.Y.


Urethral diverticula are sac-like dilatations of the urethra that communicate with its lumen. They may be congenital or acquired. In males, urethral diverticula are rare and classified as congenital (true) and acquired, which are associated with trauma, abscess, strictures, surgical procedures, in particular in patients with hypospadias. A clinical observation of urethral diverticulum with two stones in a man after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis is presented in the article. At the first stage, the patient underwent endoscopic lithotripsy with a biopsy of the diverticulum wall and laser ablation of the stricture of urethrovesical anastomosis. At the second stage the excision of the diverticulum with urethroplasty was performed. The team of authors considers this clinical observation to be unusual. Previously, postoperative urethral diverticula with two stones in patients after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis was not described in the scientific literature.
Urologiia. 2022;(2):77-83
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Our experience of using hexane extract of Serenoa Repens fruit (Permixone) in the treatment of LUTS in clinical practice

Kuzmenko A.V., Gyaurgiev T.A., Kuzmenko G.A.


Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are among the most common causes of LUTS in men. LUTS occur on average in 62.5% of males, with irritative symptoms occurring in 51%, obstructive symptoms in 26%, and postmicturic symptoms in 17% of cases. According to the literature, moderate and severe LUTS were observed in 13% of men under the age of 50 and in 28% after 70 years. It should be noted that LUTS are not BPH-specific, since may be caused by prostate inflammation. According to publications, 57% of patients examined for CP have BPH, and 39% of patients with BPH have CP. The first line of drug therapy in patients with BPH is currently considered to be alpha-blockers and inhibitors of 5-α-reductase. In addition, it is possible to use herbal preparations made from fruits, roots, seeds, pollen and plant bark. Preparations based on Serenoa repens extract are among the most studied and are widely used both in our country and worldwide for the treatment of patients with BPH and LUTS. Only lipidosterol hexane extract of Serenoa repens is recognized as a drug, the use of which has a good evidence base. The clinical examples illustrating the pharmacological properties and results of the use of the preparation of lipidosterol hexane extract Serenoa repens are presented in the article. Conclusion. The presented clinical cases demonstrate the efficiency of the hexane extract of Serenoa repens fruit for the treatment of LUTS associated with BPH and CP. At the same time, the drug can be effectively used both as monotherapy and in combination with alpha-blockers. Therefore, it is reasonable to use the hexane extract of Serenoa repens fruit in clinical practice for the treatment of LUTS associated with BPH.
Urologiia. 2022;(2):84-89
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Efficacy of Uronext in chronic recurrent bacterial-viral cystitis with multiple resistance to antibacterial drugs

Ibishev K.S., Gadzhieva Z.K., Mamedov V.K.


Chronic recurrent cystitis (CRC) is one of the most common diseases of the lower urinary tract in the female population. Difficulties in diagnosis and treatment, despite the observance of modern clinical recommendations for CRC, are due to the versatility and polyetiology of the pathogenesis of the disease. The most difficult and discussed section of this problem is the diagnosis and treatment of CRC of papillomavirus (PV) etiology. The article presents its own clinical observation - Diagnosis and treatment of a patient with CRC PV etiology. CRC, in addition to bacterial uropathogens, can be caused by various representatives of a viral infection. Among all viral pathogens, HPV has the widest pathogenic potential. Currently, there is no single etiotropic therapy for PVI of the urinary tract and reproductive organs; there is no systemic treatment of patients with HPV-associated lesions, including the bladder. Nevertheless, an important principle of therapy, which has already become an axiom, is applied - an integrated approach that includes anti-inflammatory,antiadhesive, antiviral and immunoactive therapy
Urologiia. 2022;(2):90-94
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Surgical treatment of traumatic kidney laceration in children

Khotamov K.N., Tilavov U.K., Chuliev M.S., Mamatlukov I.B.


A clinical observation of a 12-year-old patient with a traumatic right kidney laceration is described in the article. The child underwent an organ-preserving procedure, namely diagnostic laparoscopy, laparotomy, revision of the abdominal cavity and right retroperitoneal space, suturing of the right kidney, nephrostomy. Irrigation and drainage of the abdominal cavity and retroperitoneal space. The satisfactory result was seen.
Urologiia. 2022;(2):95-98
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Overactive bladder in the structure of somatized depression

Dorozhenok I.Y., Gadzhieva Z.K., Ilina E.V., Bezrukov V.E.


In everyday practice, urologists often encounter clinical manifestations of overactive bladder (OAB), without of organic or infectious disease. In such cases, OAB may appears in the structure of a somatized (more often depressive) disorder, and therefore an integrated psychosomatic approach to such patient management is becoming increasingly relevant. The relevance of studying the topic is due to the high prevalence of OAB symptoms, its recurrent course, insufficient effectiveness of urological treatment, a significant decrease in the quality of life and working capacity of the socially active part of the adult population. Our clinical observation illustrates the development of symptoms of OAB with massive «pseudo-urological» symptoms within the framework of recurrent somatized depression in a woman of involutional age.
Urologiia. 2022;(2):99-102
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Infection of the lower urinary tract: new possibilities of herbal medicine

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


The review article is devoted to using modern combined herbal remedies for the treatment and prevention of urinary tract infections. From current point of view, the mechanisms of the pharmacological action of the components of Phytolysin preparations, paste for the preparation of a suspension for oral administration and Phytolysin capsules, are described in detail. The pathogenetic explanations of using herbal preparations in urological patients is given. The results of clinical studies are presented, confirming the efficiency of the use of drugs for the treatment and prevention of lower urinary tract infections. The new dosage form Phytolysin in the form of capsules does not differ in composition from the paste. Pharmacological effects and pathogenetic bases for the use of Fitolizin suggest that the new dosage form (capsules) is identical to the traditional, previously used one (paste).
Urologiia. 2022;(2):103-112
pages 103-112 views

Perineal urethrostomy: results, clinical, statistical and terminological aspects

Katibov M.I., Bogdanov A.B.


The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Complete data on all pre- and postoperative aspects of perineal urethrostomy were provided only in a few studies. In the overwhelm of cases, perineal urethrostomy was performed after one or several unsuccessful reconstructive procedures and only in few patients it was done prior to various types of urethroplasty. It was not possible to establish any association between etiological factors and localization of urethral stricture among these patients. The incidence of pan-urethral stricture ranged from 28.6% to 100%. Only in one study the average stricture length was 2 cm, while in all other studies it was 5 cm or more. Postoperative follow-up was on average 14 to 62 months. Treatment success with perineal urethrostomy ranged from 0% to 100%, but in most studies it was 75% or more. The most common perineal urethrostomy technique used included Blandy technique, and Johanson and 7-flap techniques.
Urologiia. 2022;(2):113-120
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Male reproductive health and COVID-19

Kurashova N.A., Dashiev B.G., Kolesnikov S.I., Kolesnikova L.I.


The SARS-CoV-2 pandemic has brought serious economic and social problems worldwide'. Due to its medical consequences, it is of importance to study the mechanisms of the disease and new therapeutic interventions, as well as rehabilitation processes. Despite the fact that the genome of the new coronavirus has been sequenced and studied, clinical and epidemiological data are constantly updated and analyzed, and exact pathogenesis has not yet been understood. At the same time, domestic and foreign studies suggest that the virus is an agent that affects not only the lungs, vascular wall, hemostasis, but also the reproductive system. The aim of the review is to summarize the current knowledge about novel SARS-CoV-2, including its pathophysiology and potential impact on male reproductive function.
Urologiia. 2022;(2):122-125
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Molecular genetic predictors of the development of urolithiasis

Khotko D.N., Polukonova N.V., Khotko A.I., Navolokin N.A., Tarasenko A.I.


Urolithiasis is one of the most urgent problems of clinical urology. Currently, there is no consensus on the causes of stone formation, as well as the role of various factors in the development of urolithiasis, however, increasingly, according to various studies, the leading role is given to genetic causes. The article presents a modern review of data on genetic polymorphisms associated with ICD: rs1801197 and rs6776158 of the CASR gene; TaqI of the VDR gene; rs1801197 of the CALCR gene, rs3752472, rs650439, rs2853744 of the Klotho gene.
Urologiia. 2022;(2):126-129
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Modern molecular-genetic aspects of histological variants of renal cell carcinoma

Osmanov Y.I., Kogan E.A., Gadzhieva Z.K., Prochenko D.D.


The article presents the main molecular mechanisms of the pathogenesis of renal cell carcinoma. The molecular pathways that determine the development of histological variants of renal cell carcinoma and the role of stem cells markers in the carcinogenesis of these tumors are considered.
Urologiia. 2022;(2):130-135
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Urinary incontinence in women and its impact on quality of life

Sazonova N.A., Kiseleva M.G., Gadzhieva Z.K., Gvozdev M.Y.


The prevalence of urinary incontinence at a young age is 20-30%, gradually increasing to 40% among older women. Urinary incontinence affects many areas of the patient's life, including social, psychological, work, sexual, etc. The main causative factors, which also influence on its severity, include age, pregnancy, childbirth and obesity. To date, there are many treatment methods for stress urinary incontinence. However, more preference is given to the sling procedures, in which mesh is placed under the middle part of the urethra. Despite being the "gold" standard for the treatment of stress urinary incontinence, it is difficult to determine indications for surgical treatment, since "nonmedical" view of the patient's problem is often required. The low awareness of primary care physicians about the possibilities of treating urinary incontinence often leads to an erroneous opinion in patients about their disease and methods of treatment. Many patients regard this condition as an integral part of aging, avoid situations in which urinary incontinence is possible, which limits daily activities, sexual activity, sports and other areas of life. Based on the latest data, a review of the literature on urinary incontinence in women, risk factors, as well as existing methods of surgical correction are presented in the lecture. Particular attention is paid to the impact of urinary incontinence on the quality of life of patients and current methods for its assessment.
Urologiia. 2022;(2):136-139
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