No 2 (2019)

Introduction. Currently, chronic recurrent cystitis is one of the most important problems in urology. Considering the role of immune status disorders in the pathogenesis of inflammatory diseases, the use of immunocorrective drugs as part of the complex therapy is of particular relevance. Aim: to study the efficiency of therapy for chronic recurrent bacterial cystitis in combination with immunomodulators (Galavit). Materials and methods. A total of 60 women with acute stage of chronic recurrent bacterial cystitis were examined. The patients were randomized into 2 groups of 30 patients. In the control group, standard antibiotic therapy was administered. In the treatment group, patients received Galavit in combination with standard therapy. All patients were followed-up on the 1st, 5 th and 10th day. Voiding diaries, chronobiological status and pain severity using a 5-point scale were evaluated. In addition, complete blood count, urinalysis, urine culture and enzyme immunoassay for determination of serum level of interleukin (IL) 1, IL-6, tumor necrosis factor а (TNF-а) were analyzed. A number of recurrences after 3 months of therapy was assessed. Results. Complex therapy in combination with Galavit in women with acute stage of chronic bacterial cystitis allows to decrease in desynchronosis by 20%, reduce pain by 2.5 times, frequency of urination by 1.7 times, the number of urgent voids and night urination by 2.4 and 5 times, respectively, by the 5th day of therapy. In the group of patients receiving immunomodulators a significantly more pronounced decrease in the level of IL-1, IL-6, TNF-а and CRP was noted. During 3 months of follow-up, there were 2 recurrences in the control group and no recurrences in treatment group (10%). Conclusion. The use of Galavit in the treatment of women with chronic recurrent bacterial cystitis has pathogenetic basis. A clear advantage of the drug is more rapid relief of symptoms, normalization of laboratory parameters, recovery of chronorhythms and the achievement of clinical remission.

The aim: According to statistical data of a number of the countries, have an urolithic disease from 5% to 15% of the population today. A recurrence arises at 50-85% of patients. The purpose of this work was complex studying of morphology, structure, mineral structure of urolit, identification of regularities of their formation, establishment of interrelation between mineral and organic matter in structure of urolit. Materials: the urinary stones from the urology departments of hospitals and clinics of the Tomsk region (Russia). Methods: crystallomorphological (the study of the surface morphology of uroliths binocular and trinocular microscopes); polarizing optical (study of the mineral composition of uroliths on a polarizing microscope); x-ray crystallography (the study of spectral composition on the apparatus DRON-3); electron microscopic (study of the peculiarities of morphology of crystals in an electron microscope). Results. On features of morphology of a surface four types of urolit are allocated: druzovidny, sferolitovy, combined, korallovidny. Structural kinds of urolit: crystal and granular, dendritovidny, combined, rhythmic -zone. In structure of urolit the following types of rhythms are established: zone, granular, combined. In the urolitakh with rhythmic - the zone structure allocated elements of their building: kernel, layer, zone, rhythm. A mineral part of uric stones is presented by the crystals belonging to the classes: oxalates, phosphates, urat .Summary. The peculiarities of the morphology of the selected four types of uroliths: druzoid, with, combined, coral. Structural variations uroliths: crystal-grained Shelly, dendritic, combined, rhythmically zoned. In the structure of uroliths, the following types of rhythms: zoned, granular, combined. In urolith with rhythmically zoned structure selected elements of their structure: core, layer, area, rhythm. Discussion. Morphological and structural features of the structure of urolites, especially the presence of rhythmic zoning, due to the alternation of layers of mineral and organic matter, indicate a close relationship between the living organism and the organo-mineral aggregate in the human urinary system. With a high degree of confidence we can talk about the symbiosis of living and mineral matter in the human body; as a result of this symbiosis, organic-mineral formations are formed, which are often the further cause of some diseases (for example, urolithiasis and cholelithiasis). Conclusion. The complex research of uric stones allows to obtain important information on their structure, structure and features of morphology. Morphological and structural features of the structure of urolit, in particular existence of the rhythmic zonality caused by alternation of layers of mineral and organic matter demonstrate close interrelation between a live organism and the organo-mineral unit in an urinary system of the person.

Aim. To evaluate feasibility and efficiency of simultaneous bilateral supine mini-percutaneous nephrolithotomy in patients with bilateral kidney stones. Materials and methods. A total of 79 patients were included in prospective, randomized study. Single-stage bilateral supine mini-percutaneous nephrolithotomy was performed in the main group (n=37), while in control group (n=42) staged mini-percutaneous nephrolithotomy was done. All interventions were performed in supine position. A type and severity of postoperative complications, changes in biomarkers of acute kidney injury including serum creatinine, glomerular filtration rate (GFR) and cystatin C level were evaluated. The follow-up was 6 months. Results. Stone-free rate in main and control groups was 89.1% and 88.9%, respectively, while the mean duration of the surgery was 82.76 and 140.14 minutes, respectively (p<0.05). There were no significant differences in the type and rate of postoperative complications between groups. Recovery time was significantly shorter in the main group (8.44 vs. 17,76+2,41 days, respectively [p<0.05]). There were significant changes in serum creatinine and cystatin C levels on 1st day after surgery compared to baseline values and between groups. However, the level of GFR didn’t significantly change in both groups. After 1 month, an increase in GFR in the main group was 6.9% in comparison with 6.8% in control group. Conclusion. Our study demonstrates that simultaneous bilateral mini-percutaneous nephrolithotomy is a safe and effective treatment option for patients with bilateral kidney stones.

The fundamental question about the origin of cancer stem cells of urothelial carcinomas with luminal remains open. So far, no convincing evidence has been found to determine whether these events occur in a single cell, presumably basal, or are realized in different precursor cells of the urothelium. The potential of a number of potential stem markers as cancer stem cells in urothelial carcinomas and their prognostic significance are currently being investigated. Aim. Our aim was to carry out a comparative analysis of the expression of stem markers in the molecular subtypes of urothelial carcinomas, including ALDH1A1, CXCR4, CD24, CD82, CD105, CD133, NANOG, OCT4 and SOX-2. In addition, the relationship between the pattern of expression and the pathological features of the tumor was determined. Patients and methods. Surgical specimens from 196 patients with a diagnosis of urothelial carcinoma of the renal pelvis and bladder were studied. Immunohistochemical study was performed on paraffin sections using the standard protocol. Antibodies against ALDH1A1, CD82, CD133, CXCR4, NANOG, OCT4, SOX2 («Abcam»), CD24, CD105 («Invitrogen»), CD31, CD34 («Novocastra») were used. Results. The stem cell markers used in the study were expressed in all molecular subtypes of urothelial carcinoma and there were no differences in frequency and intensity of expression between different phenotypes. However, the frequency and intensity of expression of the markers correlated with the tumor stage and the grade of cellular anaplasia. Conclusion. Our results confirm that cancer stem cells with basal phenotype are not an exclusive subpopulation in urothelial tumors. Other progenitor cells with the immunophenotype of intermediate and/ or umbrella cells can serve as cancer stem cells. These features of the expression in cancer stem cell markers will allow to develop new approaches to the treatment of urothelial carcinomas.

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.

Lymphangioma circumscriptum (LC) is a rare, benign condition, predominantly characterized by the malformation of lymphatic skin vessels. The most common sites include the oral mucosa, tongue, skin of the extremities and torso. Lymphangioma of the penis is rare disease. In the paper a clinical case of cystic lymphangioma of the penis, which was initially diagnosed as herpes and human papillomavirus infection, is described. Early diagnosis of skin tumors of anogenital area allows to prescribe a timely therapy. After the CO2-laser vaporization there was no recurrence during the 6-month follow-up period.

Prostate cancer (PCa) is the 4th most commonly diagnosed cancer in the male population and incidence of different stages is increasing every year. The efficiency of PCa treatment is strongly dependent on the its stage. Prostate Specific Antigen (PSA) is the most widely used and universal biomarker of PCa worldwide. Considering its limited predictive value, particularly in patients older than 50 with PSA level ranging from 4.5 to 10 ng/ml, there is a need to introduce new serum biomarkers of PCa. Current data on different PCa biomarkers are reviewed in the article as well as a role of angiotensin-converting enzyme (ACE) as a novel PCa biomarker.

The place and indications for recurrence prevention of urinary stone disease, general principles of recurrence prevention, role of mineral water and changes of dietary habits during recurrence prevention are reviewed in the articIe.

The results of recent studies on the mechanisms of kidney damage are presented in the review of literature. The role of the immune system in the occurrence, development and outcome of damage to the epithelium of the renal tubules, as well as molecular, genetic and metabolic changes which determine the extent and consequences of renal trauma are described in details. The mechanisms of restoration of the renal parenchyma and the development of fibrosis following the cessation of injury are given.

The use of alkaline mineral waters leads to alkalization of urine and an increase in level of urinary citrate, which represent important factor inhibiting the formation of urinary stones. Combination of alkaline mineral waters with citrates facilitates the achievement of target urine pH level not only during dissolution therapy, but also during recurrence prevention. Alkalization of urine and reducing of the influence of alimentary factor don’t preclude drug therapy. Patients should be counselled about complex strategies aimed to modifiable risk factors for urinary stone disease.