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No 2 (2019)


The additional criterion for the diagnosis of purulent-destructive forms of acute pyelonephritis

Shchuplova E.A., Kuzmin M.D.


Aim: to develop an additional criterion for objective diagnosis of purulent-destructive forms of acute pyelonephritis. Materials and methods. A total of 35 blood samples from patients with acute pyelonephritis aged from 19 to 85 years (mean age was 52 years) were studied. For the analysis, a classical bacteriological method of isolating blood culture and a modern molecular genetic method of fluorescent in situ hybridization (FISH) using DNA probes complementary to species-specific regions of the 16S rRNA gene of microorganisms were used. The obtained results were processed using the Statistica 6.0 program. Results. The bacteriological study showed that only in one patient (2.9%) a blood culture was positive, whereas with FISH, polymicrobial infection consisting of two associates was observed in five patients (14.3%), and 207 specific luminescence from different DNA probes were detected in blood samples. The associations of members of the Enterobacteriaceae with S. aureus were 2.4 times more frequent than associations of the Enterobacteriaceae with S. epidermidis, indicating a development of the polymicrobial infection and, accordingly, the development of purulent stage of acute pyelonephritis. Conclusion. For the diagnosis of acute pyelonephritis, we suggest to use an additional criterion, which consists in applying of FISH method for the detection and simultaneous identification ofbacteria that were adhered on the surface of erythrocytes and located intracellularly. This method may allow for the differential diagnosis of serous and purulent stages of acute pyelonephritis.
Urologiia. 2019;(2):5-8
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Efficiency of immunomodulatotors for complex therapy of chronic recurrent cystitis in women

Kuz’menko A.V., Kuz’menko V.V., Gyaurgiev T.A.


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.
Urologiia. 2019;(2):9-14
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Clinical value of Canephron N after surgical treatment of urinary stone disease

Demidko Y.L., Rudenko V.I., Grigoryan V.A., Enikeev M.E., Allenov S.N., Kasiteridi I.G., Ujegov T.A., Amosov A.V.


Background. The drug Canephron N is a combination of extracts of centaury, lovage and rosemary. Moderate antispasmoic, antiinflammatory, antioxidant, diuretic and antimicrobial effects are of great interest for urological practice. The optimal combination of components that were made of herbal medicine allows to use their synergistic effect for prevention of recurrence of urinary stone disease. The experience of using the drug Canephron in clinical practice is of great interest. Aim: to clarify the clinical efficiency of Canephron N in patients with urinary stone disease after surgical treatment and to evaluate the changes in diuresis and calcium excretion. Materials and methods: The results of using the drug Canephron after surgical treatment of urinary stone disease are provided. The changes in diuresis and calcium excretion in 75 patients undergone surgical treatment of urinary stone disease were studied. Patients after ureteroscopy, percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy were prescribed treatment to prevent stone formation including herbal drug Canephron N. Results. At baseline, there was negative correlation between 24-hours diuresis and calcium excretion in all groups. During follow-up, a positive correlation between 24-hours diuresis and calcium excretion was found in patients receiving Canephron N and other types of treatment. The average follow-up was 390 days. During this period, recurrence was noted in 1 patient receiving Canephron, 4 patients in patients who took other drugs and in 5 patients who didn’t receive any treatment. Conclusion. Risk factors of stone formation persist after surgical treatment of urinary stone disease. This is reflected in a negative correlation between 24-hour diuresis and calcium excretion. During treatment, a positive correlation between diuresis and calcium excretion was noted in patients with urinary stone disease. The use of drugs that affect stone formation as well as herbal medicine Canephron N allow to obtain comparable ratio of diuresis and calcium excretion.
Urologiia. 2019;(2):15-20
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Peculiarities morphology and structure of the uroliths

Polienko A.K.


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.
Urologiia. 2019;(2):21-25
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A comparative analysis of the results of percutaneous nephrolithotomy and laparoscopic pyelolithotomy

Guliev B.G., Komyakov B.K., Zaikin A.Y.


Introduction. Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones. Materials and methods. The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5-3.8) cm and in the LP group it was 3.0 (2.6-4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared. Results. There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5+1.5 vs 4.4+1.4 days) and analgesic use (2.2+0.9 vs 2.4+1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0+25.0 vs 65.4+24.5 min; p<0.05), but the amount of blood loss was significantly lower (70+28 versus 160.0+55 ml; p<0.05) compared to the PNL group. Conclusions. PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.
Urologiia. 2019;(2):26-30
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A comparative analysis of simultaneous bilateral versus staged supine mini-percutaneous nephrolithotomy in patients with bilateral kidney stones

Panferov A.S., Kotov S.V.


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.
Urologiia. 2019;(2):31-35
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Horseshoe kidney tumor laparoscopic surgery. First 19 cases

Kochkin A.D., Gallyamov E.A., Medvedev V.L., Popov S.V., Biktimirov R.G., Sevryukov F.A., Sergeev V.P., Orlov I.N.


Introduction. Although horseshoe kidney (HSK) is the most common congenital anomaly of the upper urinary tract, renal cell cancer (RCC) in HSK develops extremely rarely. Until 2012 y. there were less than 200 cases of RCC in HSK published in PubMed. Only five cases of laparoscopic partial nephrectomies and some cases of heminephrectomies have been described in PubMed. Aim. To conduct a multicenter retrospective analysis of laparoscopic surgery for tumors in HSK. Material and methods. From January 2013 to December 2018 a total of 19 conventional laparoscopic interventions were performed in patients with RCC in HSK, including 1 isthmusectomy, 5 partial nephrectomies and 13 heminefrectomies. In addition, 16 divisions of isthmus were done in 15 patients. The video describing our operation technique is available on: . Results. There were no conversions to open surgery and mortality as well as intra- and postoperative complications of Clavien grade 3 or higher. Warm ischemia time during partial nephrectomy didn’t exceed 19 minutes. Operative time ranged from 110 to 270 min, while max estimated blood loss was 400 ml. All patients were followed for 6 month and no case of disease recurrence or progression was noted. Conclusions. The small number of laparoscopic interventions in patients with RCC in HSK doesn’t allow to carry out a proper statistical analysis and draw certain conclusions. We presented the largest experience available in the literature and our results demonstrate the efficacy and safety of conventional laparoscopic technologies in the treatment of RCC in HSK.
Urologiia. 2019;(2):36-39
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Markers of stem cells and their prognostic values for urothelial carcinomas of the urinary tract

Osmanov Y.I., Kogan E.A., Rapoport L.M., Teodorovich O.V., Gaibov J.A.


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.
Urologiia. 2019;(2):40-49
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The association of GSTP1 polymorphisms with male idiopathic infertility

Kurashova N.A., Belyaeva E.V., Ershova O.A., Ievleva K.D., Dashiyev B.G., Bairova T.A., Kolesnikova L.I.


Aim: To identify the association between Ile105Val, Ala114Val polymorphisms of gene GSTP1 (glutathione transferase pi1) and infertility in Russian men. Materials and methods: A total of 160 infertile Russian men of reproductive age (mean age 30.2+3.6 years) were included in study group, while in control group there were 104 age-matched healthy fertile Russian male (mean age 31.3+5.4 years). Molecular and genetic studies of Ile105Val, Ala114Val polymorphisms of gene GSTP1 were performed using real-time polymerase chain reaction. Genomic DNA was extracted from the peripheral blood. Results: A frequency ofgenotypes (p=0.024; df=2; p=0.024) and alleles (z=2,778; p=0,005) of Ile105Val locus was significantly different in the study and control group. In the study group, there was an increase in the frequency of the Ile/Ile genotype by 13% (х2=3.995; df=1; p=0.046) and a decrease in the frequency of the Val/Val genotype by 6% (х2=4.887; df=1; p=0.027). A rate of genotype Ile/Ile in infertile men with was 1.7 time higher than in control group (odds ratio (OR):1.73; 95% confidence interval (Cl): 1.04-2.87; p<0.05). There was not significant difference in frequency of genotypes and alleles of Ala114Val polymorphism of gene GSTP1 between the study and control groups. Conclusions: The male infertility in Russia is associated with Ile105Val polymorphism and not associated with Ala114Val polymorphism of gene GSTP1. In infertile men wild-type genotype and major allele Ile105Val polymorphism of gene GSTP1 were significant more frequent compared to control group. A rate of genotype Ile/Ile in men with infertility was 1.7 time higher.
Urologiia. 2019;(2):50-54
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Focal laser coagulation in the treatment of a patient with kidney cancer and prostate cancer

Teodorovich O.V., Shatokhin M.N., Naryshkin S.A., Abdullayev M.I., Krasnov A.V., Borisenko G.G., Zhurbenko A.A.


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.
Urologiia. 2019;(2):55-58
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A case of successful plasma transurethral enucleationof benign prostatic hyperplasia the size of 530 cm3

Sevryukov F.A., Nakagawa K., Kochkin A.D., Volodin M.A., Semenychev D.V.


The articIe presents a description of the cIinicaI case. SurgicaI treatment by pIasma transurethraI enucIeation of the prostate was performed in patients with benign prostatic hyperplasia of giant size - 530 cm3. Observation in the short term showed the absence of functional and organic complications. Comparison with the results of surgical treatment of giant prostate adenoma by cIassicaI transurethraI enucIeation of the prostate, obtained in our uroIogicaI cIinic in 2015, showed a reduction in operating time by 1 hour without a significant increase in bIood Ioss during surgery and without operationaI compIications. The resuIts demonstrate the prospects of the widespread introduction of pIasma methods of transurethral operations in urological practice.
Urologiia. 2019;(2):59-63
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Lymphangioma of the penis

Grekova Y.N., Zilberberg N.V., Toropova N.P., Kuznetsova E.I., Iglikov V.A.


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.
Urologiia. 2019;(2):64-66
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Efficiency and safety of silodosin for treatment of lower urinary tract symptoms, associated of benign prostatic hyperplasia

Krivoborodov G.G., Tur E.I.


Benign prostatic hyperplasia commonly is the most common cause of bladder outlet obstruction and can result in storage and micturition symptoms in men older than 40 years. Nowadays the a1-adrenoreceptor antagonists are the first-line drug for treatment of the lower urinary tract symptoms (LUTS). However, a1-adrenoreceptors are known to be present in other tissues and this fact could be a reason of potential risk of adverse events, associated with changes in peripheral vascular tone, such as orthostatic hypotension, syncopal states, dizziness, etc., especially in patients of advanced age, and those affected by cardiovascular diseases and taking essential drugs. A highly selective a-adrenergic blocker silodosin is characterized by a lower rate of mentioned adverse events, comparable with placebo. Silodosin is also highly effective in treating of both types of LUTS in these patients, both as monotherapy and in combination with other drugs. A detailed analysis of clinical data confirming the high efficacy and safety of silodosin is presented in this review of the literature.
Urologiia. 2019;(2):67-72
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Biomarkers of prostate cancer and potential for using ace produced in prostate gland for diagnosis of prostate cancer and benign prostatic hyperplasia

Kamalov A.A., Samokhodskaya L.M., Karpov V.K., Okhobotov D.A., Mamedov V.N.


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.
Urologiia. 2019;(2):73-81
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Perspectives of improvement of the diagnosis of prostate cancer based on analysis of PCA3 gene expression

Toropovsky A.N., Nikitin A.G., Pavlova O.N., Viktorov D.A.


Prostate cancer is the second leading cause of cancer death. The widespread introduction into the clinical practice of test for prostate specific antigen (PSA) led to an increase in the number of prostate biopsies performed. At the same time, a decrease in the threshold of age-specific PSA standards has resulted in an increase in the number of unnecessary biopsies. In this regard, a need has arisen for new prostate cancer biomarkers. PCA3 is a non-coding mRNA that is exclusively expressed by prostate cells. Currently, three generations of test diagnostic systems based on the quantitative analysis of the PCA3 mRNA in the urine or its cell sediment has already developed, and they differ in the type of material studied and the method for estimating the amount of PCA3 mRNA. Clinical studies of the developed test systems have shown that a high level of PCA3 expression in the patient’s urine correlates with the probability of detecting prostate cancer. PCA3 test has higher positive and negative predictive values than previously used PSA test. These data are repeatedly confirmed by studies conducted in different clinics. Thus, the introduction of the method of quantitative determination of PCA3 in clinical practice can significantly improve the efficiency of diagnosis of prostate cancer and reduce the number of unnecessary biopsies.
Urologiia. 2019;(2):82-87
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Urinary stone disease. Part IV. Recurrence prevention for urinary stone disease

Saenko V.S., Gazimiev M.A., Pesegov S.V., Alyaev Y.G.


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.
Urologiia. 2019;(2):88-96
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Current opportunities for symptomatic treatment of dysuria

Vinarov A.Z., Spivak L.G.


Dysuria is the one of the most common conditions in urology. Although dysuria is not an independent disease, it accompanies a wide range of urological diseases of both infectious and non-infectious origin. Dysuria is traditionally understood as a feeling of discomfort, a burning sensation, or a sensation of pain during urination. Despite a significant reduction in the quality of life of this category of patients, pathogenetic treatment of the underlying cause is often performed in routine clinical practice, while the dysuria itself can remain without proper attention. The current possibilities of symptomatic relief of dysuria are reviewed in this article.
Urologiia. 2019;(2):97-102
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Mechanisms of kidney damage

Tarasenko A.I., Alekseev A.V., Maksimova S.Y.


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.
Urologiia. 2019;(2):103-107
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Feminizing genitoplasty in virilization of the external genitalia

Morozov D.A., Ayryan E.K., Sataeva Z.F.


The review focuses on the feminizing genitoplasty of the external genitalia in patients with disorders of sex development. The opinions of various surgeons and surgical schools on the timing, stages and methods of performing feminizing genitoplasty in girls with the virilization of the genitalia are presented. The development and improvement of surgical techniques for performing clitoroloplasty in patients with virilization of genitalia are described, as well as different types of labioplasty. The main methods of reconstruction of the urogenital sinus are given.
Urologiia. 2019;(2):108-112
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Role of drinking and dietary factors in effective dissolution therapy and recurrence prevention of uric acid kidney stones

Saenko V.S., Pesegov S.V., Frolova E.A.


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.
Urologiia. 2019;(2):113-118
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