


No 5 (2017)
- Year: 2017
- Articles: 27
- URL: https://journals.eco-vector.com/1728-2985/issue/view/7239
Articles
THE EFFIECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATING PROXIMAL URETERAL STONES
Abstract
Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of α-blockers in stimulating residual stone clearance after ESWL. Aim To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using α-blockers to stimulate residual stone clearance. Materials and methods ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. Results Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. Conclusion Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.
Urologiia. 2017;(5):5-8



ULTRASOUND INDICATORS OF THE PROSTATE, URINARY BLADDER AND UROFLOWMETRY PARAMETERS IN THE DIAGNOSIS OF INFRAVESICAL OBSTRUCTION IN MEN WITH BENIGN PROSTATIC HYPERPLASIA
Abstract
Relevance Benign prostatic hyperplasia (BPH) is one of the most common urologic diseases of males. In patients who failed drug therapy of lower urinary tract symptoms (LUTS) caused by BPH, the most important indication for surgery is the presence of infravesical obstruction (IVO). IVO is detected by pressure-flow studies and is characterized by high detrusor pressure with decreased urinary flow rate. The invasiveness and high cost of this investigation has stimulated a search for non-invasive techniques that could reliably characterize the presence of IVO secondary to BPH. Aim To determine the value of ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of IVO in men with BPH. Materials and methods Seventy-six men with moderate and severe LUTS secondary to BPH underwent a comprehensive urological examination, including a clinical history, digital rectal examination, International Prostate Symptom Score (I-PSS), serum prostate-specific antigen (PSA), various ultrasound indicators of the prostate and urinary bladder, uroflowmetry and a pressure/flow study. Results Infravesical obstruction (IVO) was detected in 73.1% of men with BPH. IVO was found to have the strongest correlation with ultrasound signs of the intravesical prostatic protrusion (IPP, r = 0,667, p <0,05) compared with the prostate volume, prostate transition zone volume, prostate transition zone index, prostatic urethral angle, urethral length of the transition zone, estimated prostate circumference, prostate peripheral zone thickness, residual urine volume, weight of urinary bladder, the thickness of the detrusor, maximum and average urine flow rates and I-PSS score. The incidence of IVO increased in parallel with the increase of IPP. We established a cut-off value for IPP of 10 mm for the diagnosis of IVO with a sensitivity of 68.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 53.3%. Conclusion The ultrasound findings of IPP measuring more than 10 mm strongly correlates with the IVO in men with LUTS and BPH as compared with other ultrasound parameters of the prostate, urinary bladder and urinary flow rates. The IPP is anatomical parameter that do not require urination, and is easily detected by both transabdominal and transrectal ultrasound. However, at the PPI values less than 10 mm, the main method for detecting IVO remains the pressure/ flow study.
Urologiia. 2017;(5):9-14



STRUCTURAL-MORPHOLOGICAL CHANGES OF THE CONNECTIVE TISSUE OF THE VAGINAL MUCOSA AND PERINEAL SKIN IN WOMEN WITH STRESS URINARY INCONTINENCE
Abstract
Aim. To investigate the morphological and structural changes in the connective tissue of the vaginal mucosa and perineal skin in women with stress urinary incontinence. Materials and methods. From 2010 to 2013, 71 patients of reproductive age with stress incontinence were observed. The control group comprised 80 women, who also underwent biopsy of the vaginal mucosa and perineal skin. The sections of specimens were stained by Van Gieson, Mallory and Weigert. In immunohistochemical studies, rabbit antibodies specific for collagen types I, III, and IV were placed on each section. Results. Morphological picture of the perineal skin the study group patients completely confirms the clinical manifestations and results of immunohistochemical test, broadens the notion of structural changes in tissues. According to immunohistochemical and histological examination of the vaginal mucosa, some fibrous elements in the lamina were weakly stained. Due to the decrease in the number of vessels and the destruction of their basal membranes and the basal membrane of the epithelial layer, the amount of type IV collagen was markedly reduced. Discussion. Elastic fibers in the vaginal mucosa and skin of the perineum together with the collagen fibers are the supporting framework of the skin, and together with the interstitial substance of the above authorities lend elasticity in tension. Studies have shown that stress urinary incontinence may be the result of dysregulation of processes. For this pathology in the lamina propria of the vaginal mucosa and dermal lamina of the skin of the perineum destroyed elastic fibers and changes the ratio of collagen of various types. That is, the predominant type III
Urologiia. 2017;(5):15-20



RENAL FUNCTION AFTER LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH SUPERSELECTIVE BALLOON EMBOLIZATION OF RENAL ARTERY
Abstract
Aim. To evaluate the functional state of the renal parenchyma after partial nephrectomy, depending on surgical technique. Materials and methods. The study comprised 21 patients with kidney neoplasms of stage T1-2N0M0. The patients underwent either laparoscopic partial nephrectomy with superselective balloon embolization of the renal artery (study group, n=11), or partial nephrectomy with vascular clamping (control group, n=10). The mean age of the patients in the study group (3 men and 8 women) was 56.8 years. The tumor was located in the right kidney in 5 patients and in the left kidney in 6 patients. The size of the neoplasm ranged from 0.9 to 3.8 cm, averaging 1.9 cm. The complexity of the surgery was evaluated using R.E.N.A.L. Nephrometry Scoring System based on MSCT findings. The mean nephrometry score was 5.1, which corresponds to low complexity of the intervention. Patients of the control group underwent partial nephrectomy with vascular clamping and renal ischemia time of no more than 20 minutes. The mean age of the control group patients was 57.3 years. The tumor was located in the right kidney in 4 patients and in the left kidney in 6 patients. The tumor size ranged from 1 to 4.1 cm, averaging 2.2 cm. The mean nephrometry score based on MSCT findings was 6.1. In both groups, the difference in creatinine clearance between the operated and intact kidney was estimated before the operation and in the early postoperative period to assess the changes in glomerular filtration. Results and discussion. The level of serum creatinine remained within the normal range throughout the study period in both groups. In the postoperative period, the creatinine clearance of the operated kidneys showed 1.02-fold decrease after super selective embolization and 1.92-fold decrease after vascular clamping. The 1-minute diuresis of the operated kidney decreased by 83.21% and 43.53% after vascular clamping and embolization, respectively. Conclusion. The study’s findings show there was no significant dysfunction of operated kidneys after superselective balloon embolization of the renal artery.
Urologiia. 2017;(5):21-25



LAPAROSCOPIC RADICAL CYSTECTOMY: INNOVATIONS AND CLASSICS
Abstract
Introduction. Radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer. To combine the advantages of minimally invasive interventions and the well-established open surgery, we attempted to reproduce as accurately as possible the technique of open radical cystectomy using a laparoscopic procedure. Materials and methods. The study comprised 35 patients (27 men and 8 women) with invasive bladder cancer who underwent laparoscopic radical cystectomy (LRC) between April 2013 and March 2016. The study included only patients with fully intra-corporal ileum conduits. Results. The operating time averaged 378 min., the mean blood loss was 285 ml, the mean postoperative hospital stay was 12.4 days. Only 20% of patients needed postoperative opioid analgesia. Postoperative complications occurred in 11.4% of patients. The vast majority of them were successfully managed by minimally invasive methods. Conclusion. Laparoscopic radical cystectomy is a safe and effective treatment modality for invasive bladder cancer. However, more patients and a longer observation period are needed to recommend the method as a standard of care.
Urologiia. 2017;(5):26-31



LAPAROSCOPIC TRANSPERTONEAL ADRENALECTOMY
Abstract
Aim. To analyze the results of laparoscopic adrenalectomy (LAE) in patients with adrenal gland tumors. Materials and methods. From 2011 to 2016, 24 patients (15 men, 9 women), mean age 49.6 ± 8.2 years, underwent LAE. The right, left and bilateral LAE was performed in 12, 10 and 2 patients, respectively. Indications for surgery were mainly primary and metastatic adrenal tumors. The operations were performed using a transperitoneal 4-port approach. Results. Twenty six LAE were successfully performed in 24 patients. There were no conversions. Blood transfusion was used only in 1 patient, who had a history of the laparoscopic left nephrectomy for the renal cell carcinoma 2 years earlier. She had bleeding due to a spleen injury during the left LAE. She also developed acute postoperative pancreatitis, resolved by conservative therapy. The mean intra- and postoperative blood loss was 160 (120-750) ml, the operative time was 135 (100-205) min, and the length of hospital stay was 4 (3-5) days. Histological examination revealed adenocarcinoma and adenoma in 20 (73.1%) and 6 (26.9%) removed adrenal glands, respectively. Conclusion. Laparoscopic adrenalectomy is an effective and safe surgical modality to treat patients with adrenal tumors.
Urologiia. 2017;(5):32-35



GENERAL CLINICAL AND LABORATORY AND INSTRUMENTAL CHARACTERISTICS OF THE CHRONIC NONBAPTERIAL PROSTATITE WITH THE INFLAMMATORY COMPONENT IN MEN OF THE FIRST PERIOD OF MATURE AGE
Abstract
Aim To investigate the course of CNPIC in young men treated with general and local ozone therapy. Materials and methods 306 patients underwent standard treatment concurrently with local and systemic ozone therapy. Clinical-laboratory and instrumental parameters were evaluated before and after treatment. In addition, the blood flow of the prostate, prostatic urethra and skin at the projection point of the prostate was studied. Results Standard treatment of CNPIC with the concurrent use of general and local ozone therapy resulted in a reduction of pain intensity and severity of dysuria, improvement of the sexual function and quality of life of men. There was an increase in blood flow in the arteries and veins of the prostate, a decrease in the prostate size and volume. The study findings showed an almost twofold decrease of the mean values of the CNPIC clinical index during treatment. In the prostate secretion, the leukocyte count decreased from 29.29±0.67 to 4.75±0.15. A statistically significant (p<0.001) decrease in all sizes of the prostate was observed: height (upper) from 40.99±0.22 to 39.13±0.21 mm, width (transverse dimension) from 41.94±0.21 to 39.94±0.22 mm, and thickness (anteroposterior size) from 30.52±0.20 to 29.15±0.18 mm. Prostate volume also decreased from 27.78±0.42 to 24.10±0.36 cm (p<0.001).
Urologiia. 2017;(5):36-41



EFFEKTIVNOST' PRIMENENIYa PREPARATOV OMNIK I OMNIK OKAS U PATsIENTOV S SIMPTOMAMI NIZhNIKh MOChEVYVODYaShchIKh PUTEY NA FONE DOBROKAChESTVENNOY GIPERPLAZII PROSTATY (MNOGOTsENTROVAYa NABLYuDATEL'NAYa PROGRAMMA)
Abstract
Aim. To investigate the effectiveness and safety of six-month treatment course of Omnic and Omnic Ocas in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) in a routine urology practice in Kazakhstan. Design. This was a multicenter prospective observational program involving the collection of data from patients with LUTS caused by BPH, who received Omnic Ocas or Omnic as the first line treatment. Materials and methods. The program comprised 1513 patients with a verified diagnosis of LUTS/BPH, who received Omnic Ocas or Omnic (tamsulosin) administered by urologists at hospitals in the Republic of Kazakhstan. According to the program protocol, 1381 patients completed the study. The mean age of the patients was 63 years. The study program involved three follow-up visits: Visit 1 (baseline), during which the patient completed the IPSS questionnaire concerning urinary symptoms and quality oflife. After that they underwent a baseline examination including maximum urinary flow rate (Qmax) measured by uroflowmetry, prostate volume determined by digital rectal examination and the serum PSA level. Visit 2 and Visits 3 were scheduled on average at three and six months after Visit 1, respectively, and aimed at assessing the treatment outcomes during the follow-up. Results. During the 6-month treatment, patients of different age groups reported an improvement in the prostate symptom score (IPSS). The drug therapy was more effective in patients with a flow rate of <10 ml/s. There was a gradual decrease in the mean scores of both the storage and voiding I-PSS subscales. Uroflowmetry at six months showed a clinically significant increase in the urinary flow rate. Adverse events were reported by1.9% of patients.
Urologiia. 2017;(5):42-47



INVESTIGATION OF SERUM CYSTEINE CONCENTRATION TO MONITOR GLOMERULAR FILTRATION RATE FOR EARLY DIAGNOSIS OF ACUTE KIDNEY INJURY IN PATIENTS WITH COMBINED TRAUMA
Abstract
Aim/ To determine the early diagnostic criteria for acute kidney injury in patients with combined trauma using serum cystatin C as a biomarker in the diagnostic work-up of the affected patients. Materials and methods/ The study comprised 42 patients who suffered combined trauma from 2015 to 2016. Cystatin C level was measured in serum. Blood sampling was done on the 1st, 3rd, 7th, 14th day of the injury. The patients were predominantly men (80%). Renal function was tested by measuring the rate of filtration and reabsorption using the Reberg-Tareev test. All patients were tested for the following parameters: serum and urine creatinine, 1-minute, 1-hour and 24-hour urine output, the rate of glomerular filtration and tubular reabsorption. Results and discussion/ Forty (95.3%) patients had normal Reberg-Tareev test values. In 2 (4.7%) patients Reberg-Tareev test results were below normal values, which was associated with the development of acute renal failure on the sixth or seventh day after trauma. The overwhelming majority of patients with combined trauma had a normal serum creatinine level (n=38). In 33 (78.6%) patients serum cystatin C level was more than 30 percent above normal values. Moreover, an increase in the cystatin C level was observed in the first 3 days, with a gradual decrease thereafter. The glomerular filtration rate, according to the Reberg-Tareev test was reduced only in 4 patients, but when the Hawk formula was used to calculate GFR, it was reduced in 33 patients. On the 3rd day after trauma, based on the increase in the serum cystatin level, 12 patients were found to have subclinical acute renal damage. At the same time, this group of patients had normal azotemia parameters. These findings suggest that measuring glomerular filtration rate using serum cystatin C has a greater accuracy in detecting latent renal dysfunction.
Urologiia. 2017;(5):48-51



THE EFFECTIVENESS OF UROPROFIT IN WOMEN WITH CHRONIC CYSTITIS
Abstract
Aim. To evaluate the effectiveness of the biologically active dietary supplement Uroprofit in the comprehensive management of exacerbations of chronic recurrent cystitis in women. Materials and methods. We examined 40 women with chronic cystitis aged 20-68 years. All patients were allocated to receive either monotherapy with fosfomycin (Monural) (control group, n=20) or combination therapy with fosfomycin and biologically active dietary supplement Uroprofit (study group, n=20). The results were evaluated at 1 and 2 months after treatment initiation. All patients before and after treatment underwent diagnostic work-up including standard laboratory tests, uroflowmetry, cystometry, cystoscopy, and laser Doppler flowmetry to assess microcirculation. Results. The patients of the study group showed faster improvement in clinical manifestations of the disease, laboratory indicators, the dynamics of the endoscopic pattern and had positive changes in the bladder mucosa microcirculation. Discussion. Uroprofit produces an antimicrobial and anti-inflammatory effect, helps normalize urodynamics of the lower urinary tract, improves microcirculation in the bladder wall and reduces the risk of repeated relapses of chronic cystitis. Conclusion. Uroprofit could be recommended as a component of the comprehensive management of exacerbations of chronic recurrent cystitis in women and as the means of preventing relapses in disease-free periods.
Urologiia. 2017;(5):52-57



THE USE OF PROSTADOZ IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND COEXISTENT HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA
Abstract
Introduction. In recent years there has been an increasing interest in the drug treatment of benign prostatic hyperplasia (BPH) to improve the patients’ quality of life without surgical treatment. In this connection, phytotherapeutic drugs and biologically active dietary supplements (BADS), consisting of a combination of microelements, vitamins and plant extracts, have been increasingly used in addition to synthetic preparations. Objective. To investigate the clinical effectiveness of dietary supplement ProstaDoz® in the treatment of BPH with coexistent high-grade prostatic intraepithelial neoplasia (PIN). Materials and methods. The study group comprised 30 men with BPH and high-grade PIN who were diagnosed with primary biopsy and received ProstaDoz® for three months. The control group included 18 patients with the same diagnosis who were treated with Tamsulosin. Results. After a 3-month intake of the ProstaDoz®, a statistically significant reduction was observed in symptom scores for BPH and the quality of life index by 18% (p<0.001) and 16.7% (p<0.001), respectively. The residual urine volume and total serum PSA decreased by 28.3% (p<0.001) and 46.8% (p<0.001), respectively. Unlike the control group, the rate of prostate cancer detection was 6.25 times lower in patients taking ProstaDoz®, and 16% of them had lower grade PIN compared with baseline or no PIN at all. Conclusion. The findings suggest that using ProstaDoz® in patients with BPH and high-grade PIN contributes to improving the quality of life (QoL) of patients and the regression of dysplasia.
Urologiia. 2017;(5):58-62



AESTHETIC CRITERIA IN SURGICAL TREATMENT OF HYPOSPADIAS IN CHILDREN
Abstract
Aesthetically acceptable cosmetic results of surgical correction of external genital organ defects are important for treatment evaluation along with well-known criteria of good functional outcomes. The purpose of this study was to improve the results of treating children with hypospadias by improving the assessment of results and introducing multi-step correction modalities. Materials and methods. From 2013 to 2015, 476 patients with various forms of hypospadias were treated at the Department of Uroandrology of RCCH. The patients’ age ranged from 1 year to 17 years (mean age 3 years). All patients were divided into 3 groups depending on the form of hypospadias and type of treatment. They included patients with distal forms of hypospadias (group1, n=270), proximal forms (group 2, n=112) and patients with stem and penoscrotal hypospadias who underwent 3-6 operations before admission (group 3, n=94). Results. The study evaluated both functional and cosmetic results. Cosmetic appearance was assessed using the HOPE scoring system [2]. Despite the difference in surgical methods used for all types of hypospadias, good cosmetic results have been achieved in the majority of patients (65%). Functional outcomes differed depending on the form of hypospadias. In primary patients with distal and proximal forms of hypospadias, good results were achieved in 96% and 77% of patients, respectively. At the same time, 72% of patients who underwent repeat interventions had good results, which is comparable to the group of primary patients with proximal forms. Conclusion. The results of treating patients after repeat/failed surgery confirm the high effectiveness of our surgical methods (the Bracka two-stage graft repair, buccal mucosa hypospadias repair, reconstruction with scrotal skin flaps, correction of scrotal transposition). Using the HOPE scoring system to assess cosmetic results helps motivate surgeons to achieve the best treatment results.
Urologiia. 2017;(5):63-68



LAPAROSCOPIC HEMINEPHRURETERECTOMY FOR DUPLEX KIDNEY IN CHILDREN
Abstract
Introduction. Duplication of the upper urinary tract is one of the most common congenital urological anomalies. In patients with critically decreased or lost function of one of the renal segments, heminephrureterectomy is usually the treatment of choice. Until recently, this was an open surgery; in cases of complete removal of the ureter, an additional incision in the iliac region was required. Currently, heminephrureterectomy is increasingly performed laparoscopically. We report the experience in laparoscopic heminephrureterectomy (LHNUE) in 10 clinics in Russia and Belarus. Some of them have already used this technique for 10 years. Aim The study aimed to to improve the treatment results in children with urodynamic dysfunction due to duplicated upper urinary tract. Materials and methods. We retrospectively analyzed medical records of 111 children treated from 2007 to 2016. There were 26 (23.4%) boys and 85 (76.6%) girls with mean age 44.6 months (from 2 to 170) at the time of surgery. All children included in the study had complete duplex kidneys, including 51 (45.9%) right-sided and 60 (54.1%) left-sided. All the children underwent LHNUE for a critical decrease or absence of function of the upper or lower segment of the duplex kidney caused by the following pathology: obstruction of the ureterovesical junction with the development of the megaureter of the upper ureteral segment in 57 (51.4%) patients; ureterocele in 28 (25.2%); extra-vesical ectopic ureter with urinary incontinence in 10 (9.0%) girls; high-grade UVR in 16 (14.4%) patients. Results. There were no conversions in this series of patients. The mean operative time was 135 minutes (60-240 min.). All children included in the study were followed for 1 to 9 years after surgery. Complications occurred in 17 (15.3%) patients, of whom 12 (10.8%) required repeat surgery. In one patient with the loss of lower pole function, the treatment result was considered unsatisfactory. Conclusion. LHNUE for duplex kidney is performed by a few clinics and is still at the stage of development and accumulation of experience. Nevertheless, LHNUE, though an effective treatment modality, carries the risk of reducing or losing the function of the retained segment.
Urologiia. 2017;(5):69-74



BIOMARKERS OF RENAL INJURY IN CONTACT URETERAL LITHOTRIPSY
Abstract
Aim. To optimize the transurethral endoscopic management of patients with ureterolithiasis by measuring biomarkers of renal parenchymal damage. Materials and methods. One hundred fifty-one patients with solitary ureteral stones were tested for levels of cystatin C, neutrophil gelatinase-associated lipocalin, β2-microglobulin and interleukin 18. Results. An increase in the levels of markers of renal injury was observed both in the preoperative period and after CULT. Differences in the values of these indices depended on the timing of the CULT, the size and location of the stone and the type of lithotripter. Conclusions. All patients were found to have damage to the renal tubular system. The established critical values of the markers of renal injury in ureterolithiasis may be used as diagnostic criteria for renal injury.
Urologiia. 2017;(5):75-79



HEMORRHAGIC COMPLICATIONS OF PERCUTANEOUS INTERVENTIONS FOR NEPHROLITHIASIS
Abstract
Hemorrhagic complications are one of the major problems of percutaneous urolithiasis interventions. Aim. To investigate the incidence of hemorrhagic complications after percutaneous nephrolithotripsy. Material and methods. This was a comparative analysis of 146 percutaneous nephrolithotripsies. The study group comprised 81 patients with stag horn nephrolithiasis; the rest of the patients were assigned to the control group. Results. Both groups were comparable in age and sex (p>0.05). The body weight of the patients in the study group was statistically significantly higher than in the control group, amounting to 94.1±15.4 and 68.3±9.6 kg, respectively (p<0.05), the body mass index in the study group averaged 45.9±7.6 kg/m2 versus 28.5±9.4 kg/m2 in the control group (p<0.05). 50.6% of the study group patients had urate urolithiasis. The blood loss depended on operative time and the number of accesses to the kidney. The incidence of hemorrhagic complications did not differ in both groups and was in the range of 16 to 16.9% (p> 0.05). Early hemorrhagic complications did not exceed Grade II, according to Clavien-Dindo classification. Anticoagulant and antiplatelet therapy did not increase the number of hemorrhagic complications. Arterial hypertension was the main risk factor for hemorrhagic complications. Conclusion. Arterial hypertension in patients scheduled for percutaneous nephrolithotripsy should be corrected. To stop ongoing renal bleeding, image-guided endovascular interventions should be used.
Urologiia. 2017;(5):80-85



ARTERIAL PRIAPISM AS A COMPLICATION OF A STAB WOUND IN THE PERIANAL AREA
Abstract
The article describes a case of successful management of arterial priapism in a patient with a stab wound in the perianal area. Timely performed angiography revealed a pathological connection between a. Uretralis sinistra and spongy body. Disruption of the abnormal shunt resulted in immediate relief of erection with further preservation of erectile function. At the 3 and 6 months follow-up visits there were no signs of cavernous fibrosis or erectile dysfunction. The authors analyze the entire sequence of events in the management of the case, identify shortcomings, determine their significance and consider their prevention. The article is supplemented with a brief review of the literature on differential diagnosis of haemodynamic forms of priapism.
Urologiia. 2017;(5):86-90



CHRONIC COURSE OF LATENT UROGENITAL TUBERCULOSIS
Abstract
This is a case report of an elderly patient with urogenital tuberculosis and concurrent tuberculosis of peripheral inguinal lymph nodes. The disease manifested by a fistulous form of inguinal lymphadenitis for 10 years and spread to the kidneys and genitals, but the patient did not seek medical attention. Changes on the glans penis prompted him to consult dermatovenereologist. Due to ineffective treatment and uncovering the scar in the inguinal area the patient was send to an anti-tuberculosis institution, where he was diagnosed with tuberculosis involving the kidneys, prostate, epididymis, penis, inguinal lymph nodes. The patient had a history of a contact with the patient with respiratory tuberculosis. Treatment with antituberculosis drugs produced a positive effect.
Urologiia. 2017;(5):91-95



CASE REPORT OF RARE CO-OCCURRENCE OF RENAL CELL CARCINOMA AND CROSSED RENAL DYSTOPIA (L-SHAPED KIDNEY)
Abstract
L-shaped kidney refers to a rare anomaly of the relative kidney positioning. Due to low prevalence, the literature on the co-occurrence of this anomaly with malignancy is lacking. And, if the diagnosis of a renal anomaly does not present difficulties, if a tumor is detected in such a kidney, even MSCT does not always help differentiate a pelvic tumor from a tumor of the renal parenchyma spreading to the pelvicalyceal system. This has important implications for choosing an appropriate surgical strategy. A feature of the presented clinical observation is the co-occurrence of the rare anomaly ofkidney position and locally advanced renal cell carcinoma spreading to the renal pelvis. Due to the massive spread of the tumor, an organ-sparing surgery was not feasible. Due to the suspicion of tumor spread to the renal pelvis, the patient underwent nephrureterectomy of the L-shaped kidney. Introduction to renoprival state with transfer to chronic hemodialysis became the only option to maintain homeostasis and extend the patient’s life. Histological examination revealed clear cell renal cell carcinoma with invasion of the pelvis and renal capsule, with no clear demarcation between the fused kidneys.
Urologiia. 2017;(5):96-99



MASKS OF UROGENITAL TUBERCULOSIS AS THE CAUSE OF DIAGNOSTIC ERRORS
Abstract
Urogenital tuberculosis does not have pathognomonic symptoms, so diagnostic errors are quite common. This systematic review of literature was conducted to identify the causes and estimate the incidence of erroneous diagnoses. We critically evaluated some articles in which the authors describe observations of urogenital tuberculosis as rare and unusual because they never encountered this disease, but in fact that were typical manifestations of genitourinary tuberculosis. The authors analyzed and illustrated the features of urinary tuberculosis in patients with pulmonary tuberculosis, differential diagnosis of urogenital tuberculosis and kidney cancer and male genitourinary organs, described errors in the diagnosis of urethral, testicular, penile, prostatic and epididymal tuberculosis. Urolithiasis was described as a mask and concomitant disease of urogenital tuberculosis. Really rare forms of bladder tuberculosis as the cause of diagnostic errors are described. Examples of fatal outcomes of urogenital tuberculosis are given. The authors analyzed cases of granulomatous interstitial nephritis due to tuberculosis infection and tuberculosis of the renal artery as the cause of renovascular hypertension. The most common causes of late diagnosis of urogenital tuberculosis are the absence of a typical pattern and the tendency to manifest under the guise of other diseases.
Urologiia. 2017;(5):100-105



THE EVIDENCE FOR THE EFFICIENCY AND SAFETY OF DAPOXETINE IN TREATING PREMATURE EJACULATION
Abstract
The aim of the study is to assess the evidence on the efficacy and safety of dapoxetine in premature ejaculation (PE). The analysis includes results of randomized placebo-controlled trials, integrative reviews and one meta-analysis on the clinical efficacy and safety of dapoxetine. All studies have shown higher efficacy of dapoxetine in patients with PE compared with placebo. Its administration at a dosage of 30 and 60 mg results in an increase in the coitus duration up to approximately 3 and 3.5 minutes, respectively. The safety profile of dapoxetine allows using it in clinical practice. Dapoxetine is a novel and effective PE drug on the Russian market.
Urologiia. 2017;(5):106-110






LASER THERAPY FOR MALE INFERTILITY. PART 1. ETIOLOGY AND PATHOGENESIS. EXPERIMENTAL STUDIES
Abstract
Male infertility is associated with a wide range of pathological conditions affecting both the sexual and other body systems: endocrine, nervous, blood, and immune. Laser therapy is a form of modern physiotherapy that applies low-intensity laser radiation in various parts of the body. It is widely used in all areas of modern medicine due to its high efficiency, ease of use, the absence of contraindications and side effects. The authors reviewed the results of 171 studies investigating laser therapy, of which 93 were experimental (20 in Russian and 73 international publications), 4 clinical and experimental (all in Russian), 74 clinical (73 in Russian and 1in English). Along with domestic literature, publications in Russian from Belarus, Georgia, Kyrgyzstan, Uzbekistan and Ukraine were studied. The article analyzes the experimental studies, somehow related to the problem of infertility and its treatment using low-intensity lasers. The analysis findings suggest that there are all prerequisites to develop a laser therapy as an effective modality for treating infertile men.
Urologiia. 2017;(5):115-123



ISOLATED TERATOZOOSPERMIA: IS THERE A ROLE FOR ANTIOXIDANT THERAPY?
Abstract
Recently, literature has emerged that offers contradictory findings of idiopathic forms of isolated teratozoospermia that may confuse clinicians. Some researchers argue that at 0-1% of normal forms of spermatozoa, morphology itself cannot be a prognostic indicator of fertility, either in the planning of natural pregnancy, or when used in assisted reproduction. In this connection, the possible causes of teratozoospermia and alternative therapies are being actively sought, in addition to known invasive and costly procedures. There is convincing evidence that reactive oxygen species overproduction is associated with the occurrence of abnormal spermatozoa in the ejaculate. An abnormal morphology can be accompanied by damage to the sperm DNA, impaired chromatin condensation, and associated unsuccessful pregnancy outcomes. Most of the studies show that using antioxidants results in positive changes. This literature review highlights the role of oxidative stress and DNA fragmentation in the formation of morphologically abnormal spermatozoa. The authors discuss drug interventions to treat teratozoospermia and present their own recommendations for antioxidant therapy in the clinical management of idiopathic forms of male infertility.
Urologiia. 2017;(5):124-131



CALCIURIA AS A METABOLIC MARKER FOR VARIOUS CONDITIONS AND DISEASES
Abstract
The article analyzes the literature on the features of human calcium homeostasis. The authors describe the etiopathogenetic role of calcitropic hormones, the plasma and urine acid-base status, various ions, lifestyle and nutrition and other factors contributing to hypercalciuria due to increased intestinal absorption, bone resorption, impairment of tubular calcium reabsorption, etc. They discuss the role of calciuria as a factor in forming urinary calculi and present their own observations.
Urologiia. 2017;(5):132-138



THE ROLE OF PHARMACOLOGICAL PRECONDITIONING IN RENAL ISCHEMIC AND REPERFUSION INJURY
Abstract
Renal ischemic and reperfusion injury resulting in acute renal failure is a multidisciplinary problem at the junction of pathophysiology, transplantology, urology, nephrology, cardiac surgery and pharmacology. One of renal protection strategies is using the phenomenon of preconditioning. Preconditioning is one of the ways to adopt a tissue to repeated short-term effects of damaging factors to induce an enhanced tolerance to the long period of hypoxia and/or ischemia. There are multiple cellular and molecular mechanisms of the renal protective effects of preconditioning stimuli, but the key effectors and signaling molecules are ATP-dependent potassium channels, nitric oxide synthase, nitric oxide, and mitochondrial pore. Contradictory data on the protective effect of ischemic preconditioning allow searching for approaches to pharmacological correction of ischemic and reperfusion injuries. The article provides data on possible ways of using erythropoietin, darbepoetin and phosphodiesterase 5 inhibitors.
Urologiia. 2017;(5):139-144



THE ROLE OF THE RANDALL’S PLAQUES IN THE PATHOGENESIS OF RECURRENT UROLITASIS
Abstract
The aim of the work was to present current concept of the pathogenesis of urolithiasis. Treatment and prevention of this disease a challenging issue. The article presents basic information about Randall’s plaques that are described as calcium salt deposits on the surface of the transitional cell epithelium. The cause of Randall’s plaques was the subject of many studies and is still not completely clear. To date, we can state that the deposit formation starts in the pelvicalyceal system and is directly linked to recurrent urolithiasis. The discovery of Randall plaques in the 1940s transformed the conception of stone formation, but there are even more questions about the pathogenesis of urolithiasis. In that respect, we consider it important to analyze the studies on Randall’s plaques.
Urologiia. 2017;(5):145-149



THE ROLE OF URINARY TRACT INFECTION IN THE DEVELOPMENT OF RECURRENT NEPHROLITHIASIS
Abstract
This is a literature review on the role of microbial flora in the development of recurrent urolithiasis. The authors outline pathogenetic aspects of recurrent stone formation associated bacterial flora. A number of studies reported that standard urine culture has limited sensitivity in detecting urinary tract infection.
Urologiia. 2017;(5):150-155


