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No 1 (2023)

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Extended culture study as a keypoint to rethinking antibiotic therapy for chronic bacterial prostatitis

Kogan M.I., Ibishev K.S., Naboka Y.L., Gudima I.A., Ismailov R.S.


Objective. To juxtapose the microbiological efficacy of standard and targeted antibiotic therapy (ABT) based on the comparison of the results of extended bacteriology of biomaterial in patients suffering chronic bacterial prostatitis (CBP) before and after treatment.

Materials & methods. Study design: single-centre observational comparative study. Sixty patients with CBP aged 20 to 45 years were included in the study. All patients underwent an initial examination: questioning, Meares-Stamey 4-glass test, extended bacteriology of biomaterial samples, and determination of antibacterial susceptibility (ABS). After the initial examination, the patients were randomly assigned to two groups (30/30 patients). In group (G) 1, antibacterial drugs were prescribed following the EAU guidelines on Urological Infections (monotherapy), in G2, focusing on the results of ABS (mono or combination therapy). Evaluation of the treatment effectiveness and control bacteriology were carried out three months after therapy.

Results. In G1 vs G2, nine vs ten aerobes and eight vs nine anaerobes were identified in the expressed prostate secretion, respectively. The microbial load of the samples in ≥103 CFU / ml was established in G1 vs G2 for five vs ten aerobes and seven vs eight anaerobes, respectively. The highest ABS of bacteria was determined to moxifloxacin, ofloxacin, and levofloxacin. Cefixime was the most active against anaerobes. After treatment, no significant changes in the bacterial spectrum were observed in both groups. A more reliable decrease in the frequency of microorganism identification and the microbial load of the samples was observed in patients with G2 after the targeted ABT.

Conclusion. Targeted ABT based on extended bacteriology can be considered an effective alternative to standard guideline-approved ABT for the treatment of CBP.

Urologiia. 2023;1(1):5-11
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The efficiency of various cytokine therapy regimens in the complex treatment of men with chronic abacterial prostatitis

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


Introduction. Chronic prostatitis (CP) is one of the most important and discussed urological diseases. Treatment of bacterial CP with an established pathogen usually is not associated with any difficulties. Chronic abacterial prostatitis (CAP) remains the most problematic issue. Immune defense mechanisms are important in the development of CP, including a decrease in the functional activity of monocytes/macrophages, neutrophils, as well as imbalance of pro- and anti-inflammatory cytokines.

Aim. To evaluate the efficiency of various schemes of using the immunomodulatory drug Superlymph® as part of the combination therapy of men with CAP.

Materials and methods. A total of 90 patients with category IIIa CAP (NIH, 1995) were included in the study. In the control group, patients received basic therapy of CAP, namely behavioral therapy, α1-adrenoblocker and fluoroquinolone for 28 days. In the main group I basic therapy in combination with Superlymph® 25 ME in one suppository q.d. for 20 days was administered. In the main group II basic therapy in combination with Superlymph® 10 ME in one suppository b.i.d. for 20 days was given. Evaluation of treatment efficiency was carried out after 14 ± 2 days (visit 2) and 28± 2 days (visit 3) from the start of treatment.

Results. The study groups were homogeneous, and baseline characteristics did not differ significantly (p>0.05). However, significant differences were found between the results in the main groups and the control group at visit 2 for all the indicators (p<0.05). The number of daytime urinations was lower in the main group I and II compared to CG by 16.7% and 28.4%, the number of night urination by 28% and 40%, the average IPSS score by 29.1% and 38.3%, the average QoL score by 32.4% and 45.9%, the average NIH-CPSI score by 26.8% and 37.4%, the number of leukocytes in expressed prostatic secretion by 41.2% and 52.1%, prostate volume by 16.8% and 21.8%, bladder volume by 15.8% and 21.7%, and Qmax by 14.3% and 21.2%, respectively. Similar significant differences between the main groups and control group were also seen at visit 3, while the indicators in main groups I and II reached normal values after 28 days of therapy.

In this study, for the first time, a comparative analysis of two different treatment regimens with Superlymph® was carried out. In the main group I, patients received suppositories at a dose of 25ME q.d., while in the main group II, the drug was administered 10 ME b.i.d. The results indicate a comparable efficiency of both schemes after 4 weeks. However, in the main group II, after 2 weeks, there was a significantly more pronounced positive dynamics of all indicators in comparison with the main group I (p<0.05). Consequently, the use of Superlymph® at a dose of 10ME b.i.d. a day allows to reduce the severity of the inflammatory process in a shorter time.

Conclusion. The use of Superlymph® in patients with CAP allows to reduce the severity of clinical manifestations in a shorter time, and has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life. According to our results, the most effective scheme in patients with CAP is basic therapy in combination with Superlymph® 10 ME for 1 suppository 2 times a day for 10 days. In our opinion, Superlymph® can be effectively used as part of the combination therapy of men with CAP.

Urologiia. 2023;1(1):12-19
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Functional morphology of the bladder and its vascular system in relation to age changes and evolution of BPH

Shormanov I.S., Kulikov S.V., Soloviev A.S.


Introduction. The increase in the proportion of people with various urinary disorders, which are based on anatomical and functional bladder remodeling due to aging, is currently un-deniable. This problem becomes more relevant due to the elevation in life expectancy. At the same time, the features of bladder remodeling, in particular, the structural changes of its vascular bed, are still practically not described in the literature. In men, the lower urinary tract undergoes additional transformation associated with age due to bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Despite the long history of studying BPH, the morphological basics of its evolution have not yet been fully elucidated, including the development of lower urinary tract decompensation and, in particular, the role of vascular changes. In addition, structural re-modeling of the bladder muscles in BPH is formed in those with pre-existing age-related changes in both the detrusor and its vascular system, which cannot but influence the dynamics of disease progression.

Aim. To study the structural changes of detrusor and its vascular bed associated with age, and to establish the role of their patterns in patients with BPH.

Materials and methods. The material was a specimen of the bladder wall obtained dur-ing: a) autopsies of 35 men aged 60–80 years who died from diseases not related to urological or cardiovascular pathology; b) autopsies of 35 men aged 60–80 years who had BPH without blad-der decompensation; c) intraoperative biopsies of 25 men of the same age who undergone surgical treatment for chronic urinary retention (postvoid residual volume of more than 300 ml), bilateral hydronephrosis, as complications of BPH. As a control, we used the specimens obtained from 20 males aged 20–30 years who died as a result of violence.

Histological sections of the bladder wall were stained with hematoxylin-eosin, according to Mason and Hart. Standard microscopy and stereometry of detrusor structural components and morphometry of the urinary bladder vessels were performed using a special ocular insert with 100 equidistant points. During morphometric examination of the vascular bed the thickness of the middle layer of arteries wall (tunica media) was measured, as well as a thickness of the entire wall of the veins in microns. In addition, a Schiff test and Immunohistochemistry (IHC) of these histological sections were performed. The IHC was evaluated using a semi-quantitative method, taking into account the degree of staining in 10 fields of vision (×200).

The digital material was processed with the STATISTICA program using the Student's t-test. The distribution of the obtained data corresponded to normal. The data were considered re-liable if the probability of making error did not exceed 5% (p<0.05).

Results and discussion. In the course of natural aging, a structural remodeling of bladder vascular bed was observed, from the development of atherosclerosis of extra-organ arteries to restructuring of intra-organ arteries due to arterial hypertension. The progression of angiopathy leads to the development of chronic detrusor ischemia, which initiates the formation of focal at-rophy of the smooth muscles, destructive changes in the elastic fibers, neurodegeneration and stroma sclerosis. A long-term BPH leads to compensatory detrusor remodeling with hypertrophy of previously unchanged areas. At the same time, age-related atrophic and sclerotic changes in smooth muscles are accompanied with hypertrophy of individual areas of the bladder detrusor.

To maintain adequate blood supply to hypertrophied detrusor areas in the arterial and venous bladder vessels, a complex of myogenic structures is formed that can regulate blood circulation, making it dependent on the energy consumption of specific areas. However, progressive age-related changes in the arteries and veins eventually lead to an increase in chronic hypoxia, impaired nervous regulation and vascular dystonia, increased blood vessels sclerosis and hyalinosis, and sclerosis of intravascular myogenic structures with loss of their function of blood flow regulation, as well as the development of vein thrombosis. As a result, increasing vascular decom-pensation in patients with bladder outlet obstruction results in bladder ischemia and accelerates the decompensation of the lower urinary tract.

Urologiia. 2023;1(1):20-27
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Effects of antimicrobial peptide from lactoferrin in blood serum and urine in patients with renal colica with urolithiasis and pyelonephritis

Serebryakov A.A., Miroshnikov V.M., Kokhanov A.V., Dogadina A.O., Mekhtiev K.N.


Aim. To evaluate the role of lactoferrin and lactoferricin in blood serum and urine in patients with an attack of renal colic against the background of urolithiasis and pyelonephritis.

Materials and methods. We examined 149 patients admitted to the urological department of the City Clinical Hospital No. 3 of Astrakhan, according to emergency indications, with an attack of renal colic. Along with standard clinical, laboratory and instrumental research methods (general blood count, biochemical blood test, urinalysis, kidney ultrasonography), the concentration of CRP and lactoferrin was measured in all patients in the blood and urine using a set of reagents for ELISA (Lactoferrin «Vector-Best» Novosibirsk city). The sensitivity of the test for CRP and LF was 3–5 µg/ml and 5 ng/ml, respectively. Studies of all collected material for lactoferricin were carried out deferred in the laboratory of the Astrakhan State Medical University. Based on the results of clinical and instrumental studies, patients admitted with an attack of renal colic were retrospectively divided into three groups: the first group included 38 patients with urolithiasis. The second group included 64 patients with obstructive pyelonephritis, and the third group included 47 patients hospitalized with characteristic signs of primary non-obstructive pyelonephritis. The groups were matched by sex and age. Blood and urine samples from 25 donors served as controls.

Results. When comparing a group of patients with urolithiasis with a group of patients with non-obstructive and obstructive pyelonephritis, highly significant differences (p<0.0001) were found in LF, LFC, CRP and the number of leukocytes in the blood and urine sediment. In urine, according to the results of ROC-analysis in couples with urolithiasis without pyelonephritis in comparison with obstructive pyelonephritis, the most significant differences were established for all four parameters studied: for LF (AUC=0.823), for LFC (AUC=0.832), for CRP (AUC=0.829 ) and the number of leukocytes in the urine sediment (AUC=0.780).

Discussion. In blood and urine in patients with urolithiasis and pyelonephritis, the effects of the bactericidal peptide LPC were compared with the levels in biological fluids of CRP, LF, and the number of leukocytes. The greatest diagnostic value of all four studied indicators was found in urine, and not in serum. ROC-analysis confirmed a more significant effect of the studied parameters on pyelonephritis than on urolithiasis. The level of lactoferrin and CRP in patients at admission correlates with the number of leukocytes in the blood and urine sediment and with the degree of inflammation in the body. And the level of LFC peptide in the urine reflects the degree of infection of the urinary tract.

Conclusions. A comparative study of tests for Lf and LFC in blood serum and urine in patients admitted to a urological hospital with an attack of renal colic was carried out. Determining the concentration of lactoferricin in the urine is an informative indicator. Thus, lactoferrin and its hydrolysis product lactoferricin reflect different aspects of the infectious and inflammatory process in pyelonephritis.

Urologiia. 2023;1(1):28-33
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Surgery for pelvic organ prolapse by vaginal approach in a specialized center: the evolution of implants from «XL to XS»

Shkarupa D.D., Kubin N.D., Shulgin A.S., Labetov I.A., Kovalev G.V., Shakhaliev R.A.


Aim. To find the most safe and effective method of surgical treatment of POP.

Materials and methods. To evaluate the efficiency of surgical techniques, a retrospective study of 5031 medical records from an electronic database was carried out. As the primary endpoint, we assessed the duration of the procedure, the volume of blood loss and the length of stay. As a secondary endpoint, the number of intra- and postoperative complications was assessed. In addition to objective data, we assessed subjective measures using the validated PFDI20 and PISQ12 questionnaires.

Results. The best results in terms of blood loss were shown by unilateral hybrid pelvic floor reconstruction and three-level hybrid reconstruction (33±15 ml and 36±17 ml, respectively). Patients who underwent the three-level hybrid pelvic floor reconstruction technique had the highest result: 33±15 points of the PISQ12 questionnaire, 50±28 points of the PFDI20 questionnaire, which was significant in comparison with other techniques (p<0.001). The number of postoperative complications was also significantly lower for this procedure.

Conclusion. Three-level hybrid pelvic floor reconstruction is a safe and effective technique for the treatment of pelvic organ prolapse. In addition, this procedure can be done in a specialized hospital with the appropriate skills of surgeons.

Urologiia. 2023;1(1):34-40
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Impact of the SARS-COV-2 virus on the urinary bladder

Kulchavenya E.V., Shevchenko S.Y.


Introduction. There are publications about the impact of a new coronavirus infection (COVID) on the lower urinary tract, including the development of overactive bladder (OAB) or COVID-associated cystitis. The cause of dysuria in patients with COVID is not fully understood.

Material and methods. A total of 14 consecutive patients after COVID with complaints of frequent urination with urgency were included in the study. The main inclusion criterion was the development or worsening of OAB symptoms after resolution of COVID, confirmed by the eradication of SARS-CoV-2 by a polymerase chain reaction. The severity of OAB was assessed using the International Scale of Symptoms (Overactive Bladder Symptom Score, OABSS).

Results. Three (21.4%) out of fourteen patients had OAB symptoms prior to COVID, while in 11 (78.6%) patients OAB symptoms developed in post-COVID period. In 4 patients (28.6% of the entire cohort and 36.4% of patients in de novo group) urge urinary incontinence and urgency developed. The average score on the OABSS scale in patients with baseline OAB was 6.7±0.8, which corresponded to the moderate severity. In this group, one patient developed urge urinary incontinence and urgency, which were not present prior to COVID. In a retrospective evaluation of symptoms before the COVID, their average score on the OABSS scale was 5.2 ± 0.7, i.e., past COVID led to an increase in OAB symptoms by 1.5 points.

In patients with OAB de novo, the symptoms were less pronounced, with a score of 5.1±0.6 points, that is between mild and moderate OAB. At the same time, urinalysis in 9 patients did not have signs of inflammation: in 5 cases, 5–7 white blood cells per field of view was seen only once. A follow-up urine test was normal, suggesting contamination. None of the cases revealed bacteriuria over 102 CFU/ml.

All patients were prescribed trospium chloride at a dose of 30 mg per day. The choice of the drug was due to the absence of a negative effect on the central nervous system, which is very important both during COVID and in post-COVID period, since the neurotoxicity of SARS-CoV-2 has been proven.

Conclusion. A past history of COVID led to an increase in OAB symptoms by 1.5 points in patients who had OAB prior to infection. In 11 patients, after the treatment of COVID, the moderate symptoms of OAB developed de novo.

Our small study showed the importance of focusing the attention of internists and infectious disease doctors on urination disorders in patients with COVID and timely referral to a urologist. For the treatment of post-COVID OAB, trospium chloride is the drug of choice, as it does not aggravate the potential neurotoxicity of SARS-CoV-2.

Urologiia. 2023;1(1):41-45
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Ejaculatory disorders after surgical treatment of benign prostatic hyperplasia

Rustamov M.N., Galiullin O.F., Vinarov A.Z.


Introduction. Ejaculation disorders occur in 62-75% of patients after surgical treatment for benign prostatic hyperplasia (BPH). Despite the development and widespread introduction into clinical practice of laser procedures, which have reduced the overall incidence of complications, the frequency of ejaculatory disorders is still high. This complication negatively affects the quality of life of patients.

Aim. To study the nature of ejaculation disorders in patients with BPH after surgical treatment. In this work, we did not compare the effect of various surgical methods and techniques in patients with BPH on ejaculation. At the same time, we selected the most widely used procedures in routine urological practice and assessed the presence and development of ejaculatory dysfunction prior to and after surgery. It should be emphasized that we determined the disorders that occurred in the same patients in whom ejaculatory function was evaluated prior to surgery.

Materials and methods. A prospective study of the ejaculatory function of 224 sexually active men aged 49 to 84 years with LUTS/BPH before and after surgical treatment was performed. From 2018 to 2021, thulium laser enucleation of prostatic hyperplasia (ThuLep) was done in 72 patients, conventional TURP in 136 patients, and 16 patients underwent open transvesical simple prostatectomy. Surgical treatment was carried out by certified urologists with extensive experience. ThuLep and conventional TURP were not ejaculatory-sparing. All patients underwent a standard examination for LUTS/BPH pre- and postoperatively, including IPSS score, uroflowmetry to determine the maximum urine flow rate (Qmax), PSA, urinalysis, transrectal ultrasound examination with a calculation of prostate volume, postvoid residual. The erectile function was assessed according to the IIEF-5 score. Ejaculation function was evaluated according to the Male Sexual Health Questionnaire (MSHQ-EjD) preoperatively and at 3- and 6-months follow-up. For the diagnosis of premature ejaculation, CriPS questionnaire was used. For the differential diagnosis of retrograde ejaculation and anejaculation after surgical treatment, patients underwent an analysis of post-orgasmic urine for the presence and quantity of spermatozoa.

Results. The average age of patients was 64 years. At baseline, various ejaculatory disorders were detected in 61.6% of cases. In 48.2% of patients (n=108) a decrease in the ejaculate volume was found, while 47.3% (n=106) noted a decrease in the intensity of ejaculation. In 15.2% of cases (n=34), acquired premature ejaculation was detected, and 17% (n=38) men reported pain or discomfort during ejaculation. In addition, 11.6% (n=26) had delayed ejaculation during intercourse. There were no patients with anejaculation at baseline. The average score on the IIEF-5 scale was 17.9, and on the IPSS scale 21.5 points.

Three months after surgical treatment, the following disorders of ejaculation were documented: retrograde ejaculation in 78 (34.8%), anejaculation in 90 (40.2%) patients. In the remaining 56 (25%) men, antegrade ejaculation was preserved. Among those with antegrade ejaculation, an additional survey was carried out, which showed a decrease in ejaculate volume and in the intensity of ejaculation in 46 (20.5%) and 36 (16.1%) cases, respectively. Pain during ejaculation was noted by 4 (1.8%) men, however, there was neither premature nor delayed ejaculation after surgical treatment.

Conclusion. In patients with BPH, the predominate types of ejaculation disorders before surgical treatment were as following: a decrease in ejaculate volume (48.2%), a decrease in the speed (intensity) of ejaculation (47.3%), painful ejaculation (17%), premature ejaculation (15.2%), and delayed ejaculation (11.6%). After surgical treatment, retrograde ejaculation (34.8%, n=78) and anejaculation (40.2%, n=90) prevailed.

Urologiia. 2023;1(1):46-52
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Spermoprotective properties of Prostatex in patients with chronic abacterial prostatitis

Neymark A.I., Davydov A.V., Neymark B.A., Nozdrachev N.A., Mel’nik M.A., Kablova I.V., Borisenko D.V., Tupyakova S.G., Kovaleva Y.S.


Aim. To study the effect of Prostatex therapy on spermatogenesis in patients with infertility that developed due to chronic abacterial prostatitis.

Materials and methods. A total of 60 men with infertility in marriage and chronic abacterial prostatitis were included in the study. All patients received therapy with Prostatex rectal suppositories 10 mg 1 time per day. The duration of treatment was 30 days. After taking the drug, patients were observed for 50 days. The study was carried out for 80 days and included 3 visits at 1, 30 and 80 days.

The study showed that the use of Prostatex rectal suppositories 10 mg had a positive effect on the main indicators of spermatogenesis, as well as on the subjective and objective symptoms of chronic abacterial prostatitis. Based on these results, we recommend Prostatex rectal suppositories to patients with chronic abacterial prostatitis, accompanied by impaired spermatogenesis, according to the scheme: 1 suppository 10 mg 1 time per day for 30 days.

Urologiia. 2023;1(1):54-59
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A study of the mechanisms of action of fertiwell in vivo

Khochenkova Y.A., Machkova Y.S., Khochenkov D.A., Sidorova T.A., Safarova E.R., Bastrikova N.A., Korzhova K.V.


Aim. To investigate the specific mechanisms of action of Fertiwell in a mouse model of D-galactose-induced aging of the reproductive system.

Materials and methods. C57BL/6J mice were randomized into four groups: intact mice (control group), a group of mice with artificial accelerated aging treated with D-galactose alone (Gal), D-galactose followed by Fertiwell (PP), and D-galactose followed by a combination of L-carnitine and acetyl-L-carnitine (LC). The artificial accelerated aging of reproductive system was induced by daily intraperitoneal administration of D-galactose at a dose of 100 mg/kg for 8 weeks. After the end of therapy in all groups, the characteristics of sperm, the level of serum testosterone, immunohistochemical parameters, and the expression of specific proteins were evaluated.

Results. Fertiwell had a pronounced therapeutic effect on testicular tissues and spermatozoa, restored testosterone levels to normal values, and, in addition, was more effective protector against oxidative stress in the reproductive system compared to L-carnitine and acetyl-L-carnitine, which are widely used in male infertility. Fertiwell at a dose of 1 mg/kg allowed to significantly increase the number of motile spermatozoa to 67.4±3.1%, which was comparable to indicators in the intact group. The introduction of the Fertiwell positively affected the activity of mitochondria, which was also expressed in an increase in sperm motility. In addition, Fertiwell restored the intracellular level of ROS to the values of the control group and reduced the number of TUNEL+ cells (with fragmented DNA) to the level of intact control. Thus, Fertiwell, containing testis polypeptides, has a complex effect on reproductive function, leading to a change in gene expression, an increase in protein synthesis, the prevention of DNA damage in the testicular tissue, and an increase in mitochondrial activity in testicular tissue and spermatozoa of the vas deferens, which leads to the subsequent improvement of testicular function.

Urologiia. 2023;1(1):60-70
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Puncture access with a new atraumatic needle MG for mini-percutaneous nephrolithotomy

Kalinin N.E., Ali S.K., Dymov A.M., Chichenov D.V., Akopyan G.N., Gazimiev M.A.


Introduction. An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and perirenal tissues.

Aim. To determine the efficiency and safety of renal puncture during mini-PCNL with a new atraumatic needle MG.

Materials and methods. A total of 67 patients who underwent mini-percutaneous nephrolithotomy at the Institute of Urology and Human Reproductive Health of Sechenov University were included in the prospective study. For the purpose of homogeneity of the groups, those with staghorn nephrolithiasis, nephrostomy, a history of prior kidney surgery (including PCNL), renal and collecting system anomalies, acute pyelonephritis, and blood clotting disorders were not included. The main group consisted of 34 (50.7%) patients who underwent atraumatic kidney puncture with a new needle MG (MIT, Russia), while in the control group there were 33 (49.3%) patients, who underwent standard puncture with Chiba or Troakar needles (Coloplast A/S, Denmark). The outer diameter of all needles was 18 G.

Results. In patients with a standard access, a hemoglobin decrease in the early postoperative period was more pronounced (p=0.024). The incidence of complications according to the Clavien-Dindo classification did not differ significantly (p=0.351), however, a JJ stent was placed in two patients from the control group due to impaired urine flow and the development of urinoma.

Conclusion. Together with a similar stone-free rate, atraumatic needle allows to reduce a hemoglobin drop, as well as less development of severe complications.

Urologiia. 2023;1(1):71-75
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Pediatric urology

Balloon dilation treatment of primary obstructive megaureter in children

Lebedev D.A., Osipov I.B., Komissarov M.I., Sarychev S.A., Alekseeva L.A., Lifanova M.V., Nesterova N.V.


Purpose: Investigation of the results of ureteral stricture single balloon dilation in children with primary obstructive megaureter.

Materials and methods. Since 2012 to 2020 79 children (65 boys and 15 girls) with primary obstructive megaureter of II and III grades who had 92 affected ureters were operated on by method of ureteral stricture balloon dilation. Duration of postoperative stenting period was Me=68 [48; 91] days, bladder catheterization period – Me=15 [5; 61] days. Follow-up was from 1 to 10 years.

Results. There were no intraoperative complications in the group of investigation. Pyelonephritis exacerbation in the early postoperative period occurred in 15 cases (18,98%). Control comprehensive examination revealed that urodynamics of 63 children (79,74%) tended to normalization what persisted in the future. There was no positive dynamics in 16 cases (20,25%). Vesico-ureteral reflux was revealed in 4 cases.

Discussion. Assessment of impact of various predictors (passport, urodynamic, infectious, anatomic, operation and postoperative period characteristics) on the treatment results proved that the effectiveness of the procedure depends on the following factors: ureteral stricture length (M-U Test U=202,5 p=0,0002) and

features of the stricture rapture during ballooning (Fisher exact p=0,0006). There was significant difference in results in the group of up to 10 mm inclusive stricture length and the longer stricture group (Fisher exact p=0,00001). High activity of pyelonephritis in postoperative period was the predictor of adverse outcome (Fisher exact p=0,00001).

Conclusion. Practically 80% of children with primary obstructive megaureter may be reliably cured by the method of ureteral stricture balloon dilation. The risk of intervention failure is greatly increased in case of the stricture length is more than 10 mm and technical difficulties of ballooning indicating a high resistance of the narrowed portion of the ureter to dilation.

Urologiia. 2023;1(1):76-82
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Clinical case

Percutaneous nephrolithotomy in a patient after liver transplantation

Martov A.G., Dutov S.V., Khayridinov S.Z., Yarovoy S.K., Andronov A.S., Kozachikhina S.I., Adilkhanov M.M., Voskanyan S.E.


The work is devoted to the description of percutaneous nephrolithotomy in a patient who previously underwent liver transplantation. In case of immunodeficiency of any etiology, one-stage non-severe kidney injury is less dangerous compared to infectious and inflammatory complications, which naturally have more severe course compared to in those with intact immune system. Based on these considerations, the patient underwent percutaneous nephrolithotomy, which allowed to remove the stone of 2.5 cm in size without any complications. The choice of surgical treatment and management tactics for this category of patients are described in detail in the article.

Urologiia. 2023;1(1):83-87
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Clinical case: bladder necrosis after prostate embolization in a patient with prostatic hyperplasia

Podoynicin A.A., Mamedov E.A., Amosov N.А., Garmash S.V., Kuznecova D.A., Shpot E.V., Mashin G.A., Maltsagova P.S.


This article describes a clinical case of bladder necrosis developed after X-ray endovascular embolization of prostatic arteries of a 62-year-old patient with a verified diagnosis of BPH (benign prostatic hyperplasia). The complication resulted in the necessity of urgent surgical intervention, namely, laparotomy, cystprostatectomy and bilateral percutaneous nephrostomy. In the early postoperative period the patient had intense cutting pain in the left side of the abdomen. Examination revealed the inflow of small intestinal contents through the pelvic drainage, which was the reason for relaparotomy, abdominal cavity revision, uturing the small intestine perforation, suturing the small intestine pre-perforation, sanation and drainage of the abdominal cavity in an emergency procedure. The patient was discharged in a satisfactory condition under the supervision of a urologist by m/w on the 36th day after endovascular embolization of prostatic arteries. The eight months after discharge, the patient underwent a successful Bricker’s operation on creating an alternative urinary diversion route at the First Sechenov Moscow State Medical University of the Russian Federation.

Urologiia. 2023;1(1):88-91
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Literature reviews

Ureteroplasty using onlay graft for long ureteral strictures

Guliev B.G., Komyakov B.K., Avazkhanov Z.P., Povago I.A.


Full-text articles published in peer-reviewed journals dedicated to the results of onlay ureteroplasty using various materials, as well as monographs on surgical treatment of long ureteral strictures are presented in the article. Over the past decade, onlay technique for the treatment of long ureteral strictures using flaps or grafts on a vascular pedicle have been introduced. Experimental data on the results of onlay ureteroplasty using autologous vein or bladder mucosa, as well as the small intestine submucosa (SIS) have been published in the literature. Due to the availability and good survival rate, buccal and tongue mucosal flaps are widely recognized as the optimal graft for onlay ureteroplasty. There are also studies on the results of ureteroplasty using SIS or appendix graft onlay for the upper and middle ureteral strictures. A use of tissue-engineered flaps for ureteroplasty remains contradictory. Further research in this direction may allow to obtain optimal grafts for onlay ureteroplasty. However, oral mucosa or appendix are predominant materials, which are used for onlay ureteroplasty.

Urologiia. 2023;1(1):92-100
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Modern aspects of diagnostics and treatment of renal infarction

Popov S.V., Orlov I.N., Topuzov T.M., Malevich S.M., Chernysheva D.Y.


One of the causes of acute kidney injury is the renal artery thrombosis. Clinical manifestations depend on the level of thrombus. This pathology is characterized by non-specific clinical manifestations in the early period, the complexity of differential diagnosis, often delayed verification of the diagnosis and unfavorable prognosis in case of prolonged (5-7 days) anuria.

There is no generally accepted protocol for the diagnosis and treatment of renal artery thrombosis. To clarify the diagnosis, intravenous urography, radionuclide renography, and contrast-enhanced computed tomography are recommended. Until recently, patients with suspected renal artery thrombosis were treated with anticoagulant therapy and renal replacement therapy with hemodialysis, which is required constantly as renal function was usually irreversibly impaired. Surgical treatment is effective only in the first hours. The outcome is often unfavorable, the probability of hemorrhagic complications is high. Due to the rare frequency of detection and verification of renal infarction, no consensus has been reached regarding the diagnosis or treatment of this condition.

Urologiia. 2023;1(1):101-105
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Modern methods for determining the positive surgical margin during radical prostatectomy

Byadretdinov I.S., Kotov S.V.


Determining and evaluation of predictors of biochemical recurrence (BCR) is one of the essential aim, which may help to achieve the most effective treatment of prostate cancer. Obviously, positive surgical margins represent an independent risk factor for BR following radical prostatectomy. The development of methods determining the status of the surgical margin during surgery is an important direction which can upgrade the effectiveness of prostate cancer treatment. Moreoverit is relevant to review modern methods for diagnosing the status of the surgical margin during radical prostatectomy.

This article presents a systematic review carried out at the Department of Urology and Andrology of Pirogov Russian National Research Medical University. In September 2021, we performed a PubMed/Web of Science search to include articles published in 1995–2020 evaluating the key words «prostate cancer», «surgical margin», «radical prostatectomy», «biochemical recurrence», «methods for determining the surgical margin». Nowadays the following technologies have been developed and being actively studied: the usage of aminolevulinic acid, optical coherence tomography, optical spectroscopy, confocal laser microscopy, 3D augmented reality, 3D modeling, the study of frozen samples.

Urologiia. 2023;1(1):106-113
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Physiology of autonomic regulation of kidney and bladder functions and its clinical significance

Berdichevsky V.B., Berdichevsky B.A., Sapozhenkova Y.V., Shidin V.A., Gonyaev A.R., Pavlova I.V., Boldyrev A.L.


The results of a search in PubMed and databases using the keywords “autonomic regulation”, “kidney function”, “bladder function”, “ECG monitoring”, “PET/CT of the brain” are presented in the review. A regulation of bladder functions, control of blood pressure, heart rate and specialized functions of the nephron are discussed, which are in close relationship with the stem and cortical centers of the brain. The review presents an update at their cause-and-effect relationship and the place of each system in the formation of the general autonomic tone. The proposed integrative approach to the study of this problem will reveal previously unknown autonomous properties of the organs that form this physiological axis and determine the role of cortical dysfunction in the development of visceral pathology, which is fundamentally important for understanding the mechanisms of formation and recurrence of many urological diseases.

Urologiia. 2023;1(1):114-118
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Commemorative and jubilee dates

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