No 3 (2023)

Introduction: Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy.

Purpose: in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender.

Materials and methods: the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018–2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction.

Results. The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted.

Conclusion. The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.

Summary: to establish violations of the structural and functional properties of peripheral blood erythrocytes in serous and purulent acute pyelonephritis before and after conventional therapy.

Materials and methods. The structural and functional properties of erythrocytes of 62 patients with various forms of acute pyelonephritis, randomized by age, sex, and the minimum number of concomitant diseases in remission, were examined. Results and its discussion. In serous, to a greater extent, in the purulent form of acute pyelonephritis, violations of the usual ratio of erythrocyte membrane proteins responsible for the flexibility and shaping of the membrane, intracellular metabolism, stabilization and structure formation of the plasma membrane skeleton were established. Disturbances in the lipid content of erythrocyte membranes, which form the basis of the lipid framework of the plasma membrane and play a major role in the ordering of protein macromolecules and normal erythrocyte metabolism, were revealed. Conclusion. In the serous and purulent phases of inflammation, disturbances in the qualitative and quantitative variant of the protein and lipid fractions of the membranes cause functional changes in blood erythrocytes that are not normalized by standard treatment in the purulent form of the disease, which requires the development of correction methods.4

Conclusions: In patients with NDE before treatment, an increase in the level of only one representative of the investigated proteins of the circulating erythrocyte membrane out of 12, namely tropomyosin, was revealed, which can be used in the differential diagnosis of pyelonephritis forms. In patients with a purulent form of pyelonephritis, a more significant increase in lipid peroxidation processes, a weakening of the body’s antioxidant system, and a decrease in the adsorption characteristics of erythrocytes were revealed. Given the lack of effectiveness of basic treatment in relation to most indicators of the structural and functional properties of erythrocytes, it is necessary to include immunomodulatory and antioxidant drugs in the complex treatment for serous and purulent forms of acute pyelonephritis, which will help reduce complications and enhance regenerative processes.

Recommendations: to recommend to medical specialists to use indicators of structural and functional properties of erythrocytes in difficult cases of differential diagnosis of forms of acute pyelonephritis

Introduction. Chronic cystitis predominates in the structure of urinary tract infections (UTIs). International guidelines are mainly focused on the treatment of acute uncomplicated cystitis; the approaches for managing patients with chronic cystitis has not been sufficiently developed.

Material and methods. A total of 91 patients were included in prospective multicenter randomized comparative controlled study. They were divided into three groups. In the group 1, 32 women received only standard antibiotic therapy for 5 days. In the group 2, 28 patients (received standard therapy plus rectal suppositories Superlymph^® 25 IU 1 time per day for 10 days). In the main group, 31 women received standard therapy in combination with the use of rectal suppositories Superlymph^® at a dose of 10 IU 1 time per day for 20 days. Standard antibiotic therapy included fosfomycin trometamol 3.0 g once and furazidin 100 mg three times for 5 days.

To assess the long-term results, patients were invited for a follow-up 6 months after the end of therapy.

Aim. To determine the long-term results of combined etiologic and pathogenetic therapy, including Superlymph^® rectal suppositories at a dose of 10 U and 25 U, in patients with chronic cystitis.

Results. Six months later, 82/91 (90.1%) women were examined to assess the long-term results.

At 6 months, in group 1 a relapse of the cystitis developed in 17 women (60.7%) after an average of 67.3±9.4 days. In group 2, recurrence was observed in 12 patients (44.4%), and the relapse-free period was longer, averaging of 84.3±9.2 days. The best results were demonstrated in the main group, in which the relapse-free period lasted an average of 123.5±8.7 days, and a relapse developed in only 8 cases (29.6%). In 19 patients (70.4%) there were no symptoms after six months. Differences between groups were highly significant (p<0.001). In all groups, none of the patients had more than one recurrence of the cystitis during the follow-up.

Conclusion. Combined antibiotic therapy results in the absence of recurrence within six months in 39.3% of patients with chronic cystitis. Complex etiologic and pathogenetic therapy, including Superlymph^® rectal suppositories, allows to significantly reduce the number of recurrences and prolong the relapse-free period. Among the patients who received a course of local cytokine therapy at a dose of 25 units for 10 days, 55.6% did not have a recurrence of chronic cystitis within 6 months. In the group of patients who, along with etiologic therapy, received Superlymph^® rectal suppositories at a dose of 10 IU for 20 days, a relapse was absent in 70.4% of patients.

Aim: to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI).

Materials and methods: a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate.

Results: In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group.

Conclusion: Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.

Introduction. Currently, there are paucity of reports on the success of medical prevention of venous thromboembolic complications after urological procedures.

Aim. To evaluate the efficiency of enoxaparin sodium for prevention of postoperative venous thromboembolic complications in urological patients.

Materials and methods. According to the medical records of 151 men and women aged 22 to 92 years old who were undergone to elective surgical treatment in April 2021, the results of the thrombin generation assay and ultrasound study of the inferior vena cava were retrospectively analyzed. All patients were divided into 6 study groups depending on the degree of risk of postoperative venous thromboembolism (very low, low, moderate, high, very high and extremely high). The data obtained during the thrombin generation assay in patients from different groups were compared with those in healthy volunteers (n=30, control group) and evaluated in dynamics. In addition, intergroup comparison was done.

Results. All study participants prior to surgery had a significant increase in peak thrombin and endogenous thrombin potential (ETP) by 5-26% and 13.5-21.5%, respectively. The postoperative findings were as following: 1) one hour after the procedure, a significant (by 9-28.6%) decrease in the normal bleeding time (Lag time); 2) a significant increase in the peak thrombin by 4.8-10.6% 1 hour after surgery and by 11-40.2% at the end of the first postoperative week; 3) reducing the time to peak thrombin (ttPeak) by 13-15%; 4) increase in ETP. According to the ultrasonic data, all study participants had no signs of thrombosis of the inferior vena cava system.

Conclusion: In urological patients requiring surgical treatment, before and after procedure, there is almost always a shift in the hemostasis towards the predominance of the blood coagulation system. Under such conditions, to prevent the development of postoperative VTE, it is expedient and pathogenetically justified to use enoxaparin sodium in a single dose of 0.4 ml or 4000 anti-Xa IU administered once a day s/c 24 hours before the procedure and till full activation of a patient.

Purpose. The aim of this study was to assess the men’s androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization.

Materials and methods. The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels.

Results. T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores.

During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis.

Conclusion. SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.

Introduction. Prostate cancer (PCa) occupies a leading position in the structure of oncological morbidity and mortality and is an urgent problem of modern oncourology. In recipients after organ transplantation, due to the intake of immunosuppressants, the risk of aggressive forms of cancer increases, which necessitates active treatment. In the world, there is not enough data on the radical treatment of PCa in patients after heart transplantation (HT), especially on surgical treatment. We present the first experience in Russia and Eastern Europe of 3 robot-assisted radical prostatectomy for localized PCa in patients after HT.

Materials and methods. The procedures were performed from February 2021 to November 2021 at the FGBU NMRC named after V.A. Almazov. Preoperative preparation, as well as postoperative management of patients was carried out jointly by urologists and transplant cardiologists.

Results. The main demographic, perioperative indicators, as well as oncological and non-oncological outcomes are presented. All patients were discharged from the hospital in a satisfactory condition. During the follow-up period, there were no biochemical recurrences of PCa. Early urinary continence in all three patients was satisfactory.

Conclusion. Thus, robot-assisted radical prostatectomy in patients after HT is a technically feasible, effective, and safe treatment for PCa. The comparative studies with prolonged follow-up are needed.

Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.

This literature review is devoted to the analysis of indications for ureteroplasty with a buccal flap, its technique, and the alternative surgical options. Reconstructive surgery of the ureter has more than a century of history, during which various surgical interventions have been proposed and improved depending on the location and length of the stricture. Over the past decades, a method of replacing the ureter with a flap from the buccal or tongue mucosa was introduced. The use of such flaps for the ureteral reconstruction is not a new concept; the possibility of performing such a procedure was confirmed at the end of the last century. Successful results of experimental and clinical studies have allowed the gradual adoption of this technique to replace long defects in the upper and middle third of the ureter. In buccal ureteroplasty, robot-assisted approach is widely used, contributing to a high success rate and fewer postoperative complications. The accumulation of experience in such reconstructive procedures and the analysis of the results allow to clarify the indications and contraindications, improve the technique, and carry out multicenter studies.

According to the literature, ureteroplasty using a buccal or tongue mucosa flap is most suitable for long narrowing of the ureteropelvic junction, the upper and middle third of the ureter, which are amenable to endoscopic procedures or segmental resection with end-to-end anastomosis.

This paper analyzes the etymology of the Russian names of the organs of the urinary system (kidney, ureter, urinary bladder, urethra) and their separate parts (renal pelvis). It is shown that Russian anatomical terms originate from the root morphemes of the Indo-European language group, which convey morphological, physiological or anatomical features of this or that organ. At the moment Russian terminology is widely used in the study of anatomy and other fundamental and medical sciences in universities and clinical practice along with common Latin names and eponyms of names of these or other structures.