No 4 (2023)

Introduction. When reconstructing long ureteral strictures, the optimal substitution material is reconfigured pelvis or bladder flaps. However, it is not always possible to use them due to involvement in the pathological process or insufficient length to replace the defect. In such cases, substitution of the ureter by ileal segment is successfully used.

Materials and Methods. A total of 25 patients, 10 men (40%) and 15 women (60%), who undergone to reconstructive procedure during the period from 2012 to 2021 with a follow-up period of at least 6 months (mean 51.26 months) were included in the retrospective analysis. Additionally, a comparative analysis was carried out between the laparoscopic and open access according to a set of criteria. The endpoints in the study were the functional state of the kidneys, repeated procedures and development of metabolic disorders.

Results. The average length of the stricture was 10.7 cm (5-20 cm). Eleven patients underwent open approach (44%), while in 14 cases laparoscopic approach was used (56%). Primary procedure was performed in 16 (64%) patients, repeated intervention due to stricture recurrence was performed in 7 (28%) cases, and two patients (8%) underwent bowel substitution of the ureter, implanted into the ileal conduit after radical cystectomy. The average duration of the procedure was 240 min (Q1-186 min, Q3-307 min). For laparoscopic access it was 230 min (Q1-186 min, Q3-292 min) compared to 240 min (Q1-202 min, Q3- 312 min) for open access. Complications of the Clavien I grade developed in 5 cases (20%). With a minimally invasive approach, the length of stay in hospital was 6 days (5-6), including 0.7 days (0-1) in the intensive care unit. The average number of drains after laparoscopic procedure was 1.3 (0-2), and the drains were removed in average after 4.4 days (3-5). With open access, the median length of stay was 8 (5-11), including 2 days (1-5) in the intensive care unit. The number of drains was 1.6 (1-2), and the drains were removed in average after 4 days (3-5). Thirteen patients were undergone to follow-up examination until discharge. Regression of dilatation of the pelvicaliceal system was noted in 12 patients (92.3%). Among them, renal function stabilized in 8 (61.5%), improved in 4 (30.8%) and deteriorated in 1 case (7.7%). Clinically significant metabolic acidosis was detected in 1 patient (7.7%).

Conclusion. Substitution of the ureter by ileal segment showed satisfactory results in long-term follow-up.

Introduction. Flexible ureterorenoscopy (fURS) has become one of the most frequent procedures in urology in recent years. The main problem on the way of the spread of flexible ureterorenoscopy in everyday urological practice all over the world is the fragility of endoscopes.

Main aim. To evaluate the potential use of reusable and single-use ureterorenoscopes for kidney stones.

Materials and methods. The analysis included 30 patients who underwent of retrograde intrarenal surgery (RIRS) for kidney stones. The patients were divided into two groups. I gr. – RIRS was performed with a reusable flexible ureterorenoscope Flex XC «Karl Storz» (Germany) (n=20), II gr. – a single-use flexible ureterorenoscope PU3022 «Pusen» (China) (n=10) was used. Lithotripsy was performed with a Lumenis Pulse 100H holmium laser (Israel, USA).

Results. The age of patients, size and density of stones in I gr. and II gr. were comparable (42.5±16.9 vs 50±10.07 (years); 8.5±2.9 vs 10±2.5 (mm); 1248±315.3 vs 1376±223.3(HU+). Intraoperative complications were noted: in the I gr. - migration of stone fragments and bleeding; in the II gr. – migration of a fragment of stone. The time and efficiency of the operation of I gr. and II gr. were 75±39.9 vs 82.5±45.7 (min); 18 (90%) vs 9 (90%), respectively. Additional shock wave lithotripsy was required in 2 cases in the I gr., and more frequent usage stent was noted in the II gr. 10 (100%). In I gr. 5 (25%) patients had signs of inflammatory complication and 1 (5%) patient needed a change of antibiotics, after operation. The acute pyelonephritis was indicating in 2 (20%) patients of II gr. in the same period.

Discussion. The use of access sheath was in all patients of II gr. and in 14 (70%) cases of I gr. In 1 case of the II gr. it was not possible extract of a stone fragment from the lower calyx due to the thickness of the intrument. The possibility of bending was higher for the «Karl Storz» ureterorenoscope due to smaller diameter of the instrument. One of the disadvantages of reusable flexible ureterorenoscope is the fragility of the instrument. In our research, the repair of the instrument was required after 12 manipulations.

Conclusion. The use of smaller instruments, the use of new digital imaging, the mobility of devices, allows performing interventions simultaneously by two surgeons, achieving the greatest fragmentation or evacuation of fragments of stones with good visualization, as well as using methods of drainage-free lithotripsy («tubless»).

Aim. To perform language and cultural adaptation and validation of the OABSS (Overactive Bladder Symptom Score) questionnaire among patients with overactive bladder (OAB), proposed as an effective tool for assessing the severity of symptoms and the efficiency of treatment in clinics of the Russian Federation.

Materials and methods. In accordance with the protocols for carrying out such studies, the procedure of standardized forward-backward translation of the OABSS questionnaire was performed. Further, the intermediate Russian-language version was applied to 15 patients with subsequent correction of deficiencies and approval of the final Russian-language version of the questionnaire. In total, the study group included 176 patients of both sexes with OAB symptoms who filled out the questionnaire twice (test-retest) with an interval of 10-14 days.

Results. Based on the statistical analysis (Cronbach's alpha = 0.961), there was a significant degree of internal consistency of the sample. This fact is also supported by the very high retest reliability of the questionnaire (ICC >0.9).

Conclusion. Our data showed that the Russian version of the OABSS questionnaire is a reliable and valid tool for subjective assessment of the severity of OAB symptoms.

Aim. To evaluate the results of using Sildenafil in the form of an oral spray (Gent) for the treatment of erectile dysfunction (ED) in men with type 2 diabetes mellitus (DM) and prediabetes.

Material and methods. A total of 60 patients were divided into two groups of 30 people. The group 1 included patients with prediabetes, while group 2 consisted of patients with type 2 DM. All men had proven ED. The severity of ED was assessed using the International Index of Erectile Function (IIEF-5). To assess the state of penile blood flow, all patients underwent Doppler ultrasound before and after treatment. Patients with prediabetes used Sildenafil in the form of oral spray (Gent) 25 mg (2 doses) 1 time per day for 1 month, patients with type 2 diabetes received 50 mg (4 injections) every other day for 1 month. In addition, most of the subjects took metformin and followed diet therapy.

Results. In patients of both groups, the administration of Sildenafil oral spray led to a decrease in body weight, waist circumference, a decrease in insulin and Hemoglobin A1C level without changing of hypoglycemic therapy in those with type 2 DM. In men with prediabetes, a decrease in fasting insulin levels was found. During treatment, half of the persons with impaired glucose metabolism had an increase in the testosterone level. According to IIEF-5, a decrease in the severity of ED in both groups of patients was seen. In men with prediabetes, the average IIEF-5 score increased from 15.98 to 21.57 points (p<0.05), while in patients with type 2 DM it improved from 12.18 to 18.44 points (p<0.05). Doppler ultrasound indicated a significant increase in the maximum systolic blood flow velocity and arterial resistivity index after treatment with Sildenafil oral spray in patients with both prediabetes and type 2 diabetes.

Conclusion. Sildenafil oral spray can be effectively used for the treatment of ED in men with type 2 DM and prediabetes.

Introduction. Recently, there has been a steady upward trend in life expectancy, so it is extremely important to remember some of the features of the body associated specifically with aging. Thus, an important topic for discussion is the issue of ensuring the quality of life of an elderly woman. The prevalence of urinary incontinence in patients of the older age group leads to significant restrictions in their social life. Surgical treatment using general and regional anesthesia has significant contraindications due to age and comorbidities. In this regard, in some cases, local anesthesia is the method of choice of anesthesia in this category of patients.

Purpose of the study. Evaluation of the possibility of using local anesthesia in the surgical treatment of stress urinary incontinence in geriatric patients.

Materials and methods. We analyzed the results of surgical treatment of stress urinary incontinence in 42 patients. The mean age of the patients was 78±4 years. All patients were treated for urinary incontinence using mini loops under local anesthesia. Pre- and postoperative examination included vaginal examination in mirrors, cough test, cystoscopy (if indicated), uroflowmetry, ultrasound examination of the pelvic organs and bladder, bacterial culture of urine with determination of sensitivity to antibiotics. Taking into account the advanced age of the patients, the protocol of the preoperative examination included the obligatory performance of ultrasound Doppler examination of the veins of the lower extremities and echocardiography.

Results. The duration of the operation averaged 22±5 minutes. Complications requiring a change in the course of the operation were not registered during the operation. 1 month after the operation, at the control examination, the cough test was negative in 40 (95,2%) patients. 2 (4,8%) had a positive cough test. After 6 months, out of 40 (100%) successfully operated patients, 4 (9,52%) had urine leakage during the cough test. The maximum follow-up period for patients was 12 months. Out of 40 (100%) patients with a negative cough test after surgery, it was possible to track the long-term results of treatment only in 33 (82,5%) patients. After evaluating the results of 33 (100%) operated patients after 12 months, it was found that in 30 (90,9%) patients the symptoms of urinary incontinence were completely absent, in 3 (9,09%) there was a recurrence of urinary incontinence.

Conclusions. Surgical treatment of stress urinary incontinence using a synthetic loop under local anesthesia is effective and safe in geriatric patients.

Aim. To determine the effect of the Prostanorm on the persistent potential of microorganisms isolated from the prostatic secretion of patients with chronic bacterial prostatitis.

Materials and methods. In vitro experiments were carried out on uropathogens, isolated from prostate secretions in patients with chronic bacterial prostatitis, including Escherichia coli, Staphylococcus aureus, S. haemolyticus, S. epidermidis, Enterococcus faecalis. The effect of Prostanorm (liquid extract for oral use) of NPO FarmVILAR (Russia) on the anti-cytokine activity of bacteria against regulatory cytokines (IL4, IL6, IL8, TNFα and IL17A) was evaluated by enzyme immunoassay, while anti-lysozyme trait and the ability to form biofilms was evaluated by the photometric method.

Results. Inhibitory effect of Prostanorm on the anti-lysocyme activity and the ability of microorganisms to form biofilms was found. A decrease in the anticytokine activity against IL17A and TNFa in all studied species of microorganisms was seen, including anticytokine activity against IL4, IL6, IL8 in Escherichia coli and against IL6 and IL8 in coagulase-negative staphylococci.

Conclusion. The ability of Prostanorm to reduce the persistence factors of opportunistic microorganisms in vitro is one of the possible mechanisms, proving its prostatotropic action, bacteriostatic and anti-inflammatory activity.

Background. Renal Transplantation is the final choice for some patients with ESRD (End-Stage Renal Disease), but some transplantations suffer from acute or chronic rejection, so it’s very important to predict the outcome of transplantation.

Methods. The dataset was extracted from records of 4572 patients with kidney transplantations. We applied an Artificial Neural Network (ANN) model to predict transplantation outcome. Moreover, novel features have been explored which enhanced the prediction performance.

Results. The results show that the well configured neural networks can predict renal transplant outcome with a sensitivity and specificity of higher than 86%. The results show creatinine is the most important risk factor that affects the renal transplantation outcome.

Conclusion. The designed neural networks can properly predict the transplantation outcome with the accuracy of 86%. Recipient creatinine is the most important variable in the prediction of the renal outcome.

Introduction. Metabolic syndrome (MetS) is a combination of hormonal, metabolic and clinical disorders. Currently, MetS in men is considered as one of the main risk factors for the development of cardiovascular diseases, insulin resistance, and pathology of the reproductive system.

Aim. To study the effect of a complex of folic acid, L-carnitine, vitamin E, zinc and selenium, which are part of the biologically active food supplement «Speroton», on the parameters of carbohydrate and lipid metabolism in men with MetS, especially in the early stages of its development, as well as on erectile function and quality of life of patients.

Materials and methods. A total of 64 patients aged 30 to 51 years with MetS of varying severity were included in the study. The main group consisted of 34 patients aged 32 to 51 years (mean age 46.2±2.1 years), while in the control group, there were 30 patients aged 30 to 49 years (mean age 45.4±3.4 years). The standard therapy in the main group was supplemented by taking the dietary supplement «Speroton» for 3 months. In the control group, patients received only standard therapy for MetS. The results were evaluated after 3 and 6 months from the start of treatment.

All patients underwent laboratory evaluation of sex hormones, carbohydrate metabolism and lipid profile. In addition, the concentration of zinc in the spermatozoa was measured, as well as the level of total antioxidant capacity of the sperm. The uroflowmetry, ultrasound of the bladder with the measurement of the postvoid residual, and transrectal ultrasound of the prostate were also performed.

Results. An addition of the antioxidant complex «Speroton» to the combination treatment of MetS in the main group allowed to decrease the parameters of oxidative stress by almost two times. By the 6th month of follow-up, the level of insulin improved, which was accompanied by a decrease in the level of HbA1c by 16.3%, suggesting the stabilization of carbohydrate metabolism. A decrease in body mass index by almost 14% (p<0.05) in the main group was found, as well as normalization of the lipid profile. According to the analysis of the erectile function in patients of the main group after 6 months from the beginning of therapy, there was a decrease in the total score to a moderate erectile dysfunction (12.5±2.1 points). There was a decrease in storage symptoms and, in part, voiding symptoms in patients in the main group, who received antioxidant therapy. In addition, a positive correlation between the concentration of zinc and the level of total antioxidant capacity in the ejaculate was seen.

Conclusions: Our results suggest the high therapeutic efficiency of dietary supplement «Speroton» as an antioxidant complex for the treatment of patients with MetS of varying severity. The addition of antioxidants «Speroton» to the standard therapy of MetS contributes to the improvement of the sensitivity of insulin receptors, the normalization of carbohydrate and lipid metabolism, endothelial function and blood pressure, which is accompanied by a significant decrease in LUTS severity, as well as an improvement in the erectile function of patients.

Introduction. One of the main trends in the evolution of endoscopic treatment of urolithiasis is the miniaturization of instruments. This is obvious in the development of minimally invasive percutaneous nephro-lithotomy (PCNL) and retrograde intrarenal surgery (RIRS). However, there are few studies comparing the efficiency and safety of these methods.

Aim. To evaluate and compare the efficiency and safety of mini-PCNL, micro-PCNL and RIRS in the treatment of kidney stones up to 2 cm in size.

Materials and methods. Between October 2020 and December 2022, a total 72 patients underwent minimally invasive endoscopic procedures in two centers, including RIRS (n=30), mini-PCNL (n=26) and micro-PCNL (n=16) using thulium fiber laser FiberLase U2. The efficiency of procedure (stone free rate [SFR]) was assessed using non-contrast-enhanced CT. SFR was considered as the absence of residual fragments > 4 mm. Complications (safety) were evaluated based on the Clavien-Dindo classification.

Results. The mean age of all patients was 47.7 (22–84) years. There were no significant differences between three groups in stone characteristics according to CT (maximum diameter, density, volume and number of stones, the presence of pelvicalyceal dilation). SFR was significantly different between the groups (p=0.034). The overall SFR was 81.9% (n=59). After RIRS, mini-PCNL, and micro-PCNL the SFR was 93.3%, 80.8%, and 62.5%, respectively. A significant difference was found between the RIRS and micro-PNL groups, with 2 out of 30 and 6 out of 16 patients requiring repeat procedure, respectively (p=0.026). The overall rate of complication of grades I-II, IIIa and IIIb according to Clavien-Dindo was 6.9%, 9.7% and 6.9%, respectively. A significant difference was found between the RIRS and micro-PCNL (p=0.021) for grade I-II complications. A rate of grade III complications was not differed between the groups. The operation time was higher for mini-PNL (79.8 (30–145) min), and it was shorter for RIRS (55.7 (30–155) min). The length of stay was lower in RIRS group (4.5 (1–12) days).

Conclusion. The highest SFR was achieved in the RIRS group. In terms of the number of complications of I-II grades according to Clavien-Dindo, the duration of the procedure and the length of stay, RIRS also showed the advantage. There were no significant differences in efficiency and safety between the micro-PNL and mini-PNL. There are not enough studies comparing minimally invasive methods for treating kidney stones. It is necessary to continue research in this area in order to develop an optimal algorithm for choosing the method of endoscopic treatment.

Aim. To evaluate the possibilities of textural analysis of 3D models in differentiating the degree of nuclear dysplasia of the clear cell renal cell carcinoma (ccRCC).

Materials and methods. The specimens after surgical treatment of 190 patients with ccRCC were analyzed. In all cases, nephron-sparing surgery (NSS) was performed through laparoscopic access. The clinical characteristics were evaluated, including age, gender, tumor localization (side, surface and segments), absolute tumor volume, Charlson comorbidity index, body mass index, nephrometry scores (RENAL, PADOVA, C-index). Patients were divided into 2 groups. In group 1, there were 119 patients with the ccRCC of Grade 1 or 2, while group 2 consisted of 71 patients with ccRCC of Grade 3 and 4. All patients underwent 3D virtual planning of procedure using the 3D modeling program «Amira». At the first stage, two experienced radiologists performed manual segmentation of 3D models of kidney parenchyma tumors. At the second stage, the tumor shape was analyzed with a mathematical calculation of three indicators and more than 300 textural features of statistics of types 1-2 were extracted. Further, an intellectual analysis was carried out. For the evaluation of tumor grade according to Furman system, the classification problem was solved using the machine learning algorithm Stochastic Gradient Descent and cross-validation k=5.

Results. The accuracy of classification for the two groups of Grade 1 or 2 and Grade 3 or 4 on the F1 metric was 72.2. To build the model, the following parameters were selected: the absolute tumor volume, the Charlson comorbidity index, "Energy", the first quartile and the second decile of the pixel intensity distribution.

Conclusion. The texture analysis of 3D models for the prediction of Fuhrman grade in ccRCC demonstrated satisfactory quality for two groups of Grade 1 or 2 and Grade 3 or 4 nuclear dysplasia.

Landouzy-Dejerine myopathy (Facial-shoulder-shoulder myodystrophy) is a disease which causes weakness of the muscles of the shoulder girdle, back and hip muscles, which predisposes patients to an increased risk of injury and disability. The article presents a clinical observation of non-ischemic priapism, which developed as a result of perineal trauma with the formation of a fistula of the right cavernous body in a patient against the background of facial shoulder-shoulder myodystrophy. Methods for the differential diagnosis of this condition are also discussed.

Renal cell carcinoma (RCC) accounts for more than 90% of cases of malignant kidney tumors and represents 2-3% of all malignancies worldwide. Clear cell renal cell carcinoma (ccRCC), the most common type of RCC, comprising 70–80% of cases. RCC most commonly metastasizes to the lungs, bones, lymph nodes, liver, adrenal glands, and brain. Synchronous metastasis of RCC to the ipsilateral ureter represents an extremely rare event. Ureteral metastasis is a significant diagnostic challenge, since it is quite difficult to determine whether it has metastatic origin (RCC) or it is a primary urothelial tumor. Moreover, due to the rarity of disease, treatment strategy is not well established.

We present a rare case of patient with the RCC of a single left kidney and metachronous metastasis to the ipsilateral ureter that was initially assumed to be primary urothelial carcinoma. The robotic-assisted left-side partial nephrectomy with a segmental resection of left lower ureter and Boari reconstruction was performed.

This case of successful treatment with robotic-assisted approach shows a great organ-sparing potential of robotic surgery in the treatment of complex oncological patients for whom it is extremely important to preserve the maximum volume of functioning renal tissue, particularly in those with a metastatic RCC of a single kidney.

The perioperative management of patients involves multiple aspects. Acute urinary retention (AUR) is one of the possible postoperative complications. Alpha-adrenoblockers are commonly used for treatment and prevention of AUR. Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups. The aim of our study was to evaluate the efficiency of perioperative use of tamsulosin for the prevention of postoperative AUR. A literature review from January 2013 to June 2023 in Scopus and PubMed databases was carried out. According to the results, tamsulosin results in a significant reduction in the risk of postoperative AUR. A personalized approach allows to overcome difficulties in the perioperative management of patients and significantly improve their quality of life/satisfaction from treatment.

Purpose. To assess postoperative bacteriuria and infectious complications in terms of antibiotic prophylaxis (ABP) regimens, preoperative urine bacterial status and total prostate-specific antigen (PSA) level in patients with benign prostate hyperplasia (BPH) undergoing transurethral prostate surgery.

Materials and Methods. The PubMed, ClinicalKey, Google Scholar and the Cochrane bibliographic databases were searched from 1992 to 2022. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and inverse variance method was used to calculate mean difference (MD) with 95% confidence interval (CI). Primary outcome was the development of asymptomatic bacteriuria, secondary – development of infectious complications.

Results. This meta-analysis showed that ABP significantly decreased level of postoperative bacteriuria and infection complications. This meta-analysis was in favour of prolonged ABP (≥ 3 days) in lowering postoperative infectious complications rate compared to short regimens (≤ 24 hours). Preoperative bacteriuria was not significantly associated with postoperative bacteriuria level and infectious complications. Mean preoperative PSA level significantly differed in patients with and without postoperative bacteriuria.

Conclusion. This meta-analysis demonstrated significant gaps in the knowledge of perioperative bacterial status and antibiotic prophylaxis strategies efficacy in the group of patients undergoing transurethral prostate surgery. There is no consensus on optimal ABP regimen. Most of included studies had significant heterogeneity. Further studies are required.