No 5 (2023)

Introduction. Treatment of lower urinary tract infection primarily involves the antibiotics. However, the efficiency of antibacterial therapy has significantly decreased. Immunomodulators are recognized as the most important link in the pathogenetic therapy of chronic cystitis, which can prevent the development of chronic inflammation. In recent years, a number of publications have appeared proving the benefits of immunomodulatory therapy.

Aim. To carry out a comparative analysis of the efficiency of various dosages of the drug VIFERON^® for the combination treatment of chronic recurrent bacterial cystitis.

Materials and methods. A total of 90 women aged from 18 to 45 years with chronic bacterial cystitis in the acute stage were included in the study. They were divided into 3 groups of 30 each. In group 1, women received antibacterial therapy. In group 2, the drug VIFERON^® was prescribed in the form of suppositories of 1,000,000 IU rectally for 10 days in combination with antibacterial therapy. In group 3, standard antibacterial therapy was prescribed with VIFERON^® b at 3,000,000 IU rectally for 10 days. The follow-up was carried out on the 1st, 5th and 10th days.

Results. On the 1st day in both groups there were signs of exacerbation of chronic cystitis, such as frequent urination, burning during urination, urgency, nocturia, leukocyturia. The results of clinical and laboratory studies obtained on the 5th day of therapy in groups 2 and 3 differed significantly (p<0.05) from those in group 1. In addition, the number of episodes of nocturia and urgency per day, and the pain intensity were closer to normal in group 3. These differences were also significant (p<0.05). By the 10th day of therapy, the average values of the clinical and laboratory parameters decreased to normal levels in all three groups; there were no significant differences (p<0.05). Despite the fact that at baseline bacterial nature of the cystitis was confirmed in all patients, by the 5th day of therapy, eradication of the pathogen was registered in all cases.

Conclusion. A combination of immunomodulators and antibiotics results in a rapid significant improvement in women with chronic bacterial cystitis by the 5th day of therapy. The use of the drug VIFERON^® at a dose of 3,000,000 IU in combination with antibacterial therapy demonstrated the greatest efficiency in clinical and laboratory manifestations.

Introduction. Chronic recurrent cystitis (CRC), notwithstanding the advancements of up-to-date uroinfectology, remains an urgent and controversial problem. An important section of this issue is the study of the etiology of the disease, the determination of which defines the success of treatment and the planned scope of prophylaxis.

Objective. To study pathomorphological changes in the bladder urothelium of patients with chronic recurrent cystitis depending on the etiological factor.

Materials and methods. One hundred fifty eight sexually active female patients aged 20–45 years who had previously been diagnosed with recurrent lower urinary tract infection / chronic recurrent cystitis (RLUTI / CRC) during exacerbation were included in this prospective study. Based on the results of bacteriological and PCR studies of urine, urethral and vaginal discharge, patients were divided into four groups depending on the dominant etiological factor (bacteria / HPV / Candida spp. / M. tuberculosis). Bladder biopsy was performed in remission stage of the disease after premedication and general anaesthesia as routine during cystoscopy. Biopsy specimens after standard preparation were subjected to histological study with characterisation of the changes.

Results. The histological study results revealed characteristic specific pathomorphological tissue changes in different groups, which allowed us to define a protocol for differential diagnosis of RLUTI.

Conclusions. One of the guiding methods of differential diagnostics of RINMP / CRC defining the genesis of infectious-inflammatory process in the bladder is histological study of its biopsy specimens.

Objective: The aim of the study is to study the diagnostic possibilities of determining the excretion of stone-forming substances in the morning portion of urine, normalized by the level of urinary creatinine, as an express analysis of lithogenesis activity in patients with urolithiasis (UCD).

An object, materials, methods: Tocreate reference values of the «lithogenic substance/creatinine» indicator, two cohorts were formed: children 7–17 years old (n=364) of health group I-II (m:d=1:1,3) and adults (n=239) 18-59 years old (m:w=1:1,5) with chronic non-infectious pathology in compensated form (grade I-II hypertension, chronic gastroduodenitis, food allergy). Clinical approbation of the method was performed in patients with ICD (n=441) 45,7±14,9 years and in the comparison group (n=123) 40,2±11,4 years without diagnostic signs of urological pathology and metabolic syndrome. Determination of the concentration in the urine of Ca, P, Mg, uric acid (UA), oxalates (Ox), creatinine (Cr) was performed using commercial kits «Vital-Diagnostics SPb» (Russia), «Сormay» (Poland) on an automatic clinical analyzer DIALAB (Austria). Statistical data processing was carried out using the Statistica program (version 8.0) and ROC analysis.

Results: In the study of a single morning portion of urine, the violation of its metastability was judged by the «lithogenic substance/creatinine index», which is the concentration (mmol/l) in the biosubstrate of the substances responsible for the process of lithogenesis (Ca, P, Mg, UA, Ox), normalized by creatinine urine (Cr, mmol/l) and expressed in relative units. Developed by us in the age-sex aspect (7–10; 11–17 and >17 years), its reference indicators statistically significantly (p<0,05) decrease with age, having lower values in women compared to men. During clinical approbation of the method in patients with KSD, a significant (p<0,05) excess of the median values of the «lithogenic substance / creatinine» index for Ca, Mg, Ox, UA was revealed in comparison with the corresponding indicators in the comparison group. According to the ROC-analysis using the index differentiation scale, various degrees of diagnostic reliability of the tests were obtained: «Са/Cr» and «Ох/Cr» correspond to «acceptable information content» (DS – 72% and 71%; AUC – 0,72 and 0,73) with «extremely weak information content» of the P/Cr index (DS – 49%, AUC – 0,52).

Conclusion. As an alternative/supplement to the determination of urinary daily excretion of lithogenic substances, the method of studying the excretion of stone-forming substances (Ca, Mg, P, Ox, UA ions) normalized by urine creatinine level in a single urine portion can be recommended as an express analysis to identify the emerging lithogenic syndrome.

Aim. To evaluate the effect of basic therapy for CPPS/chronic prostatitis of category IIIA in combination with hypercapnic hypoxia on ejaculate, as well as to describe changes in hemodynamic and microcirculatory properties of the prostate.

Materials and methods. A total of 30 men with a lack of conception in marriage due to chronic abacterial prostatitis of category IIIA were included in the study. Depending on the treatment, patients were divided into 2 groups. In the group 1, patients received basic drug therapy, while in the group 2, an additional breathing training was carried out, which is based on the effect of hypercapnic hypoxia. The main parameters of the ejaculate (concentration, progressive sperm motility, morphology, DNA fragmentation index) and microcirculatory features in the prostate were analyzed using a LAKK-2 laser analyzer. In addition, hemodynamic parameters of the prostate were studied using Doppler ultrasound. All diagnostic studies were carried out at baseline and 90 days after the end of therapy, followed by statistical processing of the results.

Results. There were changes in a median of ejaculate, microcirculation and hemodynamic parameters after treatment compared to baseline in groups 1 and 2, including sperm concentration (3 million/ml vs. 12 million/ml; p=0.021), progressive motility (3 % vs. 15%; p=0.03), normal morphology (0.5% vs. 2%; p=0.04), sperm DNA fragmentation (0.5% vs. 13%; p=0.001), average blood flow (1.16 perf. units vs. 3.44 perf. units; p<0.001), microcirculation efficiency index (0.17 units vs. 0.64 units; p<0.001), bypass index (0.25 units vs. 0.52 units; p<0.001), peak systolic blood flow velocity (0.8 cm/s vs. 3.62 cm/s; p<0.001), resistance index (0.08 vs. 0.12 cm/s; p<0.001).

Conclusion. Basic drug treatment of CPPS/chronic prostatitis of category IIIA in combination with hypercapnic hypoxia have a positive effect on the clinical course manifestations, and also significantly improve the fertile properties through the correction of microcirculatory and hemodynamic insufficiency.

Introduction. The current “WHO Manual for the Laboratory Examination and Processing of Human Semen” (6th edition, 2021) states the variability and low predictive ability of traditionally ejaculate parameters (ejaculate volume, sperm concentration, motility and morphology), abandons the concept of “norm”, replacing it with 5% and 95% percentiles, and recommends the formation of regional criteria for reference ranges.

Aim. To establish reference ranges for basic indicators of ejaculate analysis from fertile Russian men to improve the clinical and economic efficiency of providing medical care to infertile couples.

Materials and methods. A multicenter cross-sectional retrospective study was carried out. Based on the results of a clinical and laboratory examination, a group of fertile men was formed who met the following criteria:

• confirmed pregnancy in the wife (regular partner) according to hCG and/or ultrasound;
• ejaculate analysis was performed in specialized andrological laboratories according to WHO protocols;
• between the date of the study performed and the estimated date of pregnancy there was no more than 3 months (the analysis could be performed before the date of pregnancy, or after the fact of pregnancy was established);
• pregnancy in a natural cycle;
• absence of any specific treatment at least 3 months before the date of pregnancy;
• pregnancy outcome (childbirth, medical abortions, miscarriages, anembryonic pregnancies) was not taken into account.

In total, the sample included 445 men who was examined in the health care facility where the authors of the article worked regarding sexual dysfunction, chronic prostatitis, or miscarriage.

Results. The reference values of basic ejaculate parameters of fertile Russian men differed from the international data presented in the WHO Guidelines, 6th edition (2021). The lower 5% percentile in Russians was higher for sperm concentration (20 and 16 million/ ml, respectively) and ejaculate volume (1.7 and 1.4 ml, respectively), but less for the proportion of sperm with progressive motility (24 and 30%, respectively). Moreover, our values were very close to those from the WHO Guidelines, 4th edition (1999): 20 million/ml, 2 ml and 25%, respectively. The lower 5% percentile of the number of sperm with progressive motility was 21 million, while the minimum value was 5.2 million. The upper 95% percentile of the percentage of abnormal forms was equal to 99%, which indicates the low predictive ability of this indicator in the assessment possibility of conception. It should be remembered that a “fertile man”, i.e. the man who caused the pregnancy is not identical to the concept of a “healthy” man in the reproductive sense, since in 30-40% of cases, anembryonic pregnancy is associated with low sperm quality (ESHRE, 2022).

Conclusion. Our data suggest that for Russian men, the following threshold values foe sperm analysis should be used: for the term “oligospermia”, ejaculate volume is <1.7 ml, “oligozoospermia” means the sperm concentration <20 million/ml, for “asthenozoospermia” is defined as <24% progressively sperm motility, and “teratozoospermia” is diagnosed when <1% of morphologically normal sperms with Papanicolaou staining using “strict” criteria. In 95% of fertile men, a number of sperms with progressive motility was at least 21 million, when in 5% it was from 5 to 20 million. A value <5 million indicate a low probability of conception.

Introduction. Trifecta and pentafecta parameters have been described in modern literature to better define success following partial nephrectomy (PN). In this study an association between patient- and tumor-specific variables with achievement of trifecta and pentafecta was examined in order to better predict outcomes following PN.

Aim. To define preoperative parameters that predict achievement of trifecta and pentafecta following PN.

Materials and methods. A total of 1218 open PN were performed by a single experienced surgeon between Jan 2010 and Dec 2019 for localized renal cell cancer in S.P. Botkin Moscow City Clinical Hospital. From prospective database we retrospectively analyzed the patient-related (age, sex, body mass index, hypertension, cardiovascular disease, hemoglobin, estimated glomerular filtration rate [eGFR], preoperative chronic kidney disease stage) and tumor-related (R.E.N.A.L score, renal mass size and intraparenchymal tumor location index) as potential predictive factors.

Results. The outcomes of PN performed in 1114 patients were analyzed. Trifecta was achieved in 705 cases (78.0%). Among the 632 patients with eGFR available at 12 months following robot-assisted PN, pentafecta was achieved in 180 cases (28.5%). Tumor size less then 4 cm (OR= 3.17, 95% СI 1.73–5.84, p<0,001), extraparenchymal tumor location (OR= 2.78, 95% CI 1.54–5.44, p<0,001) and lower R.E.N.A.L. score (6 vs 9) were all associated with increased odds of achieving trifecta (OR 3.37, CI=1,94–6,27, p < 0.001). Preoperative eGFR less then 60 ml/min was associated with pentafecta achievement (OR=2.73, 95% CI 1.62–5.21, p<0,001) as well as above mentioned variables associated with trifecta.

Conclusion: Preoperative R.E.N.A.L score was the only variable associated with achieving trifecta and pentafecta following robot-assisted PN, while kidney function indicators was associated with pentafecta achievement.

Introduction: Laparoscopic radical cystectomy (LRC) has gradually established as a reliable minimally invasive method for the treatment of muscle-invasive bladder cancer (MIBC), which can significantly reduce the number of complications. However, in the elderly and patients with serious comorbidities, LRC is still associated with a high risk of complications. There are only a few reports on the use of extraperitoneal access for LRC in the literature. At the same time, extensive experience in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic kidney procedures showed significant advantages of extraperitoneal access.

Materials and methods: During 2017–2021, four extraperitoneal laparoscopic radical cystectomy (ELRC) in male patients with MIBC of stage T2-T4. All patients had serious comorbidities. All but one patient had MIBC of G2-G3. Two of them had an invasion in the posterior urethra. In one patient, prostate adenocarcinoma (Gleason score 5+3=8) with invasion of the bladder wall was also diagnosed. He had chronic kidney disease of 3-4 stage due to hydronephrosis.

Results. All procedures were done laparoscopically by extraperitoneal approach. In one case, urine diversion was performed by transperitoneal route into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy were performed to two cases: on one side (in a patient with a single functioning kidney) and on both sides, respectively. Simultaneous bilateral retroperitoneoscopic nephrectomy was done in a patient with CKD 5, who was on chronic dialysis. In two patients, salvage cystectomy was done for recurrent bleeding. The maximum intraoperative blood loss did not exceed 500 ml. No transfusion was required in any of the patients. Bowel function in all patients was recovered within 24-36 hours after the intervention.

Conclusion. ELRC is a reproducible minimally invasive surgical procedure for patients with bladder cancer, which has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of an extraperitoneal approach may be a rational alternative for salvage cystectomy. More cases are needed to determine the role of the method in the surgical treatment of MIBC.

A placement of ureteral stents in pregnant women is a routine endoscopic procedure, which is widely used in case of obstructive uropathy, urolithiasis and hydronephrosis. At the same time, it should be remembered that there is a risk of accelerated calcification (stone formation) of stents due to gestational features of calcium metabolism, changes in the biochemical composition of urine. It can lead to obstructive, infectious and obstetric complications. Therefore, it is important to establish strict indications for upper urinary tract drainage during pregnancy and to determine the correct method for successful treatment and prevention of complications. Careful follow-up of women with ureteral stents and their timely removal or replacing are mandatory. A clinical observation of a woman with urolithiasis and the need to perform multiple urological procedure during two consecutive pregnancies is presented in the article.

Transcutaneous biopsy of one's own kidneys (TBP) remains the gold standard for establishing the etiology of kidney disease and further treatment methods and predicting complications. TBP is considered a relatively safe procedure. However, this manipulation can lead to the formation of paranephral hematoma of various volumes, hematuria of varying intensity, which requires extreme procedures in very rare cases, such as nephrectomy. The article describes the case of the formation of an extensive hematoma after a transcutaneous thick–needle biopsy of the native kidney in a patient with chronic diffuse glomerulonephritis, hematuric form, CKD – 3b, A3. According to the biopsy data, IgA nephropathy with a picture of focal segmental and global glomerulosclerosis, hypertensive nephroangiosclerosis was diagnosed. Two hours after TBP, according to ultrasound of the right biopsied kidney, there is an isoechoic formation, with fuzzy contours, irregular shape, covering the lower pole and spreading along the lateral edge of the kidney. The approximate volume is 510.3 cm3. Despite the ongoing hemostatic therapy, an increase in paranephral hematoma was noted, up to 840 cmЗ. Surgical removal of it was not performed. It was decided not to perform the retroperitoneal space revision, guided by the following considerations: absence of pain syndrome, absence of a decrease in blood hemoglobin, blood hematocrit, leukocytosis, subfebrile temperature as a sign of suppurated hematoma, satisfactory condition of the patient himself. With surgical intervention, there is a high probability of infection of a hematoma, repeated bleeding due to the absence of a compression moment by a hematoma of the puncture site, with possible loss of the right kidney. It has been shown that the use of ultrasound during the first hour after TBP can play a role in determining further treatment tactics and predicting complications. Surgical tactics are explained when this complication occurs. The formation of an extensive hematoma after TBP is not a mandatory signal for performing an audit. Since possible bleeding and hematoma formation is the main primary complication, for this reason it is always necessary to assess the risk / benefit of TBP for the patient, and obtain informed consent before a kidney biopsy.

Introduction. Currently, a large number of studies of drugs of biological origin for the treatment of patients with chronic prostatitis (CP) have been carried out. The entomological drug Adenoprosin, which is based on the biomass of insect larvae of Lymantria dispar, has demonstrated efficiency, primarily due to its anti-inflammatory effect. A large body of literature dictate the need for systematization of the results.

Aim. To carry out a systematic review and meta-analysis for evaluating the efficiency and safety of Adenoprosin for the treatment of patients with CP and/or BPH.

Material and methods. A systematic review and meta-analysis according to the PRISMA protocol was carried out. For a literature search the following databases were chosen: Scopus, MEDLINE, Elibrary, Google Scholar and Cyberleninka, using the keyword “chronic prostatitis, benign prostatic hyperplasia” and “Adenoprosin”. Randomized clinical trials were included in the analysis. Scores were assessed before treatment and after 4 weeks.

Results. A total of 11 studies met the inclusion criteria. The experimental group was treated with Adenoprosin in combination with standard therapy, while in the control group patients received standard therapy alone.

A significant benefit from the addition of Adenoprosin was confirmed by the change in the pain domain of the NIH-CPSI questionnaire (-2.06 (95%CI: -3.32, -0.45); p<0.01) and the sum of NIH-CPSI scores (-3.39 (95%CI: -5.66, -1.12); p=0.01), IPSS score (-2.51 (95%CI: -4.47, -0.56); p=0.01), IIEF-5 questionnaire score (+2.68 (95%CDI: 2.08; 3.28), p<0.01), and Qmax (+2.34 ml/s (95%CI: 0.27, 4.41); p=0.04).

Conclusion. Adding Adenoprosin to the standard therapy in patients with CP, including those with BPH, significantly improves lower urinary tract symptoms and erectile function (based on NIH-CPSI, IPSS, IIEF-5 and uroflowmetry). There were no differences with the standard therapy in QoL, prostate volume and postvoid residual, and a number of leukocytes in expressed prostatic secretions were observed. Some authors report improvement of ejaculate parameters during therapy with Adenoprosin. However, this fact however requires further study.

Reconstructive urology remains one of the most complex and dynamic sections of modern urology, where a large proportion of surgical interventions are performed on the urethra. The most common causes of urethra stricture are iatrogenic damages, injuries and infections. Despite the successes achieved, reconstructive operations on the urethra (uretroplasty) remain one of the most difficult and unsolved urological problems. The use of regenerative technologies in medicine, in our opinion, is the most promising area that can improve the results of reconstructive interventions on the urethra by reducing the risk of fibrosis formation and stimulation of neoangiogenesis. The application of tissue engineering presents the possibility of creating organospecific transplants, which can have great potential in the case of augmentation and replacement urethroplasty. Biodegradable natural bioimplants are preferred. This review identifies limitations and challenges in reconstructive urology and discusses relevant advances in tissue engineering in urethra regeneration. The first part of the literature review presents data on the use of regenerative technologies in medicine, the potential of biomaterials and cell therapy in urethroplasty and discusses experimental models. However, a number of unresolved issues limit the application of these technologies to clinical practice, which requires further research in this direction.

Urolithiasis is a polyethylological metabolic disease characterized by the formation of concrements in the kidneys. The study of trends in the prevalence of urolithiasis is of fundamental importance in practical medicine.

The incidence of nephrolithiasis is increasing worldwide. About 13% of men face urolithiasis in the course of life which is 3 times higher than in women. These data suggest that sex hormones may play an important role in the development of nephrolithiasis. It has been found that plasma oxalate concentration, urinary excretion of oxalate and calcium oxalate deposition in the kidneys can be increased by androgens and decreased by estrogens. It can reasonably be assumed that this is related to different testosterone concentrations. About 80% of the stones consist of calcium oxalate with variable amounts of calcium phosphate. Androgen receptor levels in the kidneys and plasma androgen levels in patients with nephrolithiasis have been reported to be significantly elevated.

The androgen receptor is a member of the steroid hormone receptor family and plays an important role in the physiology and pathology of various tissues and organs. Androgen receptor ligands are circulating testosterone and locally synthesized dihydrotestosterone. This knowledge may form the basis of new studies of urolitiasis and improve the understanding of the processes of kidney calculi formation.