No 3 (2021)

Introduction. In patients with long ureteral strictures, bowel substitution of the ureter or kidney autotransplantation can be performed, which are technically demanding. For recurrent uretero-pelvic junction obstruction (UPJO) and proximal ureteral strictures, substitution of the ureter using buccal graft may be an alternative. Aim: to study the results of laparoscopic ureteral substitution in patients with long proximal ureteral strictures using buccal graft. Material and methods. Laparoscopic ureteral substitution of the ureter using buccal graft was performed in 10 patients with long proximal ureteral strictures, 7 of them were men. The average age was 43.5 years. In 6 patients there was a recurrence after previous pyeloplasty, while 3 patients had ureteroscopy due to upper ureteral stone and one patient had ureteral trauma during laparoscopic excision of the kidney cyst. Three patients were admitted to the hospital with nephrostomy tube, seven with a ureteral stent. Using a laparoscopic approach, an affected part of the ureter was dissected along its length, then a stent was placed antegrade and the ureter was substituted with buccal graft using the onlay technique. Results. All patients underwent laparoscopic intervention. There were no intraoperative complications. The duration of the procedure ranged from 170 to 340 minutes. There were no cases of anastomotic leakage. Fever was observed in one patient without nephrostomy drainage (Clavien grade I). On intravenous pyelography and computed tomography, the neoureter was wide and patent. In patients with PUJO, a severity of dilation of the collecting system was decreased over time. Clinically, all procedures were successful, as patients were free of nephrostomy tube and symptoms of upper urinary tract obstruction. Conclusion. Ureteral substitution using buccal graft may be the method of choice in patients with long proximal ureteral strictures. It is relatively easy, since it does not require extensive dissection of the ureter and provides for the possibility of using buccal graft of the desired length.

Aim. Purpose to analyze the effectiveness of the herbal preparation Canephron N in the relief of nondiabetic glucosuria in patients with recurrent upper urinary tract infection (UTI). Materials and methods: the study included 100 patients, 53 of them were women (median age of all patients 42 (35; 58) years) with recurrent UTI. Patients were referred to the urology department to exclude the obstructive component and concomitant chronic diseases. Upon further examination, all patients were found to have nondiabetic glucosuria. Fifty patients received standard etiotropic treatment, in 25 patients it was simultaneously supplemented with the herbal drug Canephron N, and 25 patients, after standard treatment, continued monotherapy with this phytopreparation. Clinical and laboratory dynamics was assessed in the course of various treatment regimens. Results. The study found that the recurrent course of chronic UTI may be associated with nondiabetic glucosuria. In patients who received standard therapy in combination with the herbal preparation Kanephron N, a decrease in the intensity of nondiabetic glucosuria with more effective eradication of the bacterial pathogen was noted. At the same time, monotherapy of manifestations of IVMP, which are refractory to etiotropic therapy, with Kanefron N also proved to be quite effective. Conclusion: the combination of standard therapy for refractory manifestations of UTI with the herbal preparation Kanephron N is accompanied by the leveling of nondiabetic glucosuria (1.3+0.4 and 0.6+0.4 mmol/L, p<0.05), coinciding with a decrease in leukocyturia (25.5+4.5 and 9.5+1.5 in field of vision, p<0.05)

The aim of the study was to detect features of detrusor overactivity as an urodynamic phenomenon in patients with different etiology of low urinary tract dysfunction. Materials and methods. The study included 283 patients (61% females and 39% males) aged 18-82 years (49.2+13.5) with neurogenic overactive bladder (n=197), idiopathic overactive bladder (n=41), radiation cystitis (n=8) and chronic pelvic pain (n=37). All patients underwent an urodynamic study (UDS) in Sverdlovsk Regional Clinical Hospital in the period from 2017 to 2020. Results. Detrusor overactivity was detected by UDS in 63.4% patients with idiopathic, 94.2% with neurogenic overactive bladder (OAB) and 2.7% in patients with pelvic pain. Maximal amplitude of detrusor pressure during involuntary bladder contraction was significantly higher in neurogenic dysfunction than in idiopathic (25.76+26.21 cm Н2О and 10.1+3.4 cm Н2О respectively, p=0.003). According to the ROC-analysis, detrusor pressure amplitude has a high predictor value in the diagnosis of a neurogenic origin of overactive bladder (AUC=0.863, p=0.045). The sensitivity of pressure more than 9.5 cm Н20 was 88%. Bladder volume at the time of first involuntary contraction was 137+120 ml and 218+120 ml (p=0.07) for neurogenic and idiopathic OAB respectively. Neurogenic detrusor overactivity followed by urgency incontinence more often than idiopathic (59.5% vs 19.2%). Conclusion. Neurogenic detrusor overactivity is characterized by larger amplitude and higher rate of urgency incontinence.

Aim: to improve the differential diagnosis of infected cysts in patients with ADPKD and to reduce false-positive rate of MR-urography. Materials and methods: a total of 33 patients with ADPKD who underwent bilateral nephrectomy from 2015 to 2020 were included in the retrospective single-center study. In the group 1 (n=17) patients with histologically confirmed infected cyst (s) were included, while in the group 2 (n=16) there were patients without infected cysts. The frequency of symptoms (pain in the loin area, fever), the level of leukocytes in blood and urine, C-reactive protein (CRP) and the results of kidney MRI were compared. Results. Pain, fever, leukocytosis, leukocyturia, and increased CRP levels were significantly associated with infected cysts. The sensitivity and specificity of MRI was 88.2% and 43.8%, respectively. The infected cysts were characterized by a significantly (p=0.004) lower value of the apparent diffusion coefficient (ADC): 0.67±0.21x10-3 mm2/s (95% confidence interval (CI) 0.56-0.79), versus 1.2±0.59*10-3 mm2/s (95% CI 0.89-1.5) in group 2. According to ROC analysis, the ADC value at the cut-off point was 0.83*10-3 mm2/s. The frequency of infected cysts during histological examination increased when the volume of the cyst was more than 13 ml. In multivariate analysis, only the CRP level was a reliable predictor of the presence of infected cysts. ROC analysis showed that the CRP level at the cut-off point was 83 mg/L (sensitivity 70.6%, specificity 75%). Conclusion: In case of fever, pain in the loin area and high CRP level in patients with ADPKD, it is necessary to exclude infected cysts. MRI of the kidneys with the determination of the ADC level in cysts with limited diffusion on diffusion-weighted images is a highly informative method that allows to clarify the content of cysts.

Introduction. Transurethral resection of the prostate (TURP) is the gold standard of BPH surgical treatment. It is of current interest to search for medications that can reduce the incidence of complications after TURP. Aim. To evaluate the efficiency of Longidaza® (rectal suppositories of 3000 IU) as part of combined therapy in order to prevent complications after TURP. Materials and methods. The study included 202 patients who underwent TURP in 3 hospitals. The patients were divided into 2 groups: main group - 96 men taking standard postoperative therapy with Longidaza® rectal suppositories N 20; control group - 106 men - taking standard postoperative therapy (tamsulosin 30 days; fluoroquinolone 5 days). Follow-up included IPSS, urinalysis, urine culture, ultrasound examination of the prostate volume (PV), post void residual urine, uroflowmetry at 1,2,3,6 months after surgery. Average preoperative indices: IPSS 27 [23; 30], Qol 5 [4; 6], prostate volume (PV) 71±19cc (30-272 cc), Qmax 7.5±2.5ml/s (1,3-18,7 ml/s). Results. There was a significant improvement in IPSS, QoL, Qmax, PV, post void residual urine (PVR) compared to preoperative values during the entire observation period. There was no statistical difference between the main and control groups for these indexes in 6 months. In the main group had statistically lower incidence of bacteriuria at 3 (11% vs 17%) and 6 months (7% vs 17%), and leukocyturia at 3 (31% vs 46%) and 6 months of follow-up (20% vs 44%). Overall incidence of infectious complications and additional antibacterial drugs prescription was lower in the Longidaza® group compared to the control group (17,7% vs 20,7%). Urethral strictures developed in 7 men in the main group, and 8 in the control group. Conclusion. Our results show that prescription of Longidaza® significantly reduces the incidence of leukocyturia and bacteriuria postoperatively, decreasing the rate of infectious complications in men after TURP.

There are usually two main techniques of vessel anastomosis called as; end-to-end or end-to-side. The aim of this study was to investigate surgical vascular anastomotic and its’ correlation with early outcome after kidney transplantation. Data including gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, preference of artery or vein in addition to biochemical variables were noted analysed by SPSS. The study population was comprised of 84 females and 176 males (174 living versus 86 deceased donor). Surgical vascular anastomic techniques were based on; first artery second vein (FASV; n=209) or first vein second artery (FVSA; n=51). Vascular anastomic were performed as follow; group 1 (FASV with end-to-end; n= 52%), group 2 (FASVwith end-to-side; n=29%), group 3 (FVSA with end-to-end; n=15%) and group 4 (FVSA with end-to-side; n= 5%). Comparison of groups showed that; deceased/living donor (group 1 versus group 3; p=0.02), ATN (group 1 versus group 2; p=0.002, group 1 versus group 4; p=0.03). Despite the higher use of deceased donors, those with vascular anastomic technique based on FASV (end-to-end) revealed a lower rate of ATN when compared to other techniques. Further studies in this direction recommended.

Objective: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. Materials and methods: Retrospective multicentral comparative study. Group “Combo” was presented by patients with the mentioned combined pathology (n=15). Group “Standart” (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. Results: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+3,8 vs 15,9+4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for “Combo” & “Standart” respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. Conclusion: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

Objective: To compare the perioperative, functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. Materials and methods: A prospective analysis was performed of two groups of patients (n=54) who underwent nerve-sparing robot-assisted radical prostatectomy (period from 2017 to 2018). The first group included 29 patients who underwent nerve-sparing robot-assisted radical prostatectomy with Retzius-sparing technique, the second - 25 patients operated on according to the standard method of bilateral nerve-sparing radical prostatectomy. All patients were comparable in baseline characteristics. In all cases, patients had histologically verified localized prostate cancer pT2a-2c. Results: In cases with use Retzius-sparing technique there is no statistically significant difference in the operation time (243.60 min vs 236.64 min, in groups 1 and 2, p>0.05) and intraoperative blood loss (131.20 ml vs 122.57 ml , in groups 1 and 2, p>0.05). Regarding the dynamics of the urinary continence recovery, the Retzius-sparing technique demonstrates advantages in speed and frequency at all follow-up periods (54.13% vs 41.81%; 68.12% vs 59.21%; 94.15% vs 90 , 63%; 98.54% vs 97.12%; 98.62% vs 97.31%; 98.83% vs 97.82% - in one week after removal of the urethral catheter, 1, 3, 6, 9, and 12 months in the first and second group, respectively). The frequency of erectile function recovery after 12 months was 82.17% and 71.14% in the first and second groups, respectively. Conclusions: Retzius-sparing robot-assisted prostatectomy superior to standard operation in the speed and timing of recovery of urine continence and erectile function.

Aim: To evaluate the efficiency of additional methods of intraoperative control during transurethral resection (TUR) for the treatment of nonmuscle invasive bladder cancer. Material and methods. A total of 138 patients (92 men and 46 women) with non-muscle-invasive bladder cancer (Ta-T1N0M0) were treated in the urological clinic of Kazan State Medical University. The median age was 59 years. In 28 patients TUR was performed as monotherapy, in 28 patients TUR with photodynamic therapy (PDD) was done and other 26 patients undergone TUR under dynamic transurethral ultrasound control. In 29 patients, TUR was combined with a single intravesical instillation of a chemotherapy drug, and in 27 patients, TUR was combined with long-term intravesical chemotherapy. The frequency and type of relapses was evaluated depending on the treatment method during five-year follow-up period. Analysis of postoperative complications and their severity was performed according to the Clavien-Dindo classification. Statistical analysis was performed using the Statistica 7.0 and Microsoft Excel 2003 software package. Survival was assessed using the Kaplan-Meier method. Differences in survival between groups were determined using a log-rang test. Results. The total 5-years recurrence rate in the group 1 was 60.71% (n=17). There were 6 recurrences in the resection area (21.43%) and 8 recurrences outside the resection area (28.57%). The progression rate was 10.71% (n=3). In the group 2, the overall recurrence rate was 25% (n=7), including 2 (7.14%) and 4 (14.29%) recurrences in and outside resection area, respectively. The progression rate was 3.57% (n=1). In the group 3, where TUR was performed in combination with transurethral ultrasound, 7 recurrences were diagnosed over a five-year period (26.92%), including 1 recurrence in the resection area (3.84%) and 6 recurrences in other parts of bladder (23.07%). There was no progression of bladder cancer. In the group of patients who received a single intravenous chemotherapy after TUR, there were no significant differences with the group of patients where TUR was performed as monotherapy. The total number of recurrences was 55.16% (n=16). There were 4 recurrences in the resection area (13.79%) and 9 recurrences in other parts of bladder (31.03%), as well as 3 case of disease progression (10.34%). At the same time, in the group of patients where prolonged course of adjuvant intravesical chemotherapy was performed, a significant decrease in the recurrences rate in the resection area (7.4%; n=2) and progression (3.7%, n=1) was found. The number of recurrences outside the resection area was comparable with the group 1 (22.22%; n=6). Conclusions. According to our data, we recommend to perform TUR in combination with PDD and transurethral ultrasound in order to improve the oncological results. Long-term intravesical chemotherapy is an effective alternative in case of inability to use additional intraoperative control and it should be included in the treatment scheme of patients with a high risk of recurrence.

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. The study objective: to evaluate the quantitative correlation between varicocele and reproductive function with a large sample. Design: a cross-sectional and case control study. Materials and methods: 3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel. Results: we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (р<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (р<0.001), 0.11 for DNA fragmentation (р<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% и 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (р<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05). Conclusion. In varicocele, the sperm count decreases but in ¾ of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is ≤1.13).

Background. Management ofthe patients with urachal remnants (URs) has been under discussion for a long time. The traditional approach with surgical removal of all urachal remnants, has been changed to a more conservative, which is preferred by many surgeons, especially in asymptomatic patients. Aim. The purpose of this study was to optimize the treatment of patients with URs, primarily for asymptomatic children. Results. Our previous screening study showed that real incidence of the URs in childhood is significantly higher than it was previously stated. Based on our data and the results of literature review, we propose an algorithm for the workup and treatment of children with URs. Conclusion. We assume that the risk of developing complications (primarily, malignancy) was previously significantly overestimated. In this regard, we recommend conservative tactics in in most asymptomatic cases.

The article summarizes the world’s information on the history of the study, classification, management tactics of patients with closed kidney injury, analysis of the development of post-traumatic arterial hypertension (AH). In a research of renovascular and renoparenchymal mechanisms of a syndrome of AG there is no consensus of dependence on severity of injury of a kidney, a type of treatment, about the temporary period between getting injured and emergence of a complication that defines relevance of further studying.

Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.