No 5 (2024)

The aim of the research is to present the features of the technique and results of intestinal reconstruction surgery of ureters.

Materials and methods. From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51±3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral – 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones.

Results. The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 ± 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases.

Discussion. The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner.

Conclusion. Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.

Introduction. The most reliable method for bladder catheterization when necessary is to put a urethral catheter under visual control. However, this requires endoscopic equipment and transportation of patient to a cystoscopy unit or operating room, which is not always possible. To solve these problems, we have developed the optical urethral catheter Visus MG.

Aim. To evaluate the safety and efficacy of a new optical urethral catheter with a portable endoscopic complex.

Materials and methods. The prospective single-center clinical study included men, in whom the first bladder catheterization with a soft urethral catheter was impossible. They underwent insertion of the optical urethral Visus MG catheter under visual control.

Results. A total of 60 men were included in the study. The median age was 70 years, the average prostate volume was 40 cc. Successful repeated catheterization was performed in 57/60 (95%) patients. In 5% cases (n=3), bladder catheterization was unsuccessful due to urethral obliteration.

In 53 (88.3%) men, various surgical methods or manipulations were previously performed, including temporary bladder catheterization in most cases (n=16; 30.7%). The cause of failure of primary catheterization were urethral strictures in 19 (31.7%), benign prostatic hyperplasia in 9 (15%), false passage in 10 (16.7%), bladder neck sclerosis in 10 (16.7%), urethal obliteration in 3 (5%), and the foreign body in the urethra in 1 case (1.7%). In 6 (10%) men, there were signs of iatrogenic urethral trauma with urethrorrhagia due to previous attempts of catheterization, which, however, did not prevent a placement of the urethral catheter under vision control in safe manner.

Conclusion. Bladder catheterization with an optical urethral catheter Visus MG with a portable endoscopic complex was successful in 57/60 (95%) patients after failed primary catheterization, which indicates the high efficiency of the method. The advantages of the technology are its portability, mobility and direct visualization of the urethra.

Introduction. Prostatic hyperplasia (BPH) is one of the most common diseases of elderly and senile men. Its natural «evolution» leads to an increase in deformity disorders, gradual decompensation of the bladder and the progression of CKD. If the morphogenesis of BPH, as well as the patterns of adaptive and pathological restructuring of the lower urinary tract are described in the literature, then there is practically no evidence of adaptive processes in the prostate itself against the background of the growth of hyperplasia nodes. The purpose of the work: to study the features of morphological restructuring of prostate tissue and its vascular system in persons suffering from benign prostatic hyperplasia, with different levels of compensation for bladder function.

Material and methods. Autopsy material of 82 men aged 60-80 years was studied, divided into 4 groups: 25 men without GPH who died from causes unrelated to urological pathology; 25 men with GPH without clinical and morphological signs of bladder decompensation; 22 men with decompensated BPH, which is the main disease, where the immediate cause of death was chronic urinary retention, bilateral ureterohydronephrosis, CKD, uremia; 10 people who died from various causes, however, having a pathological diagnosis of BPH complicated by acute urinary retention. Fragments of the prostate gland were subjected to morphological examination. Histological sections were stained with hematoxylin-eosin, according to Mason and Hart, and also performed: overview microscopy, vascular morphometry and stereometry of the structural components of the prostate. In addition, an immunohistochemical study (IHC) was performed using mouse monoclonal antibodies to SMA.

The results of the study. The formation and progressive growth of prostate nodes in elderly and senile men leads to a compensatory restructuring of the tissue of this organ. Its manifestation is hypertrophy of the smooth muscles of the prostate and the restructuring of the arterial bed, which provides trophism to the overly developed smooth muscles of the stroma. Over time, sclerotic processes progress in the prostate tissue, which, on the one hand, have an inflammatory genesis, and, on the other, have a senile dyscirculatory character due to atherosclerosis of the extraorgan arteries and restructuring of the intraorgan arteries in connection with long-term arterial hypertension. As a result, the prostate gland becomes not only enlarged in volume due to hyperplasia nodes, but also rigid due to fibrosis, which, along with hypertrophy of the smooth muscle component of the stroma, contributes to a further increase in resistance to urine outflow.

An increase in the size of nodes, inflammatory edema of the organ, its sclerosis and petrification, as well as progressive reduction of the arterial bed, lead to the development of venous hyperemia and lymph circulation disorders, being a morphological prerequisite for acute urinary retention.

Conclusion. In GPH, compensatory and adaptive processes occur not only in the detrusor, but also in the prostate gland, as well as its vascular bed. At the same time, aimed at ensuring the normal functioning of the organ in conditions of formation of hyperplastic nodes, they eventually lead to its pathological restructuring, themselves becoming the cause of impaired urine outflow, predetermining the dynamics of the disease and the occurrence of its complications.

The purpose of our work was to assess the possibility of predicting the risks of postoperative complications in patients with urolithiasis in a urological hospital.

Materials and methods. We performed a retrospective comparative study. We analyzed the medical records of patients in the department of urology of hospital clinics of Siberian State Medical University from November 2022 to May 2023. A total of 48 records of patients who had a verified diagnosis of urolithiasis were selected. Inclusion criteria were the presence of stones in the kidney or ureter and surgical intervention during the current hospitalization. Exclusion criteria included bladder stones. All patients underwent surgery for urolithiasis. The laboratory range of studies included a general urine test before surgery, bacteriological examination of urine for microflora and sensitivity to antibacterial drugs before surgery, as well as bacteriological examination of stone obtained intraoperatively. Risk factors for antibiotic resistance were also assessed.

Results. Of the 48 patients included in the study, urine and stone cultures did not reveal microflora growth in 26 (54.2%) patients. In the remaining 22 patients, we received different results: 1. only positive urine culture in 9 (18.8%) patients 2. only positive stone culture in 5 (10.4%) people 3. combination of positive bacteriological examination of urine and stone in 8 (16.7%) patients. Looking separately at 22 patients who had a positive urine or stone culture, or a combination of both, we noted that the combination of a positive urine culture with a positive stone culture and the combination of a positive urine culture with a negative stone culture were not significantly different and occurred in 36.4% and 40 .9% of cases, respectively, i.e. with a positive urine culture, there is an equal probability of about 40% of both an infected stone and a sterile one, while with a negative urine culture, an infected stone can occur in 22.7% of cases. In the early postoperative period, infectious complications were recorded in 3 (6.25%) patients. Complications were observed in 2 patients on the 4th day after surgery, and in one patient on the 2nd day. All three cases were postoperative pyelonephritis.

Conclusions. Our small study demonstrated the importance of culture in planning surgical treatment for urolithiasis. And further study of bacteriological studies of urine before surgery, urine obtained from the renal pelvis intraoperatively, and stones represents new directions for creating algorithms for monitoring patients with urolithiasis, predicting complications in the postoperative period, as well as local protocols for perioperative antibiotic prophylaxis and antibacterial therapy for patients with urolithiasis.

Aim. To improve the examination of patients with chronic skenitis by developing and clinically testing a specialized retractor for visual inspection of the urethra and Skene glands.

Materials and methods. A total of 50 women aged 19 to 38 years, examined in the period 2021–2024 with a preliminary diagnosis of skenitis, were included in the study. The average duration of the symptoms was 8.6±3.6 years. This disease was suspected based on complaints, history and the palpation of the urethra, which revealed severe pain in the area of its distal and middle third, where Skene glands are located. All patients underwent two examinations of the urethra. The first evaluation was done according to the standard technique using tweezers, while during the second an original instrument was used. To determine the diagnostic efficiency of the examination, required time, the number of identified Skene's gland ducts, and the results of the assessment of the urethral mucosa (hyperemia, infiltration) were assessed. The safety of the examination was based on the evaluation of pain using a visual analogue scale (VAS) and the presence of clinically significant count of red blood cells in urine (more than 10 cells per field) in urinalysis collected immediately after the inspection.

Results. In order to improve the visualization of the urethra, as well as the Skene's gland ducts, we developed an original tool, which is a urethral speculum (patent for invention of the Russian Federation No. 2790762 dated February 28, 2023). The median examination time and the number of identified Skene's gland ducts according to the standard technique were 287 sec (Q1–Q3 248–340) and 2 (Q1–Q3 2–2), respectively. When examining the same respondents with the original tool, the respective values were 139 sec (Q1–Q3 125–157) and 3.5 (Q1–Q3 3–4), respectively. Inflammatory changes in the urethra, including hyperemia of the mucosa and/or its infiltration when assessed using the conventional method were detected in 12 (24%) women, compared to 14 (28%) cases when a specialized retractor was used. Analysis of the diagnostic accuracy revealed that the duration of the examination and the number of ducts detected differed significantly between two methods (p<0.001). Hyperemia and/or infiltration of the urethral mucosa was equally common (χ² = 0.167; p=0.684).

The differences in the safety of new visualization method were also evident. Thus, the median pain severity according to the VAS during the examination using the standard method was 7 (Q1–Q3 7–8), compared to 3 (Q1–Q3 3–4) points, when a urethral speculum was used. The results of urinalysis demonstrated that erythrocyturia was detected in 43 patients (86%) at the end of the examination using tweezers. At the same time, after the examination using the original speculum, microhematuria was detected in 10 women (20%). Statistical analysis showed significant differences both in the pain severity scores according to the VAS (p<0.001) and in the presence of microhematuria at the end of the examination (χ²=31; p<0.001). Thus, the time of the examination was reduced by 51.6%, and the number of identified ducts increased by 1.75 times, which indicates the diagnostic efficiency of using a specialized urethral retractor. The proposed device allowed to reduce the pain of examination by 2.3 times, and also reliably (by 52%) decrease erythrocyturia, which confirms its greater safety.

Conclusion. The use of a urethral speculum is an innovative, effective, fast and atraumatic way to visualize the urethra in women with suspected skenitis.

Introduction. The problem of male infertility is multifactorial. However, in recent years, the involvement of viruses, in particular human papillomaviruses (HPV), in the development of this condition has been actively discussed.

Purpose of the study: to study the effect of HPV in mono and mixed versions on ejaculate parameters.

Materials and methods. We analyzed the results of a survey of 105 patients aged from 22 to 40 years (average age – 32.3±6.4) with a diagnosis of infertility and pathospermia combined with PVI, with the absence of other risk factors.

Results. The presence of several viruses in the ejaculate increased the degree of biochemical and cytopathomorphological disorders of sperm recorded in patients with HPV-associated infertility.

Conclusions. a combination of several types of virus leads to a deterioration in the functional activity of Leydig and Sertoli cells of the testicles, characterized by a decrease in the synthesis of total testosterone levels and the development of qualitative and quantitative disorders of the ejaculate. This circumstance is due to the fact that with the association of several microorganisms, there is most likely an increase in the pathogenic potential of HPV.

Aim. To evaluate the effect of microsurgical subinguinal varicocelectomy on sperm DNA fragmentation (SDF) in patients with elevated SDF levels (more than 15%) and clinical varicocele.

Materials and methods. A single-center, retrospective, observational, uncontrolled study was carried out. The results of a survey of 33 patients with clinical varicocele, infertility or recurrent miscarriage and sperm DNA fragmentation of more than 15% were analyzed. All patients in 2021–2022 underwent microsurgical subinguinal varicocelectomy at the clinic «Mother and Child Yaroslavl». The level of sperm DNA fragmentation was assessed before and 3 months after varicocelectomy using TUNEL assay based on flow cytometry.

Results. The level of SDF before surgery ranged from 17 to 73% (Me [Q1–Q3]: 32% [21–42]). After 3 months, it ranged from 1 to 27% (14,4% [7,5–17,4]). The differences between the groups were significant (p <0.001). In all patients, SDF levels after varicocelectomy were lower compared to baseline. The differences ranged from 4 to 55% (19,1% [9,5–25,7]). In 21 patients (63.6%) SDF level after treatment did not exceed the upper limit of the reference interval (15%), and in 11 (35.4%) patients the postoperative values were higher than 15%. A significant (p<0.001) positive correlation (r=0.626) was revealed between the preoperative SDF level and the degree of reduction in sperm DNA fragmentation. However, no correlation was found with other preoperative indicators (varicocele degree, patient age, body mass index, side of varicocele).

Conclusion. Performing microsurgical subinguinal varicocelectomy in patients with an increased SDF level (more than 15%) allows reducing SDF within 3 months by an average of 19.1% and achieving normative values in 63.6% of men. The degree of reduction in SDF after varicocelectomy positively correlates with preoperative values.

Background: Throughout the course of transplantation oxidative stress is a major mediator of adverse outcome. The major objective of this investigation is to measure the total antioxidant capacity (T-AOC) and its’ correlation with immunosuppressive drug levels after kidney transplantation.

Methods: Thirty-five kidney transplanted recipients and thirty-five healthy subjects that matched for age were entered in this study. The obtained data were analyzed using the Statistical Package (SPSS Inc, Chicago, IL, USA). The significance level was set at P<0.05.

Results: In healthy controls, the mean±SD for T-AOC was 91.9±16.6 (U/ml), that was significantly higher when compared to mean value of 27.3±24.1 (U/ml), kidney transplanted recipients (P≤0.01). The mean value of tacrolimus levels was 13.7±5.3 (ng/ml). Correlation between tacrolimus trough levels and TAOC was 0.19 (P≤0.14). There were not any significant differences regarding age in cases and controls (P≤42).

Conclusion: The outcomes of this study suggested that within the limited sample size TAOC in kidney transplanted recipient was lower than controls. Further studies associated with TAOC and clinical outcome after kidney transplantation recommended.

Background and objectives: Dyslipidemia is prevalent among patients with chronic kidney disease on maintenance hemodialysis. A high LDL is a known indicator of major adverse cardiovascular outcomes, but levels may be affected by malnutrition. A high TG/HDL ratio is another indicator of hard cardiovascular outcomes that should be sought carefully.

Patients and Methods: This was a cross-sectional study conducted on 111 patients on maintenance hemodialysis attending the hemodialysis unit at Basrah Nephrology and Transplantation Center at Al-Sader Teaching Hospital from September 1, 2022, to March 1, 2023. A high LDL is defined as > 60 mg/dl, and a high TG/HDL ratio is defined as >2.

Results: Among 111 patients with CKD on maintenance hemodialysis, high LDL was prevalent in 59.1%, and high TG/HDL ratio in 64.5%. Their mean ages were 52.6±15.7 years, 51.4% were males, and their BMIs were 25.2±5.6. Thirty-nine patients (35.1%) were on Aspirin (ASA), 49 patients (44.1%) were on Statins, eight patients (7.2%) were on Fibrate, and 11 patients (9.9%) were on Omega-3 fatty acids. No correlations were found between serum LDL and serum TG/HDL ratio with clinical and laboratory characteristics. A non-linear correlation between serum LDL and TG/HDL ratio was reported.

Conclusions: A high TG/HDL ratio should be sought and addressed carefully among patients with CKD on maintenance hemodialysis, as low LDL may be misleading in those populations.

The presence of foreign bodies in the lower urinary tract has always been an interesting topic. From time to time, every urologist encounters such patients in their practice. A large number of such observations are described in the literature. A clinical case of foreign bodies in the lower urinary tract in 9 children admitted from January 2020 to December 2023 to the Department of pediatric urology of the Chelyabinsk Regional Children's Clinical Hospital are presented in the article. The patients’ charts were analyzed retrospectively. The methods of introducing foreign bodies into the lower urinary tract, diagnostic pathway, as well as the treatment tactics were studied.

The effects of the interaction of optical radiation and biological tissues underlie various optical diagnostics technologies, including laser Doppler flowmetry, diffuse reflection spectroscopy, fluorescent spectroscopy, photodynamic diagnostics (fluorescent cystoscopy), confocal microscopy, optical coherence tomography, etc. The efficiency of these technologies is the subject of study in various fields of medicine, such as dermatology and ophthalmology, anesthesiology and cardiac surgery, in the diagnosis of malignant tumors and others.

In the first part of our review, the available data on the feasibility of using laser Doppler flowmetry and diffuse reflection spectroscopy as a diagnostic tool in urological practice are reviewed and systematized.

In half of the cases, a decrease in the quantity and/or quality of spermatozoa is the cause of infertility. The pathogenesis of such disorders is multifactorial, often unknown, and data on the treatment efficiency are still contradictory. Based on the recent high-level evidences (randomized studies and meta-analyses), the real clinical efficiency of various surgical and conservative treatment methods for the main clinical forms of male reproductive dysfunction, including hypo- and hypergonadotropic hypogonadism, secretory and obstructive azoospermia, retrograde ejaculation and anejaculation, pathospermia associated with varicocele, and idiopathic forms, is analyzed. An algorithm for managing patients with these disorders is proposed, which can be convenient in the routine practice of a urologists regardless of the level of equipment of a healthcare facility.

Introduction. The review is devoted to the study of modern aspects of the pathogenesis, diagnosis and treatment of asymptomatic bacteriuria (AB). The search was conducted using the Medline, PubMed, EMBASE databases. The literature search data indicate that AB in pregnant women is currently an actively discussed section of modern uroinfection. Currently, there is no consensus on the pathogenetic basis, the need and choice of antimicrobial therapy for AB in pregnant women.

Purpose of the study. Generalization and analysis of world literature data on asymptomatic bacteriuria in pregnant women, study of the feasibility and validity of antibacterial treatment for this treatment.

Conclusions: AB in pregnant women, a physiological, non-pathological state of the body, previous principles of diagnosis and treatment of this condition, are outdated in the context of the development of new diagnostic methods and understanding of the pathogenesis of urinary tract diseases, and do not require the appointment of antibacterial therapy.