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Nº 3 (2023)
- Ano: 2023
- Artigos: 20
- URL: https://journals.eco-vector.com/1728-2985/issue/view/7915
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Original Articles
Features of the mineral composition of urinary stones depending on the region of residence, gender and age in the Russian Federation, Belarus and Kazakhstan
Resumo
Introduction: Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy.
Purpose: in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender.
Materials and methods: the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018–2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction.
Results. The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted.
Conclusion. The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.
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Prevention of urolithiasis using febuxostat in patients with metabolic syndrome
Resumo
Introduction. Urolithiasis is a chronic highly recurrent disease. The development of new methods of its pathogenetic treatment and prevention is a priority task of practical urology.
Aim. To evaluate the clinical efficiency and safety of Febuxostat-SZ and to develop the rec-ommendations for its use in patients with uric acid stones.
Materials and methods. The analysis of 525 patients with urolithiasis was carried out. On the basis of a comprehensive examination, they were divided into two groups: in the group 1, pa-tients (n=231) had urolithiasis and metabolic syndrome, while in the group 2 (n=294), only urolithia-sis was diagnosed without metabolic syndrome. In both groups, depending on the stone composi-tion, in addition to general measures, specific stone prevention was carried out, which included die-tary regimen and drug therapy.
Results. Uric acid excretion after 6 months of therapy in patients with urolithiasis and meta-bolic syndrome decreased from 9.8±1.8 to 3.9±1.1 mmol/l, urinary excretion of citrates and urine acidity increased from 0.8 ±0.6 to 2.5±0.8 mmol/l and from 5.4±0.5 to 6.3±0.5, respectively, while serum uric acid level decreased from 451.4±15.1 up to 385.2±16.2 mmol/l. In the group of patients who, in addition to prescribing stone prevention, underwent correction of the metabolic syndrome, uric acid excretion after 3 months decreased by half: from 9.7±1.9 to 5.0±1.2 mmol/l, urine pH and citrate excretion increased from 5.4±0.4 to 6.3±0.5 and from 0.8±0.5 to 2.3±1.0 mmol/l, respective-ly, while serum uric acid level decreased from 459.5±17.7 to 370.9±15.1 mmol/l after 6 months of treatment.
Conclusion. The use of Febuxostat-SZ in the complex therapy of urinary stone disease showed high efficiency in normalizing urine acidity, the level of daily excretion and serum uric acid level, as well as satisfactory tolerability and a minimal profile of side effects.
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Changes in the structural and functional properties of erythrocytes in serous and purulent acute pyelonephritis
Resumo
Summary: to establish violations of the structural and functional properties of peripheral blood erythrocytes in serous and purulent acute pyelonephritis before and after conventional therapy.
Materials and methods. The structural and functional properties of erythrocytes of 62 patients with various forms of acute pyelonephritis, randomized by age, sex, and the minimum number of concomitant diseases in remission, were examined. Results and its discussion. In serous, to a greater extent, in the purulent form of acute pyelonephritis, violations of the usual ratio of erythrocyte membrane proteins responsible for the flexibility and shaping of the membrane, intracellular metabolism, stabilization and structure formation of the plasma membrane skeleton were established. Disturbances in the lipid content of erythrocyte membranes, which form the basis of the lipid framework of the plasma membrane and play a major role in the ordering of protein macromolecules and normal erythrocyte metabolism, were revealed. Conclusion. In the serous and purulent phases of inflammation, disturbances in the qualitative and quantitative variant of the protein and lipid fractions of the membranes cause functional changes in blood erythrocytes that are not normalized by standard treatment in the purulent form of the disease, which requires the development of correction methods.4
Conclusions: In patients with NDE before treatment, an increase in the level of only one representative of the investigated proteins of the circulating erythrocyte membrane out of 12, namely tropomyosin, was revealed, which can be used in the differential diagnosis of pyelonephritis forms. In patients with a purulent form of pyelonephritis, a more significant increase in lipid peroxidation processes, a weakening of the body’s antioxidant system, and a decrease in the adsorption characteristics of erythrocytes were revealed. Given the lack of effectiveness of basic treatment in relation to most indicators of the structural and functional properties of erythrocytes, it is necessary to include immunomodulatory and antioxidant drugs in the complex treatment for serous and purulent forms of acute pyelonephritis, which will help reduce complications and enhance regenerative processes.
Recommendations: to recommend to medical specialists to use indicators of structural and functional properties of erythrocytes in difficult cases of differential diagnosis of forms of acute pyelonephritis
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The use of laser doppler flowmetry to assess the microcirculation of the kidney before and after percutaneous nephrolithotomy
Resumo
Aim. To evaluate intraoperative changes in renal microcirculation during percutaneous nephrolithotomy (PCNL), as well as its dynamics in the early postoperative period.
Materials and methods. A total of 240 patients treated in the Urology Clinic of the Saratov State Medical University in 2021-2022 were included in the study. All patients underwent PCNL. In the first group (n=105) the standard PCNL through 30 Ch access was done. In the second group (n=135), the procedure was performed through an access of 16 Ch. Intraoperatively, intrapelvic pressure was evaluated according to the author’s method, which consists in direct measurement in the collecting system during the procedure, allowing for a faster and more accurate assessment. Prior to surgery, Doppler mapping of the renal blood flow was performed, and indirect registration of the microcirculation index (MCI) was done directly on the operating table using laser Doppler flowmetry (LDF). The diagnostic study was performed at the point of intersection of the 12th rib and the psoas muscle, both on the ipsilateral and contralateral side. In addition, during the procedure, a registration of MI of the mucosa of the calyceal fornix accessible in the direct vision through the access tract for 4 minutes was carried out twice.
Results. The index of microcirculation (IM) in the fornix of the upper calyx before the fragmentation of the stone in the 1st group of patients was 26.67±4.7 pf.u. compared to 25.4±5.9 pf.u. in the second group. At the same time, the value recorded on the skin was 13.08±1.2 pf.u. in the first group compared to 13.1±0.77 pf.u. in the second group (p>0.05). During the initial registration, the PM immediately after stone fragmentation was 19.5 ± 1.2 pf.u, while on the overlying skin it was 11.2 ± 0.9 pf.u. In the contralateral kidney area, IM was 10.2±0.9 pf.u. In the case of an intraoperative increase in intrapelvic pressure, IM was 22.3±1.6 pf.u. compared to 12.1±0.7 pf.u on the skin. The dynamics of IM on the skin tended to further decrease and returned to normal values of 10.3 ± 0.7 pf.u on the 3rd day. When intraoperative intrapelvic pressure exceeded the normal value, IM by the 5th day was 10.1±0.4 pf.u. When determining the correlation of IM with RI of the ipsilateral kidney, a direct moderate correlation was revealed (r=+0.516).
Conclusion. The measurement of microcirculation in the intra- and postoperative period allows to assess changes in the intrarenal microcirculation both directly and indirectly. This method can be used as an additional tool for assessing obstructive changes and the activity of pyelonephritis. A significant correlation between IM and RI indicates that functional changes in the renal and skin microcirculation tend to develop simultaneously.
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Chronic cystitis: how to prolong the relapse-free period?
Resumo
Introduction. Chronic cystitis predominates in the structure of urinary tract infections (UTIs). International guidelines are mainly focused on the treatment of acute uncomplicated cystitis; the approaches for managing patients with chronic cystitis has not been sufficiently developed.
Material and methods. A total of 91 patients were included in prospective multicenter randomized comparative controlled study. They were divided into three groups. In the group 1, 32 women received only standard antibiotic therapy for 5 days. In the group 2, 28 patients (received standard therapy plus rectal suppositories Superlymph® 25 IU 1 time per day for 10 days). In the main group, 31 women received standard therapy in combination with the use of rectal suppositories Superlymph® at a dose of 10 IU 1 time per day for 20 days. Standard antibiotic therapy included fosfomycin trometamol 3.0 g once and furazidin 100 mg three times for 5 days.
To assess the long-term results, patients were invited for a follow-up 6 months after the end of therapy.
Aim. To determine the long-term results of combined etiologic and pathogenetic therapy, including Superlymph® rectal suppositories at a dose of 10 U and 25 U, in patients with chronic cystitis.
Results. Six months later, 82/91 (90.1%) women were examined to assess the long-term results.
At 6 months, in group 1 a relapse of the cystitis developed in 17 women (60.7%) after an average of 67.3±9.4 days. In group 2, recurrence was observed in 12 patients (44.4%), and the relapse-free period was longer, averaging of 84.3±9.2 days. The best results were demonstrated in the main group, in which the relapse-free period lasted an average of 123.5±8.7 days, and a relapse developed in only 8 cases (29.6%). In 19 patients (70.4%) there were no symptoms after six months. Differences between groups were highly significant (p<0.001). In all groups, none of the patients had more than one recurrence of the cystitis during the follow-up.
Conclusion. Combined antibiotic therapy results in the absence of recurrence within six months in 39.3% of patients with chronic cystitis. Complex etiologic and pathogenetic therapy, including Superlymph® rectal suppositories, allows to significantly reduce the number of recurrences and prolong the relapse-free period. Among the patients who received a course of local cytokine therapy at a dose of 25 units for 10 days, 55.6% did not have a recurrence of chronic cystitis within 6 months. In the group of patients who, along with etiologic therapy, received Superlymph® rectal suppositories at a dose of 10 IU for 20 days, a relapse was absent in 70.4% of patients.
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The role of electron microscopy of ejaculate in the diagnosis of infertility associated with human papillomavirus infection
Resumo
Introduction. The problem of male infertility is multifactorial. However, in recent years, the question of 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 role of ejaculate electron microscopy in the diagnosis of infertility associated with human papillomavirus infection.
Materials and methods: The analysis of the results of electron microscopic examination of the ejaculate in 51 patients aged 22 to 40 years (mean age 32.3 ± 6.4) with a diagnosis of infertility and pathospermia, combined with human papillomavirus infection (PVI), but with the absence of other risk factors, was carried out.
Results: Various variants of pathozoospermia were found in the ejaculate: asthenozoospermia (35.3%), asthenoteratazoospermia (31.4%), oligoasthenoteratazoospermia (19.6%), oligoasthenozoospermia (13.7%). Among the studied HPV types of high oncogenic risk prevailed (16, 18). More often (88.2%), HPV was registered as part of associations with dominance of types 16 and/or 18 and 33, as well as types 18 and 33. In electron microscopy, in 80.3% of cases, HPV was fixed on spermatozoa with localization on the acrosome (76.4%) and in the sperm plasma (52.9%).
Conclusions: PVI, regardless of the type of HPV and the localization of virions on spermatozoa, significantly impairs the progressive motility and morphology of spermatozoa. The electron microscopy method allows not only to detect HPV in the ejaculate, but also to clarify its localization on the spermatozoon and determine those negative changes in the spermatozoon that are caused by the virus.
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Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury
Resumo
Aim: to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI).
Materials and methods: a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate.
Results: In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group.
Conclusion: Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.
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Evaluation of the efficiency and safety of the dispersed form of sildenafil (50 mg) in males with erectile dysfunction
Resumo
Introduction. The erectile dysfunction is defined as an inability to achieve or maintain an erection sufficient for sexual intercourse lasting more than 3 months. According to literature, about 90 million men worldwide suffer from erectile dysfunction of different severity.
Aim. To evaluate the efficacy and safety of the dispersed form of sildenafil ("Ridzhamp" 50 mg), compared with the standard tablets of sildenafil (50 mg).
Materials and methods. The study included 60 men aged 27 to 67 years (average age 40.2 years) with moderate erectile dysfunction (11-15 points according to IIEF-5). In group I (n=30), patients took a dispersible form of the drug sildenafil, 50 mg ("Ridzhamp") 60 minutes before sexual intercourse; in group II (n=30), a standard form of the drug sildenafil was prescribed at a dosage of 50 mg, 60 minutes before sexual intercourse.
Results. Positive dynamics according to IIEF-5 score was found in all the study groups. In group I, IIEF-5 score increase by 53.85%, while in group II by 50% (p<0.05). The average onset of erection in group I was 45±2.2 min, while in group II it was 51±1.9 min. In the main group (group I) one patient (3.33%) complained of persistent headache after taking the drug, and therefore refused the therapy. In the comparison group (group II) one patient (3.33%) reported dyspeptic disorders while taking the drug, 1 patient (3.33%) reported dizziness. All patients in the main group noted the convenience of taking the «Ridzhamp».
Conclusions. Our results indicate the comparable efficiency of the dispersed form of sildenafil (group I) and the standard tablet form of the drug (group II). All patients in the main group (group I) noted a faster onset of erections, as well as the convenience of «Ridzhamp» and the ability to take the drug without water intake.
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Enoxaparin sodium for pharmacological prevention of postoperative venous thromboembolic complications in urological patients
Resumo
Introduction. Currently, there are paucity of reports on the success of medical prevention of venous thromboembolic complications after urological procedures.
Aim. To evaluate the efficiency of enoxaparin sodium for prevention of postoperative venous thromboembolic complications in urological patients.
Materials and methods. According to the medical records of 151 men and women aged 22 to 92 years old who were undergone to elective surgical treatment in April 2021, the results of the thrombin generation assay and ultrasound study of the inferior vena cava were retrospectively analyzed. All patients were divided into 6 study groups depending on the degree of risk of postoperative venous thromboembolism (very low, low, moderate, high, very high and extremely high). The data obtained during the thrombin generation assay in patients from different groups were compared with those in healthy volunteers (n=30, control group) and evaluated in dynamics. In addition, intergroup comparison was done.
Results. All study participants prior to surgery had a significant increase in peak thrombin and endogenous thrombin potential (ETP) by 5-26% and 13.5-21.5%, respectively. The postoperative findings were as following: 1) one hour after the procedure, a significant (by 9-28.6%) decrease in the normal bleeding time (Lag time); 2) a significant increase in the peak thrombin by 4.8-10.6% 1 hour after surgery and by 11-40.2% at the end of the first postoperative week; 3) reducing the time to peak thrombin (ttPeak) by 13-15%; 4) increase in ETP. According to the ultrasonic data, all study participants had no signs of thrombosis of the inferior vena cava system.
Conclusion: In urological patients requiring surgical treatment, before and after procedure, there is almost always a shift in the hemostasis towards the predominance of the blood coagulation system. Under such conditions, to prevent the development of postoperative VTE, it is expedient and pathogenetically justified to use enoxaparin sodium in a single dose of 0.4 ml or 4000 anti-Xa IU administered once a day s/c 24 hours before the procedure and till full activation of a patient.
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Analysis of surgical complications of reconstructive plastic surgery according to the Clavien-Dindo classification
Resumo
Introduction. The systematization of surgical complications has long been a serious problem since different types of surgical procedures have specific complications, in addition to general consequences. Created in 1992 and improved in 2004, the Clavien-Dindo classification was successfully validated in surgical centers in different countries and recognized as an important tool for the qualitative assessment of surgical complications.
Aim. To improve reconstructive procedures by systematizing complications based on the Clavien−Dindo classification.
Materials and methods: The results of substitution ileocystoplasty in 95 patients with contracted bladder due to tuberculosis and other diseases are presented. In 50 (52.6%) cases, the length of the bowel segment was 30-35 cm (group 1, main), while in 45 patients (47.4%) a segment of 45-60 cm was chosen (group 2, control).
Results: Early complications of grade II developed in 11 (22.0%) patients in the group 1 and in 13 (28.9%) in group 2, while grade III in 5 (10.0%) and 6 (13.3%) cases, respectively. Complications of IIIb grade were seen among patients of the main group in 9 (18.0%) cases compared to 12 (26.7%) in the control group. Severe complications of IVa and IVb grades were documented with the same frequency in both groups, in one case each. Complications of V grade (death) were recorded only in the group 2. Late complications were registered in 63 out of 94 patients. In group 1, there were 26 complications (16 somatic and 10 surgical), while in group 2, a total of 37 complications (24 somatic and 13 surgical) were seen, which indicates a significant higher rate in the control group (p<0.05). In group 1, transurethral resection of urethral-enteric anastomosis and ureteral reimplantation were performed less frequently than in group 2, while transurethral resection of the prostate was done with the same frequency. At the same time, percutaneous nephrostomy was required more often in the group 1 (6% vs. 4.5% in the group 2).
After intestinal cystoplasty with a shortened fragment of the ileum, the voiding volume was significantly lower but corresponded to the physiological value (more than 150 ml). In this group, there was sufficient capacity of neobladder with a minimum amount of residual urine, effective emptying, satisfactory urinary continence, and low intraluminal pressure, which contributes to the protection of kidneys from reservoir-ureteral-pelvic reflux. The serum chloride level after surgery was 106.2±0.4 in the group 1 compared to 109.7±0.3 in the group 2, while base excess was -0.93±0.3 and -3.4±0.65, respectively (p<0.05).
Conclusion: Early serious postoperative complications according to Clavien-Dindo were registered with approximately the same frequency in both groups, while late complications developed significantly more often in the group 2. The urodynamic parameters of a neobladder formed from ileum segment of 30-35 cm are satisfactory. In addition, a decrease in the length of the intestinal segment prevents the development of hyperchloremic metabolic acidosis.
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Andrology
Androgenic status of men with severe COVID-19: the role of testosterone and dihydrotestosterone [within the program founder (features of a new coronavirus infection course and options therapy depending on the androgenic status)]
Resumo
Purpose. The aim of this study was to assess the men’s androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization.
Materials and methods. The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels.
Results. T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores.
During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis.
Conclusion. SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.
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The relationship between penile hemodynamic parameters in cavernous arteries and penile rigidity
Resumo
Introduction. Blood flow parameters in cavernous arteries during full-erection phase on Doppler ultrasonography are associated with intracavernosal pressure and, consequently, with penile rigidity.
Aim. To examine the relationship between blood flow parameters in cavernous arteries and the penile rigidity.
Materials and methods. A total of 54 healthy men and patients with erectile dysfunction of various degrees of severity, with mean age of 43,0 ± 2,2 years ranging from 18 to 74 years, were included in the study. Erectile function was examined and 81 Doppler ultrasonography were performed after intracavernosal injection of alprostadil (10 mcg). In full-erection phase, peak systolic velocity (PSV) and systolic acceleration (SA) were measured, as well as resistive index (RI). Mean values were calculated for both cavernous arteries. Penile rigidity was assessed in three ways: clinical evaluation according to I. Goldstein, measurement of surface rigidity and evaluation of longitudinal rigidity.
Results. During Doppler ultrasonography a strong correlation of penile rigidity with RI (0,71-0,85) and SA (0,63-0,69) was found. Indirect assessment of penile rigidity using PSV values was less precise. With RI values close to 1,0, SA is a more reliable method for indirect rigidity assessment.
Conclusion. Penile blood flow parameters, RI and SA, allow to evaluate a degree of rigidity and to eliminate subjectivity of the specialist performing the examination, as well as to obtain a range of penile rigidity values.
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Oncourology
Experience in performing robot-assisted radical prostatectomy in patients after heart transplantation
Resumo
Introduction. Prostate cancer (PCa) occupies a leading position in the structure of oncological morbidity and mortality and is an urgent problem of modern oncourology. In recipients after organ transplantation, due to the intake of immunosuppressants, the risk of aggressive forms of cancer increases, which necessitates active treatment. In the world, there is not enough data on the radical treatment of PCa in patients after heart transplantation (HT), especially on surgical treatment. We present the first experience in Russia and Eastern Europe of 3 robot-assisted radical prostatectomy for localized PCa in patients after HT.
Materials and methods. The procedures were performed from February 2021 to November 2021 at the FGBU NMRC named after V.A. Almazov. Preoperative preparation, as well as postoperative management of patients was carried out jointly by urologists and transplant cardiologists.
Results. The main demographic, perioperative indicators, as well as oncological and non-oncological outcomes are presented. All patients were discharged from the hospital in a satisfactory condition. During the follow-up period, there were no biochemical recurrences of PCa. Early urinary continence in all three patients was satisfactory.
Conclusion. Thus, robot-assisted radical prostatectomy in patients after HT is a technically feasible, effective, and safe treatment for PCa. The comparative studies with prolonged follow-up are needed.
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Clinical case
Giant prostate stones: case report
Resumo
Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.
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Organ-sparing treatment of prostate stromal tumor of uncertain malignancy potential
Resumo
A case of organ-preserving treatment of prostate stromal tumor with an uncertain malignancy potential is presented in the article. The patient underwent laparoscopic resection of the prostate neoplasm. Mesenchymal prostate tumors are rare. Their diagnosis is difficult due to the lack of experience of both pathologists and urologists. Mesenchymal neoplasms include prostate stromal tumors of uncertain malignant potential. Due to the rare occurrence of these tumors and the difficulties of its diagnosis, there is no recommended treatment algorithm. Taking into account the anatomical location of the tumor, the patient underwent enucleoresection without removing the entire prostate. The control examination, including pelvic MRI, was carried out after 3 months. There were no signs of disease progression. The presented clinical case of prostate preservation during resection of a prostate stromal tumor of uncertain malignancy potential demonstrates a possibility of organ-preserving procedures in such a rare disease. However, due to a small number of publications and a short follow-up period, these tumors require further study and evaluation of long-term results.
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Literature reviews
Ureteroplasty with buccal flap: indications, technique, alternative methods
Resumo
This literature review is devoted to the analysis of indications for ureteroplasty with a buccal flap, its technique, and the alternative surgical options. Reconstructive surgery of the ureter has more than a century of history, during which various surgical interventions have been proposed and improved depending on the location and length of the stricture. Over the past decades, a method of replacing the ureter with a flap from the buccal or tongue mucosa was introduced. The use of such flaps for the ureteral reconstruction is not a new concept; the possibility of performing such a procedure was confirmed at the end of the last century. Successful results of experimental and clinical studies have allowed the gradual adoption of this technique to replace long defects in the upper and middle third of the ureter. In buccal ureteroplasty, robot-assisted approach is widely used, contributing to a high success rate and fewer postoperative complications. The accumulation of experience in such reconstructive procedures and the analysis of the results allow to clarify the indications and contraindications, improve the technique, and carry out multicenter studies.
According to the literature, ureteroplasty using a buccal or tongue mucosa flap is most suitable for long narrowing of the ureteropelvic junction, the upper and middle third of the ureter, which are amenable to endoscopic procedures or segmental resection with end-to-end anastomosis.
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Lectures
Etymology of russian terms in the anatomy of the urinary system
Resumo
This paper analyzes the etymology of the Russian names of the organs of the urinary system (kidney, ureter, urinary bladder, urethra) and their separate parts (renal pelvis). It is shown that Russian anatomical terms originate from the root morphemes of the Indo-European language group, which convey morphological, physiological or anatomical features of this or that organ. At the moment Russian terminology is widely used in the study of anatomy and other fundamental and medical sciences in universities and clinical practice along with common Latin names and eponyms of names of these or other structures.
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Commemorative and jubilee dates
Teodorovich Oleg Valentinovich (on the occasion of his 70th birthday)
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In memory of Professor Oleg Leonidovich Tiktinsky (on the occasion of his 95th birthday)
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In memory of Lyubov Alexandrovna Sinyakova (06.10.1953–13.06.2023)
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