Nº 3 (2024)

Objective: to evaluate the effectiveness of the recommended modes of laser lithotripsy in clinical practice by analyzing the necessity of changing laser radiation parameters during percutaneous nephrolithotripsy (PCNL), ureterolithotripsy (URS) and retrograde intrarenal surgery (RIRS).

Materials and methods: a prospective non-randomized clinical study was conducted from October 2023 to December 2023. Patients who underwent surgical procedures for urinary stones using a Thulium fiber laser at the Clinic of Urology of Sechenov University were included. Data on localization, size and radiological density of the stones, initial parameters of laser radiation, presence or absence of mode change were recorded. Statistical data was processed using IBM SPSS Statistics software, version 26.0.0.0.0.

Results: 90 patients were included in the study. Laser radiation mode change was recorded in 38% of cases when performing RIRS, in 25% – during PCNL, and in 24% – during URS. A significantly higher total energy consumption at comparable volumes and radiological density of the stones was registered in the group of mode change at RIRS. In the URS group the results suggest that the laser radiation mode change depends on the volume and density of urinary stones.

Discussion: the need for intraoperative change of laser radiation modes in 31% of all observations may indicate that the existing optimal modes for stone destruction in clinical practice may be suboptimal. New studies of the structure and mechanical properties of urinary stones, assessment of their porosity, hardness, size and properties of crystals, as well as the use of Artificial Intelligence for automatic set up of laser radiation parameters for higher efficiency of lithotripsy.

Conclusion: In addition to linear size and radiologic density urinary stones have a whole complex of morphometric and physicochemical characteristics, so the laser lithotripsy parameters preset should be viewed only as a guideline, while effective settings are to be selected intraoperatively considering urologist’s knowledge of laser radiation physical properties.

Introduction. Among the different options for varicocele surgery, microsurgical varicocelectomy demonstrates the best results, but a relapse is subsequently detected in 1–3% of cases. It was previously believed that the cause of recurrence lies in the presence of various sources of venous outflow from the testicle, but recent studies show that the collaterals of the gonadal vein are the main reason of recurrence.

Purpose of the study: to determine the leading cause of recurrence, to evaluate the effectiveness and optimal surgical tactics depending on the method of primary treatment.

Materials and methods. Surgical treatment of 74 patients with recurrent varicocele was performed for 5 years. Depending on the method of primary treatment, two groups were formed: 1 – relapse after non-microsurgical varicocelectomy (n=37), 2 – relapse after microsurgical varicocelectomy (n=37). Patients of the first group underwent microsurgical subinguinal varicocelectomy. Patients of the second group underwent endovascular surgery or redo microsurgical varicocelectomy.

Results. 1 group. Scrotal pain syndrome was relieved in 90% of cases (n=18). Among patients with complaints of infertility (n=8), natural pregnancy occurred in 57,1% (n=4). An improvement in sperm parameters was found among 18 (75%) patients with pathospermia. The US-recurrence rate was 5.4% (n=2), clinical manifestation revealed in 1 case (2,7%). Intraoperatively, preserved branches of the gonadal vein were detected in all cases.

2 group. Scrotal pain syndrome was relieved in 95,8% of cases (n=23). Among patients with complaints of infertility (n=11), natural pregnancy occurred in 27,3% (n=3). An improvement in sperm parameters was found among 14 (73,7%) patients with pathospermia. The US recurrence rate after repeated microsurgery was 13% (n=3), after endovascular intervention – 38.5% (n=5). Clinical manifestation and indications for reoperation were identified in one patient who underwent endovascular embolization. Other cases of the second recurrence were subclinical, no indications for surgical treatment were identified. Renospermatic reflux was determined in all cases of phlebographic recurrence confirmation. No patients with ileospermatic reflux, as well as May-Turner syndrome, were identified. In 8 cases of phlebography, there was no technical possibility to perform embolization; in 3 patients, recurrence was not confirmed. Always the intact gonadal vein branches were identified mainly in the immediate vicinity of the testicular artery, in case of repeated microsurgical operation. There were no cases of testicular atrophy or postoperative hydrocele in any of the groups.

Conclusion. Missing collaterals from the gonadal vein basin play a key role in the genesis of varicocele recurrence. When choosing a surgical treatment option for patients with recurrent varicocele, it is necessary to take into account the method of primary treatment. The main factor to minimize the recurrence risk is the obligatory using of microsurgical techniques and a thorough revision of the spermatic cord components during the primary operation.

Introduction: According to the literature of recent years, there has been an increased interest in non-oncological diseases of the bladder, between which differential diagnostics have to be carried out in order to determine a plan for the diagnosis and treatment of patients with these nosologies. There are often certain difficulties in the differential diagnosis of some forms of viral cystitis and leukoplakia

Objective: to determine pathomorphological criteria for the differential diagnosis of leukoplakia and chronic recurrent papillomavirus cystitis.

Materials and methods: The prospective study included 85 sexually active patients aged 20–45 years, who were divided into two groups depending on the etiological factor. Patients of group I (n=70) – with chronic recurrent cystitis (CRC) of papillomavirus (PV) etiology, group II (n=15) – with leukoplakia. All patients were examined in accordance with the recommendations of the European Association of Urology (EAU) and the Russian Society of Urology (ROU); an additional endoscopic examination of the bladder (cystoscopy) was performed, followed by a morphological examination of the bladder biopsy.

Results: A morphological examination of biopsy tissue in all patients of group I revealed koilocytic transformation of the urothelium combined with non-keratinizing metaplasia of the urothelium, and in patients of group II, in all cases, keratinizing metaplasia of the urothelium with hyperkeratosis was detected.

Conclusion: Morphological examination is the gold standard in differential leukoplakia and chronic recurrent papillomavirus cystitis

Background. Improving the efficiency of treatment and prevention of recurrent lower urinary tract infection (LUTI) is an important problem in modern urology. A significant role is given to the non-antibiotic measures.

Aim. To evaluate the clinical and microbiological efficiency of the drug Urolife-Next in patients with recurrent UTI.

Materials and methods. A total of 70 women with recurrent UTI aged 18 to 55 years (mean 35.1±10.1) and symptoms of cystitis were included in the study. After antibacterial therapy, all patients were divided into 3 groups. In the group 1 (n=24), patients took Urolife-Next 1 capsule 3 times a day for 90 days, in the group 2 (n=23) Э Urolife-Next in the same dose, but for a period of 30 days, while patients of group 3 (n=23) did not receive any treatment. The total follow-up period was 90 days. Frequency and severity of symptoms of recurrent UTI were assessed. The microbiological part of the study included evaluation of the presence and severity of anti-adhesive, anti-biofilm and direct antibacterial effects of the Urolife-Next against uropathogens isolated from urine of patients with exacerbation of UTI.

Results. In group 1, in which patients took Urolife-Next throughout the study, the lowest frequency of relapses was seen. During the 90-day follow-up, recurrences of UTI occurred in only 3 (12.5%) patients in group 1, compared to 18 (78.3%) in group 3. In addition, in the group 1 there was a significantly lower severity of symptoms during exacerbation of cystitis compared to the initial episode, as well as to 3. Urolife-Next showed antibacterial activity against 29 (41.4%) of 70 strains of uropathogens. The minimum inhibitory concentration of Urolife-Next against gram-negative microorganisms was on average 2 times higher than for gram-positive pathogens. A pronounced anti-adhesive activity of Urolife-Next in vitro was also revealed. The maximum anti-adhesive effect was observed 2 hours after the start of the study. By this time, the adhesion index for cultures in the presence of Urolife-Next was 2.3 times lower than the control values for E. coli, 2.5 times for Kl. pneumoniae, and 2.9 times for E. faecalis. Significant antibiofilm activity of Urolife-Next was also noted. The severity of biofilm formation, which was assessed by changes in the optical density of cultures, decreased by 1.3–2.2 times, depending on the type of uropathogens.

Conclusions. The results of the study prove the efficiency of the dietary supplement Urolife-Next for the prevention of recurrences in patients with UTI. Its components (D-mannose, cranberry extract, vitamins D and C, hyaluronic acid, probiotics) influence the main pathogenetic factors.

Introduction. Several techniques are used for laser enucleation of benign prostate hyperplasia, including two- and three-lobe enucleation, enucleation of all lobes in a single block (en-bloc), and enucleation of all nodes in a single block without longitudinal incisions (total en-bloc).

Aim. A prospective and retrospective analysis of the results of two-lobe, en-bloc, and total en-bloc using thulium fiber laser enucleation of the prostate (ThuFLEP) techniques was performed.

Methods. The study included a retrospective and prospective comparative analysis of the peri- and postoperative results of ThuFLEP using several techniques. Patients with benign prostatic hyperplasia causing bladder outlet obstruction (IPSS>20, Qmax<15) were undergone to ThuFLEP from January 2015 to May 2022. All patients were examined prior to and 1, 3, and 6 months after the procedure. In the pre- and postoperative period, the age of the patients, prostate volume, level of prostate-specific antigen, functional parameters (IPSS, post-void residual, Qmax, and QoL), the stress urinary incontinence were evaluated. In addition, the following intraoperative parameters were assessed: duration of the procedure, enucleation rate, morcellation rate, and mass of enucleated tissue.

Results. We found 450 patients who underwent thulium fiber laser enucleation of prostate hyperplasia (ThuFLEP). Three laser enucleation techniques were used, including two-lobe (n=148; group A), en-bloc (n=150; group B), and total en-bloc without longitudinal incision (n=152; group C). The mean prostate volume was comparable between groups. The mean operation time for the total en-bloc technique (group C) was less compared to the other two techniques (58.9±30.1 vs. 68.8±30.6 for group A and 67.4±30.1 min for group B, respectively; p<0.005). The mean enucleation rate in group C was higher compared to groups A and B (2.3±0.78 vs. 1.9±0.74 and 1.9±0.69 g/min, respectively; p<0.005). The mean morcellation rate in all three groups was comparable (2.8±1.7, 3.0±1.1, and 2.9±2.1 g/min; p>0.05). After 6 months, there were no differences in functional results, according to the IPSS, PVR, Qmax, and QoL.

Conclusion. The two-lobe, en-bloc, and total en-bloc techniques were comparable in functional results and the complication rate. Total en-bloc enucleation showed the higher enucleation efficiency.

Introduction. The reproductive potential of older men is influenced by the androgen deficiency and an increased risk of sperm DNA damage. In addition, with aging, a number of other diseases may have a detrimental effect on spermatogenesis. For this reason, the search for methods for correcting impaired spermatogenesis in men of the older age group is of relevance. The use of dietary supplements with antioxidant effects seems promising.

Aim. To increase the efficiency of preconception preparation for men aged 45 years and older using an antioxidant complex.

Materials and methods. A total of 102 patients aged 45 years and older with pathospermia and metabolic syndrome (MS) of varying severity were included in the study. The main group consisted of 52 patients aged 45 to 55 years, while in the control group there were 50 patients (45–54 years). In addition to standard therapy for MS, patients of the main group received the dietary supplement «Speroton», 1 sachet 2 times a day with meals for 3 months. In the control group, men received only standard therapy for MS. The results were assessed after 3 and 6 months from the start of treatment. A sperm analysis was used as the main criterion for assessing treatment efficiency. Sperm DNA damage was characterized by DNA fragmentation. In addition, the concentration of zinc in seminal plasma, as well as the total antioxidant activity (TAA), was determined for all patients. Laboratory analysis of sex hormones, carbohydrate metabolism parameters, and lipid profile was also performed.

Results. As a result of the adding the antioxidant complex «Speroton», the indicators of oxidative stress in the main group decreased almost two-fold. By the 6th month, the level of immunoreactive insulin (IRI) decreased by 22%, which was accompanied by a decrease in the level of glycosylated hemoglobin (HbA1c) by 6.6%, indicating stabilization of carbohydrate metabolism. Positive dynamics in reducing body mass index (BMI) by almost 12% in the main group were seen, as well as normalization of the lipid profile. In addition, there was a significant increase in sperm concentration from 10.5±5.5 million/ml to 21.5±4.8 after 3 months of taking the antioxidant complex «Speroton», positive dynamics were also noted in terms of DNA fragmentation, TAA level and zinc level in seminal plasma.

Conclusions. The use of the antioxidant complex «Speroton» in an increased dose of 2 sachets per day for 3 months in men older than 45 years with pathospermia and MS of varying severity improves the qualitative and quantitative sperm indicators and the morphological state of the male reproductive system. A determination of the level of zinc in seminal plasma, TAA, as well as the sperm DNA fragmentation, especially in patients aged 45 years and older suffering from MS, is justified. The use of the «Speroton» results in a decrease in the percentage of sperm with DNA fragmentation and the oxidative stress in the ejaculate. The adding of antioxidants in the dietary supplement «Speroton» in men with pathospermia and MS of varying severity allows to effectively restore the sensitivity of insulin receptors and normalize carbohydrate and lipid metabolism.

The intrarenal reflux is caused by impaired emptying of the renal pelvis, that leads to increased intrarenal pressure. Increased pelvis pressure can be the result of a variety of states. The most common causes are acute upper urinary tract obstruction or overfilling of the pelvis during retrograde intrarenal surgery (RIRS) or retrograde pyelography. In rare cases, it is due to impaired neuromuscular tone of the upper urinary tract that leads to hyperkinetic state.

We have presented case with a 73-year-old patient with intrarenal reflux into the peripelvic renal cysts. Since no such cases were found in the literature, this observation is unique.

Introduction. Ewing's extraosseous sarcoma of the genitourinary system is an extremely rare disease. There are sporadic publications about the genitourinary sarcomas.

We present a case of a primitive neuroectodermal pelvic tumor with bladder invasion in a 58-year-old man. Initially, he was admitted with complaints of intense lower abdominal and right lumbar pain, severe dysuria, macrohematuria, weight loss (by 15 kg in 6 months) and general weakness. Previously, a nephrostomy tube was put due the right hydronephrosis. Nephrostomy output was up to 100-150 ml per day, and glomerular filtration rate was estimated within 5 ml/min. According to MRI data, the extra-organ pelvis tumor with bladder invasion along the right posterolateral wall was diagnosed. Cystoprostatectomy, right nephroureterectomy and left ureterocutaneostomy were performed. In the postoperative period, the patient firstly manifested neurological symptoms (paresis). According to the brain CT, two lesions of the right frontal and left parietal regions were found (most likely metastases of the primary tumor). Late admission and disseminated tumor with local invasion and brain metastases, right terminal hydronephrosis, anemia due to pronounced macrohematuria and decrease of the body weight determined an unfavorable outcome.

Conclusions. Our case report allows us to remind urologists about the presence of orphan oncological diseases with an extremely aggressive course. In-depth diagnosis requires the use of immunohistochemical methods, and the treatment of such patients should be based on a multidisciplinary approach.

The literature review dedicated to a problem of using various types of water for the primary and secondary prevention of urolithiasis is presented. According to the one of the oldest hypotheses, water with different characteristics may contribute to urinary stone formation. The role of hard or soft water in the development of kidney stones is still controversial. Currently, it can be convincingly stated that there is no association between water hardness and the occurrence of urolithiasis. The hardness of drinking water is not a major factor contributing to the urinary stone disease, and this situation is confirmed by many domestic and foreign studies. Understanding the importance of the various electrolytes contained in water is critical to providing patients with an effective non-drug solution for the prevention of recurrent urolithiasis. When characterizing water, it is necessary to consider the level of calcium, magnesium and bicarbonate. Education in the use of various drinks, primarily tap, bottled, and mineral water, can and should serve as a therapeutic strategy for preventing and reducing the risk of urinary stones.

Currently, the problem of antibiotic resistance is of great relevance to society not only for medical, but also for social and economic reasons. Infections caused by multidrug-resistant pathogens have a longer course, more often require hospitalization, and increase the risk of mortality. The antimicrobial resistance is most relevant for hospitals in the case of the development of nosocomial infections. However, in recent years in Russia and Europe, resistant microorganisms have become more often found in patients with community-acquired urinary tract infections. In this review, we present data from two recent large Russian studies on antibiotic resistance of community-acquired strains of uropathogens and a microbiological study carried out in Switzerland to study the antimicrobial activity of furazidin, soluble furazidin, nitrofurantoin and ciprofloxacin. For the first time, an evaluation of the antimicrobial activity of soluble furazidin allowed to explain the high clinical efficiency of furazidin potassium, documented in trials and real clinical practice. This study, in line with Russian data, indicates the high activity of nitrofurans against Escherichia coli, the main causative agent of UTI.