No 2 (2021)

Introduction. The study of the structure of strictures of various etiologies is an open and uncertain issue of modern urology. Aim. To evaluate the morphological and immunohistochemical structure of strictures of various etiologies. Materials and methods. The study involved postoperative tissue of a pathologically altered urethra of 110 patients aged 23 to 74 years who underwent treatment at the University Clinic of Urology, Russian National Research Medical University. N.I. Pirogova (2014-2018) with Ds: urethral stricture. Morphological study: Van-Gieson staining; hemotoxylin - eosin. Immunohistochemical study: mouse monoclonal antibodies to muscle and connective tissue markers (Smooth Muscle Actin, Vimentin, Calponin) and inflammation markers (CD45R, CD58, CD138, CD20, CD3) were used as primary antibodies in all reactions. Results. According to the revealed morphological changes, the material was divided into three groups: group I (n=27) - active inflammation; group II (n=33) - the predominant development of connective tissue with low activity of inflammation; group III (n=50) - mixed (chronic mild inflammation, an even amount of connective tissue). In a morphological study of idiopathic urethral strictures, it was noted that the multicolumnar epithelium was replaced by a multi-layer flat epithelium with a weakly pronounced keratinization. Inflammatory changes were mild, including the submucosal connective tissue and the spongy body. Spongiofibrosis is accompanied by a significant reduction in the vascular bed of both venous sinuses and arteries. The same changes were observed in the inflammatory genesis of urethral strictures. In the study of strictures with traumatic etiology, a restructuring of the cylindrical epithelium was observed. In cases with severe inflammation in the mucosa, the changes were atrophic-hyperplastic in nature with reactive cell atypia. Conclusion: urethral Strictures in men have a specific etiological factor, but the pathogenesis of urethral lesions can be divided into: post-traumatic and post-inflammatory.

Introduction. The length of the operation to remove urinary concernments has a marked effect on the occurrence of postoperative complications in the time of the postoperative patients in the hospital. A significant factor contributing to the increase in time is the clouding of the fragmentation region, which increases the operation time and the number of complications. Purpose: to develop a method of reducing the time of additional costs in contact lithotripsy with a holmium laser in order to reduce the risk of postoperative complications. Materials and methods. The paper presents the own results of in vivo measurements of time intervals spent on fragmentation of stone. Fragmentation of stones in kidney was carried out by a holmium lithotripter of Triple type with the help of semirigid and flexible ureteroscopes. In the case of severe clouding of the fragmentation region, the author ‘s technique of percutaneous micro-drainage of the kidney was used. The evaluation of the duration ofthe fragmentation procedure is based on statistical processing of the obtained measurement data using Excell Data Analysis tools. Results. In the process of analysis of literary sources and results of own studies it was revealed that with increase in duration of contact laser lithotripsy the number of postoperative complications significantly increases. In order to reduce the time of transurethral contact holmium lithotripsy, the author ‘s technique of percutaneous micro-drainage has been developed. By in vivo measurements and statistical processing of the data, it was found that by using the micro-drainage technique, the average additional washing time of the fragmentation region was reduced by an average of 4 times compared to the conventional technique. Conclusion. By further washing the fragmentation region, it is possible to reduce the time of additional crushing costs by at least 4 times and reduce the number of postoperative complications.

Introduction. The problem of chronic prostatitis is still to be resolved. Aim: to compare the frequency of the main symptoms (pain, dysuria, sexual dysfunction) in patients with chronic bacterial and abacterial prostatitis, as well as prostate tuberculosis (PTB); to determine the prevalence of latent infectious prostatitis in patients with chronic abacterial prostatitis (CAP). Materials and methods. A total 73 men who were followed with a diagnosis of chronic prostatitis for at least two years and had a history of at least three exacerbations per year were included in the study. A microbiological study of expressed prostate secretions (EPS) was carried out using both routine and molecular genetic methods. Results. Chronic bacterial prostatitis (CBP) was diagnosed in 27 patients (37.0%). 36.7% of pathogens were resistant to antibiotics. In 46 patients (63%) no microflora was not isolated at the first examination. In some patients with CBP, prostate tuberculosis (PTB) was diagnosed. Thus, in the total cohort of patients, only 17 (23.3%) had isolated CBP, and other 10 (13.7%) had CBP in combination with PTB. All patients with CAP received longidaza rectal suppositories for diagnostic purposes. In 23 men (50.0% of patients with CAP), uropathogens were isolated from EPS after administration of longidaza, and 56.9% of them were resistant to antibacterial drugs. Five patients from this group also had PTB, and 18 (24.6%) had CBP, which was not diagnosed by standard methods. There were no significant differences in the frequency of pain and urinary disorders. However, sexual dysfunction more often developed in patients with CAP and PTB (p<0.05); hemospermia, on the other hand, was not typical for patients with CAP, occurred in few cases with CBP and latent CAP, but was present in two-thirds of patients with PTB. Conclusion. As a mask of CAP, both latent CPB and PTB can present. Although CBP, CAP, latent CBP and PTB have a number of significant differences in the clinical manifestations, no pathognomonic symptoms have been identified for these subgroups of chronic prostatitis. Considering that half of patients with CAP actually have latent CBP, it is necessary to use rectal suppositories of the drug longidaza for diagnostic purposes with repeated analysis of expressed prostate secretions. To identify pathogens, molecular genetic diagnostics should be used along with routine methods. PTB can manifest as chronic bacterial or abacterial prostatitis. It is necessary to carefully study the patient's history, epidemic history, and, if indicated, to perform an appropriate examination to exclude PTB.

Objective: to study the effectiveness of methods of endovascular treatment of May-Turner syndrome and nutcracker syndrome as a cause of varicose veins of the pelvis in men with chronic pelvic pain syndrome. Materials and methods: a comprehensive examination was carried out in 445 men with chronic pelvic pain syndrome. The patients’ age ranged from 20 to 68 years (mean age 39.5 years). The diagnosis of varicose veins of the pelvis was established in 49 patients, of which 25 had primary varicose veins of the pelvis, in 24 - secondary varicose veins of the pelvis (13 patients with May-Turner syndrome, 11 patients with nutcracker syndrome). The patients with the nutcracker syndrome underwent embolization of the testicular and pelvic veins using the combined sandwich technique. Patients with May-Turner syndrome underwent stenting of the left common iliac vein. Results: In order to assess the technical efficiency of endovascular treatment, control ultrasound was performed at 1, 3, 6 and 12 months. In 100% of cases, throughout the observation period, the patency of venous stents was maintained; in all cases of embolization of the left testicular vein, there was no blood flow in the embolized vein. In order to assess the clinical efficacy of endovascular treatment after 1, 3, 6, 9 and 12 months. after it, patients were questioned using the NIH-CPSI scale and VAS. The most significant changes in clinical manifestations and ultrasound data were observed after 3 months. after endovascular treatment. Conclusions: Balloon angioplasty and iliac vein stenting in May-Turner syndrome and left gonadal vein embolization in nutcracker syndrome are minimally invasive treatments with a favorable patient safety profile.

Objective: To evaluate the efficacy and safety of radical prostatectomy (RP) with nerve-saving technique (NST) in patients ≥ 65 years of age compared with a younger group of patients. Materials and methods: The study group comprised 117 patients ≥ 65 years old, the control group - 333 patients <65 years old, who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. The analysis of pathomorphological results, complications rate, recurrence free survival (RFS) and the restoration of erectile function (EF) in both groups was performed. Results: The majority of older patients belonged to intermediate and high risk groups of biochemical recurrence. Extracapsular tumor extension was significantly more often observed in the group ≥ 65 years of age: 16.2% and 6.9%, p=0.028. There were no differences between the two groups in the frequency of serious postoperative complications (> III class according to the Clavien-Dindo classification): 2.55% and 2.7%; p=0.94. The five-year RFS after RP was 95.4% in the group <65 years old and 92.1% in the group ≥ 65 years old (p=0.31). There was a moderate tendency to a slower recovery of EF in older patients: sufficient EF after 6 and 12 months was observed in 21.9% and 59.4% versus 33.3% and 73% in the group <65 years old (p=0.12). Minimal differences in EF were observed 24 months after RP with bilateral NST (84.2% and 87.9%), and more relevant differences with unilateral NST: 53.8% and 66.7% in the study and control group (p=0.033). Conclusions: The performance of RP with NST in elderly patients is not associated with additional oncological risks, while the restoration of EF is somewhat slowed down in comparison with a group of patients <65 years of age. Bilateral NST provides high potency recovery results regardless of age.

About 30% of male infertility is associated with genetic abnormalities. Genetic polymorphisms increase the level of individual susceptibility to adverse environmental factors and affect human reproductive function. Aim. To study associations of glutathione S-transferase GSTP1(Ile/ Val) gene polymorphisms (A313G; rs1695) with the risk of pathospermia in men of the Moscow region. Materials and methods. We examined 138 men in the Moscow region (n=70 - proven pathospermia, n=68 - fertile men). We obtained genomic DNA from blood leukocytes and studied the gene polymorphisms of glutathione-S-transferase GSTP1 (Ile/Val) (A313G; rs1695) in real time. Results. In the analysis of the distribution frequencies of polymorphisms GSTP1 (Ile/Val) (A>G rs1695), we revealed the predominance of the AA genotype in fertile men and the predominance of the GG genotype (homozygous minor allele) in men with pathospermia. However, we found no significant difference in these parameters between the compared groups of patients (p=0.344). For GSTP1 (Ile/Val) polymorphism (A313G, rs1695), significant differences in the distribution of genotype frequencies in the subgroup of men with teratospermia (χ2=7.00; p=0.03) were revealed. The frequency of allele G in the subgroup of men with teratospermia is statistically significantly different from the frequencies of alleles in the control group: 52% versus 30% (χ2=10,004; p=0.0015). In subgroups of men with azoospermia and asthenospermia, we did not find significant differences in the distribution of genotypes of GSTP1 polymorphism (rs1695) (p>0.05). Discussion: Glutathione-S-transferase (GSTP1) is a multifunctional protein that protects sperm cells from the damaging effects of reactive oxygen species and xenobiotics. The Association of GSTP1 polymorphism (Ile/Val) (A313G, rs1695) with teratospermia explains the main stages of the pathogenesis of male infertility in this category of patients. Conclusion. Gene polymorphism GSTP1 (A313G, rs1695) can be considered a genetic marker of susceptibility to pathospermia in men.

Aim. To suggest new method of surgical correction of hypospadias in girls. Materials and Methods. For 50 years under our supervision there were 220 girls diagnosed with hypospadias of various forms. In the diagnosis used anamnesis, examination, catheterization and cystoscopy of the bladder, vaginoscopy, ultrasound and X-ray research methods. Results and Discussion. Of 220 girls with a diagnosis of hypospadias, vestibular (partial) hypospadias occurred in 201 girls, vestibulovaginal (subtotal) in 16, and vaginal (total) in 3. Of 201 girls with vestibular hypospadias, 37 suffered from urinary incontinence, 16 had vesicoureteral reflux, 21 had doubling, 5 had renal hypoplasia, and 12 had renal dystopia. The vulvovaginal form was manifested not only by the dystopia of the external opening of the urethra, but also combined with the underdevelopment of the sphincteral apparatus of the bladder. All children had daytime and nighttime urinary incontinence, vulvovaginitis. Cystoscopy revealed hyperemia of the urethra and bladder neck. X-ray urological examination revealed VUR in 6 children, ureterohydronephrosis - in 2. All children suffered from chronic pyelonephritis, 8 - day and night urinary incontinence. There were 3 girls (14-16 years old) with vaginal (total) hypospadias. All suffered from constant urinary incontinence, vulvovaginitis, cystitis, chronic pyelonephritis, all had VUR. The new operation for the vaginal (total) form ofhypospadias, proposed by us, restores the closure function of the bladder sphincter by suturing the defect in the posterior wall of the bladder neck. Conclusion. Hypospadias is rare in girls. There are vestibular, vestibulovaginal and vaginal forms of hypospadias. In most cases, the vestibular form does not require surgical treatment. With the vestibulovaginal and vaginal (total) form of hypospadias, surgical treatment is indicated.

Urethral destruction in women is a rare pathology which is result of traumatic damage of the urethra during pelvic fractures, sexual trauma, iatrogenic effects (operative vaginal delivery, prolonged catheterization of the bladder, complicated surgical interventions on the urethra, etc.). The main symptom of urethral destruction is involuntary urinary incontinence. The relevance and complexity of this problem are determined by the fact that the choice of surgical treatment for urethral destruction is still unsolved. This requires such kind of intervention, which will be aimed not only at restoring of the anatomy, but also at correcting urinary incontinence - often in several stages. This article describes two clinical cases of urethral destruction in women with iatrogenic damage to the urethra.

Based on the literary analysis, the influence of cellular technologies on the results of implantation of mesh materials was studied. The scientific literature of recent years contains a large amount of data devoted to the study of mesh structures and the possibilities of their modification using multipotent stromal cells (MSC) for implantation into patients for correcting tissue defects and pelvic organ prolapse. However, the ideal implant has not yet been created. Additional studies with a longer follow-up period are needed to determine the most successful and safe methods and materials for the restoration of pathologically altered or lost tissues and the transition to clinical trials. It is also yet to come to an unambiguous understanding of the best sources of MSC, ways for stimulation of proliferation, preservation and delivery of these cells into the necessary tissues of the body, to thoroughly study the causes of inefficiency and the risks of developing various complications, especially in the long term. The progress of urological implantology in modern conditions, of course, will be associated with the introduction of modern materials and technologies, including the using MSC.

This manuscript provides an overview of the available literature about unilateral combination of nephrolithiasis and renal tumor. Analysis of publications has shown that ipsilateral staghorn calculus and kidney tumors are an extremely rare combination. The majority of these infrequent papers describe case reports where the method of treating such patients is limited by the capabilities and competence of the surgeon or clinic. Despite some messages of favorable outcomes of combined interventions, the effectiveness of simultaneous laparoscopic partial nephrectomy and pyelolithotomy has not been studied, and the technique of this procedure, tactics and criteria for choosing this method are not defined.

COVID-19 is an acute respiratory viral disease that primarily affects the lungs, but can also affect other organs, including the kidneys. Damage to the kidneys can be caused by direct effects arising from the invasion of the virus into kidney cells, or it occurs secondarily due to immunological, hemocoagulation and ischemic disorders. Given the importance of preserving kidney function during illness and after recovery, this review aims to investigate the impact of novel coronavirus infection on the kidney and its role in the development of acute kidney injury.

Bulbourethral glands are the accessory glands of the male reproductive system, the leading function of which is associated with ejaculation and includes both the neutralization of the acidic urine residues and environment of the female vagina, and friction reduction during the sexual intercourse. These glands play the role of immune barrier for urogenital infections, and also synthesize important autocrine and paracrine factors for the male urogenital system development. Gland’s pathologies usually have a subclinical course, however they can also lead to the functional disorders of the human urogenital system. The list of the most common diseases include cuperitis and syringocele. Usually their duration is asymptomatic and they are nearly impossible to diagnose; as a consequence, it is quite difficult to evaluate the real incidence of morbidity and importance of the bulbourethral gland pathology. In recent years, the vast majority of the bulbourethral glands researches are dedicated to the features of X-ray diagnostics and pathology detection, as well as to the description of rare clinical cases. Authors have analyzed the various available scientific data in order to review of morphological, physiological and clinical aspects of the Cowper’s glands.