编号 1 (2025)

Aim. To evaluate the efficiency of behavioral and drug therapy aimed at reducing the severity of storage symptoms, and to determine the influence of therapy with an anticholinergic drug and a beta-3-adrenergic receptor agonist on the severity of lower urinary tract symptoms (LUTS) and urodynamic parameters in patients with LUTS that persist after surgical treatment of benign prostatic hyperplasia (BPH).

Materials and methods. A total of 115 patients with detrusor overactivity and LUTS that persisted one month after surgical treatment of BPH (IPSS score of 8 or more) were included in the study. Preoperatively, these patients, in addition to a standard examination, underwent urodynamic study (UDS), which revealed concomitant detrusor overactivity. Surgical procedures included transurethral resection of the prostate, endoscopic enucleation of the prostate gland (laser or bipolar), retropubic or laparoscopic simple prostatectomy. At inclusion in the study, patients were randomized into three groups. In group 1 (n=39), behavioral therapy was recommended. In Group 2 (n=39), M-anticholinergic (Solifenacin 5 mg once a day) was administered, while in Group 3 (n=37) a beta-3-adrenergic receptor agonist (Mirabegron 50 mg) was used. After two months of therapy, patients underwent repeated UDS and the severity of LUTS was assessed using the IPSS questionnaire.

Results. After two months of therapy, in each group a significant decrease in the total IPSS score, the sum of the storage and voiding symptom scores, and the median Quality of Life (QoL) score was achieved (p<0.05). At the same time, in groups with drug treatment a lower average IPSS and storage symptom scores (7.7±3.6 and 5.8±2.3 for the behavioral therapy group, 6.1±2.7 and 4.3±2.1 for the M-anticholinergic group, 6.3±3.1 and 4.5±2.2 for the beta-3 agonist group, respectively, p<0.05 when comparing the behavioral therapy group with each of the drug therapy groups) was seen. According to the control UDS, detrusor overactivity persisted in 97.4% of patients in the behavioral therapy group, 89.7% in the M-anticholinergic group, and 91.9% in the beta-3 agonist group. In each group, a significant (p<0.05) increase in the maximum cystometric capacity, volume of occurrence of the first involuntary bladder contraction, and a decrease in the maximum detrusor pressure during involuntary contraction were found. In each group, surgical treatment allowed to alleviate bladder outlet obstruction (BOO). In those who received M-anticholinergic drug and a beta-3-adrenergic receptor agonist, the maximum detrusor pressure during involuntary contraction was lower than with behavioral therapy (32±15.5 in the M-anticholinergic drug group vs. 33.9±15.2 in the beta-3-agonist group vs. 40.5±20.6 in the behavioral therapy group). According to the control UDS, the maximum cystometric capacity, volume of occurrence of the first involuntary bladder contraction, and the BOO index were comparable in all groups. Mirabegron caused side effects less frequently than Solifenacin; there were only 3 adverse events (8.1%) in the Mirabegron group and 11 (28.2%) in the Solifenacin group. The rate of refusal to continue therapy in patients taking beta-3-agonist (2.7%; n=1) was also lower than for Solifenacin (7.7%; n=3).

Conclusion. The study demonstrated the high efficiency of behavioral therapy and monotherapy with M-anticholinergic and beta-3-agonist in the treatment of LUTS that persist after surgical treatment of BPH. At the same time, both options of drug therapy demonstrate significantly greater efficiency than behavioral therapy in reducing the severity of LUTS and storage symptoms in particular, as well as in reducing detrusor pressure during its involuntary contractions. Therapy with the beta-3-agonist Mirabegron has a better safety profile than therapy with the M-anticholinergic Solifenacin, which results in greater patient compliance.

Aim. To discuss the feasibility, safety, and efficiency of conventional laparoscopic partial nephrectomy (LPN) for patients with renal hilar tumors.

Material and methods. A single-center retrospective comparative study of perioperative results included 166 patients who have undergone LPN. Patients were divided into two groups. In the group 1, there were 44 patients with hilar tumor of any R.E.N.A.L. index, while the control group consisted of 122 patients with cortical tumors of R.E.N.A.L. >7. Perioperative factors and results were studied and compared. The rate and structure of intra- and postoperative complications, reasons for conversion, volume of blood loss and ischemia time, duration of the procedure and length of stay, as well as changes of glomerular filtration rate and creatinine were assessed.

Results. There were no conversions to open approach or nephrectomy, as well as positive surgical margins. The RENAL score was higher for hilar tumor group (9 vs 8; p<0.001). No significant difference was obtained according to the frequency of complications, blood loss volume, warm ischemia time and length of stay (p>0.05 for all values). The average drop of hemoglobin level and glomerular filtration rate were also similar (p>0.05 for all values). Therefore, there were no any significant differences between groups except for three parameters. Among all patients with left-sided hilar tumors transmesocolic approach was used more often (31.6% vs 6.8%; p=0.025). Unlike standard procedures, about a third of hilar interventions were completed without renorrhaphy (8.2% vs 27.3% for the control and main groups, respectively; p=0.001). In the group 1, benign lesions were identified in 20.5%, while in the control group in 4.9% cases (p=0.002).

Conclusion. Our study showed that conventional LPN is safe and efficient procedure even in cases of “complex” renal hilar tumors.

Aim: This study aims to find out the correlation of catheter use duration with the incidence of OABS post TURP in patients with urinary retention due to BPH.

Materials and Methods: An observational analytical research correlation with a cohort approach was carried out on 29 patients with urinary retention due to BPH post TURP in five hospitals in Padang from January to August 2019. Data collected included the characteristics and duration of catheter use, obtained through interviews using questionnaires, OABS were obtained based on the total score of the overactive bladder symptoms score (OABSS) standard questionnaire. The numerical variable measurement scale is between the duration of catheter use and OABSS post TURP with the Pearson test using IBM SPSS software v23.

Results: The average of catheter used duration was 14,9±8,0 days, and the total OABSS score was 4,7±2,5. Bivariate analysis showed a positive correlation with a weak strength between the duration of catheter used and the total OABSS score (Pearson’s correlation, r=0,396, p=0,033). The longer the catheter is used, the higher the total OABSS.

Conclusion: The longer the catheter used increase the incidence of OABS post TURP, it is necessary to shorten the duration of catheter use to decrease the incidence and severity of OABS in urinary retention due to BPH patients post TURP.

Introduction. The pathogenesis of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) is quite complex and may be associated with overactive bladder (OAB). Alpha-1-blockers are not effective enough to resolve irritative LUTS caused by OAB. According to recent studies, regulatory polypeptides of the bovine urinary bladder (Vesusten) have shown their efficiency in patients with OAB.

Aim. To evaluate the efficiency and safety of combination therapy of LUTS caused by BPH with alpha-1-blockers and Vesusten in comparison with standard monotherapy with alpha-1-blockers.

Materials and methods. An open, prospective, randomized, single-center study was carried out. In the main group, patients received Vesusten intramuscularly 3 times a week (a total of 10 doses) and an alpha-1-adrenoblocker daily, while in the control group patients received alpha-blockers as monotherapy. Uroflowmetry and ultrasound parameters, IPSS and OAB-q questionnaires, as well as adverse events (AE) were assessed.

Results. A total of 100 patients were included in the study, 93 of whom completed the protocol. The baseline characteristics of the groups were comparable, all patients received selective alpha-adrenoblockers (silodosin or tamsulosin) before inclusion in the study. The IPSS change in the main group was -2.43, compared to -0.38 in the control group (p<0.001). OAB-q parameters also significantly improved in the main group (-2.89 vs. -0.12; p<0.001). There was a significant decrease in the frequency of urinations per 72 hours in the group of combination therapy (-3 vs. -0.17 in the monotherapy group; p<0.001). Also, the voided volume significantly increased in the main group by an average of 27.4 ml (p<0.001), and the postvoid residual volume decreased by an average of 10.7 ml. Qmax and Qave significantly improved in the main group (+1.7 ml/s and +1.5 ml/s vs. +0.1 ml/s and +0.1 ml/s in the control group, respectively; p<0.001). A total of 17 mild AEs associated with intramuscular administration of Vesusten were recorded.

Conclusions. The addition of Vesusten to alpha-blockers in patients with LUTS and OAB caused by BPH significantly reduced irritative symptoms according to questionnaires, uroflowmetry and postvoid residual volume. Only mild local AEs were observed that did not require discontinuation of therapy.

Aim. To carry out a comparative analysis of the taxonomic structure of the testicular and urethral microbiota of patients with non-obstructive azoospermia (NOA) in ART protocols with positive (live birth) and negative outcomes.

Materials and methods. The samples of testicular tissue and urethra of infertile patients with NOA (n=62) were evaluated. To realize the reproductive potential, all patients underwent micro-TESE in the ART protocol. All patients were retrospectively divided into two groups. In group 1, there were patients with NOA and a positive ART result (n=16), while in group 2 patients had NOA and a negative ART result (n=46). To study the bacterial diversity of testicular tissue, an analysis of amplicons of the bacterial 16S rRNA gene was performed using high-throughput NGS.

Results. A comparative analysis of the relative representation of bacterial taxa in the testicular tissue of patients with NOA with positive and negative ART outcomes revealed a number of significant differences. For example, significant differences (p<0.05) were found in the relative representation of the phylum Fusobacteriota, the Pasteurellaceae, Dialisteraceae, Porphyromonadaceae, Alcanivoracaceae, Neisseriaceae_563222, Ruminococcaceae, Acutalibacteraceae, Peptostreptococcaceae_256921, Marinilabiliaceae, Exiguobacteraceae, Coprobacillaceae, Bacillaceae_H_289398, Burkholderiaceae_A_595427 in patients of group 1. Significant differences (p<0.05) were also found in the frequency of occurrence of the phylum Fusobacteriota, the families Lactobacillaceae, Pasteurellaceae, Alcanivoracaceae, Acutalibacteraceae, Peptostreptococcaceae_256921, Exiguobacteraceae, Coprobacillaceae, Bacillaceae_H_289398, Burkholderiaceae_A_595427 in patients with positive ART outcomes. When analyzing the urethral microbiome using high-throughput sequencing, no significant differences in alpha-diversity indices were shown. We also found significant differences (p<0.05) in the frequency of occurrence of the Streptococcaceae family, and they were more common in patients with negative ART outcomes. Meanwhile, representatives of the Enterococcaceae and Brevibacteriaceae families were more common in patients with positive ART outcomes.

Conclusions. It is obvious that changes in the microbiota of the genital tract have a specific effect on the reproductive system, and correction of abnormal microbiomes can improve reproductive outcomes.

Introduction. Benign prostatic hyperplasia (BPH) is a condition that occurs in up to 1/3 of men over 50 years of age and can lead to lower urinary tract symptoms (LUTS) requiring surgical treatment. The main adverse event that men experience after surgical methods of alleviating LUTS is the ejaculatory dysfunction. Currently, surgical techniques are available that increase the chance of maintaining antegrade ejaculation after endoscopic treatment of BPH.

Aim. To evaluate the efficiency and safety of ejaculatory-protective laser enucleation of the prostate with respect to preservation of antegrade ejaculation and improvement of urinary parameters.

Materials and methods. From December 2020 to January 2023, 75 ejaculatory-protective laser enucleations of the prostate were performed in City Clinical Hospital No. 1 named after N.I. Pirogov, Moscow (study group). In addition, 61 patients underwent the classical laser enucleation technique (control group). The study included sexually active men with antegrade ejaculation, who were re-examined 18 months after surgical treatment. Comprehensive history data were collected using the questionnaires, such as IPSS (International Prostate Symptom Score) and IIEF-5 (International Index of Erectile Function). Moreover, ejaculatory function was assessed, and each patient underwent a wide range of clinical, laboratory and instrumental studies, including transrectal ultrasound of the prostate and bladder ultrasound with determination of the postvoid residual volume and uroflowmetry.

Results. In both groups, significant changes in IPSS, quality of life (QoL) were found, while there were no significant differences in IIEF-5 scores in patients who underwent the ejaculatory-protective technique, and, on the contrary, in those undergoing classical laser enucleation, a significant decrease in the total IIEF-5 score from 18.9±3.3 to 17.6±4.0 (p<0.05) was noted. According to the survey, 36 patients (48%) reported a preservation of antegrade ejaculation after the ejaculatory-protective laser enucleation. The chances in patients who underwent the ejaculatory-protective technique were 2.372 times higher than in the classical enucleation; the difference was significant (OR=0.361; 95% CI: 0.169–0.769). Roc analysis revealed that the highest chance of a preservation of antegrade ejaculation was observed with a prostate volume of 66.3 cc or less. A decrease in the total IIEF-5 score with a simultaneous increase in the frequency of ejaculatory dysfunction in patients who underwent the classical laser enucleation of the prostate may indicate a decrease in the perceived quality of sexual life after the loss of antegrade ejaculation. According to the instrumental studies in both groups, the maximum urine flow rate and postvoid residual volume 18 months after surgical treatment were significantly different (p<0.05) from the baseline parameters, indicating an improvement in the quality of urination regardless of the chosen technique.

Conclusion. Ejaculatory-protective laser enucleation of the prostate is a safe and effective alternative to standard technique of laser enucleation of the prostate.

Aim. To estimate frequency and type of renal injury in patients with metastatic renal cell carcinoma (RCC) receiving ipilimumab and nivolumab after nephrectomy.

Materials and methods. The retrospective study involved 50 patients, including 38 (76%) men and 12 (24%) women with a single kidney and progressive metastatic RCC. After nephrectomy before the start of immunotherapy for the progression of RCC, chronic kidney disease (CKD) stage 3 and higher was diagnosed in 39 (78%) cases.

Results. During immunotherapy, acute kidney injury (AKI) developed in 9 (11%) patients after 14 weeks of treatment. The maximum incidence of AKI (n=7; 25%) was documented after the 10th administration of the drugs. When assessing the dynamics of creatinine levels over 28 weeks, a significant increase was noted after the 2nd, 3rd, 4th and 10th administrations. After the 2nd administration of the drugs, the creatinine level in the total sample of patients increased on average to 159.7 μmol/l with a baseline level of 127.8 μmol/l (p<0.001), while after the 3rd, 4th and 10th administration to 160.3, 151.6 and 147.9 μmol/l, respectively (p<0.039, p=0.003 and p=0.029, respectively). Similar dynamics were also seen for urea with a significant increase after the 2nd, 3rd, 4th, 5th and 7th administrations. For example, the maximum urea level was recorded after the 3rd and 5th administrations of the drugs and was 10.2 mmol/l, while before the start of therapy it was 8.1 mmol/l (p=0.001 and p=0.003, respectively).

Conclusion. A significant renal injury was seen during 28 weeks of follow-up in patients with metastatic RCC after nephrectomy receiving ipilimumab and nivolumab.

Fat necrosis is a benign inflammation of adipose tissue, which is associated with sterile saponification, due to impaired blood supply. At the same time, differential diagnostics with malignant neoplasms and tumor relapses is extremely difficult due to the similar features according to imaging studies (ultrasound, CT, MRI, PET/CT).

We present a clinical case of fat necrosis, confirmed by the immunohistochemical study, simulating recurrent kidney cancer. The patient underwent partial nephrectomy for renal cell carcinoma. After 6 months, radiological signs of tumor recurrence were detected in the resection area, due to which patient underwent laparoscopic nephrectomy. Immunohistochemical study indicated fat necrosis.

Retroperitoneal fibrosis (RPF) is a rare cause of postrenal acute kidney injury (AKI). We present a clinical case of a 65-year-old patient who developed acute right-sided hydronephrosis with postrenal AKI. Contrast-enhanced computed tomography showed dilation of the ureter, pelvis and calyxes on the right, diminished size of the left kidney and signs of RPF, including fat tissue thickening, compaction and stranding along the aorta and its visceral branches, mesenteric sinuses, thickening of the peritoneum at the level of the paracolic gutters, pelvic tissue compaction, descending and infrarenal abdominal aortic aneurisms, subocclusion of the left renal artery, and atherosclerosis of the visceral arteries. The patient received hemodialysis. IgG4-related RPF was diagnosed. A 6Ch/24 cm stent was placed in the right ureter, after that AKI resolved. Patients with RPF require multidisciplinary approach for timely diagnosis and successful treatment.

The prevalence of symptomatic post-pubertal hypogonadism in men 40-79 is 2,1-5,7% and increases with age. The aim of testosterone replacement therapy is to restore testosterone levels in blood plasma to normal physiological averages and provide numerous positive clinical effects: improved sexual function, reduced symptoms of depression, improved mood, normalization of the muscle-fat ratio of body composition and bone mineral density, and many others. The recommendations of various testosterone therapy manuals did not allow us to form an unambiguous opinion on the safety of long-term testosterone replacement therapy. The main purpose of the present work is to analyze the effectiveness of testosterone replacement therapy in the treatment of the main symptoms of post-pubertal hypogonadism, its effect on concomitant somatic pathology, safety and a reasonable choice of the dosage form of the testosterone preparation.

Overactive bladder (OAB) is a common lower urinary tract disorder characterized by urgency, increased frequency, and, in some cases, urinary incontinence. Although antimuscarinic drugs (M-anticholinergics) or β3-adrenergic agonists as monotherapy provides relief to some patients, moderate treatment efficiency and tolerability often require drug switching (in case of side effects) or combination therapy (due to insufficient efficiency). The aim of this review was to analyze the combined use of mirabegron (β3-adrenergic agonist) and solifenacin (M-anticholinergic or muscarinic receptor antagonist), focusing on clinical trials, safety issues, and practical aspects. The combination therapy showed superior efficacy compared to monotherapy and an acceptable safety profile, making it a viable treatment strategy for patients with OAB who do not achieve optimal outcomes with a monotherapy.

Mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are increasingly used to treat kidney stones. There is still debate in the literature regarding the efficiency and safety of these surgical procedures.

Aim. To carry out a systematic review of the results of mini-PCNL and RIRS.

A search of publications in the PubMed, Scopus, and Web of Science databases for the past 10 years was carried out to identify all studies that compared the results of mini-PCNL and RIRS. The following parameters were assessed: number and age of patients, stone size, presence of a lower-pole stone, duration of the procedure, complications according to the Clavien-Dindo classification, efficiency of the procedure, and length of hospital stay.

A total of 21 publications with comparative analyze of various variables for mini-PCNL and RIRS for kidney stones larger than 10 mm were found. The difference in the duration of the procedure between mini-PCNL and RIRS was 2.34 min, in the length of hospital stay 1.62 days. The relative risk (RR) of developing complications according to Clavien-Dindo grades I-III during mini-PCNL compared to RIRS was 1.16 (95% CI 0.88-1.53, p=0.2929), and the probability of SFR was 1.08 (95% CI 1.05-1.12).

The analysis showed that RIRS is associated with a shorter duration of procedure and length of hospital stay compared to mini-PCNL. The results were statistically significant regardless of stone size. For stones larger than 15 mm, mini-PCNL provides a slight advantage in efficiency compared to RIRS, and for stones larger than 25 mm, mini-PCNL is more preferable than RIRS, although the results do not differ significantly.

Introduction. The second most common reason for prescribing antibiotics in children is urinary tract infection (UTI). Since antimicrobial stewardship is a priority in the further development of strategies of the treatment of children with UTIs, the need to form an optimal model for its diagnosis and treatment is relevant in pediatric urology.

Aim. To analyze domestic and foreign publications devoted to the study of the urinary tract microbiome in children.

Results. Cultivation or culturing methods continue to be considered the “gold standard” in many countries for the diagnosis of bacterial infections, although more sensitive and specific technologies are available. A urine sample was previously considered sterile if uropathogens did not grow using standard techniques. It remains unclear whether standard microbial culturing methods are adequate to determine species diversity and identify all microorganisms capable of causing UTIs.

A study of the bladder microbiome and maintenance of its homeostasis to prevent inflammatory lower urinary tract diseases is an emerging area of research. It is known that the bladder of a healthy person contains non-uropathogenic bacteria, such as Lactobacillus, which are believed to function as an immune system and protect against the effects of uropathogens.

Saint Petersburg is a separate independent administrative unit of Russia and is not part of the Northwestern Federal District. This is also related to the city's medical service, including urology. It is subordinate to the Health Committee and the chief urologist of Saint Petersburg and is represented by 116 medical institutions, including 20 children’s clinics. The number of urology outpatient clinics is 180, including 26 for children. The total amount of urologic wards is 1,489. The number of wards is 26.6 per 100,000 people. For adults, this value is 31.2, and for children 9.8 per 100,000 people. According to the Health Committee, there are 387 urologists in the city, and Urologist-to-Population Ratio (per 100,000 of the adult population) is 8.8. Taking into account 6 large departmental hospitals with 80 urologists, and private clinics, where 397 adult urologists work, a total amount of urologists in St. Petersburg, providing medical care to the adult population, is 864. Urologist-to-Population Ratio (per 100,000) is 16.0. Educational and scientific work is carried out at six departments of urology and four research centers. Among urologists, 44 are Doctors of medical sciences and 118 have Ph.D. degree.

Obstruction of the upper urinary tract (UUT) is a heterogeneous clinical case, which, if necessary or in case of complications, is relieved by percutaneous nephrostomy or ureteral JJ-stent placement, which have its «pros and cons» in relation to complications, costs, difficulties in performing various pathological conditions, quality of life of patients and further treatment. The European Association of Urology Guidelines on Urolithiasis 2024 are based on the 2010’s data review., fourteen years later, the optimal method of UUT decompression in various pathological conditions remains under debate. In this lecture we present methods, indications, contraindications, complications, quality of life of patients under various methods of UUT draining, as well as the benefits of ureteral stenting and percutaneous nephrostomy.