Urology reports (St. - Petersburg)

BACKGROUND: Vesicoureteral reflux (VUR) is one of the most common congenital anomalies of the urinary system in children. In most cases, urinary tract infection (UTI) serves as a clinical prerequisite for identifying VUR. However, a standardized approach to the diagnosis and management of this patient cohort has not yet been established.

AIM: To study the intestinal microbiota in children with VUR who received antibiotic therapy and antibiotic prophylaxis due to episodes of UTIs.

MATERIALS AND METHODS: The study included 40 children (12 boys and 28 girls) with VUR and chronic UTIs. All children received antibiotic therapy for acute episodes of infection, and, after the diagnosis of VUR, they also received continuous antibiotic prophylaxis. The control groups included 18 healthy boys and 14 healthy girls. Identification of microorganisms isolated from feces was carried out using generally accepted methods.

RESULTS: In the feces of children with VUR, aerobic taxa of microbiota dominate over anaerobic ones. Klebsiella spp., Proteus vulgaris, and Pseudomona aeruginosa appear in the feces of both boys and girls. An increase in the detection rate of most aerobic microorganisms and a decrease in anaerobic taxa were observed compared to healthy controls. In boys with VUR, the maximum (100%) detection rate of microorganisms is more common than in girls.

CONCLUSIONS: Dysbiotic changes were detected in the feces of all children after antibiotic therapy, providing new insights into the effects of the conventional strategy of long-term antibacterial treatment and prevention of UTIs in children with VUR.

BACKGROUND: Simple renal cysts are quite common in the general population and are often accompanied by a decrease in the glomerular filtration rate, which may be linked to latent glomerulopathies. Delayed diagnosis of glomerular damage inevitably leads to the progression of chronic kidney disease.

AIM: To assess the likelihood of hidden glomerular lesions in patients with simple renal cysts.

MATERIALS AND METHODS: The study involved a group of 78 patients, including 29 men (37%) and 49 women (63%), with renal cysts of classes I and II according to the Bosniak classification (2019). An exclusion criterion for the study was a history of nephrological diseases. The mean age of the patients was 59.11±1.47 years, and the mean cyst size was 7.19±1.98 cm. All patients underwent laparoscopic excision of the renal cyst walls. Intraoperatively, a renal parenchymal biopsy was performed under visual control, and the nephrobiopsy specimens were examined using light microscopy, immunofluorescence analysis, and electron microscopy.

RESULTS: Based on the analysis of 234 nephrobiopsy specimens, morphological signs of glomerulopathy were identified in 20.5% of patients, including diabetic nephropathy (37.5%), focal segmental glomerulosclerosis (31.3%), mesangioproliferative IgA glomerulonephritis and hypertensive nephropathy (12.5% each), and thin basement membrane disease (6.2%). Patients with glomerulopathy exhibited reduced glomerular filtration rate and increased creatinine and uric acid levels in the serum. Moreover, proteinuria and leukocyturia were more frequently observed in the common urinalysis of this group of patients.

CONCLUSIONS: The combination of a renal cyst, changes in urinalysis, and biochemical blood analysis may indicate hidden glomerular injury. Focusing on the markers of renal damage in the preoperative period allows for determining the indications for intraoperative nephrobiopsy during surgical treatment of renal cysts. This facilitates early morphological identification of glomerulopathy and timely initiation of nephroprotective therapy to reduce the risk of chronic kidney disease progression.

BACKGROUND: Contact ureteral lithotripsy is considered a minimally invasive treatment method that can reduce the recurrence rate of urolithiasis. However, its use in children requires a specialized approach due to the unique anatomical and physiological characteristics of pediatric patients.

AIM: To study the efficacy and intraoperative complication rate in children with ureteral stones undergoing contact ureteral lithotripsy.

MATERIALS AND METHODS: A retrospective study of 253 children who underwent contact ureteral lithotripsy between 2018 and 2022 was conducted. The mean age of the patients was 9.8±4.1 years, with a predominance of boys (70.4%). Pneumatic and laser lithotripters were used for fragmentation. In some cases, a ureteral stent was placed. The efficacy and safety of the procedure was assessed in children, taking into account the localization of stones and the patient’s age.

RESULTS: The stones were located in the left ureter in 57.7% of cases and in the right ureter in 42.3% of cases. The stones were distributed according to their localization in the distal (30.1%), middle (27.6%), and proximal (42.3%) parts of the ureter. The mean stone size was 10.2±1.3 mm. Laser lithotripsy was used in 58% of cases, while pneumatic lithotripsy was performed in 42% of cases, with a stone-free rate of 92.1%. The mean procedure duration was 62.8±19.3 min, while the length of hospital stay was 2.3±0.5 days. Intraoperative complications were observed in 20 patients (7.9%), with a higher rate in children aged 4–7 years (3.9%), including stone transposition (1.2%) and failure of retrograde access (1.9%). Conversion to open surgery was required in 0.6% of cases due to anatomical complexities in younger patients.

CONCLUSIONS: Contact ureteral lithotripsy is an effective and safe method for ureteral stone removal in children, particularly when using a laser lithotripter, which reduces operative time and minimizes the risk of tissue damage. However, in younger children, additional precautions and an individual approach are required to minimize the risk of complications.

The main cause of the impaired storage function of the bladder in patients with neurogenic dysfunctions of the lower urinary tract is detrusor overactivity, clinically manifested by symptoms of an overactive bladder. The article presents data on the epidemiology, pathogenesis, clinical course and modern approaches to the treatment of detrusor overactivity in neurological patients. It is emphasized that the most important aspect of the clinical course of neurogenic detrusor overactivity is the high risk of upper urinary tract dysfunction, and reducing the threat of kidney damage is the main goal of treating such patients. Pharmacological and clinical aspects of the use of the β3-adrenoreceptor agonist mirabegron in patients with neurogenic bladder dysfunctions are presented. The results of experimental and clinical studies of its use in the treatment of neurogenic detrusor overactivity are presented. A high safety profile of the drug is noted. It is shown that the mechanisms of the therapeutic effect of mirabegron in neurogenic detrusor overactivity include a decrease in detrusor tone, inhibition of spontaneous myocyte contractions, and a decrease in myogenic and urotheliogenic mechanosensory afferent activity. The features of the clinical and urodynamic effects of mirabegron in patients with neurogenic detrusor overactivity in various neurological diseases — multiple sclerosis, Parkinson’s disease, spinal cord injury — are highlighted. The leading role of the results of urodynamic research in choosing the treatment tactics for patients with neurogenic detrusor overactivity is emphasized.

Prostate cancer is the most common malignant disease among men, accounting for approximately 29% of all cancer cases in males. Recent research in the prostate cancer treatment has shown that immunotherapy can significantly improve the quality of treatment, extend remission, and enhance patient survival. However, the tumor microenvironment can negatively affect the efficacy of immunotherapy. Insufficient T-cell infiltration, immunosuppressive microenvironment, tumor-associated T and B lymphocytes, macrophages, and myeloid-derived suppressor cells substantially reduce the efficacy of immunotherapy. Current immunotherapy strategies include vaccine-based approaches, immune checkpoint inhibitors, CAR T-cell therapy, T-cell activators, etc. This review highlights the key therapeutic approaches aimed at reprogramming the immune response in prostate cancer, including nucleic acid-based vaccines, peptide-based vaccines, viral vector-based vaccines, immune cell-based vaccines, checkpoint inhibitors, CAR T-cell therapy, and bispecific antibodies. It also presents clinical and preclinical data on these therapies. Current immunotherapy approaches demonstrate significant potential in activating and directing the immune response against tumor cells. However, further research is required to better understand the underlying mechanisms and to develop new therapeutic strategies.

This article presents a clinical case of one of the rarest pathologies in emergency urology, previously described only five times in the global medical literature — rupture of the superficial dorsal vein with penile deviation. Clinical diagnosis of this condition is quite difficult without the use of additional imaging methods, which may not be available in emergency settings. However, establishing an accurate diagnosis in the shortest possible time allows for the most appropriate treatment using conservative or surgical methods. The paper provides an analysis of the causes, differential and clinical diagnosis, management strategies, and therapeutic principles with clear indications for surgical intervention. Currently, there are no clinical guidelines for the management of patients with rupture of the superficial dorsal penile vein. Patient complaints and physical examination, as well as Doppler ultrasound imaging, which allows assessing the vascular network of the penis, including the superficial dorsal vein, can assist in establishing a diagnosis of this condition. Magnetic resonance imaging can help identify tunica albuginea rupture, vascular injury, and penile fracture. If there is any doubt regarding the diagnosis, surgical intervention should be performed, including exploration of the corpora cavernosa and the urethra.