Urology reports (St. - Petersburg)

BACKGROUND: The incidence of acute pyelonephritis in Russia is growing. In the context of rising antimicrobial resistance and declining clinical effectiveness of antibiotics, there is a need for combination treatment strategies, including systemic enzyme therapy.

AIM: This study aimed to evaluate the effectiveness of systemic enzyme therapy as part of combination treatment in patients with acute pyelonephritis during the hospital treatment stage.

METHODS: A prospective analysis included 61 patients receiving standard antibacterial therapy. Patients in the main group (n = 30) additionally received a systemic enzyme therapy preparation at a dose of 5 tablets three times daily. All patients underwent renal ultrasound with Doppler assessment of interlobar and arcuate arteries before and after treatment. The mean age of patients was 39.2 years, mean body mass index was 24.8 kg/m², mean duration of an acute pyelonephritis episode was 3.1 days, and the follow-up period ranged from 5 to 11 days. Non-obstructive pyelonephritis was diagnosed in 41 patients and obstructive pyelonephritis in 20 patients. The groups were comparable by age, body mass index, and clinical disease parameters.

RESULTS: In patients receiving systemic enzyme therapy as part of combination treatment for acute pyelonephritis, faster resolution of fever, pain, and dyspeptic symptoms was observed. The resistance index in interlobar and arcuate arteries, elevated at baseline during hospitalization, decreased significantly on follow-up Doppler ultrasound from 0.67–0.69 to 0.62–0.63 (p < 0.01). In the comparison group, the resistance index also decreased from 0.65–0.70 to 0.64–0.68, but without statistical significance (p = 0.07).

CONCLUSION: Combination therapy including systemic enzyme therapy demonstrates advantages over antibiotic monotherapy, manifesting in faster symptom resolution and improved renal blood flow, with comparable safety profiles.

BACKGROUND: One of the standard steps of open or endovideosurgical adenomectomy is reconstruction of the bladder neck using trigonization or a circumferential suture. The presumed benefit of this step is accelerated epithelialization of the prostatic fossa and prevention of bleeding. However, given the limited number of comparative studies, the necessity of bladder neck reconstruction remains unclear.

AIM: This study aimed to evaluate the feasibility of laparoscopic transvesical adenomectomy without bladder flap reconstruction by assessing voiding parameters, intraoperative characteristics, and the incidence of postoperative complications.

METHODS: Outcomes of 72 patients with benign prostatic hyperplasia who underwent laparoscopic transvesical adenomectomy with or without bladder flap reconstruction between January 2020 and December 2024 were analyzed. Intraoperative parameters and postoperative outcomes were assessed using laboratory tests during hospitalization, as well as the International Prostate Symptom Score, Quality of Life score, and uroflowmetry parameters at 1, 3, 6, and 12 months after surgery.

RESULTS: Patients were divided into two groups by surgical technique: 38 patients with and 34 patients without bladder flap reconstruction, respectively. Baseline characteristics were comparable between the groups. The median operative time was 97.50 [81.25; 108.75] min in the group without bladder flap reconstruction and 122.50 [82.50; 143.75] min in the group with bladder flap reconstruction (p = 0.021). At 6 months after surgery, both groups demonstrated significant improvement in uroflowmetry parameters: the median maximum urinary flow rate increased more than 1.5-fold, and postvoid residual volume decreased by 85% (p < 0.001); these results were maintained at 12 months. No significant between-group differences were observed in the key outcomes, i.e. maximum urinary flow rate, postvoid residual volume, total International Prostate Symptom Score, and Quality of Life score.

CONCLUSION: Laparoscopic transvesical adenomectomy without bladder flap reconstruction provides urodynamic outcomes comparable to those achieved with bladder flap reconstruction over a 12-month follow-up period, whereas operative time appears significantly reduced. Study limitations include its pilot nature, retrospective design, and short follow-up period.

BACKGROUND: This study is relevant due to the high frequency of infertility, controversial data on the prevalence of antisperm antibodies in the ejaculate and threshold values of test results that allow assessment of immune male infertility, as well as the lack of consensus among specialists on the advisability of conducting the Mixed Antiglobulin Reaction (MAR) test when examining men to assess the state of their reproductive health.

Aim: This study aimed to investigate the MAR test indicators in men who attended a reproductive medicine center, and the relationship between the content of antisperm antibodies and the indicators of the basic ejaculate study.

Methods: The results of the basic ejaculate study and the mixed antiglobulin reaction test of 2076 men (mean age 36.7 ± 6.4 years) who sequentially attended the International Center for Reproductive Medicine in 2022–2023 were retrospectively studied. The ejaculate volume, concentration, total number, morphology, and motility of spermatozoa were determined; the MAR test was performed in accordance with the requirements of the World Health Organization 2010 guidelines; and the relationship of the obtained indicators was analyzed.

Results: MAR test values equal to 0% were obtained in 39 (1.8%) men, in 1867 (89.9%) men the proportion of spermatozoa covered with antisperm antibodies did not exceed 10%, and values of 91%–100% were found in 31 (1.5%) men. Sperm concentration and total sperm count in the ejaculate, as well as the proportion of sperm with normal morphology, were higher in men who had zero MAR test values (p < 0.01, p < 0.05 and p < 0.0001, respectively). Differences in sperm count and motility in men with antisperm antibodies became apparent when the threshold values of the MAR test exceeded 10% and 50%, respectively.

Conclusion: The prevalence of antisperm antibodies in the ejaculate is high. The obtained data support the recommendation of MAR testing for men undergoing evaluation of reproductive function and preserving reproductive health.

BACKGROUND: Anastomotic urethroplasty remains the standard treatment for short bulbomembranous urethral strictures; however, the risk of sexual dysfunction associated with transecting the corpus spongiosum remains a subject of debate.

AIM: This trial aimed to compare the efficacy and safety of transecting and non-transecting urethroplasty for bulbomembranous urethral strictures.

METHODS: A single-center retrospective trial included 46 patients with < 3 cm bulbomembranous urethral strictures. Anastomotic non-transecting urethroplasty was performed in group 1 (n = 21); whereas group 2 (n = 25) received transecting urethroplasty. The efficacy was evaluated at 3, 6, and 12 months after surgery.

RESULTS: Regardless of the method, the efficacy of urethroplasty was high. At 3 and 12 months postoperatively, both groups showed significant improvements in uroflowmetric parameters compared with baseline assessments. At 3 and 12 months postoperatively, the mean International Index of Erectile Function (IIEF) score in group 1 patients did not change from baseline, whereas in group 2 patients it decreased significantly by 3 months postoperatively and returned to baseline values by 12 months.

CONCLUSION: The trial shows that both non-transecting and transecting urethroplasty methods are highly effective for short bulbomembranous urethral strictures. However, those who underwent transecting urethroplasty noted a temporary decrease in erectile function, which was restored during the first year after surgery. In non-transecting urethroplasty group, the patients did not experience decreased erectile function.

BACKGROUND: Given the high efficacy of medical treatment for erectile dysfunction, active discussions continue regarding the optimal timing for prosthesis implantation after radical prostatectomy.

Aim: This study aimed to compare the efficacy of early surgical and conservative treatment of erectile dysfunction in patients after radical prostatectomy.

Methods: The study included 53 patients with erectile dysfunction who had undergone radical prostatectomy for localized prostate cancer. All patients began taking phosphodiesterase type 5 inhibitors immediately after surgery. The main group (n = 19) consisted of patients with insufficient efficacy of medical therapy for erectile dysfunction, who underwent penile prosthesis implantation within 1 year after radical prostatectomy, but not earlier than 3 months post-surgery. Patients in the control group (n = 34) continued conservative therapy. At 3 months, 1 year, and 1.5 years after radical prostatectomy, patients were assessed for erectile function using the IIEF-5 questionnaire, quality of life using the SF-36 questionnaires, and levels of anxiety and depression using the Beck and Spielberger–Hanin questionnaires.

Results: Analysis of psychoemotional status over time at 1 year after radical prostatectomy showed that patients in the prosthesis group had significantly lower depression scores (p = 0.001) and reactive anxiety (p = 0.03) compared to patients in the control group. This trend between the patient groups persisted at 1.5 years (p = 0.001). The quality of life of patients after prosthesis implantation was also higher at 1 year after radical prostatectomy compared with the control group. This trend between the groups also persisted at 1.5 years. The study data demonstrated that prosthesis implantation significantly improved patients’ erectile function, assessed by IIEF-5, unlike patients in the control group.

Conclusion: Penile prosthesis implantation within a year after radical prostatectomy in patients with severe erectile dysfunction is an effective and safe alternative for treating erectile dysfunction as the primary method after 3 months of ineffective medical treatment, with a good level of patient satisfaction and improvement in their psychoemotional status and quality of life.

Prostate cancer is one of the most common cancers in men. Timely detection of clinically significant prostate cancer remains one of the key tasks of healthcare, while minimizing overdiagnosis of clinically insignificant prostate cancer, thereby avoiding overtreatment and resource waste. In recent decades, significant progress has been made in the diagnosis of prostate cancer, primarily due to the introduction of multiparametric magnetic resonance imaging and targeted biopsy. The sensitivity of targeted biopsy in detecting an index lesion exceeds 90%. However, systematic biopsy remains an important addition, as it helps detect 5% to 16% of clinically significant prostate cancer cases that may be missed when performing a targeted biopsy only. The utility of performing a systematic prostate biopsy when a lesion is detected on multiparametric magnetic resonance imaging remains a controversial issue. The results of most of the above procedures do not convincingly exclude the need for this biopsy. Of note, the conditions for performing multiparametric magnetic resonance imaging, the approaches and experience of urologists in performing biopsies, and the expertise of pathologists vary across different medical institutions. Centralized performance of multiparametric magnetic resonance imaging, prostate biopsy, and pathomorphological examination at expert centers is essential to improve the timely diagnosis and treatment of clinically significant prostate cancer.

BACKGROUND: Kidney cancer remains one of the most urgent problems in modern urologic oncology, holding a major place in the structure of the urinary system cancers. Radical nephrectomy served as the standard of surgical treatment for this condition for a long time; however, recent years have seen increasing attention paid to organ preservation surgeries, primarily kidney resection.

Aim: This systematic review aimed to conduct a systematic review and analysis of published meta-analyses dedicated to the comparative evaluation of kidney resection and nephrectomy in the treatment of localized kidney cancer.

Methods: A systematic search for meta-analyses comparing the effectiveness, safety, and intraoperative indicators of various types of kidney resection, nephrectomy, and ablation techniques, as well as analyzing the technical features of performing kidney resection and factors influencing the results of kidney resection, published between 2011 and 2024, was conducted in the PubMed, Scopus, and Web of Science databases.

Results: According to the data from the conducted review, kidney resection can be considered the optimal method of surgical treatment for patients with a kidney tumor, as it demonstrates comparable oncological outcomes with nephrectomy, but provides better functional outcomes and a lower risk of developing chronic kidney disease. The use of minimally invasive methods such as robot-assisted or laparoscopic kidney resection is associated with more favorable intra- and postoperative outcomes in terms of reduced blood loss volume, frequency of transfusions, complications, and shortened hospitalization duration compared to open surgery. Ablation techniques are a less invasive alternative to kidney resection; however, their use is associated with a higher risk of local recurrence. Methods that minimize kidney ischemia have a clear advantage in terms of higher rates of renal function preservation and can be considered the preferred approach when performing kidney resection in patients with a single kidney, in patients with reduced renal function, and in patients with risk factors for the development or progression of renal failure in the postoperative period. The use of nephrometry scales is predictive of operation time, ischemia time, blood loss volume, probability of complications, preservation of renal function, and probability of detecting adherent perirenal fat, the presence of which in turn is an objective risk factor for increased operation time and volume of intraoperative blood loss. The detection of a positive surgical margin is a risk factor for the development of local recurrence, distant metastases, and a reduction in overall and cancer-specific survival rates. The use of 3D technologies allows reduction of blood loss volume, lowering the frequency of intraoperative opening of the renal collecting system and transfusions during kidney resection.

Conclusion: The obtained results can be used for practical decision-making in clinical oncologic urology, as well as for developing recommendations with a high level of evidence.

Bladder neck contracture is considered one of the most common late complications of transurethral treatment of benign prostatic hyperplasia. Its incidence ranges from 0 to 10%–15%, reaching even higher values in the presence of risk factors, the most frequently discussed of which is a small volume of prostatic hyperplasia. The first stage of surgical treatment of benign prostatic hyperplasia involves transurethral incision or resection of the bladder neck; however, during long-term follow-up, the recurrence rate after this procedure may reach 50%–70%. In this context, various minimally invasive approaches to the management of bladder neck contracture have been proposed to improve treatment efficacy and safety. One such approach is balloon dilation of the bladder neck, which involves mechanical expansion of the fibrotic ring to stabilize the process at a urodynamically acceptable level. Balloon dilation may be combined with targeted pharmacological action of a drug directly on the affected tissue in parallel with mechanical expansion of the bladder neck. For this purpose, the balloon surface is coated with antiproliferative and antifibrotic agents. One such agent is the glucocorticoid methylprednisolone. In the present study, we report a clinical case of balloon dilation using a, ultrasound-triggered urethral catheter with a biopolymer drug-eluting coating (methylprednisolone) and provide illustrative visualization. Over a follow-up period of 31 months, the described patient with previously recurrent bladder neck contracture showed no recurrence of the condition.