Urology reports (St. - Petersburg)

BACKGROUND: Despite the development of nerve-sparing techniques, erectile dysfunction remains a common complication after radical prostatectomy. The method of hemostasis is one of the important factors determining the risk of cavernous nerve injury during surgery. A review of the published data demonstrates the evolution of hemostatic approaches: from traumatic monopolar coagulation with deep thermal damage to modern methods with minimal impact. Research data are conflicting: although “cold” methods (clipping, ligation) have traditionally been considered the “gold standard,” some studies indicate a risk of ischemia and fibrosis from clips, whereas modern precision bipolar coagulation and lasers with shallow penetration depth show comparable erectile outcomes.

AIM: To compare clipping and precision bipolar coagulation as intraoperative hemostasis methods in terms of optimizing erectile function preservation during nerve-sparing robot-assisted radical prostatectomy.

METHODS: A retrospective analysis of data from 157 patients operated by a single expert surgeon between 2011 and 2024 was performed. Inclusion criteria: localized prostate cancer (cT1-2N0M0), preserved preoperative erectile function (22–25 points on the IIEF-5). Patients were divided into two groups: the clipping group (n = 74) and the precision bipolar coagulation group (n = 83). Erectile function was assessed using the IIEF-5 questionnaire 12 months after surgery. Statistical analysis included Student t-test, χ² test, and calculation of odds ratios.

RESULTS: The groups were comparable in age and baseline IIEF-5 score. The proportion of patients with recovered erectile function (IIEF-5 ≥ 17) was 71.1% in the precision coagulation group vs. 54.1% in the clipping group (p = 0.027). In the clipping group, the odds of erectile function recovery were 2.1 times lower (odds ratio 0.47; 95% CI: 0.24–0.91). The rate of biochemical recurrence at 12 months did not differ statistically significantly (17.6% vs. 8.4%; p = 0.089), although a trend favoring the coagulation group was observed.

CONCLUSION: Precision bipolar coagulation during nerve-sparing robot-assisted radical prostatectomy is associated with significantly higher rates of erectile function recovery at 12 months postoperatively compared to clipping, without compromising oncological safety. These findings indicate the multifactorial nature of cavernous nerve injury and suggest that precision bipolar coagulation can be considered an effective alternative to clipping. Prospective randomized studies are needed to definitively confirm these results.

BACKGROUND: Warm renal ischemia (WRI) is an important step in partial nephrectomy for malignant tumors. This procedure reduces blood loss and improves visualization. However, hypoxia damages renal tissue cells, leading to postoperative complications. Pharmacological agents with antihypoxic properties are used to reduce the risk of complications. The development and implementation of new methods for intraoperative monitoring of the renal parenchyma are of interest because they can provide additional quantitative information on blood microcirculation in the kidney and help investigate the nephroprotective efficacy of various drugs. One such method is laser Doppler flowmetry (LDF).

AIM: To evaluate the feasibility of using LDF for intraoperative monitoring of renal blood microcirculation during WRI and subsequent reperfusion.

METHODS: The study was conducted on 11 Wistar rats, 8 of which underwent prior right nephrectomy. The animals were divided into groups: group 1, WRI for 40 min in rats without nephrectomy; group 2, WRI for 40 min and saline administration in nephrectomized rats; and group 3, WRI for 40 min and administration of 15% sodium fumarate in nephrectomized rats. Sodium fumarate was administered intravenously at 1 mL/kg on the day before and on the day of WRI, 1 hour before surgery. Saline was administered in an equivalent volume on the same schedule. The blood microcirculation index (MI) was measured every 10 minutes before, during, and after ischemia.

RESULTS: Averaged MI values showed decreased renal perfusion in the nephrectomized groups. A greater relative increase in MI was also observed during reperfusion in the experimental groups compared with the intact group, with a pronounced hyperemic effect in the first 10 minutes after reperfusion with 15% sodium fumarate. In the saline (0.9% NaCl) control group, higher mean MI values were recorded during ischemia, but the increase during reperfusion was less pronounced.

CONCLUSION: These preliminary findings demonstrate the sensitivity of LDF for detecting dynamic changes in renal microvascular blood flow during ischemia and reperfusion in an experimental WRI model. The changes and differences observed at various stages warrant further investigation into the relationship between the effects of the tested substances on cell status and renal microhemodynamics, with expansion of the studied perfusion-metabolic parameters of renal tissue.

BACKGROUND: Bladder leukoplakia is a condition in which normal urothelium is replaced by stratified squamous epithelium. Surgical methods are the leading treatment for this condition.

AIM: To evaluate the effectiveness of surgical treatment of bladder leukoplakia in women with recurrent cystitis and to identify predictors of postoperative urinary tract infection (UTI) recurrence.

METHODS: This retrospective study included 488 women with chronic recurrent cystitis who underwent transurethral ablation of bladder leukoplakia from 2012 to 2024. The mean age was 25.1 ± 6.9 years. Ablation methods included monopolar (63%), bipolar (27%), and laser (9%). Histology confirmed keratinizing squamous metaplasia in 14% of patients, while the rest had chronic inflammation or non-keratinizing changes. The median follow-up was 36 months. The primary outcome was cystitis recurrence. Multivariable logistic regression and machine learning models (MLP and RandomForest) were used to identify predictors. Prognostic accuracy was assessed using ROC analysis.

RESULTS: At 12 months after surgery, 75% of patients had no recurrent UTIs. Multivariable regression identified three independent predictors of recurrence: ≥ 3 UTIs per year (OR 3.24, p < 0.001), disease duration > 3 years (OR 2.12, p = 0.044), and absence of keratinizing leukoplakia on histology (OR 3.79, p < 0.001). The logistic model had an AUC of 0.80. The RandomForest and MLP models showed similar performance (AUC 0.84 and 0.79, respectively). Kaplan–Meier analysis of a subset of 206 patients with informative histology (70 with keratinizing metaplasia and 136 without) showed significantly shorter recurrence-free survival in patients without keratinizing metaplasia (log-rank p < 0.05).

CONCLUSION: Transurethral ablation of bladder leukoplakia is effective in most women with recurrent cystitis. Recurrence risk is higher in patients with frequent prior UTIs, long disease duration, and no histological evidence of keratinizing metaplasia. The developed prognostic models may support individualized post-treatment monitoring.

BACKGROUND: Urolithiasis is one of the most common urological diseases in Uzbekistan, as the region is endemic. Studying the primary and overall incidence of urolithiasis in Uzbekistan and comparing it with other countries is a pressing issue.

AIM: To analyze trends in the incidence of urolithiasis in the Republic of Uzbekistan from 2000 to 2019.

METHODS: Using data from the Ministry of Health of the Republic of Uzbekistan, we studied primary and overall morbidity in individual regions of Uzbekistan in the general and pediatric populations, compared morbidity between the Russian Federation and Uzbekistan, and performed a correlation analysis with the incidence of gout, diabetes mellitus, gastrointestinal diseases, and obesity.

RESULTS: The incidence of urolithiasis increased steadily from 43,802 cases in 2000 to 104,364 cases in 2019. The primary incidence rate was 66.5 per 100,000 population in 2000 and 116.1 in 2019. The highest incidence was consistently in the Syrdarya region (over 500 cases per year). Correlation analysis revealed a statistically significant positive association with gout, obesity, gastrointestinal diseases, and diabetes.

CONCLUSION: These data show a progressive increase in primary and overall urolithiasis incidence in Uzbekistan. Further study of local factors contributing to regional heterogeneity is needed.

Thrombosis is one of the most common complications in cancer patients. It poses a life-threatening risk and may delay treatment. Because thrombosis is relatively rare in prostate cancer, its occurrence is often underestimated. This review systematizes current data (2010–2025) on the epidemiology, pathogenesis, and management of thrombotic complications in prostate cancer patients. A search was conducted in PubMed, Scopus, and Web of Science using the keywords рак предстательной железы (prostate cancer), венозная тромбоэмболия (venous thromboembolism), андроген-депривационная терапия (androgen-deprivation therapy), AДТ (ADT), гиперкоагуляция (hypercoagulation), онкологический тромбоз (cancer-associated thrombosis), and профилактика (prevention) for 2010–2025. Original studies, systematic reviews, and clinical guidelines were selected. The adjusted thrombosis risk in prostate cancer patients is increased 1.5-fold, with the highest risk in the first 6 months after diagnosis, persisting for 5 years. Pathogenesis involves tissue factor, proinflammatory cytokines, endothelial dysfunction, and thrombocytosis. Standard coagulation tests and thromboelastography may be used to diagnose cancer-related hypercoagulation. Radical prostatectomy, androgen deprivation therapy, chemotherapy, and radiotherapy increase thrombosis risk. Thrombosis may have prognostic value, reflecting tumor aggressiveness, and can cause treatment interruptions and death. Prevention strategies should include risk stratification, pharmacological prophylaxis (low-molecular-weight heparins and oral anticoagulants), and non-pharmacological measures (adequate hydration, physical activity). Thromboembolic complications should be treated for at least 6 months. Prostate cancer carries a significant venous thromboembolism risk, requiring clinician awareness and active screening. Future research should focus on developing validated risk stratification tools specifically for prostate cancer and exploring novel biomarkers and hemostatic monitoring methods.

One of the serious and rare complications of Intrauterine Contraceptive Device (IUCD) migration is intravesical stone formation. This report presents a case of a large bladder calculus secondary to a migrated IUCD, highlighting the clinical presentation, diagnostic challenges, and subsequent surgical management. We report the case of a 41-year-old multiparous woman with a history of long-term IUCD use, presenting with a four-month history of chronic lower abdominal pain, dysuria, urinary frequency, urgency, incomplete bladder emptying, and straining to void. Abdominal radiography revealed a large bladder calculus with a central nidus suggestive of a forgotten and migrated IUCD. The patient's contraceptive history included multiple IUCD insertions between 2009 and 2022. The patient underwent open vesicolithotomy under regional anesthesia. Intraoperatively, a bladder stone measuring 4.7 × 4.0 cm encasing an IUCD was successfully removed. Three months postoperatively, the patient's lower urinary tract symptoms had resolved, demonstrating significant clinical improvement. Clinical awareness of this rare complication enhance early detection and facilitate appropriate management to prevent long-term complications.

Cystinuria is an inherited disorder caused by pathogenic variants in SLC3A1 or SLC7A9, leading to impaired tubular reabsorption of cystine and recurrent cystine stone formation. Disease severity is determined by genotype, the degree of cystinuria, and patient adherence to long-term preventive therapy. Cases with long-term follow-up and molecular genetic confirmation are of particular clinical interest. We report a 36-year-old woman with severe recurrent cystine nephrolithiasis who was followed for 12 years after disease onset at the age of 24 years, shortly after her second pregnancy. Despite standard preventive measures, including high fluid intake, sodium and animal protein restriction, urinary alkalinization, and repeated attempts at standard-dose D-penicillamine therapy, the disease remained highly refractory. During follow-up, the patient experienced 6 surgical interventions and 10 episodes of spontaneous stone passage. Stone analysis repeatedly confirmed 100% cystine composition. Urinary cystine excretion ranged from 169.8 to 979 mg/day. Sanger sequencing identified a pathogenic homozygous SLC3A1 variant, c.1400T>C (p.Met467Thr), associated with severe impairment of rBAT subunit trafficking and protein folding defects. Following poor tolerance of conventional thiol therapy doses, continuous low-dose D-penicillamine (250 mg/day) was initiated in February 2024 and was well tolerated. With this regimen, combined with dietary measures and high fluid intake, no new stones were detected on CT imaging over nearly 2 years of follow-up. This case illustrates a severe genotype-associated cystinuria phenotype linked to homozygous SLC3A1 c.1400T>C (p.Met467Thr) and suggests that long-term low-dose D-penicillamine may be an effective and better tolerated therapeutic option in patients who cannot tolerate standard dosing regimens.