Vol 10, No 1 (2020)

Original articles
Bladder neck stenosis surgery in interstitial cystitis / bladder pain syndrome treatment
Medvedev V.L., Mihailov I.V., Lepetunov S.N., Medoev Y.N., Kogan M.I.

Introduction. Current methods of interstitial cystitis / bladder pain syndrome (IC/BPS) treatment don’t allow to achieve long-term clinical remission.

Aim of the study was to investigate the clinical efficacy of bladder neck transurethral incision (TUI) in women with IC/BPS, who had bladder outlet obstruction signs.

Materials and methods. TUI was performed to patients with IC/BPS and proven bladder neck stenosis (n = 29). Assessment of the results of this operation was provided after 1, 3 and 6 months after surgical treatment. Treatment efficacy was evaluated by using Global Response Assessment (GRA) Scale, Pelvic Pain and Urgency / Frequency (PUF) Patient Symptom Scale, urination diaries, analysis of which allowed to determine functional bladder capacity, urinary frequency and nocturia. Pain assessment was made with 10-point Visual Analogue Pain Scale (VAS). Functional efficacy was evaluated with urodynamic examination, which included cystometric bladder capacity, maximal urinary flow rate and residual volume rate. Treatment results were compared with such in 39 patients with IC/BPS without signs of bladder neck stenosis.

Results. GRA score ≥2 had 96.5% and 72.4% in 1 and 3 months after bladder neck TUI, respectively. VAS, PUF Scale parameters, cystometric bladder capacity, maximal urinary flow rate, residual volume rate, urinary frequency and nocturia values also significantly improved after surgery.

Conclusions. This prospective clinical study is the first, in which IC/BPS course in women with bladder neck stenosis was investigated. It was noticed, that in 1 month after bladder TUI in 96.5% of patients decreased severity of IC/BPS symptoms, there were no urinary tract infection and local complications. In addition, this effect lasted for 3 months after surgery in 72.4% of patients and for 6 months in 68.9% of patients.

Urology reports (St - Petersburg). 2020;10(1):5-10
Testicular microlithiasis in male infertility: prevalence, diagnosis and treatment algorithm
Korneyev I.A., Zasseev R.D., Aloyan A.A., Grinina A.A., Kondrashkin P.S., Makeev V.A., Furin V.E.

Aim of study. To estimate testicular microlithiasis (TM) prevalence in men seeking help for infertility in reproductive medicine center, and generate an algorithm for TM management according to patient’s choice to perform testicular biopsy or not.

Materials and methods. We retrospectively reviewed charts of 143 consecutive adult male patients between 19 and 73 years (mean age 34.6 ± 7.9) seeking help for infertility in International Center for Reproductive Medicine. Gray-scale and color Doppler were used to calculate testicular volume and to study a spectrum of scrotal disorders including testicular microlithiasis.

Results. Testicular size varied from 0.5 to 33.3 ml (mean 12.3 ± 5.8 ml), testicular hypoplasia, varicocele, hydrocele and epididymal cysts were detected in 88 (61.5%), 35 (24.5%), 9 (6.3%) and 50 (35%) patients respectively. TM signs were identified in 12 (8.4%) men, including 5 (42%) cases of classic TM and 7 (58%) cases of limited TM; 5 (42%) men had bilateral TM. One 1 (8%) patient with bilateral ТМ had ultrasonic appearance of non-palpable testicular tumor, radical surgical treatment was performed. Patients with TM had smaller testicles, higher prevalence of azoospermia and testicular tumor (p = 0.002, 0.013 and 0.085 respectively). All patients with TM were informed about their risks to harbor testicular cancer and taught self-examination technique. Testicular biopsy was offered to all men with concomitant risk factors for testicular cancer development, however none of the patients agreed. We have consequently developed algorithm for TM management according to patient’s choice to perform or to avoid testicular biopsy.

Conclusion. ТМ is common in infertile men, scrotum ultrasound is indicated to detect it. The suggested algorithm for TM management is aimed towards early testicular cancer detection and successful treatment with fertility potential preservation.

Urology reports (St - Petersburg). 2020;10(1):11-18
Pathomorphology of adaptive changes in the remaining kidney in the early postoperative period after nephrectomy
Shormanov I.S., Los M.S., Kosenko M.V., Shormanova N.S.

Objective. To study the adaptive capacity of a single remaining kidney in the early postoperative period of nephrectomy in an experiment.

Materials and methods. The experiment involved 35 laboratory white rats, which were divided into three experimental groups. Group 1 (n = 5) intact animals, group 2 (n = 15) animals underwent nephrectomy on the left; group 3 (n = 15) animals underwent nephrectomy and additionally were created 90 minute hypoxic hypoxia. Histological material was collected on the 5th, 21st and 60th days after surgery.

Results. Characteristic morphological changes in the only remaining kidney were an increase in the size of the glomeruli and a decrease in their number. Nephron fibrosis was detected, accompanied by increased production of antigens by the tubular epithelium, which is likely a response to a cascade increase in oxidative stress and increased release of cytokines that stimulate the production of intrarenal collagen.

Conclusion. Nephrectomy and hypoxia are provocateurs for the development of systemic distress syndrome, the result of which is the formation of a “vicious pathogenetic circle”, which reduces the functionality of the renal tissue. This can be considered as one of the early preclinical mechanisms for the initiation of single kidney disease in the future.

Urology reports (St - Petersburg). 2020;10(1):19-24
Clinical effectiveness of intradetrusor injections of botulinum toxin type a in dose 100 units in multiple sclerosis patients with neurogenic detrusor overactivity
Filippova Е.S., Bazhenov I.V., Zyrjanov A.V., Zhuravlev V.N., Borzunov I.V., Ustinov G.S.

Intravesical injections of botunulinum toxin type A (BTA) demonstrate good results in treatment of detrusor overactivity symptoms in patients with neurogenic low urinary tract dysfunction (NLUTD) when use in recommended doses of 200 and 300 Units. In clinical practice a government insurance dose not cover the price for the 200 BTA Units and only 100 Units may be injected in patients with neurogenic and nonneurogenic detrusor overactivity.

The aim was to evaluate the efficiency of intradetrusor injections of BTA in patients with NLUTD.

Materials and methods. The study included 28 MS patients with resistant to medical treatment neurogenic detrusor overactivity. All patients received intradetrusor injections of 100 BTA Units. The results were assessed after 1, 3 and 6 months after procedure.

Results. Clinical improvement had been achieved in all 28 patients. According to the urodynamic studies three months after BTA injections maximal cystometric capacity increased by 119.9 ± 37.6% (p < 0,05), volume at first detrusor involuntary contraction increased by 74.8 ± 21.4% (p < 0,05), maximal detrusor pressure at involuntary contraction decreased by 53.5 ± 29.7% (p < 0,05). The NBSS total score decreased from 38.04 ± 14.27 to 29.06 ± 14.46 (p = 0,000), mainly because of questions about incontinence and urgency. SF-Qualiveen total score turned from 2.32 ± 0.70 to 1.61 ± 0.85 (p = 0.000). Before procedure 2 patients performed intermittent catheterization, 4 patients catheterized after BTA injections.

Conclusion. Intradetrusor injection of 100 BTA Units in MS patients with NLUTD resulted in improvement of urodynamic parameters followed by reduction of clinical symptoms and life quality improvement for 6 months of observation. Using of BTA low dose didn’t provide a total abortion of neurogenic detrusor overactivity symptoms but led to the starting of IC only in 2 patients.

Urology reports (St - Petersburg). 2020;10(1):25-32
Blood flow condition in the left renal vein in operative treatment of patients with varicocele
Krupin V.N., Uezdnyj M.N., Zubova S.Y., Petrova P.I.

The purpose of the study was to evaluate the blood flow in the left renal vein after ligation of the internal spermatic vein with varicocele and to study the changing of the level of biological markers of acute kidney damage in these patients.

Materials and methods. Under observation were 64 men in age 18–23 years with the first hemodynamic type of varicocele. In 3 patients clinically significant compression of the left renal vein was revealed and the remaining 61 patients underwent surgery by Ivanissevich approach. Before the operation, on the 2nd, 10th, 30th and 90th days after the operation patients underwent Doppler blood flow rate by ultrasound with color mapping of the left renal vein with measurement of venous blood flow velocity. During these periods all patients underwent laboratory tests, including the study of the content of cystatin C and interleukin 18 in the blood and urine.

Results. On the first day after ligation of the internal spermatic vein an increase in the concentration of biological markers of acute kidney damage in the blood and urine was noted. After surgery all patients showed an increase in the diameter of the left renal vein by 1.5–2 mm and a decrease in the linear blood flow velocity in the region of the renal vien by 5–6 cm/s. On the 10th day after the operation the diameter of the left renal vein was increasesd by 3–4 mm more and the linear blood flow velocity slows down by 2–2.5 cm/s. The restoration of blood flow velocity and the diameter of the left renal vein occurred within three months and in most cases returned to baseline and in 22.9% of patients recovery did not occur by the 90th day of observation.

Conclusion. Ligation of the internal spermatic vein with varicocele is accompanied by impaired blood flow in the left renal vein and an increase in the concentration of biological markers of acute kidney damage, which is a manifestation of venous hypertension and renal hypoxia. In most patients these indicators normalize to the 90th day of observation after surgery.

Urology reports (St - Petersburg). 2020;10(1):33-38
Results of using of terpens-based medication renotinex in patients with urolithiasis after extracorporeal shockwave lithotripsy
Popkov V.M., Osnovin O.V., Fomkina O.A.

In spite of high efficacy and safety of extracorporeal shockwave lithotripsy (ESWL), the question of reduction of this procedure complications risk continues to be relevant. In this study results of Renotinex prescription for patients with urolithiasis after ESWL are presented. Renotinex is a terpens-based drug and it has anti-inflammatory and lithokinetic properties. Inclusion of this medication in complex therapy leads to reduction of terms of stone fragments excretion, pain sensation reduction, bacteriuria frequency decrease.

Urology reports (St - Petersburg). 2020;10(1):39-42
Effect of cryoprecipitate on neoangiogenesis in patients with purulent pyelonephritis
Chernova Y.G., Nejmark A.I., Momot A.P.

The aim of the study is to investigate the effectiveness of conservative therapy with the inclusion of cryoprecipitate in its composition and its effect on the angiogenesis of renal blood vessels in patients with purulent pyelonephritis.

Materials and methods. The study included 30 patients aged from 20 to 45 years (6 men, 24 women) with acute purulent pyelonephritis. All patients were assessed for markers of angiogenesis in blood plasma: vascular endothelial growth factor (VEGF-A), angiopoietin 1 (Ang1) and angiopoietin 2 (Ang2). The patients were divided into two groups. Patients of group 1 (n = 15) received conservative therapy with the inclusion of cryoprecipitate, patients of group 2 (n = 15) received surgical treatment. The control group consisted of 10 healthy donors aged 20–35 years, whose blood angiogenesis markers were determined to obtain reference values.

Results. In the course of preliminary studies, the blood content of angiogenesis markers was determined in 10 healthy donors. The level of VEGF-A in patients of both groups and the level of Ang1 in patients of group 1 at admission to the hospital significantly exceeded the corresponding values in the control group. In group 2 patients, the level of VEGF-A and Ang1 remained elevated during treatment, which indirectly indicated an ongoing inflammatory process. The level of Ang2 in patients of both groups did not change significantly. Conservative treatment of group 1 patients showed high efficiency, which was confirmed by positive dynamics of clinical and laboratory indicators, as well as data from instrumental examination.

Conclusions. The results obtained indicate the effectiveness of conservative therapy with the administration of cryoprecipitate in patients with purulent pyelonephritis, and the effectiveness of such treatment is comparable to the effectiveness of surgical treatment . The use of cryoprecipitate has an endothelioprotective and anti-inflammatory effect on blood vessels, stabilizes the processes of angiogenesis, which contributes to limiting the inflammatory process and its regression.

Urology reports (St - Petersburg). 2020;10(1):43-49
Microbial load of the urine in patients with recurrent urolithiasis and its correction
Goloshchapov E.T., Chetverikov A.V.

Among the causes of stone formation in the urinary system, an important role belongs to the microbiome, which affects the stability of the colloidal system of urine. Understanding the level of microbial tension in the urine allows to use pathogenetic approaches both for prevention and for the relapses of stone formation. The study included 162 patients with recurrent urolithiasis, 12 patients underwent complex anti-relapse therapy after surgical treatment (or spontaneous discharge of concretions after litokinetic therapy). It was determined that along with the known factors, there is a violation of quantitative indicators of urine microbiota. An increase of the microbial load of urine leads to a violation of the structure of uromodulin (Tamm – Horsfall protein), which in turn determines the high frequency of recurrence of urinary lithogenesis. Thus, a comprehensive assessment of the urine microbiota and its impact on the state of uromodulin, lead to an improvement in the quality of urolithiasis metaphylaxis. In the complex of metaphylaxis and prevention of urolithiasis, it is advisable to use antimicrobial agents (uroseptics) not only to reduce the risk of infectious and inflammatory complications, but also to increase the stability of the colloidal properties of urine.

Urology reports (St - Petersburg). 2020;10(1):51-55
The effectiveness of different regimens of testosterone gel therapy in men with androgen deficiency
Kuzmenko A.V., Gyaurgiev T.A., Bakutina Y.Y., Zarubayco A.Y.

The results of androgen replacement therapy with the appointment of a transdermal gel with testosterone in patients with androgen deficiency were presented. 90 men with testosterone deficiency (<12 nmol/L) and impaired erectile function were observed. The average age of patients was 58 ± 5.2 years. Patients were divided into 3 groups. Patients of the 1st (control) group underwent basic behavioral therapy, the 2nd group received basic therapy with testosterone gel for a dose of 50 mg, the 3rd group received basic therapy with testosterone gel at a dose of 100 mg. The duration of treatment was 6 months. The use of testosterone in the form of a transdermal gel led to a significant increase in the content of total testosterone in both patients of the 2nd (50 mg) and 3rd groups (100 mg). A dose-dependent effect was noted, in patients of the 3rd group the level of testosterone was significantly higher than in patients 2nd group. An increase in testosterone was accompanied by a decrease in FSH and LH levels.

Urology reports (St - Petersburg). 2020;10(1):57-60
The diagnostic value of nerve growth factor and c-reactive protein in patients with interstitial cystitis / painful bladder syndrome
Sholan R.F.

Objective: to determine the diagnostic value of nerve growth factor (NGF) and C-reactive protein (CRP) in patients with interstitial cystitis / painful bladder syndrome (IC/BPS).

Material and methods. 44 patients with IC/BPS (main group) and 20 volunteers (control group) were examined. The average age of the patients of the main group was 46.4 ± 13.9 years, the control group – 35.3 ± 9.7 years. Cystoscopy and hydrodistension of the bladder were performed. The severity of pain was evaluated on a visual analogue scale (VAS). The concentration of NGF was determined in the blood by the method of ELISA, CRP by the immunoturbidimetric method.

Results. The average total score on the VAS scale was 5.47 ± 0.91, mild pain (2–4 points) was noted by 20.4%, moderate pain (5–6 points) – 54.5%, severe pain (7–8 points) – 25.0% of patients. Diffuse bleeding of the bladder mucosa in 45.4% of cases was observed. In IC/BPS patients the average NGF level was 11.23 ± 8.22 ng/ml, CRP – 3.56 ± 1.66 mg/l. The concentration of NGF exceeded the control level by 22.7% (p < 0.05), CRP – by 71.3% (p = 0.015). The correlation coefficient of NGF with CRP was r = + 0.179 (p = 0.42), and the determination coefficient was R2 = 0.032.

Conclusion. Identified statistically significantly increased levels of NGF and CRP in the blood serum of IC/BPS patients confirm the presence of a systemic inflammatory reaction. A weak direct correlation is determined between NGF and CRP in patients with IC/BPS patients. The determination of serum NGF and CRP in combination with clinical data can be used to diagnose IC/ BPS.

Urology reports (St - Petersburg). 2020;10(1):61-66
Phosphodiesterase type 5 inhibitors in treatment of lower urinary tract dysfunctions
Kuzmin I.V., Ajub A.K., Slesarevskaya M.N.

The article provides a review of current data on the pharmacological and pathogenetic principles of the use of selective type 5 PDE inhibitors in patients with lower urinary tract dysfunctions. The mechanisms of the therapeutic action of these drugs for various urinary tract dysfunctions are examined in detail, the leading of which is the improvement of blood circulation and the reduction of ischemia of the pelvic organs.

Urology reports (St - Petersburg). 2020;10(1):67-74
Case reports
Surgical treatment of a large paraurethral cyst
Slesarevskaya M.N., Ponomareva Y.A., Sozdanov P.V., Tyurin A.G., Sycheva A.M., Kuzmin I.V.

The paraurethral cysts are benign cystic formations, the clinical symptoms of which vary depending on the size of the cyst. The presented clinical observation describes the clinical picture, stages of surgical treatment, and results of histological examination of a large paraurethral cyst in a 36-year-old woman. The review of modern methods of diagnostics and treatment of paraurethral formations in women is made.

Urology reports (St - Petersburg). 2020;10(1):75-80
Lectures for the doctors
Urosepsis. Pathogenesis, diagnosis and treatment
Uchvatkin G.V., Gaivoronskiy E.A., Slesarevskaya M.N.

Modern data on terminology, classification, pathogenesis, diagnostics and treatment of urosepsis were presented in clinical lecture. Particular attention is paid to laboratory and clinical criteria for assessing the severity and prognosis of the disease, as well as methods for preventing urosepsis.

Urology reports (St - Petersburg). 2020;10(1):81-91
History of medicine
Professor Georges Marion – outstanding french surgeon and urologist (on the 150th anniversary of the birth)
Morgoshia T.S., Kuzmin I.V.

The article is dedicated to the 150th anniversary of the birth of Professor Georges Marion, an outstanding French surgeon and urologist. The main stages of his clinical and scientific activities are presented. G. Marion is the author of more than 300 scientific papers, including the fundamental guide to urology. He made a great contribution to the development of the surgical field in urology. G. Marion first performed many operations, subsequently named after him, and the hypertrophy of the bladder neck described by him was called Marion’s disease.

Urology reports (St - Petersburg). 2020;10(1):93-95

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