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Vol 10, No 2 (2020)

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Information about scientific conferences and congresses

Professor Vladimir Nikolaevich Tkachuk (On the 90th anniversary of the birth)

Urology reports (St. - Petersburg). 2020;10(2):105-106
pages 105-106 views

Original articles

Urine stones of different chemical composition occurrence depending on the level of uricuria

Prosiannikov M.Y., Anokhin N.V., Golovanov S.A., Konstantinova O.V., Sivkov A.V., Apolihin O.I.


Introduction. According to modern concepts one of the key links in the pathogenesis of urolithiasis is metabolic lithogenic disturbances. The study of the complex effect of many factors on the metabolism of urolithiasis patient is the basis of modern scientific research. We studied the frequency of various chemical urinary stones occurrence depending on various levels of uricuria.

Materials and methods. Data from of 708 urolithiasis patients (303 men and 405 women) were analized. The results of blood and urine biochemical analysis and chemical composition of urinary stone were studied. The degree of uricuria was ranked by 10 intervals: from 0.4 to 14.8 mmol/day to assess the occurrence of different stones at various levels of uricuria.

Results. The incidence of calculi consisting of uric acid also increases with increasing levels of uric acid in the urine. An increase in the level of uricuria above 3.11 mmol/day is observed to increase calcium-oxalate stones occurrence. Decrease in the prevalence of carbonatapatite and struvite stones observed at an increase of urine uric acid excretion. At high levels of uric acid excretion, we found uric acid and calcium oxalate stones most often.

Conclusion. Control over the level of urinary acid excretion in urine is important in case of calcium-oxalate and uric acid urolithiasis.

Urology reports (St. - Petersburg). 2020;10(2):107-113
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Quality of life of patients with kidney stones

Protoshchak V.V., Paronnikov M.V., Sivakov A.A., Kiselev A.O.


Relevance. In 2013, the Wisconsin Stone Quality of Life Questionnaire (WISQoL) was developed – a specific tool for assessing the quality of life (QoL) in patients with urolithiasis.

Aim. To determine the possibility of using the WISQoL and SF-36 questionnaires to study the treatment results of patients with kidney stones.

Materials and methods. The study included 218 patients with nephrolithiasis. Patients were divided into 2 groups: the first – the size of the stone up to 10 mm and the second – from 11 to 20 mm. At the first stage, the efficacy of treatment patients by the extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolitholapaxy (PNL) 1 week, 1 and 3 months after surgery was compared. Questionnaires were used to study factors affecting the QOL of patients, including: gender, age, number, density and size of stones, hydronephrosis, stone free rate (SFR), type of surgery. At the next stage, the dynamics of changes in scores for the domains of questionnaires at different stages of treatment was evaluated.

Results. The efficacy of treating kidney stones up to 1 cm in size after 3 months with ESWL was 86,1% and PNL – 94,4 %, while stones up to 20 mm using ESWL – 73,4% and percutaneous techniques – 90,6%. Gender, age, stone size, SFR affected the QoL of patients with nephrolithiasis, while the number and density of stones, the presence of hydronephrosis and the type of operation were not significant. Patients 1 week after PNL had lower QoL scores in the domains of social impact and impact on vitalyty of WISQoL and mental heals of SF-36. After 1 month, these changes were determined only in the social impact domain and completely regressed by the 3rd month.

Conclusion. SFR after ESWL and PNL in the first group is comparable, in the second group, percutaneous operations were 17,2% more effective. Male gender, age up to 40 years, stone size more than 1 cm, and also not reached SFR negatively affects patients with nephrolithiasis. Compared with ESWL and PNL is accompanied by the worst dynamics of QOL scores only 1 week after the operation; upon further observation, negative changes are leveled.

Urology reports (St. - Petersburg). 2020;10(2):115-124
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Retrospective analysis of the results of transurethral contact pyelocalycolithotripsy in patients with kidney stones

Nazarov T.K., Rychkov I.V., Akhmedov M.A., Trubnikova K.E., Tursunov A.I., Nikolaev V.A.


Transurethral contact lithotripsy is a promising treatment method and occupies an important place among endoscopic methods for removing kidney stones.

The aim of the study was to identify the advantages and disadvantages of transurethral contact pyelocalycolithotripsy in patients with kidney stones based on retrospective analysis.

Material and methods. A retrospective analysis of 178 clinical cases of treating patients aged from 19 to 71 years who suffered from kidney stones and underwent transurethral contact pyelocalycolithotripsy was performed. All patients were diagnosed with calculi of the pyelocaliceal system with the diameter ranging from 10 to 20 mm according to multispiral CT data. Renal calculi had different composition and their density varied from 460 HU to 1440 HU. Pneumatic and laser energy was used for lithotripsy in 102 (57.3%) and 76 (42.7%) patients respectively.

Results. The obtained data show that complete destruction of the stones and the removal of fragments within 2 weeks after transurethral contact pyelocalycolithotripsy was noted in 143 (80.3%) patients. In 140 (78.7%) cases positive results were achieved in one surgical intervention and in 38 (21.3%) patients after two procedures. Complications of this treatment method were relatively rare and included intraoperative bleeding, pelvic perforation, acute pyelonephritis, stent migration, postoperative bleeding, and residual stones.

Conclusion. Transurethral contact pyelocalycolithotripsy is a promising method due to the fact that in most cases it allows you to simultaneously rid a patient of kidney stones with minimal complications

Urology reports (St. - Petersburg). 2020;10(2):125-131
pages 125-131 views

First Russian experience of the stereotactic radiotherapy on the prostate bed

Novikov R.V., Melnik J.S., Ponomareva O.I., Novikov S.N.


Purpose. Assess the safety of postoperative radiation therapy on the area of the prostate bed (PB) using extreme dose hypofractionation (5 fractions of 6.6–7 Gy).

Materials and methods. from April 2019 to March 2020 at the National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of the Russian Federation in the first 15 patients of the prostate cancer carried out stereotactic radiation therapy (SRT) on the PB. Depending on the clinical situation, adjuvant and salvage SRT were distinguished. Linear electron accelerators with 6 MeV energy are used for treatment. Three factional regimes were evaluated: 5 factions of 6.6 Gy, 5 factions of 6.8 Gy and 5 factions of 7 Gy. The clinical target volume is defined by RTOG (2010).

Results. The median of follow-up was 7.6 (1.3-11.6) months. Of the 15 patients, adjuvant SRT performed three observed, and the remaining 12 patients – salvage SRT (4 – early, 8 – delayed). Acute radiation toxicity was estimated in 12 patients. Early impairment from the lower urinary tract 1 degree was observed in 8 (66.7%) 12 of them. Toxicity of 2 or more degree in the early period was not observed. Clinical signs of early 1st degree toxicity from the rectum were found in five (41.7%) of the bowel of the 12 observed. One patient (8.3%) there was a mixture of blood in the feces, which required a medical correction, which was considered as toxicity of the 2nd degree.

Conclusions. Postoperative SRT of the PB region is a promising modern method of radiation treatment of patients with prostate cancer. The presented methods of adjuvant and salvage SRT are feasible in clinical practice and are characterized by an acceptable level of early radiation toxicity.

Urology reports (St. - Petersburg). 2020;10(2):133-142
pages 133-142 views

Personified correction of micronutrient deficiency as a therapeutic tactic for improving the quality of ejaculate in idiopathic infertility

Tsukanov A.Y., Satibaldin D.A.


Introduction. Marital infertility is one of the key medical problems. Almost 50% of infertility in marriage is caused by male infertility. The proportion of idiopathic male infertility is 30–40%.

Material and methods. 157 patients with idiopathic infertility were randomized into 2 groups. The main group (MG) (n = 82): conducted a correction of the level of micronutrients in case of their deficiency by the appointment of monocomponent drugs in the maximum permitted daily doses. The control group (n = 75) (empirical therapy with complex drugs) was randomized to subgroup 1 (CG1) (n = 38): complex preparations with L-carnitine were used; and subgroup 2 (CG2) (n = 37): complex multivitamin preparations without L-carnitine were used. To identify micronutrient deficiencies, 93 healthy volunteers who realized a fertile function were examined (their partners were in the third trimester of pregnancy).

Results. Deficiencies of micronutrients were determined: selenium, zinc, vitamins C and E. Correction was carried out for three months with monocomponent preparations. In the exhaust gas, there was a positive dynamics in all parameters of the spermogram. In the control subgroups the ejaculate volume, concentration, total sperm count did not change, an increase in the general and progressive motility was revealed. The proportion of normal spermatozoa increased in MG, CG1 and CG2 groups by 61.9%, 28.6% (in comparison with MG p < 0.01) and 20.0% (in comparison with MG p < 0.001), respectively. Total mobility increased – by 44.5%, 24.5% (compared to MG p < 0.05), by 12.0% (compared to exhaust gas p < 0.001), respectively. Progressive mobility – by 60.4%, 54.5% (compared with MG p > 0.05), 14.7% (compared with MG p < 0.001), respectively. Pregnancy in MG was 21.9%, in CG1 – 5.2% (p < 0.05) and CG2 – 2.7% (p < 0.05).

Conclusion. Personified correction of micronutrient deficiency in order to improve the quality of ejaculate in idiopathic male infertility was an effective therapeutic tactic. The results obtained suggest that this approach is more pathogenetically justified, which requires further study.

Urology reports (St. - Petersburg). 2020;10(2):143-150
pages 143-150 views

Experience of surgical treatment of leukoplakia of the urinary bladder in women with chronic cystitis

Ensebaev E.Z., Bajgaskinov Z.K.


28 women with leukoplakia of the bladder, clinically manifested by dysuria and pain in the bladder were observed. All patients have a history of chronic urinary tract infection. At the time of inclusion in the study there were no signs of exacerbation of cystitis. All patients underwent laser ablation of the altered bladder mucosa. Control examinations were performed 1, 3, and 6 months after surgery. Positive dynamics of clinical indicators was noted after surgery in all patients. Tolerance to laser ablation was satisfactory, there were no postoperative complications. A complete recovery of urothelium in the operation area was achieved after 6 months according to control cystoscopy. The results of the study showed high efficiency and safety of laser ablation of the altered bladder mucosa in patients with leukoplakia.


Urology reports (St. - Petersburg). 2020;10(2):151-156
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Estimation of efficiency of empirical antibiotic therapy of catheter-associated infection in a urological hospital

Kuzmenko A.V., Gyaurgiev T.A., Halchenko A.E., Vorkel Y.M.


An analysis of case histories of 119 patients who underwent treatment in the urology department of the Voronezh City Clinical Emergency Hospital No. 10 was performed. All patients were drained with a urethral catheter, a bacteriological examination of the urine was performed, and empirical antibiotic therapy was prescribed. Microflora growth was detected in the urine of 30 (25.2%) patients, most often revealed Klebsiella spp. and Enterococcus faecalis. A high frequency of resistance of uropathogens to antibacterial drugs prescribed as empirical therapy was noted. 66% were resistant to ceftriaxone, and 70% of the isolated microorganism strains to ciprofloxacin. Significantly lower resistance was noted for amikacin and doxycycline. To increase the effectiveness of empirical antibiotic therapy in patients with catheter-associated urinary tract infections, it is necessary to select antibacterial drugs based on the results of monitoring the sensitivity of hospital strains, followed by treatment correction in accordance with the results of urine bacteriological studies.

Urology reports (St. - Petersburg). 2020;10(2):157-162
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Fesoterodine for the treatment of overactive bladder: pharmacological bases and clinical results

Kuzmin I.V., Al-Shukri S.K.


The results of the clinical use of the new anticholinergic drug fesoterodine in the treatment of patients with overactive bladder was presented in the review. An analysis was made of the pharmacological effects of fesoterodine, which provide its high clinical efficacy and good tolerance.

Urology reports (St. - Petersburg). 2020;10(2):163-171
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Fragmentation of sperm DNA: clinical significance, reasons, methods of evaluation and correction

Borovets S.Y., Egorova V.A., Gzgzian A.M., Al-Shukri S.K.


A review of the main causes of male infertility in the aspect of the relationship with the degree of sperm DNA fragmentation is presented. Information is provided on the main methods for assessing sperm DNA fragmentation and its effect on male fertility. The effect of oxidative stress on the integrity of sperm DNA structure, the reparative capabilities of antioxidant therapy, and the effect of varicocele on male fertility are described.

Urology reports (St. - Petersburg). 2020;10(2):173-180
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Case reports

Aggressive course of a rare type of urethral cancer in women

Streltsova O.S., Yunusova K.E., Krupin V.N., Vlasov V.V., Kuyarov A.S.


The article provides a clinical case of urethral cancer in women. Primary urethral carcinomas are rare, less than 1% of all malignant tumors. According to the Rarecare Cancer Surveillance Agency for Europe (RARECARE), urethral cancer in women is 0.6 and 1.6 in men per 1 million people per year. A 56-year-old patient with histologically verified clear cell adenocarcinoma of the proximal urethra was monitored for 18 months. An aggressive course of the tumor process has been shown, which led to the need to perform anterior exenteration of the pelvic organs. The histogenesis of primary clear cell urethral adenocarcinoma has not been definitively determined. The atypical external localization in the described case suggests the periurethral origin of this cancerous tumor from the Skene’s glands. The demonstration of a rare form of urethral cancer, clear cell adenocarcinoma, contributes to the accumulation of knowledge about its histopathology and clinical course, as well as increasing cancer alertness in the treatment of urethral diseases in doctors of any specialty.

Urology reports (St. - Petersburg). 2020;10(2):181-186
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Spontaneous rupture of the renal pelvis due to acute obstruction of the upper urinary tract

Zamyatnin S.A., Tsygankov A.V., Gonchar I.S.


Cases of spontaneous rupture of the pyelocaliceal system of the kidney, not associated with the consequences of endourological surgery, are described extremely rarely in the literature. Most often, such a complication develops in patients with urolithiasis. The article analyzes the literature data on urinary tract apoplexy and presents its own clinical observations.

Urology reports (St. - Petersburg). 2020;10(2):187-190
pages 187-190 views

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