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Vol 10, No 4 (2020)

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Original articles

Prognostic value of tumor growth rate and biomarker dynamics in patients with renal cell carcinoma

Molchanov O.E., Maistrenko D.N., Granov D.A., Lisitsyn I.Y.

Abstract

The article discusses the features of the main modern prognostic models in patients with metastatic renal cell carcinoma. The possibilities of using molecular biological markers associated with the activation or proliferation of tumor cells and the microenvironment are highlighted. The possibility of integrating parameters that reflect the intensity of growth or decrease in the volume of tumor mass into prognostic systems is shown. Data from our own research is presented. A model is presented that, along with the components used earlier, includes immunological parameters (spontaneous production of IL-6 and IL-8) and kinetic parameters of tumor growth or regression. These factors are associated with the degree of malignancy and aggressiveness, and are independent predictors. The article presents literature data on the relationship of the studied components of the immune system with invasiveness, proliferative activity and metastatic potential of the tumor. Future research directions are outlined regarding the possibility of integrating biomarkers into predictive models for renal cell carcinoma.

Urology reports (St. - Petersburg). 2020;10(4):281-291
pages 281-291 views

Microbiological monitoring of causative agents of nosocomial infection in the urological clinic

Slesarevskaya M.N., Spiridonova A.A., Krasnova M.V., Reva S.A., Gadzhiev N.K., Ponomareva Y.A., Al-Shukri A.S., Kuzmin I.V., Petrov S.B., Al-Shukri S.K.

Abstract

The analysis of the results of microbiological examination of urine samples of 1022 patients (559 women and 463 men) who were hospitalized at the urological clinic of the I.P. Pavlov First Saint Petersburg State Medical University in period from 2018 to 2020 was performed. The age of the patients varied from 18 to 88 years (average 63.1 ± 17.6 years). In 587 (57.5%) patients, gram-negative microflora was detected, in 355 (34.7%) – gram-positive microflora, and in 80 (7.8%) – mixed microflora. Escherichia coli (28.2%), Enterococcus faecalis (20.9%), Klebsiella pneumoniae (14.1%) and bacteria of the Staphylococcaceae family (11.6%) were prevailed in the structure of uropathogens. The share of other microorganisms did not exceed 5%. A high level of microflora resistance to ampicillin, cephalosporins of the 2nd and 3rd generations, fluoroquinolones was noted. The highest level of antibiotic resistance was observed in K. pneumonia. In general the results obtained correspond to the general trends in the dynamics of the etiological structure and the level of antibiotic resistance of nosocomial urinary tract infections. This study confirms the need for local microbiological monitoring to develop optimal regimens for empiric antibiotic therapy and perioperative antibiotic prophylaxis.

Urology reports (St. - Petersburg). 2020;10(4):293-300
pages 293-300 views

The working of the urology department during the COVID-19 epidemic

Kul’chavenya E.V., Kholtobin D.P., Neymark A.I.

Abstract

Introduction. In March 2020, the World Health Organization declared the outbreak of the novel coronavirus infection (COVID-19) a pandemic. The pandemic also significantly affected all academic, scientific and educational activities.

Material and methods. We compared the work of the urological departments of the private (Medical Center “Avicenna”, Novosibisk) and municipal (City Clinical Hospital No. 11, Barnaul) clinics, as well as the urogenital department of the Novosibirsk Research Institute of Tuberculosis of the Ministry of Healthcare of Russia for 6 months of “calm” 2019, and the first half of 2020, which coincided with the start of the COVID-19 coronavirus pandemic.

Results. In March 2020, the urogenital department of the Novosibirsk Research Institute of Tuberculosis of the Ministry of Healthcare of Russia was redesigned into an observational one. In the first half of 2020, patients with malignant neoplasms, varicocele, chronic pyelonephritis, hydronephrosis, dropsy of the testicular membranes and with phimosis/paraphimosis were admitted to the urology department of the City Hospital No. 11 in Barnaul in the first half of 2020. On the contrary, statistically significant in 2020 the number of patients admitted for kidney abscess and acute prostatitis prevailed. It can be assumed that, due to the tense epidemic situation, patients postponed seeking medical attention until their condition required emergency intervention. In the Medical Center “Avicenna” (Novosibirsk) in the first half of 2020 the number of visits to the pediatric urologist significantly decreased, the inpatient and average bed-day decreased. On the contrary the total duration of the patients' stay in the day hospital has significantly increased, which is logically explained by the epidemic situation; there was a statistically significant decrease in the number of most operations and outpatient procedures.

Conclusion. The new coronavirus infection has affected all spheres of human life, to a maximum extent – on medicine. In the first six months, no unified approaches to the management of urological patients in epidemic conditions were developed; clinics worked according to internal standards. Our analysis showed that strict adherence to sanitary and hygienic standards and the implementation of anti-epidemic measures allows us to provide urological care to patients in full-even in such unfavorable conditions.

Urology reports (St. - Petersburg). 2020;10(4):301-307
pages 301-307 views

Assessment of postoperative complications of transurethral contact pyelocalycоlithotripsy in patients with high-density stones according to the Clavien – Dindo classification

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

Abstract

 Improving the effectiveness of treatment of urolithiasis is a topical issue in modern urology. Despite a large number of studies on this problem, there is currently no unified algorithm for assessing postoperative complications of removal of calculi of the renal cavity system by transurethral access.

Purpose of the study: based on a retrospective analysis to adapt the classification of postoperative complications according to Clavien – Dind from 2004 to describe the complications of transurethral contact pyelocalicolithotripsy.

Materials and methods. A retrospective analysis of the results of surgical treatment of 211 patients with kidney stones with a density of 960 HU to 1840 HU was performed. Ultrasonic energy was used for lithotripsy. Criteria for the normal course of the postoperative period in patients have been formulated.

Results. The number of postoperative complications was calculated. The obtained data are distributed according to the corresponding gradations of the adapted Clavien – Dindо classification.

Conclusion. The improved Clavien – Dindo classification, taking into account the adaptation, can be used as an up-to-date, accessible and logical template for assessing the postoperative complications of transurethral contact pyelocalicolithotripsy.

Urology reports (St. - Petersburg). 2020;10(4):309-316
pages 309-316 views

Possibilities of phytotherapy in patients with lower urinary tract symptoms due to benign prostate enlargement

Al-Shukri A.S., Kostyukov S.V.

Abstract

The results of the use of the phytopreparation Tadimax in the treatment of 60 men with mild and moderate lower urinary tract symptoms (LUTS) developed as a result of benign enlargement of the prostate gland are presented. The average age of the patients was 66.5 ± 3.8 years. Tadimax was prescribed 2 tablets 3 times a day, in courses of 7 days with 7 day breaks for 3 months (a total of 6 courses). The data obtained indicate high efficacy and good tolerability of treatment. A decrease in the severity of LUTS was noted in 59 (96.6%) patients, which was accompanied by significant changes in objective clinical indicators: a decrease in residual urine volume and an increase in urine flow rate. Tadimax is a combined preparation, which includes extracts of several medicinal plants, and the main component is Crinum latifolium. The therapeutic effect of Tadimax is based on anti-inflammatory, antiproliferative and immunotropic action.

Urology reports (St. - Petersburg). 2020;10(4):317-323
pages 317-323 views

Reviews

Optimal lubricants for urological practice

Banaru A.M., Salyukov R.V.

Abstract

The importance of choosing a lubricant depending on the therapeutic or diagnostic manipulation performed and the clinical situation is rarely the focus of attention of the practicing urologist. Meanwhile, the components of the lubricant can both provide adjuvant treatment and prevention of complications of the performed manipulations, and vice versa, be the cause of complications themselves. Based on the analysis of the scientific literature of the past 20 years, an overview of lubricants used in urological practice, as well as their main components – gelling agents, anesthetics, antiseptics, is presented, their main advantages and disadvantages are shown.

Urology reports (St. - Petersburg). 2020;10(4):325-336
pages 325-336 views

Sperm DNA fragmentation: etiology, pathogenesis, the influence on reproductive function

Korshunov M.N., Korshunova E.S., Darenkov S.P.

Abstract

The literature review of sperm DNA fragmentation is evaluated. Russian and foreign literary data over the past 10 years, including fundamental researching of the evaluation of the gametes genome integrity, are analyzed. The main etiological factors and the possible reasons of the DNA breaks formation on the different stages of spermatogenesis are described. The influence of the sperm oxidative stress reaction to the DNA integrity is analyzed. The relationship between DNA fragmentation of spermatozoa pregnancy and live birth rates in the assisted reproductive techniqueare noted. Risk of the recurrent pregnancy losses in male infertility cases with the sperm DNA damage is presented. Review confirms the significant prognostic value of sperm DNA fragmentation detection in infertility cases. Further studies in evaluation of pathogenesis of sperm DNA have a clinical interest to reproductive health physicians.

Urology reports (St. - Petersburg). 2020;10(4):337-345
pages 337-345 views

Advantages and disadvantages of main surgical approaches for robot-assisted radical prostatectomy

Il’in D.M., Makeev V.A.

Abstract

The introduction of robotic-assisted surgery into clinical practice has opened up new possibilities for the surgical treatment of urological patients. Robot-assisted radical prostatectomy (RARP) is one of the most commonly performed robot-assisted surgery. The review is devoted to the main surgical approaches for RARP. An analysis of publications on this topic was carried out using the search engines of the scientific databases PubMed, Medscape, Google Scholar, eLibrary when writing the article The article presents an overview of the advantages and disadvantages of the existing four access options for RARP: anterior, perineal, lateral and posterior, as well as oncological and functional outcomes of operations. It has been shown that a surgeon with different approaches can choose the most suitable one for a given clinical situation, focusing on the stage of the disease, the patient’s age, anatomical features of the prostate gland, the state of the patient’s erectile function, and the history of operations on the abdominal cavity and pelvic organs.

Urology reports (St. - Petersburg). 2020;10(4):347-354
pages 347-354 views

Case reports

New method for the treatment of cavernous prostate tuberculosis

Kholtobin D.P., Kul'chavenya E.V.

Abstract

Prostate tuberculosis (PT) is not uncommon, but rarely diagnosed. Treatment of PT is a difficult task, since it is difficult to achieve an adequate concentration of antibacterial drugs in the parenchyma of even a healthy organ, and in the case of the formation of prostate caverns, their fibrous walls almost completely prevent the penetration of anti-tuberculosis drugs into the destruction focus. The method of combined surgical treatment of PT is described in detail on the example of the patient. During polychemotherapy, the cavity is opened by means of transurethral electroresection, followed by coagulation of the cavity wall by radiation of a high-energy diode laser with a wavelength of 940 nm and a power of 150 W. This approach allows to cleanse the prostate cavity from purulent-necrotic detritus and interrupt the pathological infectious and inflammatory process in its wall due to coagulation with laser radiation. The proposed method of surgical treatment of PT is both radical, since the walls of the cavities are excised and coagulated, and is minimally invasive, therefore it can be recommended for wider application.

Urology reports (St. - Petersburg). 2020;10(4):355-359
pages 355-359 views

Urethral erosion developed after implantation of artificial urinary sphincter

Kyzlasov P.S., Mustafaev A.T., Kazantsev D.V., Volokitin E.V.

Abstract

The case report presents a clinical observation of urethral erosion that developed after a long-term presence of a urethral catheter in a patient after implantation of an artificial bladder sphincter. The stages of the patient’s surgical treatment are described. The frequency of such complications in patients with an established artificial bladder sphincter according to literature data is presented.

Urology reports (St. - Petersburg). 2020;10(4):361-363
pages 361-363 views

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