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Vol 11, No 3 (2021)

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Original articles

Persistent dysuria in women: etiological diagnostics and treatment

Slesarevskaya M.N., Ignashov Y.A., Kuzmin I.V., Al-Shukri S.K.


INTRODUCTION: Dysuria is a painful urination combined with its frequency and/or difficulty. Dysuria is observed in many urological diseases and is one of the most common reasons for treatment for urological cause.

AIM: The aim of the study is to identify the etiological factors of dysuria in women and to evaluate a personalized approach to their treatment.

MATERIALS AND METHODS: We analyzed the data of 368 women with chronical cystitis. The inclusion criteria for the study were the presence of dysuria (painful and frequent urination more than 8 times a day with or without difficulty), the prescription of urination disorders over one year old and age 18 and over. All patients underwent a comprehensive urological examination to identify the causes of urinary disorders.

RESULTS: The Bacterial cystitis was confirmed only in 78 (21.2%) patients among all 368 women. In the remaining 290 (78.8%) patients, the causes of persistent dysuria were other diseases: bladder leukoplakia in 154 (41.8%), bladder pain syndrome/interstitial cystitis in 38 (10.3%), viral cystitis in 34 (9.3%), paraurethral formations in 29 (7.9%), neurogenic urinary dysfunction bladder in 25 (6.8%), urethral pain syndrome in 5 (1.4%) patients. Dysuria was also caused by postradiation cystitis (2 patients), secondary stones in the urinary bladder (2 patients), and one patient had extragenital endometriosis.

CONCLUSIONS: The variety of reasons for the development of persistent dysuria in women requires careful examination of patients. Treatment should be carried out only after accurate verification of the diagnosis.

Urology reports (St. - Petersburg). 2021;11(3):195-204
pages 195-204 views

Prostate-specific antigen density as a prognostic marker in patients with localized prostate cancer

Kneev A.Y., Shkolnik M.I., Bogomolov O.A., Vershinskaya J.G., Zharinov G.M.


BACKGROUND: The most important task in the field of improving the results of treatment of patients with prostate cancer (PCa) is their correct stratification by risk groups. Modern stratification systems do not fully provide an adequate risk assessment for all patients with prostate cancer. Further development of algorithms for predicting the clinical course of prostate cancer for a particular patient can positively affect the course and outcome of the disease.

AIM: Determination of the clinical and prognostic value of the density of prostate-specific antigen (PSAD) in patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy.

MATERIALS AND METHODS: The effect of the PSAD parameter on the tumor-specific survival rates, as well as the clinical and morphological parameters of the tumor process, was assessed in 272 patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy from January 1996 to July 2007.

RESULTS: The high clinical significance of the PSAD indicator has been demonstrated. An increase in PSAD correlated with an increase in serum PSA concentration, a decrease in PSA doubling time, and a decrease in tumor differentiation. The prognostic value of PSAD was confirmed in patients with localized prostate cancer who received combined hormone-radiation therapy. Using ROC-analysis, the threshold value of the PSAD index was determined – 0.36 ng / ml / cm3, the excess of which was associated with a statistically significant decrease in the level of tumor-specific survival. The area under the curve was 0.703 (95% CI 0.236–0.434; p < 0.001). The risk of tumor-specific mortality and recurrence increased as the PSAD value increased.

CONCLUSION: The PSAD parameter is a reliable biomarker of prostate cancer with high rates of clinical and prognostic significance, the use of which is not associated with the introduction of costly and cumbersome methods of laboratory and instrumental diagnostics.

Urology reports (St. - Petersburg). 2021;11(3):205-212
pages 205-212 views

Features of the extraction of foreign bodies from the lower urinary tract

Shanava G.S., Mosoyan M.S., Grabsky A.M., Arzumanyan K.G.


BACKGROUND: Foreign bodies introduced by patients into the bladder and urethra are relatively rare in clinical practice. As a result, there is insufficient information in the scientific literature regarding methods of extracting foreign bodies from the urinary tract.

AIM: determination of the optimal methods for extracting foreign bodies from the urethra and bladder.

MATERIALS AND METHODS: Foreign bodies of the lower urinary tract were removed in 21 patients: 15 (71.4%) men and 6 (28.6%) women. Foreign bodies were found in the urethra in 7 (33.3%) patients and in the bladder in 14 (66.7%) patients. Removal of foreign bodies from the urethra and bladder was performed endoscopically or during open surgery.

RESULTS: Removal of stabbing, cutting and glass objects from the urinary tract in 9 patients was performed during open surgery. Foreign bodies with even smooth edges were removed in 12 patients under urethrocystoscopic control. At the same time, in two patients, coagulated suppositories were first fragmented in the bladder cavity, and then removed in parts. Cystolithotripsy was performed in one patient with a suppository inlaid with calculus before fragmentation.

CONCLUSIONS: Foreign bodies with sharp edges or made of glass are safer to be removed from the lower urinary tract during open surgery. Foreign bodies with a smooth and even surface are optimally removed endoscopically. Long and bulky foreign objects that can be fragmented in the bladder cavity are best removed in parts. When foreign bodies are encrusted with large calculi, cystolithotripsy should be performed before their endoscopic extraction.

Urology reports (St. - Petersburg). 2021;11(3):213-218
pages 213-218 views

Application of the complex Edelim in pathogenetic management of patients with erectile dysfunction

Kyzlasov P.S., Volokitin E.V., Mustafayev A.T., Pomeshkin E.V.


AIM: To assess the degree of changes in complaints, dynamics of biochemical parameters of lipid metabolism, penile hemodynamics in patients with ED during therapy with EDELIM in comparison with PDE-5 inhibitors. Assess the tolerability of the drug based on the analysis of reported adverse events.

MATERIALS AND METHODS: The study was prospective comparative observational cohort. The study included 60 patients over 18 years old with complaints of persistent, at least 1 month, erectile dysfunction. The patients were divided into 2 groups: group 1 – patients with ED received Edelim on a regular basis, one capsule 2 times daily for 3 months; group 2 – patients with ED received generic tadalafil 5 mg daily for 1 month, then 1 month break, then 5 mg per day for 1 month.

RESULTS: The mean age of the patients was 38.4 ± 9.2 years. In group 1, significant differences were noted in the all hemodynamic and biochemical indicators, except for HDL levels (2.2 ± 0.4 vs. 2.3 ± 0.4 mmol/L; p = 0.067). In group 2, significant differences were noted in the dynamics of the IIEF-5 scale, the level of HDL, and the blood flow velocity in the right and left cavernous arteries. There were no significant differences in blood flow in the left and right dorsal arteries, levels of total cholesterol, LDL, triglycerides, glucose, HbA1c, systolic blood pressure. In the 1st group of patients, there were no adverse events, in the 2nd group, in 3 patients – mild side effects.

CONCLUSIONS: The improvement in the quality of erection in the group of patients taking Edelim is associated with decrease in the lipid profile, glucose, glycated hemoglobin, which can be regarded as a variant of pathogenetic conservative treatment of ED.

Urology reports (St. - Petersburg). 2021;11(3):219-225
pages 219-225 views

Hemodynamics and functional state of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer

Tityaev I.I., Tikhonov I.V., Neymark B.A., Andreev S.S., Andreeva S.V., Udalov K.V., Kasyanov D.S.


AIM: To study the hemodynamics and functional state of the renal tissue of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer.

MATERIALS AND METHODS: The prospective study included 58 patients with renal cell carcinoma, 36 (62.1%) of whom underwent radical nephrectomy, and 22 (37.9%) underwent partial nephrectomy. Tumor sizes ranged from 1.0 to 12.0 cm. All patients before surgery and in the early postoperative period underwent ultrasound examination of the structure and size of the kidneys, Doppler ultrasonography of the renal vessels, biomicroscopy of the bulbar conjunctiva, measured peripheral blood pressure, determined the glomerular filtration rate (GFR) and performed a coagulogram. The control group included 16 healthy adults.

RESULTS: In 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy a tendency towards an increase in blood pressure compared with the initial values was noted by the 2-4th day after the operation. By the 5th day after surgery, the volume of the only kidney remaining after radical nephrectomy increased by an average of 4% (from 126.1 ± 1.4 to 131.2 ± 2.1 cm3, p < 0.05), while after partial nephrectomy has not changed reliably. After surgery, a decrease in GFR was detected in 34 (58.6%; p < 0.05) patients, including after radical nephrectomy (n = 28) – up to 73.4 ± 8.2 ml / min / 1.73 m2, after partial nephrectomy (n = 6) – up to 98.2 ± 3.4 ml / min / 1.73 m2. Doppler ultrasonography of the vessels of a single kidney in patients after radical nephrectomy showed a moderate increase in linear blood flow, an increase in the resistance index in the main trunk of the renal artery, and a decrease in the pulsation index in the segmental and arc arteries. In patients after partial nephrectomy in the contralateral kidney these changes were not observed. When performing biomicroscopy of the bulbar conjunctiva in 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy, changes in the microvasculature were revealed: narrowing of arterioles, expansion of venules, slowing of venular and capillary blood flow. Before the operation and in the early postoperative period, the content of fibrinogen and soluble fibrin-monomer complex in the blood of patients with renal cell carcinoma was significantly higher than in the control group.

CONCLUSIONS: In patients with renal cell carcinoma, changes in the contralateral kidney in the early postoperative period after radical nephrectomy are significantly more pronounced than after partial nephrectomy, and are accompanied by changes in systemic and local hemodynamics and kidney function. The results of the study confirm the feasibility of performing organ-preserving surgeries in patients with renal cell carcinoma.

Urology reports (St. - Petersburg). 2021;11(3):227-233
pages 227-233 views

Kidney damage in COVID-19 patients

Antonov A.V., Vorob'ev A.S.


The results of the analysis of case histories of 100 deceased patients (55 women and 45 men), whose cause of death was the syndrome of multiple organ failure due to COVID-19, are presented. The case histories of patients who had no previous renal dysfunction were selected for the analysis. The average age of the patients was 76 years. At the terminal stage of the disease, microhematuria was detected in 27 patients, hypercreatininemia was noted in 17 patients, while the creatinine content in the blood did not exceed 437 μmol / L in any of 100 patients. Oliguria was observed in 9 patients, polyuria – in 43 patients. A possible cause of kidney damage is the damaging effect of SARS-CoV-2 on the proximal convoluted tubules of the nephron. At the same time, in no patient with a severe course of COVID-19, kidney damage did not determine the severity of the condition and was not the cause of death.

Urology reports (St. - Petersburg). 2021;11(3):235-240
pages 235-240 views


Anatomical, physiological and pathophysiological features of the lower urinary tract in gender and age aspects

Shormanov I.S., Solovyov A.S., Tyuzikov I.A., Kulikov S.V.


In the review article, based on the results of modern clinical and experimental studies, gender and age-related features of the anatomy, physiology and pathophysiology of the lower urinary tract are considered. The features of the structure and functioning of the urothelium, myothelium, neurothelium and endothelium of the lower urinary tract in men and women are described in detail. A separate section of the review is devoted to the peculiarities of hormonal regulation of the lower urinary tract, depending on gender and age.

Urology reports (St. - Petersburg). 2021;11(3):241-256
pages 241-256 views

Lectures for the doctors

Autonomic dysreflexia in the practice of a urologist

Salyukov R.V., Bushkov F.A., Frolova M.V.


Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral α-adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction of the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.

Urology reports (St. - Petersburg). 2021;11(3):257-262
pages 257-262 views

Case reports

Is neoadjuvant chemotherapy necessary for the surgical treatment of renal tuberculosis?

Kholtobin D.P., Kulchavenya E.V.


The relevance of urogenital tuberculosis remains high as well as its social significance. With the advent of anti-tuberculosis drugs it became possible to perform organ-preserving surgeries, both anti-tuberculosis chemotherapy in the preoperative period and after surgery is extremely important. Violation of this principle leads to the development of severe complications, which is demonstrated by clinical observation. Patient I., female 40 years. Diagnosis: polycavernous tuberculosis of the right kidney, cavernous tuberculosis of the left kidney, bladder tuberculosis of stage 4 (microcystis). Her anti-tuberculosis therapy was irregular and occasionally. In the general urology department a laparoscopic nephrectomy on the right and nephrostomy on the left were performed. Anti-tuberculosis therapy was discontinued, which led to the progression of renal failure and repeated attacks of pyelonephritis. In this regards she was re-operated in the Avicenna Medical Center: laparoscopic cavernotomy of the left solitary kidney and cystectomy with enterocystoplasty by Studer were performed. In the postoperative period a reservoir-uterine fistula was formed. She did not receive anti-tuberculosis therapy. The patient returned to the Avicenna Medical Center after 9 months, laparoscopic removal of the shrunken intestinal reservoir was performed with the formation of Bricker ileal conduit with a good short-term and long-term (follow-up period of 10 months) result.

Urology reports (St. - Petersburg). 2021;11(3):263-270
pages 263-270 views

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