Vol 11, No 3 (2021)

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.

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.

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.

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.

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.

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.