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Vol 11, No 4 (2021)

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Original articles

The method of extracorporeal resection of the kidney in conditions of pharmaco-cold ischemia in kidney cancer with orthotopic renal replantation

Miroshkina I.V., Baytman T.P., Polotbek uulu Z., Oganyan V.A., Chevina A.A., Raguzina V.Y., Simonov A.D., Chzhao A.V., Pranovich A.A.


BACKGROUND: Increasing the effectiveness of the treatment of patients with kidney cancer is one of the main problems of oncourology. In its solution, great importance is attached to the development of new surgical technologies.

AIM: The aim of the study – to evaluate the results of extracorporeal kidney resection in conditions of pharmaco-cold ischemia with orthotopic renal replantation in kidney cancer patients. Our study is aimed at assessing the results of extracorporeal resection of the kidney under pharmaco-cold ischemia with orthotopic replantation of renal vessels in patients with kidney cancer.

MATERIALS AND METHODS: 44 patients [of them, 70.5% (n = 31) – men and 29.5% (n = 13) – women] with kidney cancer were recruited in a study. All patients were treated between 2012 and 2021. The mean age of patients was 55.92 ± 12.6 years. The stage was determined using the TNM system: pT1a-3bN0M0-1 G1-3. 75% (n = 33) of patients had stage pT1a–1b; 11.4% (n = 5) – pT2a–2b, one patient was present with multiple lesions; 13.6% (n = 6) – pT3a–3b, one patient had up to 15 lesions in a single kidney. Two previously operated patients had cancer of a single kidney with intraluminal invasion. The mean R.E.N.A.L nephrometric score was 10.32 ± 1.34.

RESULTS: The duration of the surgery was 402.07 ± 83.21 minutes. The duration of cold ischemia was 149.9 ± 53.1 minutes. Blood loss – 751.1 ± 633.6 ml. Renal vascular replacement was performed in 13 patients. Postoperative complications >II degree according to Clavien – Dindo were detected in 36.6% (16) of patients. There was only one lethal outcome due to mesenteric thrombosis at day 4. Disease progressed in 6.8% (n = 3) of cases. The GFR level before surgery was on average 72.3 ± 16.8 ml / (min · 1.73 m2), in the early postoperative period – 58.7 ± 28.3 ml / (min · 1.73 m2), 1 year after surgery – 69.4 ± 26.2 ml / (min · 1.73 m2). One year after surgery it was 69.4 ± 26.2 μmol/l. The follow-up period ranged from 8 to 86 months (on average 58.7 ± 19.1 months).

CONCLUSIONS: This technique is effective in patients with multiple foci, centrally located and large tumors, for hard-to-reach localizations, as well as in patients with the impossibility of intracorporeal pharmaco-cold ischemia, peculiarities of organ blood supply.

Urology reports (St. - Petersburg). 2021;11(4):275-284
pages 275-284 views

Predictive value of inflammatory indices LMR, PLR and NLR in patients with muscle-invasive bladder cancer

Gorelov A.I., Zhuravskii D.A., Gorelova A.A.


BACKGROUND: Increasing the efficiency of predicting the results of treatment of patients with bladder cancer is one of the important tasks of modern urology.

AIM: Our aim was to identify and evaluate the association between the most significant clinical, morphological and immunological markers and survival of muscle-invasive bladder cancer patients treated with radical cystectomy. We also developed an algorithm for diagnosis and treatment of patients with muscle-invasive bladder cancer.

MATERIALS AND METHODS: This retrospective study included 100 muscle-invasive bladder cancer patients, who underwent radical cystectomy between 1995 and 2013. The study endpoints were overall survival.

RESULTS: Univariable analysis revealed that continuous (Lymphocyte-monocyte ratio), PLR (platelet-lymphocyte ratio) и NLR (neutrophil-lymphocyte ratio) were significantly associated with overall survival. On multivariable regression model analysis, continuous LMR, NLR, and PLR independently predicted both endpoints.

CONCLUSIONS: Our findings indicate that the cheap and simple blood-based biomarkers may be valuable in identifying muscle-invasive bladder cancer patients treated with radical cystectomy, who are at higher risk of all-cause mortality.

Urology reports (St. - Petersburg). 2021;11(4):285-294
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Antioxidant therapy of male infertility in patients with varicocele

Krupin V.N., Nashivochnikova N.A., Uezdnyj M.N.


BACKGROUND: The study of the relationship between the presence of varicocele and male infertility is the subject of numerous studies, while many aspects of impaired spermatogenesis remain unclear. It has been established that after surgical treatment of varicocele, fertility is not restored in a significant number of patients. In this regard, the search for new and pathogenetically substantiated methods of treating such patients seems to be very relevant.

AIM: To evaluate the effectiveness of antioxidant therapy in spermatogenesis disorders in men with varicocele, prescribed both in combination with surgery and as monotherapy.

MATERIALS AND METHODS: Three groups of infertile men with varicocele were observed, who were treated with Speroton (a complex containing folic acid, L-carnitine, zinc, selenium, vitamin E) 1 sachet once a day, the duration of the course was three months. Patients of the first group (n = 43) were prescribed the drug after the Ivanissevich operation, the patients of the second group (n = 37) received antioxidant therapy during three months before the Ivanissevich operation and continued for three months after it. Patients of the third group (n = 21) did not undergo surgery, but received only antioxidant therapy for six months. The results of the combined treatment and conservative therapy with Speroton were compared with the results of treatment of 65 infertile patients who underwent only Ivanissevich’s operation.

RESULTS: In patients with varicocele with initially pathological parameters of ejaculate, who were prescribed drugs with antioxidant properties in the postoperative period as an adjuvant treatment for 3 months, in 76.7% of cases there was a change in spermogram indicators towards improvement. The most significant changes were observed six months after the operation and subsequent adjuvant therapy. The indicators characterizing sperm motility underwent more noticeable changes. In patients who received only antioxidant therapy for six months, in all cases, there was a statistically significant (p < 0.001) improvement in sperm motility, which persisted for six months and exceeded these changes in groups of patients with adjuvant therapy and neo- and adjuvant therapy.

CONCLUSIONS: The results obtained allow us to conclude that there is no need for surgical treatment for varicocele in order to treat male infertility, since the operation itself can negatively affect the state of spermatogenesis, and conservative antioxidant therapy leads to better results in infertility treatment than the performed operation or any combination of it with antioxidant therapy.

Urology reports (St. - Petersburg). 2021;11(4):294-304
pages 294-304 views

Results of ultrasound dopplerography of the penis in patients with before and after transurethral enucleation of benign prostatic hyperplasia

Vydrin P.S., Kalinina S.N., Korenkov D.G.


BACKGROUND: The development of modern technologies for the surgical treatment of urological diseases poses new questions for urologists. One of them is to evaluate the effect of transurethral enucleation of benign prostatic hyperplasia on the erectile function of patients.

AIM: The aim of the study was to assess the state of erectile function in patients before and after transurethral enucleation of benign prostatic hyperplasia using Doppler ultrasound of the vessels of the penis.

MATERIALS AND METHODS: The study included 102 patients with benign prostatic hyperplasia aged 50 to 80 years (average 65 years) with complaints of erectile dysfunction and urinary disorders. All patients underwent transurethral enucleation of benign prostatic hyperplasia: 55 patients with the laser method (HoLEP, group 1) and 47 patients – with the bipolar method (TUEB, group 2). The severity of ED was assessed using the IIEF-5 questionnaire (International Index of Erectile Function). To assess the state of blood flow in the penis, ultrasound dopplerography of the vessels of the penis was performed using a vasoactive erection stimulator. The studies were carried out before surgery and 24 weeks after it.

RESULTS: The results of ultrasound dopplerography of the vessels of the penis before surgery revealed the arteriogenic type of ED in 18 (17.6%) patients, the venous type – in 45 (44.2%) patients, the mixed arteriovenogenic type – in 22 (21.6%) patients. In 17 (16.7%) patients ED was regarded as psychogenic. 24 weeks after the operation in patients of both the 1st and 2nd groups, according to the data of the IIEF-5 questionnaire, positive dynamics of the severity of erectile function was noted, regardless of the type of ED. For patients with vasculogenic types of ED, similar trends were noted regardless of the type of surgery. Thus, in patients with arteriogenic and arteriovenogenic ED a significant increase in the maximum systolic blood flow velocity (Vmax) in the cavernous arteries was recorded, while the values of the resistance index (RI) did not change significantly. At the same time, the Vmax values in these patients were initially low before the operation, and after the operation did not reach the reference values. In patients with venogenic ED, there was no significant improvement in penile blood flow, as evidenced by the absence of significant differences in Vmax and RI values. At the same time, the RI in these patients before the operation was reduced, and the Vmax values were in the range of normal values.

CONCLUSIONS: The erectile function of patients after transurethral enucleation of benign prostatic hyperplasia improves regardless of the type of operation and the type of erectile dysfunction. Ultrasound dopplerography of the vessels of the penis is a minimally invasive and highly informative diagnostic method that makes it possible to detect circulatory disorders in the penis and assess its state in dynamics during treatment.

Urology reports (St. - Petersburg). 2021;11(4):305-314
pages 305-314 views

Complex conservative therapy of chronic abacterial prostatitis

Neymark A.I., Neymark B.A., Borisenko D.V., Maksimova S.S.


BACKGROUND: Improving the results of treatment of patients with chronic prostatitis is one of the important problems of modern urology.

AIM: To compare the effect of ozone therapy and hypercapnic therapy on the hemodynamics of the prostate and immune status in patients with chronic abacterial prostatitis.

MATERIALS AND METHODS: The study included 58 patients with chronic abacterial prostatitis, who were divided into three groups. Patients of the 1st group (n = 18) received standard therapy. Patients of the 2nd group additionally underwent a course of transrectal ozone therapy for 10 days. Patients of the 3rd group, in addition to the basic therapy, performed training on a breathing simulator to obtain the effect of hypercapnic hypoxia; the course of treatment consisted of 10 daily trainings. The effectiveness of therapy was assessed using the NIH-CPSI questionnaire. To assess the immune status of patients, we studied the content of IgA, IgG and IgM in the blood, the activity of the pro-inflammatory cytokines IL-1β, TNF-α, IL-6 in the blood serum and IL-8 in the urine. The state of blood flow in the prostate gland was assessed using laser Doppler flowmetry, as well as TRUS performed in the color Doppler imaging mode. The control group included 22 healthy men.

RESULTS: In patients with chronic abacterial prostatitis hemodynamic and microcirculatory changes in the prostate gland were revealed, which were accompanied by characteristic clinical manifestations, urinary disorders, as well as impaired immune status in the form of an increase in the content of interleukins and tumor necrosis factor. The use of basic therapy (1st group) helps to reduce the clinical manifestations of chronic abacterial prostatitis, but its effect on the immune status, hemodynamics and microcirculation of the prostate gland is insufficiently expressed. Complex therapy, supplemented by training on a breathing simulator using the effect of hypercapnic hypoxia, has a positive effect on the course of the disease (3rd group). This type of therapy is able to improve the microcirculation of the prostate gland, increasing the index of microcirculation efficiency and average blood flow, reducing the shunting rates, but its effect on immunity is lower than in patients whose treatment included transrectal ozone therapy (2nd group). This type of treatment leads to a decrease in the activity of the pro-inflammatory cytokines IL-1β, TNF-α, IL-6 in the blood serum, and IL-8 in the urine, but at the same time does not have a sufficient effect on prostate hemodynamics and microcirculation.

CONCLUSIONS: In patients with CAP with pronounced disorders of the immune status, complex treatment is indicated, supplemented by transrectal ozone therapy, and in the presence of pronounced hemodynamic disorders of the prostate gland, complex therapy is indicated, supplemented by the use of the effect of hypercapnic hypoxia.

Urology reports (St. - Petersburg). 2021;11(4):315-324
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Physico-biochemical parameters of urine and blood and biominerology of urinary bladder stones in patients with bladder outlet obstruction

Nazarov T.H., Nikolaev V.A., Rychkov I.V., Trubnikova K.E., Izatulina A.R., Abulboqiev U.V., Madumarov D.N.


BACKGROUND: Bladder outlet obstruction is one of the main factors leading to the formation of stones in the urinary bladder. Understanding of the physico-biochemical processes in urine and blood, as well as the biomineralogy of urinary bladder stones, will make it possible to determine the pathogenetically justified treatment of such patients.

AIM: The aim of the study was to identify and study the relationship between the physico-biochemical parameters of urine and blood and the biomineralogical composition of urinary bladder stones in patients with bladder outlet obstruction.

MATERIALS AND METHODS: A comprehensive examination of 76 patients at the age of 37 to 89 years with urinary bladder stones occurred against the background of bladder outlet obstruction was carried out. A comprehensive diagnosis, including an assessment of the physico-biochemical parameters of urine and blood, bacteriological urine tests, radiological diagnostics, as well as biomineralogical studies of concretions, was carried out.

RESULTS: The data obtained show that not all physicochemical parameters of blood and urine of the subjects are comparable with the data of patients with nephrolithiasis. In the vast majority of the studied kidney calculi were not detected, in addition, blood biochemical parameters, including the level of stone-forming substances were within the reference values. In urine tests an increase in some lithogenic substances is detected. Urinary stones in patients with bladder outlet obstruction had a mixed composition, more often phosphates and uric acid salts were detected (75 and 54% of cases, respectively). Considering the nature of metabolism and the increase in uric acid excretion with age, as well as the presence of residual urine in case of bladder outlet obstruction, it can be assumed that uric acid is the primary matrix in cystolithiasis. The data obtained indicate a connection between the infectious process in the bladder and the composition of urinary stones. Against this background, there is a more intensive process of cystolithogenesis.

CONCLUSIONS: The algorithm for the diagnosis of urinary bladder stones secondary to bladder outlet obstruction should include not only the collection of anamnesis and the performance of routine blood and urine tests, but also specific physical and biochemical studies, as well as assess the biomineralogy of urinary stones, which will make it possible to choose an adequate tactics for the pathogenetic treatment of patients and effective metaphylaxis of stone formation.

Urology reports (St. - Petersburg). 2021;11(4):325-334
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Efficacy evaluation of entomological drug Adenoprosin® usage in combined treatment of patients with lower urinary tract symptoms due to benign prostate enlargement

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


BACKGROUND: Increasing the effectiveness of treatment of patients with symptoms of the lower urinary tract is one of the main problems of modern urology, which is associated both with their high prevalence and with a significant deterioration in the quality of life of patients.

AIM: The article presents the results of the usage of the entomological drug Adenoprosin® in the combined treatment of patients with lower urinary tract symptoms due to benign prostatic enlargement.

MATERIALS AND METHODS: 80 patients were treated (mean age 63.6 ± 6.4 years). At the initial phase of the study, all patients received Tamsulosin 0.4 mg once a day for 4 weeks. At the second phase, the patients were divided into two groups. Group 1 patients were prescribed a combination therapy with Adenoprosin (1 rectal suppository (150 mg) at night, for a course of 30 suppositories) and Tamsulosin (0.4 mg per day). Patients of the 2nd group continued monotherapy with Tamsulosin (0.4 mg per day). The duration of the second phase of treatment was 4 weeks.

RESULTS: The results of the study showed a more pronounced positive dynamics of clinical indicators in patients of the 1st group, who received combination therapy with Adenoprosin and Tamsulosin, compared to patients of the 2nd group. There was a more pronounced decrease in the IPSS score, an improvement in the quality of life, an increase in the urine flow rate and a decrease in the volume of residual urine. The volume of the prostate gland did not change significantly. When examined 2 weeks after the end of treatment, the positive dynamics of clinical indicators in patients of the 1st group persisted. The tolerability of the treatment was satisfactory in patients of both groups.

CONCLUSIONS: The results of the study indicate the advisability of including Adenoprosin in the combination therapy of patients with lower urinary tract symptoms due to benign enlargement of the prostate gland.

Urology reports (St. - Petersburg). 2021;11(4):337-344
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Extracorporeal magnetic stimulation in urology

Amdiy R.E., Al-Shukri S.K., Kuzmin I.V., Makeev V.A., Sozdanov P.V.


The review article is devoted to the usage of extracorporeal magnetic stimulation in the treatment of urological diseases. Based on the analysis of scientific publications in the PubMed, Medscape, Google Scholar databases, modern data on the mechanism of the therapeutic effect of this method, the method of performing the procedure, the results of clinical studies of its effectiveness in the treatment of urinary incontinence, bladder hypoactivity, chronic pelvic pain syndrome, erectile dysfunction and premature ejaculation are presented.

Urology reports (St. - Petersburg). 2021;11(4):345-353
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Photodynamic methods of treatment of nonmuscular-invasive bladder cancer

Kasymov B.G., Shanazarov N.A., Muratov T.M., Daniyarova G.D., Zhumakayev A.M., Kyzlasov P.S., Kazhera A.A., Slesarevskaya M.N., Kuzmin I.V., Al-Shukri S.K.


The review article is devoted to the application of photodynamic therapy for non-muscle invasive bladder cancer. The data on the mechanism and pathogenetic bases of the application of this method of treatment, the method of its implementation, the advantages and disadvantages of the photosensitizers and the results of clinical studies are presented. It has been shown that intraoperative photodynamic therapy significantly reduces the rate of recurrence of bladder cancer after transurethral resection, including in patients with carcinoma in situ and multifocal growth of urothelial tumors.

Urology reports (St. - Petersburg). 2021;11(4):355-363
pages 355-363 views

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