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Vol 12, No 2 (2022)

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Original articles

Prevalence and predictors of incidence of urolithiasis in a representative region

Streltsova O.S., Krupin V.N., Lazukin V.F., Pochtin D.P., Khalili V.D., Manakova E.A.


BACKGROUND: Domestic and foreign studies have shown the presence of correlations between the prevalence of urolithiasis, anthropogenic factors, and composition of the water consumed by the population. In the Nizhny Novgorod Region, there is a high incidence of urolithiasis; thus, the identification of its causes appears to be an urgent task.

AIM: To assess the prevalence and identify predictors of the incidence of urolithiasis in the rural population of the Nizhny Novgorod Region.

MATERIALS AND METHODS: The study was conducted in the Nizhny Novgorod Region. Annual reports of patients seeking medical care for urolithiasis for 3 years in 49 central district hospitals and two large regional hospitals were analyzed. The incidence rate of urolithiasis was calculated according to the treatment of patients with urolithiasis also for 3 years in relation to the population of each district. Information about drinking sources was obtained by questioning 800 patients with urolithiasis who were treated at the Nizhny Novgorod Regional Clinical Hospital. The chemical composition of drinking water was assessed in accordance with the requirements for drinking water SanPiN The mineralogical composition of 1000 urinary stones of patients from rural areas of the Nizhny Novgorod Rregion was retrospectively analyzed using a Nicolet iS5 IR-Fourier spectrometer.

RESULTS: In this study, 38 (77.5%) districts of the Nizhny Novgorod Region have unfavorable conditions for urolithiasis. Moreover, 59.5% of the rural population are using water from underground sources (wells). Significant correlations were found between the incidence of urolithiasis and the chemical composition of the water consumed, particularly water hardness. The analysis of the mineralogical composition of urinary stones showed their polycomponent composition in 89.5% of the cases. Differences in the chemical composition of stones are associated with the environmental factors of the region, one of which is drinking water.

CONCLUSIONS: Most of the rural population of the Nizhny Novgorod Region is at risk for urolithiasis. Significant differences in the incidence of urolithiasis were dependent on the degree of hardness of the groundwater used for drinking. Increased water hardness is a significant risk factor for the development of urolithiasis.

Urology reports (St. - Petersburg). 2022;12(2):105-116
pages 105-116 views

Retrograde intrarenal surgery in patients with high-density stones

Tursunov A.I., Nazarov T.K., Rychkov I.V.


BACKGROUND: Retrograde intrarenal lithotripsy is a modern method of endoscopic treatment of patients with nephrolithiasis, whereas some aspects of its use remain the subject of discussion.

AIM: To reveal the advantages and disadvantages of retrograde intrarenal lithotripsy in patients with nephrolithiasis having high-density calculi.

MATERIALS AND METHODS: A retrospective and prospective analysis of treatment of 260 clinical cases of high-density kidney stones by transurethral contact pyelocalicolithotripsy was conducted. In all patients, kidney calculi were diagnosed and detected, ranging in size from 8 to 20 mm (average 15.4 mm) and density from 1105 to 1634 HU. Patients were divided into the main group and control group and further into two subgroups according to the lithotripsy method. The main group underwent transurethral contact pyelocalicolithotripsy according to our improved method and the control group according to the standard method. The main subgroup of ultrasonic lithotripsy and the control subgroup included 80 and 50 patients, respectively. The main subgroup of laser lithotripsy and the control subgroup included 50 and 80 patients, respectively.

RESULTS: In 223 (85.8%) patients, it was possible to completely crush the calculi and eliminate them from the urinary tract. The stone-free rate in the main group was 96.9% (126 patients) after the first operation, including 96.2% (n = 77) in the ultrasonic lithotripsy subgroup and 98% (n = 49) in the laser lithotripsy subgroup. In the control group, the SFR value was 74.6% (n = 97), including 72% (n = 36) in the ultrasonic lithotripsy subgroup and 83.2% (n = 61) in the laser lithotripsy subgroup. Intra- and postoperative complications were observed in 74 (28.5%) patients, and none had grade IV and V complications according to the adapted Clavien–Dindo classification. The frequency of complications was significantly lower in the main group and those who underwent laser lithotripsy. The relationship of postoperative complications with intraoperative damage to the structures of the pelvicalyceal system of the kidney has been established.

CONCLUSIONS: Transurethral contact pyelocalicolithotripsy is an effective and relatively safe method of treating patients with nephrolithiasis having high-density calculi. The proposed improved surgical intervention has advantages over traditional methods.

Urology reports (St. - Petersburg). 2022;12(2):117-126
pages 117-126 views

Features of compensatory and adaptive reactions of the vascular bed of the bladder of elderly and senile men with prostatic hyperplasia

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


BACKGROUND: Bladder outlet obstruction caused by prostatic hyperplasia eventually leads to detrusor working hypertrophy, and its development is impossible without synchronous remodeling of its vascular bed. Taking into account the age-associated nature of the disease, bladder transformation occurs following involutive structural changes of both the organ and its vascular system due to natural aging. To date, morphological features of compensatory reactions of the vascular bed, taking into account background age-related changes in the bladder wall, is not fully disclosed.

AIM: To investigate the structural transformations of the bladder and its vascular bed in elderly and senile persons with prostatic hyperplasia and to determine the significance of vascular restructuring in providing compensatory detrusor hypertrophy.

MATERIALS AND METHODS: Autopsy material from 35 men aged 60–80 years who died from diseases not related to urological and cardiovascular pathology was examined, as well as those from 25 men of the same age who had prostatic hyperplasia without signs of bladder decompensation. The control group included 15 men aged 20–30 years who died as a result of injuries. A complex of histological, morphometric and immunohistochemical methods was used

RESULTS: In patients with prostatic hyperplasia, there is a violation of the histoarchitectonics of the bladder, which is expressed in the development of focal detrusor hypertrophy, layering on the existing involutive changes, which are characterized by the atrophy of muscle fibers, sclerosis of the intermuscular stroma, defragmentation of the elastic frame, and neurodegenerative processes. A similar state of the detrusor is caused by sclerosis and hyalinosis of small arteries and arterioles, hypertrophy and hyperelastosis of large arteries associated with arterial hypertension, combined with atherosclerosis of extraorganic arteries. Moreover, a complex is formed in the vascular basin of the bladder that can regulate blood transport in conditions of increasing chronic ischemia and provide a normal blood supply to the preserved parts of the detrusor that can undergo hypertrophy with an increase in functional impairment. These structures include intimate muscles, muscular elastic sphincters, polypoid cushions of the conti arteries, muscle “couplings,” muscle rollers, and vein valves.

CONCLUSIONS: Structural changes in the bladder are characterized by a combination of focal detrusor atrophy resulting from angiosclerosis and development of hypertrophy of preserved areas with an increase in functional load. The hypertrophic potential of the detrusor is attributed to vascular regulatory structures.

Urology reports (St. - Petersburg). 2022;12(2):127-135
pages 127-135 views

Molecular mechanisms modulating hemostasis and development of acute pyelonephritis after contact ureteral lithotripsy

Barinov E.F., Malinin Y.Y.


BACKGROUND: Improving the efficiency and reducing the frequency of complications of surgical treatment of urolithiasis is an actual problem in urology.

AIM: To establish the molecular mechanisms that modulate the hemostasis and development of acute pyelonephritis after percutaneous contact ureteral lithotripsy.

MATERIALS AND METHODS: The study included 21 patients with urolithiasis and concretions in the upper third of the ureter in whom, after standard lithokinetic therapy for 7 days, according to imaging control data, the calculus did not move from the pyelo-ureteral zone to the middle third of the ureter. All patients underwent contact ureteral lithotripsy. After the operation, nonsteroidal anti-inflammatory drugs and antibiotics were used for 2 days. The severity of hematuria and leukocyturia was assessed 24, 48, and 72 h after contact ureteral lithotripsy. Functional activity receptors were analyzed in vitro on a platelet suspension. Platelet aggregation was assessed by the turbidimetric method using a ChronoLog analyzer (USA).

RESULTS: At 24, 48, and 72 h after contact ureteral lithotripsy, a significant decrease was found in the severity of microhematuria (p < 0.001). The leukocyturia level decreased over 48 h (p < 0.05) and increased 72 h after surgery (p < 0.001). The above dynamics of complications after hours indicates that two pathological processes simultaneously develop in the ureteral mucosa: induction of thrombogenesis and modulation of an acute inflammatory reaction. Аfter 24 h of NSAID discontinuation (3 days after contact ureteral lithotripsy), normoreactivity of the α2-adrenergic receptors, GPVI receptors, AT1 receptors, PAF receptors, P2X1 receptors, and A2A receptors was found, as well as hyporeactivity of purine P2Y receptors and β2-adrenergic receptors. The correlation between the severity of hematuria and the activity of GPVI receptors for collagen, α2-adrenergic receptors for adrenaline, and AT1 receptors for angiotensin-2 (p < 0.05) makes it possible to specify the possible interaction of platelet receptors that maintain hemostasis during inhibition of the COX–TxA2 axis. Maintaining the severity of pyelonephritis after contact ureteral lithotripsy is associated with the interaction of the PAF receptors, purine ionotropic P2X1 receptors, and α2-adrenergic receptors on blood cells.

CONCLUSIONS: The analysis of targets — receptors on platelets and leukocytes after contact ureteral lithotripsy in the upper third of the ureter with ineffective lithokinetic therapy—allows us to outline ways to improve conservative therapy to limit the development of postoperative complications.

Urology reports (St. - Petersburg). 2022;12(2):137-145
pages 137-145 views

Tadalafil-SZ in the treatment of premature ejaculation in young age men: a comparative placebo-controlled study

Al-Shukri A.S., Kostyukov S.V., Maksimova A.V., Pygamov K.G., Dubinsky V.Y.


BACKGROUND: The frequency of occurrence reaches premature ejaculation (PE) in young men reaches 30%. Increasing the effectiveness of treatment of patients with PE is one of the important problems of urology.

AIM: Evaluation of the effectiveness of treatment of young patients with premature ejaculation with the phosphodiesterase 5-type inhibitor Tadalafil-SZ in monotherapy and in combination with behavioral therapy, as well as its comparison with the appointment of only behavioral therapy and placebo.

MATERIALS AND METHODS: We observed 70 men with premature ejaculation aged 18 to 25 years. All patients were divided into 4 groups. Patients of the 1st group (n = 20) were prescribed Tadalafil-SZ at a dose of 5 mg once a day as monotherapy, patients of the 2nd group (n = 20) received behavioral therapy according to the “start–stop” method; patients of the 3rd group (n = 20) were prescribed a combination therapy with Tadalafil-SZ at a dose of 5 mg per day together with the “start–stop” behavioral technique; patients of the 4th group (n = 10) were prescribed a placebo. The duration of treatment is 30 days. Control examinations were performed before the start of treatment, immediately after its completion and 2 months after the end of therapy. To assess ejaculatory function the PEDT and AIPE questionnaires were used, as well as the IELT test.

RESULTS: After the end of the 30-day course of treatment in patients of the 1st and 3rd groups, a significant increase in the duration of sexual intercourse by 2–2.5 times was noted compared with the values before treatment, as well as with the values in patients of the 4th group who received placebo. In patients of the 2nd group, we did not notice significant changes in comparison with the indicators before treatment in terms of the total scores of the PEDT questionnaire and the results of the IELT test, however, an increase in the total scores of the AIPE questionnaire was found. In patients of the 4th control group, there was no improvement in any of the tests performed. 2 months after the end of treatment, patients of the 1st group noted a return to the initial duration of sexual intercourse. The effect of the treatment was noted only in patients of the 3rd group, in whom during the control examination after 2 months the duration of sexual intercourse was significantly higher compared to the initial values before the start of treatment.

CONCLUSIONS: The results of the study indicate the high efficiency of the phosphodiesterase 5-type inhibitor Tadalafil-SZ in the treatment of patients with premature ejaculation. The best results of treatment were achieved with the combined use of drug and behavioral therapy.

Urology reports (St. - Petersburg). 2022;12(2):147-155
pages 147-155 views


Microbiome and urine microbiota: modern concepts and gender features

Slesarevskaya M.N., Kuzmin I.V., Zhumadillayev K.G., Vvedenskiy G.A., Mikheev Y.А., Maksimova A.V.


The review article provides definitions and presents current data on the biological significance of the microbiome and microbiota of urine. The urinary microbiota is less well understood than the intestinal microbiota, but its biological role is complex and multifaceted. To date, its importance in the formation of colonization resistance, which prevents the invasion of uropathogens, is obvious. An analysis of methods for assessing the microbiome and microbiota of urine was carried out. The shortcomings of widely used standard microbiological research methods are shown. The method of 16S rRNA gene sequencing is described in detail. Information about the gender characteristics of the urine microbiota and the results of its study in healthy women and men are given. Further progress in the study of the urobiome is associated with the acquisition of new technologies for genomic research and the development of bioinformatics.

Urology reports (St. - Petersburg). 2022;12(2):157-165
pages 157-165 views

Case reports

Robot-assisted partial nephrectomy with calicolithotomy

Mosoyan M.S., Shanava G.S., Simonyan A.M., Aysina N.A.


The combination of renal cell carcinoma and urolithiasis in the same kidney is rare. The management of patients who have two such diseases simultaneously is primarily determined by renal cell carcinoma as the dominant disease. To date, modern diagnostic and surgical technologies make it possible to perform partial nephrectomy with simultaneous removal of a calculus from the pelvicalyceal system using minimally invasive endovideosurgical methods.

This study aimed to demonstrate the possibility of performing robot-assisted nephrectomy with calicolithotomy in a patient with abnormalities of renal vessels.

This work presents a clinical case of a 36-year-old man hospitalized with a neoplasm of the right kidney measuring 38 × 35 × 35 mm, detected during multislice computed tomography. In the lower group of calices of the kidney, a 5 × 4 mm calculus with a density of 1200 HU was found. The presence of anomalies of the renal vessels served as the basis for a three-dimensional (3D) reconstruction of the right kidney using the 3D Slicer modeling program. The patient underwent a robot-assisted kidney resection with calicolithotomy on a da Vinci SI robot. Intraoperatively, an ultrasound examination of the kidney was performed using an intracavitary sensor BK Flex Focus 800.

The console operating time of the operating surgeon was 110 min. Blood loss was approximately 100 ml. The warm ischemia time was 20 min. The postoperative period proceeded without complications. At 3 weeks postoperatively, nephrogenic arterial hypertension disappeared. Laboratory studies conducted 3 months after surgery indicated an increase in the glomerular filtration rate compared with preoperative results.

3D reconstruction allows rational planning of the scope of surgical intervention during preoperative preparation. Kidney resection with calicolithotomy is optimally performed using the da Vinci robot, which allows complex surgical techniques to be performed using endovideosurgical methods.

Urology reports (St. - Petersburg). 2022;12(2):167-173
pages 167-173 views

Percutaneous methods for the treatment of urothelial tumors of the pyelocaliceal system (case report and literature review)

Popov S.V., Orlov I.N., Suleimanov M.M., Topuzov T.M., Perfiliev M.A., Gavrilov V.Y., Mayorov I.D.


Urothelial carcinoma is one of the most common solid malignancies. Moreover, urothelial cancer of the ureter of a single kidney is a rare entity that requires nephron-sparing treatment and carries a high risk of postoperative recurrence. An analysis of the literature on this disease was conducted using the databases of PubMed, Scopus, and Web of Science for the period from 2011 to 2022. A clinical case of recurrence of urothelial cancer of the pyelocaliceal system of the kidney in a 73-year-old patient was presented. For the primary tumor, the patient underwent percutaneous laser en bloc resection on the narrow base of the tumor. In case of recurrence, given the acute angle of attack and the wide tumor base, bipolar loop resection became necessary. This clinical observation demonstrates the need for logistical equipment with laser, mono- and bipolar energy sources, and flexible nephroscopes for the most effective and personalized treatment.

Urology reports (St. - Petersburg). 2022;12(2):175-183
pages 175-183 views

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