Vol 12, No 2 (2022)

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 2.1.4.1074-01. 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.

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.

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 1^st group (n = 20) were prescribed Tadalafil-SZ at a dose of 5 mg once a day as monotherapy, patients of the 2^nd group (n = 20) received behavioral therapy according to the “start–stop” method; patients of the 3^rd 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 4^th 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 1^st and 3^rd 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 4^th group who received placebo. In patients of the 2^nd 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 4^th control group, there was no improvement in any of the tests performed. 2 months after the end of treatment, patients of the 1^st group noted a return to the initial duration of sexual intercourse. The effect of the treatment was noted only in patients of the 3^rd 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.

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.

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.