Vol 8, No 2 (2018)


Botulinum toxin type A in the treatment of bladder pain syndrome in women: initial results

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


We present the results of botulinum toxin type A (BT-A) treatment in 49 women (aged 41–65 years) with bladder pain syndrome. Previously, all patients underwent oral and intravesical drug therapy in addition to hydrodistention of the bladder without significant clinical effect. BT-A at a dose of 100 U (20 points at 5 units) was injected into the bladder under general anesthesia. Treatment results were evaluated 3 months after the treatment using specialized questionnaires such as the Pelvic Pain and Urgency/Frequency (PUF) Scale, O’Leary-Sant Symptom Index and Interstitial Cystitis Scale, visual analogue pain scale (VAS), and urinary diaries. Remarkably, the treatment was effective in 46 (93.8%) patients. By the end of the third month after the BT-A injection, the PUF Scale score, the O’Leary-Sant Symptom and Interstitial Cystitis Scale, and VAS reduced by 41.3%, 32%, and 34%, respectively, and urination frequency decreased by 38.5%. Thus, BT-A is an effective method for treating bladder pain syndrome in patients who are refractory to other treatment methods.

Urology reports (St. - Petersburg). 2018;8(2):5-10
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Pathophysiology of the cortico-sympathoadrenal system in the postoperative period of partial nephrectomy

Shormanov I.S., Los M.S.


Introduction. Organ-preserving kidney surgeries are widespread in urological practice. Any surgical intervention triggers a cascade of reactions in the body that are characteristic of stressful situations, which adversely affects blood flow volume in the parenchymal organs, worsens microcirculation, and reduces the trophic and reparative abilities of organs. The application of anti-ischemic protection is an essential part of patient rehabilitation to maintain renal function.

Objective. To investigate the nephroprotective properties of α-tocopherol acetate (a-TA) and its effect on α-tocopherol acetate (a-TA) parameters of the cortico-sympathoadrenal system following organ-preserving kidney surgery.

Material and methods. An experimental study was performed on 70 white laboratory rats, 10 of which were not subjected to surgical treatment. Sixty rats underwent lower pole left kidney superimposition with Z-joints. Postoperatively, 30 rats were intramuscularly injected with a 10% oil solution of 0.2 mL a-TA twice a day for 5 days. The cortico-sympathoadrenal system parameters were determined on the 7th, 14th, and 28th days. Results. Postoperative administration of a-TA resulted in early normalization of the cortico-sympathoadrenal system.

Conclusion. The studied indices regar ding the tissue of the operated kidney are responsible for regulating vascular tone, severity of the inflammatory response, microcirculation, and reparative processes. The use of a-TA accelerates recovery from organ-preserving surgery and biochemical abnormalities.

Urology reports (St. - Petersburg). 2018;8(2):11-17
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Use of mineral water in rehabilitation therapy of patients with nephrolithiasis

Nejmark A.I., Saldan I.P., Davydov A.V.


Background. Study of alternative non-pharmacological methods of rehabilitation therapy is an actual task in the direction of preventive and restorative medicine. An important role in rehabilitation measures in preventing urolithiasis relapse is therapy using balneological therapeutic methods.

The aim of the study was to perform a clinical and laboratory analysis of the effectiveness of mineral water “Serebrjanniy kluch” (Silver Rill) in rehabilitation therapy for patients with urolithiasis.

Materials and methods. The study is based on the results of survey data analysis and treatment of 36 patients with urolithiasis. All patients were randomized into two groups: the first (control) group comprised 17 patients who received standard conservative therapy (antispasmodics and analgesics) and fresh drinking water and the second (main) group comprised 19 patients who received standard conservative therapy and mineral drinking water “Serebrjanniy kljuch” at 5 ml/kg of body weight per serving, at 18°C-25°C for 30-40 minutes before meals 4 times a day in an outpatient setting.

Results. In the second group, self-sustained calculus removal was recorded in 78.9% of cases, and there was an increase in daily diuresis in all patients, a decrease in the excretion of oxalate and uric acid in daily urine by 52.3% and 49.9%, respectively, and decrease and normalization of lactate dehydrogenase, leucine aminopeptidase, and N-acetyl-β-D-glucosaminidase concentrations were 28.3%, 24.5%, and 12.5% (p < 0.05), respectively. In addition, the decrease and normalization of the accumulation time indicators were registered 2.7 times (p < 0.05), the half-life period was 2.1 times (p < 0.05), and the glomerular filtration rate increased by 60.1% (p < 0.05) with simultaneous improvement in microcirculation of the kidneys.

Conclusions. Consuming mineral water “Serebrjanniy kljuch” as a part of rehabilitation therapy of patients with urolithiasis positively influences the clinical course of the disease, helps reduce the excretion of oxalates and uric acid in daily urine, reduces enzymes, and leads to an increase in daily diuresis.

Urology reports (St. - Petersburg). 2018;8(2):18-23
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Surgical treatment of Peyronie disease

Kalinina S.N., Fesenko V.N., Nikolskii A.V., Burlaka O.O.


We present the results of operative treatment of 25 men with Peyronie disease. Indications for surgical treatment included plaques > 1.5 cm and a penile curvature angle > 45°. In total, 11 patients underwent plaque plication of the penis following the method of P.A. Shcheplev, 5 patients underwent substitutive corporoplasty of plaque using the large saphenous vein of the thigh, 5 patients underwent patchwork сorporoplasty using xenopericardium, and 4 patients underwent corporoplasty using buccal mucosa graft. The results of the operative treatment of all patients were considered positive. In conclusion, operative treatment of patients with Peyronie disease undergoing corporoplasty replacement is indicated for plaque stabilization, particularly while using xenopericardium.

Urology reports (St. - Petersburg). 2018;8(2):24-29
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Prevalence of sexually transmitted diseases among men from infertile couples

Korneyev I.A., Zasseev R.D., Shevchuk I.G., Pelipejchenko A.A.


Introduction. Sexually transmitted diseases (STDs) can potentially disrupt male fertility; however, the prevalence data for STDs among men from infertile couples is controversial.

Aim. The aim of the study was to estimate the prevalence of STDs among men from infertile couples seeking medical assistance in an assisted reproductive technology clinic.

Materials and methods. We retrospectively studied the medical records of 307 men (mean age: 35 ± 15 years) conse cutively attending an outpatient reproductive clinic for infertility treatment. Duration of the infertile period varied from 4 to 228 months (mean: 38 ± 12 months). We collected urethral swab specimen to investigate the presence of Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma, and Ureaplasma species in 235 (76.5%), 232 (75.6%), 270 (87.9%), 301 (98.1%), and 300 (97.7%) men, respectively. Blood tests for syphilis, hepatitis B and C, human immunodeficiency virus (HIV), human herpesvirus (HHV), and cytomegalovirus (CMV) were conducted in 229 (74.6%), 224 (73%), 227 (73.9%), 230 (74.9%), 233(75.9%), and 232 (75.6%) men, respectively, and statistical analysis of the data was performed.

Results. Remarkably, all tests were negative in 94 (30.6%) men, and no patient had T. vaginalis or C. trachomatis infection. However, N. gonorrhoeae, Mycoplasma, and Ureaplasma were detected in 1 (0.4%), 6 (2.6%), and 14 (4.7%) men, respectively. Syphilis, hepatitis B and C, HIV, HSV, and CMV tests were positive in 1 (0.4%), 2 (0.9%), 6 (2.6%), 1(0.4%), 177 (76%), and 133 (57%) men, respectively.

Conclusions. The prevalence of STDs is high among men from infertile couples. Further studies are warranted to investigate the relationship between STDs and male infertility.

Urology reports (St. - Petersburg). 2018;8(2):30-35
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Current treatment methods for sarcopenia in patients undergoing hemodialysis

Jakovenko A.A.


Aim. To evaluate the effectiveness of combined post-dilution online hemodiafiltration therapy and ketoanalogue amino acid medications at a dose of 0.2 g/kg of ideal body weight/day for sarcopenia-correcting interventions in patients on hemodialysis with adequate intake of essential nutrients.

Materials and methods. In total, 645 patients undergoing hemodialysis were examined. Nutritional status of all patients was evaluated to identify pre-sarcopenia and sarcopenia. In addition, leptin and interleukin-6 serum levels were determined. The patients with signs of sarcopenia were divided into three groups depending on the treatment method.

Results. We demonstrated the effectiveness of combined post-dilution online hemodiafiltration therapy and ketoanalogue amino acids at a dose of 0.2 g/kg of ideal body weight/day for correction of sarcopenia in patients on hemodialysis.

Conclusion. Combined therapy with post-dilution online hemodiafiltration therapy and ketoanalogue amino acids at a dose of 0.2 g/kg of ideal body weight/day is regarded as a pathogenetically grounded method for correction of sarcopenia in patients on hemodialysis with adequate intake of essential nutrients.

Urology reports (St. - Petersburg). 2018;8(2):36-42
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Medical and social rehabilitation following testicular prosthesis in post-orchiectomy patients

Shormanov I.S., Shchedrov D.N.


Aim. The aim of this study was to optimize indications and techniques and to develop the optimal timing for testicular prosthesis following inversion in adolescence considering the assessment of quality of life of patients at different times following the surgery.

Materials and methods. We observed 70 patients with gonadal loss following critical ischemia (torsion) at ages 11-18 years (average, 15.5 ± 2.3 years). In total, 49 patients underwent joint replacement after orchiectomy due to torsion. In 21 patients, prosthetics were preceded by orchiectomy for testicular atrophy as a result of twis ting. The interval from an acute episode to joint replacement ranged from 6 months to 15 years. Three techniques for testicular prosthesis implantation were applied: prosthetics with inguinal access without suturing the scrotal entrance (n = 14); prosthetics with inguinal access with suturing the scrotal entrance by the originally developed technique (n = 34); and a prosthetic scrotum (n = 22). Patient satisfaction was assessed based on the different outcomes of testicular inversion according to the originally developed questionnaire.

Results. Suturing the scrotal entrance reduces the risk of implant migration in the proximal direction due to anatomical prerequisites. Scrotal access does not have this drawback but increases the risk of inflammatory complications. The esthetic result of prosthetics depends on patient’s age during orchiectomy. Older patients tend to have better cosmetic results. The most favorable results of prosthetics are noted at the time that has passed since the turn – no more than 3 years; all unsatisfactory results are noted at the time of more than 5 years since the twist. Testicular prosthesis increases social adaptation of patients after gonadal loss and improves their quality of life.

Conclusions. 1. Testicular prosthesis is an essential stage of patient rehabilitation after an orchiectomy for inversion. 2. Prosthetic inguinal access by the originally developed technique is optimal from a technical perspective and provides the most physiological standing of the implant. 3. Prosthetics results directly depend on the period following the initial operation. 4. Testicular prosthesis complications can be minimized with the accumulation of knowledge and surgical experience and their rational prevention. 5. Assessment of patients’ quality of life illustrates the necessity of gonadal prosthetics for cosmetic compensation of organ loss and psycho-emotional and social rehabilitation

Urology reports (St. - Petersburg). 2018;8(2):43-52
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Arteryovenous conflicts in men with urological pathology

Kapto A.A.


For the present study, we analyzed previously known and current data on arteriovenous conflicts in men from the perspective of urologists and andrologists. The least studied and controversial decision-making position was for iliac venous compression and pelvic varicose veins in men. The data testify to the need to revise the traditional and generally accepted positions for managing varicocele.

Urology reports (St. - Petersburg). 2018;8(2):53-63
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A review of the PD-1/PD-l1 checkpoint in bladder cancer: from mediator of immune escape to target for treatment

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


Treatment of bladder cancer has evolved over time to include the traditional modalities of chemotherapy and surgery, and it has been greatly impacted by the use of immunotherapy. Modern immunotherapy focuses on checkpoint protein inhibitors, which are molecules impeding immune function, thereby allowing unregulated tumor cell growth and proliferation. Several immune checkpoint targets (programmed death ligand-1 [PD-L1], programmed cell death protein-1 [PD-1], and cytotoxic T-lymphocyte-associated protein 4 [CTLA-4]) have received the most attention in the treatment of bladder cancer, whereas inhibitor agents have either been approved or are in late-stage development. This review describes the most recent data on PD-L1-inhibiting agents, found on the surface of tumor cells, and PD-1, found on activated T and B cells and macrophages. Aim. A review of modern PD-1 and PD-L1 inhibitors as target immunotherapeutic agents for the treatment of bladder cancer.

Materials and methods. We performed a comprehensive literature review using MEDLINE/PubMed and EMBASE.

Results. The PD-1/PD-L1 pathway is possibly manipulated by cancer cells to suppress the immune system. PD-1/PD-L1 blockade has been tested in clinical trials for various malignancies, including metastatic urothelial carcinoma, with significant response rates and limited adverse effects. PD-L1 expression has mixed results as a prognostic marker for bladder cancer.

Conclusions. PD-1 is a key receptor mediating immune escape, and agents targeting its ligand, PD-L1, have already been successful in patients with metastatic urothelial cancer. Further research is warranted to standardize the criteria for PD-L1 positivity and to optimize its use in the treatment of bladder cancer.

Urology reports (St. - Petersburg). 2018;8(2):64-72
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Lohg-term results of cystectomy and bilateral ureterosigmoidostomy in patients with bladder eхstrophy

Uchvatkin G.V., Kapustin N.G., Erokhina N.D., Kuzmin I.V.


In this case report, we present the long-term results of cystectomy and bilateral ureteral and sigma anastomosis performed due to bladder exstrophy in a 1-year-old patient. Purulent pyelonephritis of the single functioning kidney was diagnosed 36 years after the surgery, leading to the need for nephrectomy and chronic hemodialysis.

Urology reports (St. - Petersburg). 2018;8(2):73-76
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