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Vol 12, No 4 (2022)

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Original articles

Local recurrences after radical cystectomy in bladder cancer patients

Komyakov B.K., Saad A.E., Fadeev V.A., Al-Attar T.H., Sergeev A.V.


BACKGROUND: Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer and superficial neoplasms in cases of resistance to intravesical immunochemotherapy.

AIM: To establish the frequency of local pelvic recurrence in patients with bladder cancer after radical cystectomy.

MATERIALS AND METHODS: From 1997 to 2022 radical cystectomy was performed in 407 patients with bladder cancer: 344 (84.5%) men and 63 (15.5%) women. Orthotopic urinary diversion methods were performed in 302 (74.2%) patients, including gastrocystoplasty — 24 (5.9%), ileocystoplasty — 253 (63.8%) and sigmocystoplasty — 25 (6.1%) patients. Continent skin diversion of urine was performed in 13 (3.2%) patients, ureter transplantation into the sigmoid colon — in 42 (10.3%) patients, and ureterocutaneostomy — in 50 (12.3%) patients.

RESULTS: Local recurrence in the pelvis after radical cystectomy was observed in 33 (8.1%) patients: 27 (81.8%) men and 6 (18.2%) women. The average age of men with relapses was 58.7 ± 11.7 years (from 43 to 73 years), women — 50.0 ± 7.8 years (from 24 to 65 years). Simultaneous metastatic lesions of internal organs were detected in 6 (18.2%) patients. Local pelvic recurrence after radical cystectomy occurred more often in lymphopositive patients with extravesical spread of the primary low-grade tumor. The median time from radical cystectomy to detection of pelvic recurrence was 7.0 months, from the moment of detection of pelvic recurrence to the death of the patient — 4.5 months.

CONCLUSIONS: The frequency of local pelvic recurrence of bladder cancer after radical cystectomy is 8.1%. The survival rate of patients with local pelvic recurrence is extremely low.

Urology reports (St. - Petersburg). 2022;12(4):269-276
pages 269-276 views

Multi-stage surgery for anterior urethral strictures: assessment of immediate and long-term surgical outcomes

Kogan M.I., Glukhov V.P., Ilyash A.V., Mitusov V.V., Vasilyev O.N.


BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations.

AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures.

MATERIALS AND METHODS: The study included 110 men aged 18–84 years who underwent multi-stage urethroplasty for the anterior urethral structures in 2010–2019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months.

RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases.

CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.

Urology reports (St. - Petersburg). 2022;12(4):277-286
pages 277-286 views

Comparative evaluation of the effectiveness and safety of different dosages of Glancin (tamsulosin) in the treatment of patients with lower urinary tract symptoms due to benign prostatic hyperplasia

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


BACKGROUND: Alpha-blockers are the first-line treatment for the elimination of symptoms of impaired urination due to benign prostatic hyperplasia. At the same time, the focus is not only on efficiency, but also on the safety of their appointment.

AIM: Comparison of the efficacy and tolerability of the alpha1-blocker tamsulosin at a dosage of 0.2 mg twice a day and 0.4 mg once a day in patients with benign prostatic hyperplasia presenting with mild to moderate LUTS.

MATERIALS AND METHODS: The study is based on the results of examination and treatment of 90 patients with symptoms of impaired urination in benign prostatic hyperplasia, aged 50 to 80 years. In the 1st group (n = 45) patients received tamsulosin 0.2 mg twice a day, in the 2nd group (n = 45) — 0.4 mg once a day. The duration of treatment was 4 weeks.

RESULTS: In patients of both groups, according to the IPSS questionnaire, a statistically significant decrease in the severity of obstructive and irritative symptoms, an improvement in the quality of life, an increase in the maximum urine flow rate, and a decrease in the volume of residual urine were revealed. When comparing the dynamics of clinical indicators in patients of the 1st and 2nd groups, no significant differences were found between the groups. At the same time, treatment tolerance was somewhat better in patients of the 1st group, which manifested itself in a smaller number of adverse events from the cardiovascular system and ejaculatory function disorders.

CONCLUSIONS: The results of the study demonstrate the same efficacy of tamsulosin 0.2 mg twice a day and 0.4 mg once a day. At the same time, taking tamsulosin at a dose of 0.2 mg twice a day was characterized by better tolerability of therapy.

Urology reports (St. - Petersburg). 2022;12(4):287-295
pages 287-295 views

Our experience of surgical treatment of recurrent urinary incontinence in women after the installation of a synthetic implant

Suleymanov S.I., Pavlov D.A., Arakelov S.E., Baranov A.V., Babkin A.S.


BACKGROUND: The article presents data on the frequency of recurrence of urinary incontinence in women after the installation of a synthetic implant, as well as methods for the surgical elimination of this pathology. The described urogynecological problem is relevant and widespread.

MATERIALS AND METHODS: The results of surgical treatment of 16 women with pelvic organ prolapse and recurrent urinary incontinence after sling operations are presented. All patients underwent laparoscopic colpovesicosuspension.

RESULTS: In the postoperative period positive dynamics was noted during the examination using the POP-Q system and the results of the questionnaire using the ICIQ-SF questionnaire, which was observed throughout the follow-up period of 12 months. Complications in the immediate and long-term postoperative period were not identified. For the entire period of observation of the patients, recurrence of prolapse was not observed in any case.

CONCLUSION: The proposed method of surgical treatment of recurrence of urinary incontinence in women with mesh implants is effective and safe.

Urology reports (St. - Petersburg). 2022;12(4):297-303
pages 297-303 views

Changes in the penile microcirculation in the treatment of mixed erectile dysfunction on the background of arterial hypentension in locomotive team workers

Arkhipova A.Y., Neymark B.A., Neymark A.I.


BACKGROUND: Railway workers constantly experience stress in the workplace, associated with the need to maintain high attention and be ready for emergency action, which provokes a persistent increase in blood pressure. A significant number of such patients have erectile dysfunction. Most patients require complex therapy for stress-induced arterial hypertension and erectile dysfunction.

AIM: To evaluate the dynamics of penile microcirculation indicators in the treatment of erectile dysfunction against the background of arterial hypotension in locomotive team workers.

MATERIALS AND METHODS: A comprehensive examination and treatment of 65 young and middle-aged men from 30 to 55 years old (mean age 48.1 ± 0.7 years), working as machinists or assistant machinists, was carried out. All observed patients complained of erectile dysfunction of varying severity and were registered with a general practitioner and (or) a cardiologist for controlled hypertension stage I–II. The patients were divided into three groups. Patients of the 1st group (n = 20) were prescribed basic treatment with antihypertensive drugs, as well as the drug Afalasa sublingually, 2 tablets 2 times a day. Patients of the 2nd group (n = 25) also received basic antihypertensive therapy, Afalasa (2 tablets 2 times a day sublingually) and the 5-PDE inhibitor tadalafil 5 mg once a day. Group 3 included 20 patients receiving basic antihypertensive therapy. The course of treatment for patients in each group was 4 months. The control 4th group consisted of 20 healthy men. In all patients before and after treatment and representatives of the control group, the state of microcirculation of the penis was assessed by laser Doppler flowmetry.

RESULTS: According to the Doppler flowmetry technique, microcirculatory disorders of varying severity were detected in the penis before treatment. The most pronounced positive dynamic at 4 months after the start of treatment was noted in patients of the 2nd group who received complex treatment, which included antihypertensive therapy, a 5-PDE inhibitor, and Afalasa. In patients, the index of microcirculation significantly increased, the index of hypoxia and tissue ischemia decreased, an increase in the inert mechanism of blood flow regulation was noted, which was expressed in an increase in the index of microcirculation efficiency from 0.79 ± 0.08 to 2.01 ± 0.29 c.u. (p < 0.05) and an increase in the bypass rate from 0.69 ± 0.13 to 1.06 ± 0.33 c.u. (p < 0.05). The improvement in microcirculation was accompanied by an improvement in erectile function, most pronounced in patients of the 2nd group.

CONCLUSIONS: Locomotive team workers with arterial hypertension have a mixed form of erectile dysfunction caused by a psychogenic factor and disruption of the vascular endothelium. The monitoring revealed significant violations of the penile microcirculation. The most pronounced improvement in penile hemodynamics and erectile function was noted with complex treatment, including basic antihypertensive therapy, a NO synthase activator, and a 5-PDE inhibitor.

Urology reports (St. - Petersburg). 2022;12(4):305-311
pages 305-311 views


Features of the microenvironment of oncourological tumors

Molchanov O.E., Maistrenko D.N., Granov D.A., Lisitsin I.Y., Romanov A.A.


The interaction of tumor cells, especially if they are stem or resting, with myeloid and lymphoid components, as well as extracellular matrix producers, leads to the formation of a pathological microenvironment that causes resistance to many systemic treatment options. The aim of the work is to present modern literature and own data concerning the features of the composition and structure of the microenvironment in tumors of the kidney, prostate and bladder. The article presents data on the composition and interaction of various subpopulations of cells in the tumor microenvironment, as well as on the role of stem tumor cells in its formation. Defects of signaling pathways of stem tumor cells are described, as well as the mechanism of interaction between the tumor and the immune system in the process of carcinogenesis. Approaches to the assessment of the type of microenvironment for the purpose of individualization of treatment are analyzed in detail. The authors present their own data on the nature of the distribution of subpopulations of lymphocytes and suppressor cells of myeloid origin in patients with metastatic forms of tumors of the genitourinary tract. The variants of using data on the structure of the microenvironment in order to optimize treatment tactics in cancer patients are indicated.

Urology reports (St. - Petersburg). 2022;12(4):313-331
pages 313-331 views

Modern concepts about chronic prostate inflammation

Vinnik Y.Y., Kuzmenko A.V., Amelchenko A.A.


The review presents modern aspects of the epidemiology, pathogenesis, diagnosis, drug treatment of chronic prostatitis. We performed a comprehensive search using multiple databases. There is still no single pharmacological approach in the management of patients with chronic prostate. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.

Urology reports (St. - Petersburg). 2022;12(4):333-345
pages 333-345 views

Nocturnal enuresis — a new look at the old problem

Smirnova N.N., Belyakova A.V., Kuprienko N.B., Nikolskaya T.I.


Nocturnal enuresis is the most common functional disorder of the urinary system in children, significantly reducing the quality of life of both patients and their parents. There are several hypotheses for the development of this disease, none of which can be taken as dominant. In this regard, Nocturnal enuresis is considered as a polyetiological condition. This review details the main factors that are associated with the development of nocturnal enuresis in children. These include hereditary predisposition, bladder dysfunction, sleep and awakening disorders, delayed maturation of central nervous system structures, disruption of the circadian rhythm of antidiuretic hormone and aquaporin-2 production. Despite many publications on nocturnal enuresis in children, many aspects of the pathogenesis of the disease remain unclear and require further study.

Urology reports (St. - Petersburg). 2022;12(4):347-356
pages 347-356 views

Case reports

Congenital diverticulum of the anterior urethra of non-obstructive genesisS

Shchedrov D.N., Shormanov I.S., Morozov E.V., Garova D.Y., Solovyev A.S.


Congenital diverticulum of the distal urethra is extremely rare in urological practice, there are isolated descriptions of it in the literature, as a result every clinical observation is of interest. The aim of this study is demonstration of a rare clinical observation — congenital diverticula of the distal urethra without infravesical obstruction (meatostenosis) in a teenager.

The article describes a clinical case of treatment of congenital diverticula of the anterior urethra without signs of infravesical obstruction in a 13-year-old teenager.

A case of surgical treatment of congenital urethral diverticulum without infravesical obstruction in a 13-year-old teenager is presented. Diverticulectomy with suture of the urethra was performed with good anatomical and functional results.

A distal urethral diverticulum of a congenital nature is extremely rarely noted as an isolated condition without an anterior urethral valve or another variant of infravesical obstruction. The method of choice is to perform diverticulectomy with suturing of the urethra.

Urology reports (St. - Petersburg). 2022;12(4):357-362
pages 357-362 views

Colovesical fistula in a patient with diverticular disease and foreign body of the colonj

Simanov R.N., Fetyukov A.I., Malyshev V.A., Kagachev P.N., Barysheva O.Y.


A clinical observation of a 50-year-old patient with colonic diverticular disease with perforation of one diverticulum by a fish bone and the formation of a colovesical fistula is presented in the article. The history of the disease, clinical picture, the course of the disease, results of pre-hospital and hospital examination, methods of treatment of the patient were analyzed. The presented material is illustrated by MSCT images, photographs made during the surgical treatment, results of histological examination. Surgical treatment included lower midline laparotomy, resection of the sigmoid colon and bladder with complete removal of the fistula with a diverticulum and bone inside it as a single block, formation of a colostomy, suturing the bladder defect tightly with urethral drainage with a Foley catheter. There were no complications during the operation and in the early postoperative period, the patient was discharged at the usual time. At a later date, a reconstructive operation was performed with the restoration of the passage of intestinal contents, without complications. A review of the literature on the diagnosis and treatment of patients with colovesical fistulas is presented.

Urology reports (St. - Petersburg). 2022;12(4):363-371
pages 363-371 views

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