Vol 8, No 3 (2018)

Functional and early oncological results in 2D vs 3D laparoscopic prostatectomy
Bogomolov O.A., Shkolnik M.I., Belov A.D., Sidorova S.A., Prokhorov D.G., Lisitsyn I.Y., Emirgaev Z.K.

Aim. To evaluate functional and early oncologic results with 2D and 3D laparoscopic prostatectomy in patients with localized prostate cancer.

Materials and methods. In 2016 to 2017, 124 laparoscopic radical prostatectomies were performed for localized prostate cancer, 71 using 2D-HD and 53 using 3D-HD laparoscopic systems (Karl Storz). Data on total operative time, time required for prostatectomy and for anastomosis, estimated blood loss, intraoperative and early postoperative complications (Clavien-Dindo grade), early functional results, surgical margins, upgrading of clinical stage, and frequency of biochemical recurrence were recorded.

Results. The total operative was significantly higher in the 2D than in the 3D group (152 min [range 100–192 min] vs 126 min [90–154 min]), (p < 0.05). The shorter time in the 3D group was achieved by a decrease in the anastomosis time (38 ± 4 min vs 26 ± 4 min, p < 0.05). Significant blood loss was significantly greater in the 2D group (240 ± 80 ml vs 190 ± 70 ml, p < 0.05). The two groups did not differ significantly in terms of the incidence and severity of postoperative complications.

Conclusion. Compared with traditional 2D devices, using stereoscopic 3D laparoscopic devices for prostatectomy reduces total operative time, particularly during the reconstructive stage, as well as the volume of intraoperative blood loss. Additional prospective, randomized trials and longer postoperative follow-up are needed to confirm these findings.

Urology reports (St - Petersburg). 2018;8(3):5-10
Prognostic significance of the evaluation of expression of the gene PCA3 in urine in patients with localized prostate cancer and histomorphological changes in the peritumoral zone
Bova P.S.

Aim. To determine the prognostic significance PCA3 gene expression in urine sediment and exosomes in patients with localized prostate cancer (PC) and associated histologic changes in the peritumoral zone as a predictor of biochemical recurrence after radical prostatectomy (RPE).

Materials and methods. Of 148 patients with localized PC, 96 (65%) had high-grade prostatic intraepithelial neoplasia (PIN-2) in the peritumoral zone. The other 52 (35%) had no pathologic tissue of the peritumoral zone. PDA3 expression in urine sediment and exosomes was determined with real-time PCR with respect to the reference gene KLK3.

Results. The PCA3 gene expression level in urine exosomes in patients with PIN-2 in the prostatic peritumoral zone and synchronous pancreatic adenocarcinoma was higher among patients with subsequent disease recurrence. Increased PCA3 gene expression in the urine sediment was also predictive of the risk of recurrence of a prostatic tumor with PIN-2 in the peritumoral zone, although to a lesser degree than the results with urine exosomes. When the ∆Ct РСА3-KLK3 was ≥1,86 in the urine sediment, biochemical recurrence of PC and PIN-2 developed more frequently in the peritumoral zone (84% versus 51%, p = 0,013).

Conclusions. Increased PCA3 gene expression in urine sediment and exosomes is a predictor of increased risk of biochemical recurrence after RPE in patients with localized PC and PIN-2 in the peritumoral zone.

Urology reports (St - Petersburg). 2018;8(3):11-19
Urine cytokine profile and nephroprotective effect of lercanidipine in patients with urolithiasis with obstructive uropathy before and after nephrostomy
Popkov V.M., Zakharova N.B., Polozov A.B., Khotko A.I., Khotko D.N., Durnov D.A.

Objective. To study the nephroprotective effect of lercanidipine and its influence on creatinine clearance and cytokine damage in patients with urolithiasis with obstructive uropathy.

Material and methods. Of 96 patients evaluated, 66 were diagnosed with kidney stones in the ureteropelvic segment and obstructive uropathy, which was then treated with percutaneous nephrostomy. All 66 patients were given antibacterial and anti-inflammatory therapy to prevent postoperative infections, but in addition, 33 were treated with lercanidipine, 10 mg per day. IL-8, VEGF, MCP-1, G-CSF, and GM-CSF concentrations in the urine were determined by solid-phase ELISA. The estimated glomerular filtration rate was calculated using the CKD-EPI formula. All studies were done preoperatively and on days 7, 14, 21, and 28 after nephrostomy. A control group consisted of 30 people with kidney stones without sings of obstruction.

Results. In the patients with obstructive uropathy, a correlation was found between VEGF, IL-8, and MCP-1 concentrations in the urine and the serum creatinine and estimated glomerular filtration rate. Patients in the lercanidipine group had a faster decrease in IL-8, VEGF, MCP-1, and GM-CSF concentrations in the urine and improved renal function compared with patients who did not receive lercanidipine. By day 21 after nephrostomy, the lercanidipine group had values comparable with the control group, whereas the group not treated with lercanidipine did not achieve similar values until day 28.

Conclusion. The third generation calcium channel blocker lercanidipine is nephroprotective in patients with obstructive uropathy.

Urology reports (St - Petersburg). 2018;8(3):20-27
Analysis of seasonal variability of sperm donors’ semen parameters
Korneyev I.A., Zasseev R.D., Pashina O.B., Mamedov A.E., Dogov A.M., Krylov O.A.

Introduction. The concept of seasonal variability of sperm parameters is controversial. However, it should be considered during medical evaluation and solicitation of sperm donors.

Aim. To evaluate seasonal variability of sperm parameters from anonymous sperm donors in a reproductive medicine center.

Materials and methods. A retrospective study of 1252 semen samples from 39 sperm donors (mean age 27.1 ± 3.9 years) in a reproductive medicine center in Saint Petersburg during the period from October 1, 2015 to October 1, 2017 was performed according to WHO 2010 recommendations. Semen volume, sperm concentration, total sperm number, progressive motility, and number of progressively motile sperm were analyzed.

Results. Individual variability in semen parameters was high. The mean ejaculate volume in the summer months was higher than in the autumn, winter, and spring (t = 3.65, p < 0.001; t = 4.18, p < 0.0001; t = 1.92, p = 0.056 respectively). The lowest volume (2.83 ± 1.32 ml) was registered in January. The mean sperm concentration in summer was lower than in autumn, winter, and spring (t = 3.65, p < 0.001; t = 4.18, p < 0.0001; t = 1.92, p = 0.056 respectively). It was higher in winter than in spring and autumn (t = 2.54, p = 0.012; t = 1.72, p = 0.082 respectively). The highest mean sperm concentration was registered in January and the lowest in July (157.2 ± 46.6 and 131.9 ± 44.0 million sperm per ml, respectively). No significant seasonal differences were found in total sperm number, progressive motility, or number of progressively motile sperm (p > 0.1).

Conclusions. The study suggests there is both individual and seasonal variability in sperm donors’ semen parameters. As several semen samples are needed to rate semen quality, we recommend that semen analysis for a potential sperm donor be performed in the summer months.

Urology reports (St - Petersburg). 2018;8(3):28-35
Pathogenetic treatment of patients with chronic bacterial prostatitis and accompanying neurological pathology: our experience
Krupin V.N., Krupin A.V., Belova A.N.

A total of 127 patients (mean age 38.1 ± 7.8 years) with chronic bacterial prostatitis who had concomitant neurologic diseases were treated. The patients were divided into 3 groups: group 1 (n = 47) included those with pain of the upper lumbar spine and myofascial syndrome; group 2 (n= 41), those with disorders of general and peripheral autonomic tone with vascular disorders in the pelvis; and group 3 (n = 39), those with disorders of the joints of the pelvic girdle, ligaments, and muscles of the pelvic floor. Treatment was given for the specific neurologic and hemodynamic disorders identified. No antibiotic therapy was prescribed. Patients in group 1 were prescribed pathogenetic therapy, including manual and regional therapy (for effects on the sclerotome and myotome), as well as medical correction of hemodynamics, physiothe rapy, psychotherapy, and hyperbaric oxygenation. Group 2 received treatment aimed at correcting autonomic innervation, including medications and magnetic therapy. Patients in group 3 were prescribed specific therapy aimed at eliminating pain-provoking factors, medications, massage, physiotherapy, manual therapy, therapeutic exercises, and reflex therapy. Treatment was associated with a decrease in the severity of pain and improvement of pelvic hemodynamics in patients in all 3 groups. Thus, the results indicate the potential efficacy of pathogenetic therapy for patients with chronic bacterial prostatitis with concomitant neurologic pathology.

Urology reports (St - Petersburg). 2018;8(3):36-43
Pathological anatomy of reparative processes in the resected kidney treated with α-tocopherol acetate in experiment
Shormanov I.S., Los M.S., Shormanova N.S.

Violation of the integrity of the kidney parenchyma during organ-preserving surgery is always accompanied by functional impairment in that part of the organ. This is due to mechanical damage to the nephron and the development of aseptic necrosis in the area of the resection, followed by development of an ischemic zone that expands during the repair process due to disrupted parenchymal cell metabolism and pressure from regenerating connective tissue.

Objective. To investigate the effect of α-tocopherol acetate on repair processes in the kidney parenchyma after an organ-preserving operation in a rat model.

Materials and methods. An experimental study was performed on 60 white laboratory rats that underwent resection of the lower pole of the left kidney. Postoperatively, a study group (n = 30) underwent intramuscular injections of a 10% α-tocopherol acetate oil solution, 0.2 ml 2 times a day for 5 days. A control group (n = 30) were left untreated.

Results. Compared with the control group, animals in the study group had a narrower zone of total necrosis and less pronounced inflammation and vascular stasis on days 7, 14, and 28 after the operation.

Conclusion. Use of the natural antioxidant α-tocopherol acetate in the postoperative period of organ-preserving kidney surgery may accelerate reparative processes in the damaged parenchyma.

Urology reports (St - Petersburg). 2018;8(3):44-52
Psychological mechanisms in the formation of attitude toward the disease among patients with prostate cancer after radical prostatectomy
Vagaytseva M.V., Karavaeva T.A., Vasileva A.V., Chulkova V.A., Nosov A.K.

Within the framework of a biopsychosocial disease model, this article considers the impact of psychological issues as they relate to malignant disease, specifically assessing the attitude toward or perception of the disease in patients with prostate cancer after radical prostatectomy. A total of 107 patients with prostate cancer depending on the disease phase after radical prostatectomy were enrolled in the study. The patients’ age range was 48 to 84 years. Pathogenic reactions caused by patient’s perception of the diagnosis and internal illness model had an impact on the disease course, adherence to treatment, and quality of life. Psychological tests were used to study the relationship between the disease and related psychological characteristics. The findings can improve the understanding of the role of psychological factors in the complex treatment and rehabilitation of patients with a malignancy, aiding in the choice of targets for psychosocial interventions.

Urology reports (St - Petersburg). 2018;8(3):53-66
Immunotherapy of renal cell carcinoma: Current state of the problem and promising areas of research
Molchanov O.E.

This review considers current variants of immunotherapy in patients with disseminated renal cell carcinoma. Data from experimental studies concerning defects in immunocompetent cells and mechanisms that block the normal immune response in patients with tumors are presented. Data of completed clinical trials of blockers of co-inhibiting molecules and cytokines in patients with renal cell carcinoma are analyzed.

Urology reports (St - Petersburg). 2018;8(3):67-79

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