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Vol 13, No 1 (2023)
- Year: 2023
- Articles: 11
- URL: https://journals.eco-vector.com/uroved/issue/view/7102
- DOI: https://doi.org/10.17816/uroved.131
Original articles
Effectiveness of treatment of detrusor overactivity after transurethral resection of benign prostate hyperplasia
Abstract
BACKGROUND: In a significant number of patients with benign prostatic hyperplasia who underwent transurethral resection (TURP), micturition disorders are detected in the late postoperative period. The issues of drug treatment of overactive bladder are widely covered in the literature and clinical guidelines. However, the number of studies on the treatment of patients with detrusor overactivity after TURP is relatively small.
AIM: The aim of the study is to increase the effectiveness of treatment of patients with detrusor overactivity after TURP in the late postoperative period.
MATERIALS AND METHODS: We treated 51 patients with urodynamically confirmed detrusor overactivity after TURP aged 56 to 87 years (mean 71.5 ± 8.4 years). Taking into account the comorbid background, concomitant therapy, age characteristics and the presence of contraindications, 8 patients were prescribed solifenacin, 9 — trospium chloride, 34 — mirabegron. Appointment of anticholinergic therapy for 1 month in 7 patients was ineffective, they were prescribed mirabegron. Drug treatment lasted 3 months. With insufficient effectiveness of drug therapy, combined treatment with mirabegron was performed in combination with extracorporeal magnetic stimulation (ECMS) for 1 month (12 sessions of ECMS in total). When the combination of ECMS and mirabegron was ineffective, intravesical botulinum therapy was performed. The effectiveness of treatment was assessed by subjective assessment by patients, the results of patients filling out IPSS questionnaires, urination diaries, ultrasound results and uroflowmetry.
RESULTS: After the end of drug therapy 17 (33.3%) patients subjectively rated the result of treatment as “excellent”, 15 (29.4%) patients as “good”. In 19 (37.3%) patients the effectiveness of drug therapy was regarded as insufficient and they underwent combined therapy with mirabegron and ECMS. As a successful combination therapy was recognized in 10 (52.6%) patients. Botulinum therapy was performed in 6 patients with ineffectiveness of the previous stages of treatment with a positive effect in 5 (83.3%) of them. Tolerability of treatment was satisfactory. Based on the results of the study, an algorithm for the treatment of detrusor overactivity in patients with urination disorders in the late postoperative period after TURP was proposed.
CONCLUSIONS: The applied treatment regimen for patients with detrusor overactivity after TURP is effective and can be recommended for use in clinical practice.
5-13
Analysis of outcomes of the first line systemic therapy in patients with solitary, single and multiple metastases of renal cell carcinoma
Abstract
BACKGROUND: Currently there are practically no works in the literature to assess the outcomes of systemic therapy in patients with solitary, single and multiple metastases of renal cell carcinoma.
AIM: The aim of the study was to analyze the outcomes of systemic drug therapy of the first line in patients with solitary, single and multiple metastases of renal cell carcinoma.
MATERIALS AND METHODS: The data of 981 patients with metastatic renal cell carcinoma who underwent systemic therapy of the first line at the City Oncological Hospital No. 62 in Moscow and the City Oncological Dispensary in St. Petersburg from 2006 to 2022 were retrospectively analyzed. All patients underwent clinical, laboratory and pathomorphological examination. 90 (9.2%) patients had solitary metastases, 252 (25.7%) single metastases and 639 (65.1%) multiple metastases. An analysis was made of the outcomes of 1st line therapy, which were conditionally divided into favorable, including all cases of complete response, partial response and stabilization, and unfavorable — progression during treatment, death or deregistration. Subsequently patients who had previously received chemotherapy or cytokine treatment were excluded from the analysis.
RESULTS: Complete response (3.3%) and deregistration (5.56%) were more often observed in patients with solitary metastases, stabilization more often occurred in patients with single metastases (51.1%), partial response (9.4%) and death (6.2%) — in patients with multiple metastases. In patients with multiple metastases treated with immune checkpoint inhibitors a partial response was observed in almost half of the cases. Stabilization and progression were observed in almost the same percentage of cases (about a quarter of cases), and only two patients had a fatal outcome, which is slightly lower than in patients receiving tyrosine kinase inhibitors. Frequent outcomes when using tyrosine kinase inhibitors were stabilization of the process (40.72% of cases) or progression (38.72%), a complete and partial response was rarely recorded. Significant differences in the occurrence of favorable and unfavorable outcomes were revealed in patients with multiple metastases, depending on the number of affected organs and the prescribed drug. When comparing the results of systemic therapy of the first line, a higher efficiency of tyrosine kinase inhibitors was observed in solitary metastases of tumors with a high and moderate degree of differentiation. Systemic therapy of G3 tumors with solitary metastases had low efficacy in the appointment of tyrosine kinase inhibitors in 27.27% of patients. Higher efficiency was noted in single and multiple metastases. The effectiveness of immune checkpoint inhibitors was revealed in 70.6% of patients with single and multiple metastases.
CONCLUSIONS: When choosing systemic therapy for metastatic renal cell carcinoma in clinical practice, it is necessary to take into account such prognostic factors as histological variants, the degree of differentiation of the tumor and the number of affected organs.
15-21
Effect of the complex of natural terpenes and vitamin E Renotinex® on free radical processes in patients with urolithiasis
Abstract
BACKGROUND: One of the leading links in the pathogenesis of urolithiasis is oxidative stress, which occurs as a result of the intensification of free radical oxidation with insufficient activity of the antioxidant defense system of the body.
AIM: The aim of the study was to study the effect of a complex of natural terpenes and vitamin E Renotineх® on the state of oxidative stress in patients with urolithiasis in the postoperative period after percutaneous nephrolithotripsy.
MATERIALS AND METHODS: The study included 42 patients. Of the 35 people who underwent percutaneous nephrolithotripsy, 2 groups were formed. Patients of the main group (n = 20), in contrast to the control group (n = 15), received Renotinex® (Polaris LLC, Russia) before and after surgery, 2 capsules (1 capsule 300 mg) twice a day. To determine the main indicators of the activity of free-radical processes in the body, all patients underwent a blood test on the 3rd day after surgery. The total activity of the pro- and antioxidant systems in blood plasma was determined by the method of induced chemiluminescence. The activity of lipid peroxidation was assessed by determining the concentration of active products of thiobarbituric acid — secondary products of lipid peroxidation in blood erythrocytes. The activity of antioxidant enzymes was studied by spectrophotometric method. To determine the ability of blood plasma to crystallize in some of the same patients with urolithiasis while taking Renotinex®, the method of wedge dehydration was used. For a comparative analysis of the crystal structure of dried blood plasma samples (facies), 7 healthy volunteers were included in the study, which made up the third group (comparison group).
RESULTS: The results of the study reliably demonstrate that the composition of the complex of natural terpenes and vitamin E Renotinex® has a positive effect on free-radical processes in patients with urolithiasis, biochemical parameters of blood plasma (indicators of induced chemiluminescence, catalase activity, malondialdehyde level), as well as on crystallization processes blood plasma, which is confirmed by the method of wedge dehydration of blood plasma. Any change in the body caused by excessive activity of free-radical oxidation processes is reflected in the composition of the blood, and specifically in the indicators of the “mechanical” characteristics of blood plasma (viscosity, structure, surface tension), which determine the shape of the resulting structures of the drying drop of biological fluid.
CONCLUSIONS: The complex of natural terpenes and vitamin E Renotinex® has a positive effect on free-radical processes, biochemical parameters of blood plasma, as well as on the systemic structural organization of blood plasma in patients operated on for urolithiasis. The inclusion of the combined product Renotinex® in the treatment regimen for patients with urolithiasis is pathogenetically justified.
31-41
Annual trends in semen parameters among men attending a fertility center between 2016 and 2022
Abstract
BACKGROUND: Multiple studies have shown sperm concentration and count decline in many countries, however, authors’ conclusions were inconsistent. These types of studies were not conducted in Russia so far.
AIM: To evaluate and analyze semen parameters among men attending a fertility center in St. Petersburg between 2016 and 2022.
MATERIALS AND METHODS: In a retrospective study parameters of 14234 consequent semen analyses performed according to WHO guidelines (2010) were sorted, analyzed and compared by year.
RESULTS: The distribution parameters of the ejaculate volume did not have change over observation period. Azoospermia and cryptozoospermia were detected in 597 (4.2%) and 435 (3.1%) men respectively. A downward trends for sperm concentration of 1.6 million/ml (1.9%)/year and sperm count of 7 million (1.8%)/year were found, with simultaneous annual increase of 1.3% in the proportion of progressively motile spermatozoa. No noticeable changes in the number of motile spermatozoa and the proportion of spermatozoa with normal morphology were found.
CONCLUSIONS: Further research is needed to obtain final conclusions about the gradual decline in the semen quality and reproductive function of men, also in other centers of the Russian Federation.
23-29
Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter
Abstract
BACKGROUND: With recurrent extended strictures of the pyeloureteral segment and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a flap from the cheek mucosa.
AIM: The aim of the study is the results of laparoscopic plastic surgery of the pyeloureteral segment and proximal ureter with buccal graft.
MATERIALS AND METHODS: Minimally invasive plastic surgery of the extended stricture of the pyeloureteral segment, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 27 patients. There were 16 men, 11 women, and the average age was 51 years. The cause of narrowing in 16 patients was previously performed pyeloplasty, in 10 — contact ureterolithotripsy in the proximal ureter, in 1 — his injury during laparoscopic excision of a parapelvical kidney cyst. Laparoscopic access was used in 24 patients, and robot-assisted access was used in 3 patients. In 17 of them, the narrowed area was replaced by the onlay technique, in 10 patients, anastomosis augmentation was performed with a buccal graft.
RESULTS: There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 °C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien ≥ IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with pyeloureteral segment strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction.
CONCLUSIONS: Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the pyeloureteral segment and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.
43-51
Transurethral incision of the bladder neck in recurrent bladder neck stenosis
Abstract
BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.
AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.
MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.
RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 ± 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 ± 6.92 ml/s, and after 12 months — to 9.4 ± 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.
CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.
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Evaluation of the clinical efficacy of the use of oxidized dextran in the form of suppositories in the treatment of patients with chronic prostatitis
Abstract
BACKGROUND: Increasing the efficacy of treatment of patients with chronic prostatitis / chronic pelvic pain syndrome remains an urgent problem of modern urology.
AIM: The aim of the study is to evaluate the clinical efficacy of rectal suppositories with oxidized dextran in the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.
MATERIALS AND METHODS: 52 patients with chronic prostatitis / chronic pelvic pain syndrome were treated (mean age 33.1 ± 1.7 years). The patients were divided into 2 groups. Patients of the 1st group (n = 25) received oxidized dextran in the form of rectal suppositories for 50 days according to the following scheme: for the first 10 days, 1 rectal suppository at night, daily; the next 40 days — 1 rectal suppository every other day. A total of 30 rectal suppositories per course. Patients of the 2nd group (n = 27) received a placebo in the form of rectal suppositories according to the same scheme. Treatment efficacy was assessed on the basis of the original IPPS-MS Genitourinary Disease Assessment questionnaire, the NIH-CPSI and IIEF-5 questionnaires, as well as the results of microscopic examination of prostate secretions.
RESULTS: In patients of the 1st group a significant clinical improvement was revealed by the end of treatment. According to the IPPS-MS questionnaire there was a decrease in the severity of dysuria by 67%, pain syndrome — by 80%, psychosomatic disorders — by 47.6%. There was a decrease in the total score of the NIH-CPSI questionnaire by 66.2% (from 25.4 ± 2.4 to 8.6 ± 2.1 points, p < 0.05) and an increase in the total score of the IIEF-5 questionnaire by 79.3 % (from 11.6 ± 1.8 to 20.8 ± 2.1 points, p < 0.05). Positive changes in the clinical parameters of patients of the 1st group were accompanied by an improvement in the results of microscopy of the secretion of the prostate — a decrease in the number of leukocytes and an increase in the number of lecithin grains. There were no significant changes in any of the studied parameters in patients of the 2nd group. None of the patients in both groups had side effects from the therapy.
CONCLUSIONS: Oxidized dextran in the form of rectal suppositories has a pronounced anti-inflammatory activity and significantly reduces the severity of dysuria, pain and psychosomatic disorders in patients with chronic prostatitis / chronic pelvic pain syndrome. The results of the study indicate the promise of using oxidized dextran in the form of rectal suppositories for the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.
61-69
Renal function, endotoxicosis, and oxidative stress in patients after open and laparoscopic nephrectomy
Abstract
BACKGROUND: Renal cell cancer is accompanied by the development of a disorder of renal function. The parameters of homeostasis after nephrectomy in renal cell cancer are not well understood.
AIM: The aim of the study is to compare the kidney functional status and parameters of homeostasis in patients with RCC after nephrectomy performed by open and laparoscopic surgery.
MATERIALS AND METHODS: Eighty patients with renal cell cancer Т3N0M0 were randomized according to the surgery into the comparison group with open nephrectomy (n = 40; 50,1 ± 3,4 years old; 18 males, 22 females) and the main group with laparoscopic nephrectomy (n = 40; 52,4 ± 5,1 years old; 16 males, 24 females). The control group was comprises from twenty subjects without urological pathology, 22–58 years old, 10 males, 10 females. Laboratory parameters of endotoxicosis, lipid peroxidation, kidney functional status, partial kidney functions, and urinary syndrome were assessed on the 1st, 3rd, 6th and 10th days after the surgery.
RESULTS: The early postoperative period of nephrectomy in renal cell cancer is accompanied by the development of endotoxicosis, activation of lipid peroxidation, deterioration of the functional state of the remaining kidney, and the formation of chronic kidney disease. At the same time, both systemic indicators (toxicity index, as well as concentrations of medium-weight molecules, diene conjugates, malondialdehyde), and renal parameters (glomerular filtration rate, albumin-creatinine ratio) are associated with the method of surgery: with a laparoscopic approach, changes in these indicators are reversible and less pronounced than with open nephrectomy.
CONCLUSIONS: The present study demonstrates the advantage of laparoscopic nephrectomy compared to open nephrectomy in patients with renal cell cancer.
71-78
Reviews
History of urine diversion techniques
Abstract
The review article is devoted to the history of the development of urine diversion methods, starting from the very first operations for the imposition of skin fistulas and ending with modern high-tech surgical interventions. The advantages and disadvantages of various methods of urine diversion are described. It is shown that the gold standard today is orthotopic bladder plastic surgery, which allows to achieve good functional results and a high quality of life for patients.
79-86
Kidney cystosis — hereditary, congenital and acquired
Abstract
Renal cysts can be both an independent nosological entity, and a clinical manifestation, or a complication of a severe diseases. Understanding the epidemiology, pathogenesis and diversity of causes of cystic kidney disease contributes to the timely diagnosis and selection of reasonable treatment and prevention tactics. The presented literature review describes the most common processes that contribute to the development of this pathology, as well as genetic diseases and rare causes, the clinical manifestation of which is the formation of cystic cavities. The article presents the main diagnostic algorithms and modern classifications of the disease for practical assistance to the doctor. The review contains up-to-date information on the modern staging of cystic kidney disease according to the Bosniak classification, and also presents the risk of malignancy, according to the statistical data presented in the literature.
87-97
Сlinical observations
Zinner’s syndrome. Clinical case
Abstract
Zinner’s syndrome refers to rare malformations and is characterized by a triad of signs - unilateral renal agenesis, obstruction of the vas deferens, and cystic transformation of the seminal vesicle. A description of a clinical case of Zinner’s syndrome with an atypical clinical picture is presented. This observation indicates the need for an in-depth examination of the genital organs in men with renal agenesis.
99-104
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