Vol 9, No 4 (2019)

Original articles
Clinical course and surgical treatment of paraurethral cysts in women
Slesarevskaya M.N., Al-Shukri S.K., Sokolov A.V., Kuzmin I.V.

Abstract

The results of surgical treatment of 59 women (average age 31.9 ± 1.3 years) who underwent laser ablation of paraurethral cysts using the Lakhta-Milon laser apparatus (Russia) (diode laser with a wavelength of 0.97 μm) are presented. The postoperative period in all patients proceeded without serious complications. The average hospital stay was 1.7 ± 1.5 days. 4 weeks after surgery, all 59 patients noted improvement such as lack of dysuria, only 10 (16.9%) had minor discharge from the genital tract. 6 weeks after surgery all 59 operated patients had wound epithelization. Conclusion: The treatment of paraurethral cysts should be surgical and as radical as possible. The operation of choice is laser ablation of paraurethral formations.

Urology reports (St. - Petersburg). 2019;9(4):5-10
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Regarding the efficacy of low-level laser therapy in infrared spectrum in male secretory infertility
Potapova M.K., Borovets S.Y., Sokolov A.V., Al-Shukri S.K., Tkachuk V.N.

Abstract

The aim of study was to assess the effect of low-level laser therapy (LLLT) in infrared spectrum on the main sperm parameters, sperm DNA fragmentation, MAR-test in men with nonobstructive pathozoospermia.

Patients and methods. The study included 50 men from 23 to 40 years old (average age 31.0 ± 5.4), suffering from secretory infertility. Physical examination, semen analysis, MAR-test, sperm DNA fragmentation analysis, male hormone panel, assessment of prostate microbiocenosis, testes and prostate tumor markers, ultrasound examination with color flow mapping were performed. After the examination patients had a course of LLLT in infrared spectrum on a Rubin-C device. 10 laser therapy procedures were carried out every two days with active luminescence for 3 minutes of both testicles. Control examination was done immediately after the LLLT, within one and two months.

Results. Increase in sperm concentration (by an average of 25%), active mobile sperm forms (by an average of 25%), morphologically normal sperm forms (by an average of 58%) was noticed after the LLLT. MAR-test decreased by an average of 69% after the therapy. From 10 patients with initially increased sperm DNA fragmentation level, in 9 patients its level became normal after the treatment. Increase in concentration of total and free testosterone in blood plasma was noticed within one month after the LLLT. As a result of the treatment pregnancies developed in 11 (22%) out of 50 couples.

Conclusions. LLLT in infrared spectrum improves sperm quality in patients with secretory infertility, decreases MAR-test level, normalizes sperm DNA-fragmentation level, increases chances of pregnancy in reproductive cycle, which allows to recommend this method as preparation for assisted reproductive technologies.

Urology reports (St. - Petersburg). 2019;9(4):11-17
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Retzius-sparing robot-assisted radical prostatectomy: initial experience and surgical technique
Ilin D.M., Guliev B.G.

Abstract

To present own initial experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and surgical technique. In October–November 2019 on the basis of the Urological Department and the Center for Robotic Surgery of City Mariinsky Hospital (Saint Petersburg, Russia) five patients with localized prostate cancer were treated with RS-RARP. The operation time was from 140 to 205 min. The blood loss volume was from 50 to 250 ml. No conversions and intraoperative complications were recorded. Nervous-saving RS-RARP was performed in three patients. No blood transfusions were performed. Two patients faced Clavien Grade I postoperative complications. Immediate continence after removal of the urethral catheter was noted in 3 out of 5 patients. All the patients became continent for 2 weeks. One extraprostatic positive surgical margin was recorded. RS-RARPis an accessible technique for treating patients with localized prostate cancer, which allows achieving high early results. It is necessary to accumulate more experience of such surgeries to assess the distant outcomes and compare them with the data of the robot-assisted radical prostatectomies performed by other approaches.

Urology reports (St. - Petersburg). 2019;9(4):19-24
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Influence of operative treatment of variсocele on the development of arterial hypertension
Krupin V.N., Uezdnyj M.N., Petrova P.I.

Abstract

Purpose of the research. To assess the incidence of arterial hypertension in men with varicocele and to identify the relationship between increased blood pressure and surgical treatment of varicocele.

Material and methods. A survey of 412 men receiving treatment for arterial hypertension, 482 men previously operated on for varicocele and 68 patients with varicocele who had no surgical treatment was conducted.

Results. Varicose veins of the spermatic cord in patients with arterial hypertension were detected in 44.6% of cases, which exceeds the incidence of varicocele occurrence in men of a comparable age category by 1.5–2 times. Surgical treatment of the left spermatic cord varicocele is combined with the development of arterial hypertension in 51.2% of patients, which is three times higher than the incidence of hypertension in men who didn’t undergo surgical treatment for varicocele and twice the frequency of hypertension in the general population of men of comparable age. The more frequent occurrence of renal arterial hypertension in patients who underwent surgical treatment for varicocele may indicate an adverse effect of occlusion of the internal spermatic vein on the state of renal venous hemodynamics.

Conclusion. Varicocele should be considered as a compensatory process for renal venous hypertension due to obstruction of blood flow through the renal vein, and elimination of compensatory blood flow can lead to renal venous hypertension, hypoxia and the development of arterial hypertension.

Urology reports (St. - Petersburg). 2019;9(4):25-30
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Rehabilitation of patients with chronic pyelonephritis using mineral waters
Nejmark A.I., Davydov A.V., Nejmark B.A., Kablova I.V.

Abstract

Relevance. The study of alternative non-drug methods of rehabilitation therapy is an important task in the preventive direction of rehabilitation medicine. An important role in rehabilitation measures to prevent relapse of nephrolithiasis is therapy with the use of balneological therapeutic factors. The purpose of the study is to increase the effectiveness of rehabilitation therapy in patients with chronic pyelonephritis with the use of “Serebryaniy klyuch” mineral water.

Materials and research methods. The basis of the work is the analysis of data from examination and treatment of 48 patients with chronic pyelonephritis in the phase of latent inflammation. All patients included in the study were divided into 2 groups. Patients of the 1st group (n = 23) were prescribed antibacterial, antispasmodic, herbal medicine and drinking fresh water. In addition to standard therapy, patients of the 2nd main group (n = 25) were prescribed 300–350 ml of “Serebryaniy klyuch” mineral water 30–40 minutes before meals up to 2 liters per day at a temperature of 39–40 °C.

Results. In patients of the 2nd group in 91.4% of cases, curation of the clinical signs of the disease was noted, pathogens were eliminated in 100% of patients. At the same time, normalization of cytokine homeostasis and humoral immunity was observed, which contributed to a decrease in interstitial edema and normalization of renal vascular tone.

Conclusion. The internal intake of “Serebryaniy klyuch” mineral water in the rehabilitation therapy of patients with chronic pyelonephritis has a positive effect on the elimination of the clinical manifestations of the disease, increases the percentage of sterile urine culture, improves the basal blood flow in the kidneys, the immune status of patients, the cytokine profile of blood serum and there by increases the duration of the full clinical and laboratory remission in this category of patients.

Urology reports (St. - Petersburg). 2019;9(4):31-36
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Antibacterial therapy for uncompleted upper urinary tract infections
Al-Shukri A.S., Zakharevich E.E.

Abstract

To evaluate the efficacy and safety of the use of the drug Hileflox 750 (levofloxacin) in the treatment of uncomplicated infections of the upper urinary tract (pyelonephritis). 46 patients (9 men and 37 women) with uncomplicated pyelonephritis were observed. All patients were treated with Hileflox 750 mg orally once a day for 5 days. The drug showed high antibacterial activity, clinical efficacy and good tolerance. During follow-up for 6 months, not one patient showed abnormalities in laboratory tests, the development of complications or relapses of the disease. Conclusions: the results of the study showed the feasibility and effectiveness of the use of the drug Hayleflox 750 for the treatment of uncomplicated pyelonephritis in monotherapy.

Urology reports (St. - Petersburg). 2019;9(4):37-40
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Patient management tactics with primary detected prostate-specific antigen increase
Los M.S.

Abstract

The main screening test for prostate cancer is the determination of prostate-specific antigen (PSA) in the blood. Increasing of the PSA level above 4 ng/ml is an indication for a detailed clinical examination of the patient. At the same time only in a quarter of cases with a PSA level of 4 to 10 ng/ml prostate cancer is diagnosed, and in 70–80% of cases prostatic hyperplasia and prostatitis are diagnosed.

Objective: to determine the need for anti-inflammatory treatment in the initial detection of elevated PSA blood levels within the “gray area” in men over 50 years of age to minimize the number of puncture biopsies of the prostate.

Materials and methods. The study was divided into 2 parts. Part 1 – a retrospective study, in which results of the histological examinations of the prostate gland of 297 men after a puncture biopsy about an increase in the PSA level of more than 4 ng/ml were analyzed. Part 2 – a prospective study in which 118 men over 50 years of age with a primary increase in the PSA level from 4 to 9 ng/ml received anti-inflammatory treatment to monitor the dynamics of the PSA level.

Results: the appointment of anti-inflammatory treatment allows in 69% cases to avoid puncture biopsy of the prostate, increase the predictive value of PSA, reduce the frequency of post-puncture complications of inflammatory genesis.

Conclusion: the appointment of anti-inflammatory treatment is advisable when the primary increase in blood PSA levels to 9 ng/ml.

Urology reports (St. - Petersburg). 2019;9(4):41-46
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Reviews
Pseudoprogression in patients with renal cell carcinoma during immunotherapy
Molchanov O.E., Lisitsyn I.Y.

Abstract

The article deals with the main problems concerning the optimization of treatment of patients with renal cell carcinoma. Variants of the course of the disease after pseudoprogression are considered. The strategies of differential diagnosis and correction of treatment based on modern ideas about the pathogenesis of renal cell carcinoma are considered in detail. Data of own researches in which the assessment of possibility of treatment without change of preparations in the first and second lines after primary progression is carried out are resulted.

Urology reports (St. - Petersburg). 2019;9(4):47-58
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Significance of the pharmacoeconomic approach in the choice of treatment of hyperplasia of the prostate
Peshekhonov K.S., Shpilenia E.S., Burlaka O.O.

Abstract

 The article presents an analysis of literature data on the study of the medical and economic aspects of medical, surgical and minimally invasive methods of treating patients with the lower urinary tract symptoms due to prostatic hyperplasia. It was noted that modern surgical treatment, new minimally invasive technologies have certain clinical and economic advantages in the long term compared with drug therapy in carefully selected patients with prostatic hyperplasia.

Urology reports (St. - Petersburg). 2019;9(4):59-72
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Case reports
Constructing neourethra after urethral damage by a prolene mesh sling – stages and 5-year outcomes
Korshunov M.Y., Zhivov A.V., Plekhanov A.Y.

Abstract

The article presents a successful trial of constructing neourethra with the use of a free graft of the mucous tissue of the cheek in a patient with a post-trauma total urethral loss.

Urology reports (St. - Petersburg). 2019;9(4):73-76
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Renal echinococcosis mistaken for a cystic tumor of the kidney
Ghandour R., Nassar G., Hejase M.

Abstract

 Renal echinococcosis is a relatively rare disease. Making a preoperative clinical, biological and radiological diagnosis is quite challenging and hard. A clinical case of a 63-year-old patient operated on for renal echinococcosis is presented. The formation had the form of multiple grape-like cysts were mistaken for a cystic tumor of the kidney before surgery.

Urology reports (St. - Petersburg). 2019;9(4):77-80
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History of medicine
Academician R.M. Fronshtein – outstanding urologist, scientist, teacher (on the 70th anniversary of the death)
Morgoshiia T.S., Sasova V.D., Beljaeva D.O.

Abstract

The article is dedicated to the 70th anniversary of the death of Academician Richard Mikhailovich Fronshtein who was an outstanding clinician, scientist and teacher. The main stages of scientific, pedagogical activity and practical activity are presented. R.M. Fronshtein published more 140 scientific papers, including manuals on operative urology. In 1922 together with prof. S.P. Fedorov he founded the journal “Urologiia” and for 19 years was its responsible editor.

Urology reports (St. - Petersburg). 2019;9(4):81-84
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