卷 15, 编号 2 (2025)

BACKGROUND: Methods for microbial inactivation, including physical approaches aimed at the destruction of biofilms formed by uropathogenic microorganisms for the prevention of infectious and inflammatory diseases in urology, remain insufficiently studied. The development of new strategies in this field remains relevant.

AIM: To evaluate the feasibility of photodynamic inactivation of biofilms formed by typical representatives of uropathogenic microorganisms using an antiseptic agent with a bacteriostatic effect—methylene blue—possessing photochemical properties.

METHODS: Cultures of Staphylococcus aureus and Escherichia coli isolated from renal calculi of patients from a urology department were used. In vitro experiments on photodynamic inactivation of microorganisms were conducted on mature preformed biofilms. Irradiation was performed using a diode laser emitting at a wavelength of 662 nm through a sterile 0.1% methylene blue solution in continuous mode across five setups (three control, two experimental). After irradiation, biofilms on the cover glasses were fixed on microscope slides using colorless varnish. The prepared specimens were stained with acridine orange solution, dried in the dark, examined under a fluorescence microscope at ×100 magnification using an immersion system, and photographed with a digital camera. Images were digitally processed using 3D modeling technologies with ImageJ software version 1.52a.

RESULTS: The impact of the photoactive agent and laser irradiation was assessed at two power settings—450 mW and 1100 mW. In the first case, partial destruction of the biofilms was noted (41.9% of the original biofilm structure for S. aureus and 82.4% for E. coli), whereas in the second case, exposure at 1100 mW resulted in complete degradation of the mature multilayer biofilm into single cells without extracellular matrix, corresponding to 97.7% destruction of the original biofilm structure for S. aureus and 96.5% for E. coli.

CONCLUSION: This study is the first to demonstrate the feasibility of photodynamic inactivation of uropathogenic biofilm-forming microorganisms using a photochemically active agent—methylene blue. The promising results suggest that combined laser irradiation and methylene blue application may serve as an alternative or adjunct to systemic antibiotic therapy in urological practice.

BACKGROUND: Overactive bladder is a common syndrome with symptoms that significantly reduce patients’ quality of life. Conventional treatment methods are not always satisfactory, prompting ongoing research into novel and effective therapeutic options. Intravesical instillations of botulinum toxin A represent one of the promising minimally invasive treatment modalities.

AIM: To evaluate the efficacy of intravesical administration of a combination of titanium glycerosolvate and botulinum toxin A in patients with overactive bladder.

METHODS: This clinical study included 10 patients (9 females and 1 male, mean age 63.2 ± 7.78 years) with idiopathic overactive bladder. All patients underwent a single intravesical instillation of a combination consisting of 25 mL of 40% titanium glycerosolvate solution and 500 IU of abobotulinumtoxinA diluted in 4 mL of 0.9% NaCl solution. The mean exposure time of the mixture in the bladder was 2 hours. Treatment efficacy was assessed based on voiding diaries and the Overactive Bladder Symptom Score (OABSS), completed by patients before treatment and at 1, 3, and 6 months thereafter.

RESULTS: At 1 month after intravesical instillation of the experimental mixture, the mean OABSS score decreased from 10.0 ± 3.1 to 7.67 ± 3.35 (−23% compared to baseline), the frequency of urgency episodes decreased from 3.4 ± 2.78 to 1.82 ± 1.6 per day (−46.5%), the frequency of micturition decreased from 13.69 ± 3.67 to 10.4 ± 3.12 times per day (−24%), and the mean voided volume increased from 90.4 ± 74.4 to 105.6 ± 69.2 mL (+16.8%). At 3 months of follow-up, a return of overactive bladder symptom severity to baseline levels was observed in treated patients. This was evidenced by an increase in total OABSS scores, a rise in the frequency of urgency episodes and micturitions, and a decrease in mean voided volume.

CONCLUSION: The results of this pilot study demonstrate the efficacy of intravesical instillation of a combination of titanium glycerosolvate and botulinum toxin A in patients with overactive bladder, with therapeutic effects persisting for up to 3 months. The observed positive clinical changes suggest that further research in this direction is warranted.

BACKGROUND: Radical prostatectomy remains the primary surgical treatment for patients with localized prostate cancer. Regardless of the surgical approaches, the risk of complications persists. Therefore, improving the technique of radical prostatectomy remains a pressing issue in uro-oncology.

AIM: To evaluate the effectiveness of a novel technique for laparoscopic radical prostatectomy in patients with localized prostate cancer.

METHODS: An analysis of surgical treatment was performed in 137 patients with localized prostate cancer. Laparoscopic radical prostatectomy was performed in all patients: 80 patients (group 1) underwent the procedure using a modified technique with preservation of the pelvic supportive ligamentous structures, and 57 patients (group 2) — using the standard technique.

RESULTS: Patients in group 1 demonstrated shorter total operative time, reduced intraoperative blood loss, and a decreased duration of urinary bladder drainage via urethral catheter. Earlier recovery of spontaneous urination was associated with a shorter postoperative hospital stay. On average, patients in group 1 had a 1.4-fold shorter hospitalization compared to those in group 2.

CONCLUSION: A new technique for extraperitoneal laparoscopic radical prostatectomy with preservation of the pelvic supportive ligamentous structures has been developed, implemented, and clinically tested in patients with localized prostate cancer. Further research is warranted to assess long-term surgical outcomes.

The limited coverage of female infravesical obstruction has led to the absence of a clear algorithm for the diagnosis and treatment of urethral strictures in women. Currently, various treatment methods are used—from urethral dilation to urethroplasty—with their effectiveness and indications remaining the subject of ongoing discussion. The article discusses the issues of etiology, diagnosis, and treatment of urethral strictures in women and examines the effectiveness of various invasive methods for managing narrowing of the female urethra. The required information was searched in PubMed, Web of Science, CyberLeninka, eLibrary, and Scopus databases for the period 1999–2022 using the following keywords: стеноз меатуса (meatal stenosis), стриктура уретры у женщин (female urethral stricture), стриктурная болезнь уретры (urethral stricture disease), вентральная уретропластика слизистой половой губы и влагалища (ventral urethroplasty using labial and vaginal mucosa), дорсальная буккальная уретропластика (dorsal buccal urethroplasty), пластика уретры лоскутом стенки влагалища (urethral reconstruction using vaginal wall flap), бужирование (urethral dilation), обструктивное мочеиспускание у женщин (female obstructive voiding), and инфравезикальная обструкция у женщин (female infravesical obstruction). It was noted that urethral dilation and internal optical urethrotomy are often used as initial treatments and demonstrate satisfactory results, though they are associated with a relatively high recurrence rate. In patients with partial urethral obliteration and recurrent stricture after previous interventions, subsequent surgical options may include urethral reconstruction using flaps of the anterior or lateral vaginal wall, vestibular flaps, or free grafts (in dorsal or ventral position). The choice of surgical technique may be influenced by several factors—location and length of the stricture, presence of trophic changes in the mucosa, mechanism of development, as well as the surgeon’s experience and preferences. Urethrotomy and dilation may be used as initial treatment methods in some cases; however, in the presence of recurrence, marked fibrotic changes, and significant stenosis, urethroplasty is considered more appropriate. Flap-based urethroplasty techniques have demonstrated effectiveness and safety and may therefore represent a preferred treatment method for female urethral strictures.

The Enhanced Recovery After Surgery (ERAS) concept is a comprehensive multidisciplinary approach based on scientific principles, aimed at optimizing patient management during the perioperative period. Despite the proven efficacy of ERAS across various oncological surgeries, the impact of this approach on perioperative outcomes in the treatment of prostate cancer remains underexplored. This review analyzes current scientific data on the application of ERAS principles in the preoperative, intraoperative, and postoperative stages of prostate cancer treatment. A literature search was conducted in the electronic databases PubMed and Google Scholar using the following keywords in Russian and English: концепция ускоренного восстановления после операции / enhanced recovery after surgery, радикальная простатэктомия / radical prostatectomy, роботическая радикальная простатэктомия / robotic radical prostatectomy, рак предстательной железы / prostate cancer, and eras. The search was performed in accordance with PRISMA guidelines. A total of 100 studies were included in the review. ERAS encompasses the entire perioperative period, from patient preparation to postoperative recovery. This enables effective implementation of radical prostatectomy and ensures high-quality rehabilitation. Currently, the combination of ERAS with robotic radical prostatectomy demonstrates advantages related to minimal invasiveness and high procedural reliability, which contribute to shorter operative times, reduced postoperative complications, accelerated patient’s recovery, and improved healthcare staff satisfaction. To fully assess the benefits of ERAS, it is essential to systematize existing concepts and recommendations in the field of surgical treatment of prostate cancer and to conduct high-quality multicenter studies aimed at exploring rehabilitation, complication prevention, and patient-reported outcomes. This will help expand the potential of ERAS and enhance its impact on treatment outcomes.