Vol 12, No 1 (2022)

BACKGROUND: The pandemic of a new coronavirus infection has had a significant impact on the work of the entire medical service, including urological departments.

AIM: to assess the impact of the COVID-19 pandemic on the work of urological departments in private and public medical institutions.

MATERIALS AND METHODS: We assessed the impact of the restrictions imposed by the pandemic on the work of the urology department of a private clinic (MC Avicenna, Novosibirsk) and the urogenital department of the Novosibirsk Research Institute of Tuberculosis for 2019 and 2020. We assessed the change in the range of surgical interventions, as well as the structure visits to the urologist.

RESULTS: The urogenital department of the Novosibirsk Research Institute of Tuberculosis in March 2020 was redesigned into an observational one. The Avicenna Medical Center also established the procedure for anti-epidemic measures, which made it possible not only not to reduce, but in a number of positions to increase the volume of surgical care provided.

CONCLUSION: Thus, thanks to anti-epidemic measures: separation of flows, introduction of mandatory testing of patients, early detection of patients and carriers among employees, mask regimen, opening of an observational department, single rooms, lack of contact between patients, short stays, it was possible to prevent an outbreak of infection among patients and staff. Both in the municipal and private urological clinics, well-organized work did not allow the negative impact of the pandemic to manifest itself.

BACKGROUND: The most dangerous disease in the structure of urinary tract infections during pregnancy is pyelonephritis. Favorable ground for its occurrence is created by anatomical and physiological changes in the urinary system in pregnant women against the background of gestational restructuring of the body. It seems very relevant to study the constitutional features of pregnant women with pyelonephritis and reference points - markers associated with the risk of developing pyelonephritis, the individual characteristics of its course and the effectiveness of therapy using the fundamental basis of clinical anthropology.

AIM: Evaluation and comparative analysis of anthropometric and bioelectrical impedance body parameters in pregnant women with pyelonephritis.

MATERIALS AND METHODS: The study included 94 pregnant women with pyelonephritis hospitalized in the urological department of the Clinical Regional Hospital (Krasnoyarsk) from 2019 to 2021. In addition to traditional tests, anthropometric and bioelectrical impedance analysis was carried out to assess the constitutional features and criteria of normal and pathological variability boundaries of pregnant women with pyelonephritis. The control group included 39 women with physiological course of pregnancy without urological diseases.

RESULTS: The constitutional identification in the group of women with pyelonephritis in pregnancy was dominated by the mesomorph body type, with a smaller proportion presenting the endomorph type and the rarely detected central and ectomorph types. Vector analysis of soma components in pregnant women with pyelonephritis are characterized by high mesomorph scores reflecting the degree of skeletal and muscular development compared to the control group, with the lowest ectomorph values. According to bioelectrical impedance analysis, most patients have significant differences in a number of body composition parameters. Morphometric features of the pelvicalyceal system on the affected side are most prominent in the representatives of endomorph and central body types. There are significant correlations between the degree of pelvicalyceal system dilatation on the affected side and anthropometric and bioimpedance parameters of body composition.

CONCLUSION: The study revealed a number of clinical and anthropometric parallels and constitutional features of pregnant women with pyelonephritis with the characteristics of the component body composition. Relationships have been established between various indicators, which at first glance are not related to each other, but have a significant impact on the clinical manifestations of gestational pyelonephritis. The results of the pilot study and further development of the methodology will make it possible to determine the most significant constitutional predictors of the development of pyelonephritis in pregnancy and the possibility of conducting preventive therapy.

BACKGROUND: Infertility and obesity are actual and at the same time occurring problems of many couples. Conflicting data have been obtained on ejaculate parameters and the results of infertility treatment using in vitro fertilization treatment (IVF) in overweight and obese men.

AIM: To evaluate the results of examination and treatment using ART, depending on the body mass index (BMI) of men in infertile couples.

MATERIALS AND METHODS: A retrospective analysis of the results of treatment at the International Center for Reproductive Medicine in 368 infertile couples was carried out. The mean age of men and women was 36.4 ± 6.2 and 33.9 ± 5 years, respectively. Previous treatment for varicocele, sexually transmitted infections, prostatitis and cryptorchidism was performed in 58 (15.7%), 43 (11.7%), 42 (11.4%) and 11 (2.9%) men, respectively. Height and weight were measured for all patients, and BMI was calculated. The ejaculate was processed using a gradient medium (SupraSperm, Origio), IVF or ICSI were used in 110 (29.9%) and 258 (70.1%) couples, respectively, signs of good embryo quality were determined according to recommendations of professional societies for reproductive medicine. The onset of pregnancy was confirmed by the results of ultrasound sonography of the uterus. The results were subjected to statistical analysis.

RESULTS: The BMI mean was 27.4 ± 4.4 kg/m², overweight and obesity of the 1^st and 2^nd degrees were observed in 161 (43%), 58 (15.8%) and 23 (7%) men respectively. Higher BMI values of men corresponded to higher BMI values of women (p < 0.001), BMI values did not depend on ejaculate volume, concentration, total number and number of motile spermatozoa, proportion of high-quality embryos, and pregnancy rate. The highest pregnancy rate was noted after treatment of couples with younger women and higher values of the total number, concentration and number of progressively motile spermatozoa and ejaculate volume (p = 0.037, p = 0.028, p < 0.001, p = 0.003, p < 0.0001, respectively).

CONCLUSIONS: Overweight and obese men prevail in infertile couples seeking IVF treatment. IVF treatment can overcome infertility in couples with overweight and obese men.

BACKGROUND: Ablation is a method of destroying a pathological focus using a controlled temperature or other effect. The most promising ablative treatment for localized kidney cancer today is cryoablation.

AIM: To analyze functional and oncological results of cryoablation of localized kidney cancer using liquid nitrogen as cryogen.

MATERIALS AND METHODS: Between 2017 and 2020, 56 patients with suspected localized kidney cancer were observed and treated at the N.N. Petrov National Medical Research Center of Oncology. With morphological verification, renal cell carcinoma was detected in 19 (65.5%) patients, chromophobe renal cell carcinoma – in 3 (10.4%), oncocytoma – in 3 (10.4%), in 4 (13.8%) cases the tumor was not detected in morphological material. All patients underwent cryoablation using the MKS cryotherapy unit with liquid nitrogen as a cryogen (ultrasound-guide cryotherapy was performed in 4 (7.1%) cases, CT-guide – in 46 (82.1%), laparoscopically – in 6 (10.7%) patients).

RESULTS: Renal function in this study was assessed by creatinine level and glomerular filtration rate (GFR) before and after cryoablation. The creatinine level before cryoablation was 101 ± 18 µmol/l, after – 113.8 ± 18 µmol/l (p = 0.21), GFR before cryoablation – 63 ± 13 ml/min, after – 65 ± 13 ml/min. These differences were not significant (p = 0.87). Local disease control was achieved in 100% of cases. The overall and specific survival rate were 100% (one patient died from synchronous primary multiple cancer at 4 years of observation), the survival rate to recurrence was 90.9 ± 3.9%, and the event-free survival was 70.2 ± 6.6%. During the follow-up period, 9 (16%) recurrences of the disease were diagnosed.

CONCLUSIONS: Cryoablation makes it possible to maintain a large volume of renal parenchyma, thereby not reducing the functional ability of the kidney. In addition, the outcomes and survival rates are quite high, making it an alternative option for other nephron-saving operations.

The review article presents data on the efficacy and tolerability of intravesical injections of botulinum toxin in patients with overactive bladder. The pharmacological bases of the use of botulinum therapy in this category of patients are described in detail. Data on the history of the use of botulinum toxin for medical purposes are presented. Experience to date shows that intravesical botulinum toxin injections are highly effective and well tolerated in patients with refractory overactive bladder. Botulinum therapy is included in domestic and foreign clinical guidelines as a 3rd line treatment for idiopathic and neurogenic overactive bladder. Indications for its implementation are the inefficiency and/or poor tolerability of oral pharmacotherapy. It is noted that the only botulinum toxin recommended for use in clinical practice for the treatment of overactive bladder is onabotulinumtoxin A (Botox®). The results of clinical studies are presented, showing that the effectiveness and safety of botulinum therapy do not decrease over time.

The article presents a clinical case of treatment of a patient with benign prostatic hyperplasia and high serum prostate-specific antigen values. Prostate-specific antigen (total) blood level – 160.1 ng/ml. The volume of the prostate gland is 230 cm³, the average proportion is 53 mm. The patient underwent a full range of diagnostic tests. A retropubic transvesical adenomectomy was performed. During a histological examination of the preparation, no data was obtained for the presence of an oncological process.