卷 14, 编号 2 (2024)

BACKGROUND: Laparoscopic ureteroureterostomy is increasingly used as a surgical correction method for obstructive uropathies of the duplicated kidney. A complicating factor for this technique may be a significant difference between the diameters of the ureters.

AIM: This study aimed to analyze the effectiveness and safety of laparoscopic ureteroureterostomy in patients with obstructive uropathies of the duplicated kidney with a twofold or more difference in ureter diameters.

MATERIALS AND METHODS: Among 14 children who underwent laparoscopic ureteroureterostomy for obstructive uropathies of the duplicated kidney at Almazov National Medical Research Centre between 2021 and 2023, in 10 patients (71.4%), the diameter of the “donor” ureter exceeded the diameter of the “recipient” ureter two times or more.

RESULTS: In most patients, the indication for surgery was obstructive megaureter of the segment. All patients underwent laparoscopic ureteroureterostomy, proximal in 90% of cases and distal in one child. One of five patients underwent transurethral resection of the ureterocele as the first stage of operative treatment. The only complication observed in the postoperative period in the presented patients was a stent-associated urinary tract infection, which was treated conservatively. One child (10%) required ureter reimplantation with stump resection after ureteroureterostomy.

CONCLUSIONS: Laparoscopic ureteroureterostomy is a safe and effective method for surgical correction of obstructive uropathies of the duplicated kidney although a significant difference is noted between the diameters of the “donor” and “recipient” ureters. This factor does not reduce the effectiveness of ureteroureterostomy and does not lead to an increased risk of postoperative complications and reoperations. Thus, laparoscopic ureteroureterostomy can be used in patients with obstructive uropathies of the duplicated kidney.

BACKGROUND: Benign prostatic hyperplasia (BPH) is common middle-aged and elderly men. In modern urology, transurethral resection and its modifications are used in surgical treatment of BPH. In the last decades, an active tendency of laser technologies development in urology was noted. The search for the most appropriate techniques of transurethral removal of prostate adenoma by comparing the results of treatment of patients with the use of different technologies remains relevant.

AIM: This study aimed to evaluate the clinical effectiveness of transurethral bipolar surgery and laser technologies in the treatment of BPH.

MATERIALS AND METHODS: Transurethral enucleation of the prostate using various technologies was performed in 273 patients with BPH between 2021 and 2023: 94 patients underwent bipolar transurethral enucleation of the prostate, 87 underwent thulium enucleation of the prostate (ThuLEP), and 92 underwent holmium enucleation of the prostate (HoLEP).

RESULTS: Clinical evaluation showed the absence of intraoperative complications. For ThuLEP, a trend toward shorter operative times compared to other techniques was observed. In the early postoperative period, significant bleeding was noted in six cases of using bipolar technology, three cases of using a thulium laser, and five cases of using a holmium laser. An examination of patients 6 months postsurgery showed pronounced positive dynamics in all three groups. No significant differences were found in clinical parameters 6 months postsurgery in patients of different groups.

CONCLUSIONS: Bipolar enucleation of the prostate, ThuLEP, and HoLEP are comparable in effectiveness and the number of complications in the surgical treatment of BPH. Study results indicated that it is advisable to actively use these methods in wide clinical practice.

BACKGROUND: Combined pelvic trauma in men in 10%–24% of cases is accompanied by damage to the posterior urethra, and no consensus on the treatment tactics has been established for such patients.

AIM: This study aimed to evaluate the results of treatment of patients with closed injury of the posterior urethra and traumatic shock.

MATERIALS AND METHODS: A retrospective analysis of the results of treatment of 46 patients with closed injury of the posterior urethra caused by a fracture of the pelvic bones and traumatic shock was performed. The average age of patients was 42.1 ± 9.9 years. The severity of urethral injuries was assessed according to the American Association for the Surgery of Trauma (AAST) classification.

RESULTS: The choice of treatment techniques depended on the degree of damage to the urethra and severity of traumatic shock. Upon hospital admission, 15 (32.6%) patients were diagnosed with grade I, 21 (45.6%) with grade II, and 10 (21.7%) with grade III traumatic shock. In grade I–II traumatic shock patients with incomplete urethral rupture, a urethral catheter was inserted, followed by conservative therapy. If a catheter insertion was possible, a retropubic revision of the urethra was performed. Patients with grade III–V urethral injury according to AAST and grade I–II traumatic shock underwent primary or delayed urethroplasty, such as urethral suturing and urethra-urethral anastomosis. Patients with grade III traumatic shock had a urethral catheter or cystostomy. In the long-term, 6 of 17 (36.9%) patients who underwent primary or delayed urethroplasty had short-term (up to 5 mm) urethral strictures, for which optical urethrotomy was performed. All patients with complete urethral avulsion who did not undergo early urethroplasty developed 10–20 mm strictures, requiring reconstructive surgery.

CONCLUSIONS: The choice of treatment techniques for patients with concomitant damage to the posterior urethra depends on the degree of damage to the urethra and severity of traumatic shock. The scope of treatment in the acute period may include urethral or suprapubic drainage of the bladder or reconstructive surgery.

The review article shows the main stages of studying botulinum toxin and its use in medicine. The possibilities of using botulinum toxin for the treatment of urological patients are similarly described. Furthermore, the most significant studies on the use of botulinum toxin in patients with neurogenic detrusor c, idiopathic overactive bladder, detrusor sphincter dyssynergia, chronic pelvic pain, benign prostatic hyperplasia, erectile dysfunction, and premature ejaculation are presented.

Intraperitoneal traumatic perforations of the bladder of any origin (e.g., external trauma, iatrogenic injuries) and spontaneous ruptures are conditions that, according to the canons of surgery, require emergency surgical intervention by one or another access. However, some studies have indicated the possibility of conservative management of such patients — both adults and children. A review of publications describing the results of conservative treatment of patients with intraperitoneal bladder perforations was performed. Overall, 2,679 publications related to intraperitoneal perforations of the bladder were found in the available scientific databases, of which only 72 focused on issues of conservative treatment. In 13 of them, the possibility of such an approach is denied, but without reference to their own material. Analysis of the literature demonstrated that conservative management of intraperitoneal perforations of the may be feasible in certain circumstances, sometimes being a crucial measure. Indications for conservative treatment techniques include the absence of peritonitis, small perforation size, and short periods from the moment of perforation. However, all these indications are in the nature of opinions and assumptions and are not part of algorithmic tactics. The effectiveness of this approach remains unclear. The frequency of unsatisfactory outcomes ranges from 10% to 50%, which indicates the inappropriateness of conservative treatment. With the small number of studies and conflicting results obtained prohibits us to consider this technique as the method of choice for treating patients with intraperitoneal perforations of the bladder.

The development of acute kidney injury during surgical renal-preserving interventions characterizes the nature of the clinical course and prognosis for the development of chronic kidney disease. The use of standard indicators of disease progression (serum creatinine and urea nitrogen) in clinical practice can lead to unfavorable outcomes of acute kidney injury due to their low sensitivity and high specificity against the background of damage to more than 50% of the renal parenchyma). Other biomarkers of acute kidney injury (cystatin C, IL-18, KIM-1, NGAL, L-FABP, NAG and others) are superior to creatinine in sensitivity and specificity, but require additional research to identify the most optimal ones for clinical practice.

Prostatic bleeding is life-threatening, and its most common cause is locally advanced prostate cancer. In several patients, hemostatic therapy is ineffective. Surgery is not feasible in most patients owing to the high surgical risk. In such cases, prostatic artery embolization may be the method of choice to stop the bleeding. This procedure is minimally invasive; thus, it can be performed in patients with contraindications to more extensive operations. Despite limited experience with embolization of prostatic arteries, according to the literature, it is effective in 90% of treated patients. This article provides a review of the literature and clinical observations of the successful use of prostatic artery embolization to stop bleeding in patients with locally advanced prostate cancer.

This article is dedicated to outstanding clinical scientist Professor B.N. Kholtsov (1861–1940). The main stages of his scientific, clinical, and teaching activities and his scientific achievements in the development of novel methods for treating diseases of the urinary and male genital organs are presented. He was the first to propose a two-stage adenomectomy technique, an original method of urethral resection in case of stricture, and developed a surgical treatment method for contracture of the bladder neck. The role of Kholtsov in the training of urologists at the Department of Urology of the Leningrad State Institute for Advanced Training of Doctors, which he headed in 1926–1940, is shown. Kholtsov was a talented clinician, scientist, teacher, and innovator, whose main ideas remains in demand today.