Urologiia最新文献

Introduction: Benign prostatic hyperplasia (BPH), despite advances in pharmacotherapy and surgical treatment, remains a pressing problem in modern urology. The success of therapy depends on the condition of the prostate epithelial compartment.

Objective: To conduct a histological assessment of glandular epithelium in BPH in hypo- and eugonadal men.

Materials and methods: The results of morphological examination of the resected prostate tissue of 188 men with BPH were analyzed, who were divided into two groups: Group I - 71 patients with testosterone (Tc) deficiency, group II (control) - 117 patients with testosterone levels above 12.1 nmol/L.

Results: In patients with Tc deficiency, morphological examination of resected prostate tissue samples revealed a stromal pattern of BPH, combined with cystic deformation of the acini, with flattened and non-secretory epithelium. In patients with normal Tc levels, all patients had a glandular pattern of hyperplasia, and the epithelial cells of the acini were tall, columnar, and showed signs of active secretion.

Conclusions: In patients with testosterone deficiency, morphological examination of resected prostate tissue samples revealed atrophic, flattened, and non-secretory epithelium. In patients with Tc levels within the reference range, all epithelial cells were tall, columnar, and showed signs of active secretion.

It has been established that women who undergo hysterectomy, even in cases where the ovaries are preserved, frequently experience premature ovarian insufficiency syndrome, which can lead to various endocrine and metabolic disorders. A comparable inquiry emerges in the context of radical prostatectomy (RP) in males: whether the extraction of the prostate gland itself influences testicular function and the emergence of polymetabolic disorders in the absence of androgen deprivation therapy (ADT). Radical prostatectomy has been recognized as an effective treatment for localized prostate cancer (PCa), providing high survival rates for patients diagnosed with this disease. The primary focus of specialists in this field has historically centered on the surgical consequences of RP, such as erectile dysfunction and stress urinary incontinence. However, mounting evidence suggests that prostate removal itself can also result in a transient decrease in testosterone levels, manifesting as biochemical or manifest hypogonadism, along with moderate metabolic disturbances, though not to the same extent as observed with adjuvant hormone therapy. In some cases, patients already in the preoperative period may have risk factors for metabolic syndrome, osteopenia, and other perioperative complications, which makes it difficult to objectively assess the direct effect of RP. A more profound comprehension of the pathophysiologic mechanisms underlying these changes appears to be a pivotal element in facilitating timely diagnosis, prevention, and treatment of potential endocrine-metabolic complications associated with RP.

Introduction: Erectile dysfunction (ED) remains one of the important issues in modern urology, as it affects not only the quality of life but also the psychological and reproductive health of patients. Diagnostic challenges persist, as there is still no universal, minimally invasive method to evaluate the quality of erection and the efficiency of therapy in patients with a confirmed diagnosis of ED.

Aim: To assess the feasibility of using the Androscan-MIT device as a minimally invasive tool for monitoring the efficiency of conservative treatment in patients with vasculogenic erectile dysfunction.

Materials and methods: The study included 80 men aged 37 to 61 years with mild to moderate ED and 20 healthy volunteers as a control group. Patients were divided into four groups: group 1 (n=30): patients received local negative pressure therapy (LOD-therapy), low-intensity shockwave therapy (LiSWT), and Avantron chair stimulation (10 sessions); group 2 (n=30): patients received daily phosphodiesterase type 5 inhibitor (PDE5i) therapy at a dose of 5 mg for 2 months; group 3 (n=20): patients received combined therapy including LOD-therapy, LiSWT, Avantron chair stimulation, and platelet-rich plasma (PRP) injections (5 sessions); group 4 (n=20): control group of healthy volunteers. Therapeutic efficacy was assessed using the IIEF-5 questionnaire (International Index of Erectile Function) and Androscan-MIT measurements before and after treatment.

Results: In Group 3, a significant improvement was observed after therapy: the IIEF-5 score increased to 21.1+/-2.1, corresponding to a 39.7% rise from baseline. Repeat nocturnal penile tumescence (NPT) monitoring demonstrated erectile function parameters comparable to those in the control group. The absolute increase in penile diameter reached 12.5+/-0.4 mm (+48.8% from baseline). The average number of effective nocturnal erections increased to 4.6+/-0.4 (+67.6%), and the average duration of each effective erection reached 20.9+/-1.5 minutes (+36.6%). The total erection time per night was 81.8+/-5.3 minutes (+74.8% from baseline). In Groups 1 and 2, no statistically significant changes in these parameters were recorded compared to baseline.

Conclusion: The use of the Androscan-MIT device allowed for effective diagnosis of vasculogenic erectile dysfunction and minimally invasive assessment of therapeutic outcomes. The observed improvements following treatment confirm the potential of Androscan-MIT for both diagnostic evaluation and monitoring of conservative therapy efficiency in patients with vasculogenic ED.

Introduction: The authors consider gestational pyelonephritis as a relevant clinical problem requiring timely diagnosis and a well-grounded choice of treatment strategy.

Aim: To develop and validate a scale for stratifying the risk of acute pyelonephritis in pregnant women, allowing determination of the optimal management strategy (conservative therapy or upper urinary tract drainage) at various gestational stages.

Materials and methods: A retrospective analysis was performed on 161 cases of urinary tract infection in pregnant women: 73 patients observed in 2024 using the proposed scale and 88 patients from 2023, who formed the control group.

Results: Implementation of the scale in 2024 increased the frequency of ureteral stenting (32.8% vs. 17% in 2023) and reduced the number of cases with kidney decapsulation (2.9% vs. 3.5%). A statistically significant increase was observed in the proportion of hospitalizations during the third trimester (20.6% vs. 6.8% in the first trimester), indicating more accurate risk stratification and timely selection of treatment tactics.

Conclusion: The developed scale facilitates objectification of clinical decisions in managing pregnant women with gestational pyelonephritis, ensures timely drainage in high-risk patients, and reduces the frequency of unnecessary invasive interventions.

The management of overactive bladder (OAB) involves drugs from several pharmacological classes, among which anticholinergic agents occupy an important place. The choice of therapy should be strictly individualized, taking into account not only the expected efficacy but also potential drug interactions, age-related pharmacokinetic and pharmacodynamic changes, comorbidities, the overall anticholinergic burden, and the risk of adverse effects. Trospium chloride (Spasmex) is considered the drug of choice for patients with OAB. Its pharmacological properties ensure both clinical efficacy and good tolerability, along with proven cognitive safety. Trospium chloride does not cross the blood-brain barrier and therefore does not cause central nervous system adverse effects. Another advantage of trospium chloride is the flexible dosing regimen, which allows for individualized dose titration according to patient response and tolerability.

Background: To decrease the high morbidity and mortality of patients with end-stage renal disease kidney transplantation is the most effective management. This study aimed to investigate changes in clinical, biochemical, inflammation, rejection, and its association with the renal arterial resistive index after kidney transplantation.

Methods: In this study, we assessed changes in clinical, biochemical, and renal arterial resistive (RRI) index measured by doppler ultrasound and its association with graft rejection after kidney transplantation in 60 adult recipients. Data included; gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, donor (living or cadaver), preference of vessel anastomosis (first artery- second vein; FASV or FVSA), preference of arterial anastomosis (as end-to-end to hypogastric artery or end-to-side to common or external iliac artery), evidence for acute tubular necrosis (ATN), in addition to biochemical variables were noted analyzed by SPSS.

Results: With a minimum of 16 and a maximum of 68, the mean+/-SD was 42,3+/-13,7 years old. Of the total population studied 52% received kidneys from cadaver donors. Although acute tubular necrosis versus acute rejection was reported at 32% versus 60%, the value of RRI in the total population was 0,76+/-0,11. There was a significant difference in rejected versus non-rejected (p=0,001) and living versus cadaver donors regarding the values of reported RRI (=0,018).

Conclusion: In this study, the recorded RRI suggested respected information regarding changes within intraparanchymal vascularization linked to rejection after kidney transplantation. Further evidence-based studies regarding RRI with more sample size are recommended.

Objective: To evaluate the efficacy and safety of intraluminal nitinol ureteral stents ("MIT", Russia) in patients with benign ureteral strictures who experience a significant decline in their quality of life due to standard drainage systems and have contraindications to radical surgical treatment.

Materials and methods: Between 2021 and 2025, a total of 27 MIT nitinol stents were implanted in 25 patients with benign ureteral obstruction. In the first stage, all the patients underwent an endoscopic assessment of the stricture determining its length, followed by a temporary placement of a double J stent. In the second stage, an intraluminal stent was implanted. The effectiveness was evaluated based on technical and clinical success, as well as changes in quality of life assessed by the Visual Analogue Scale (VAS).

Results: The mean operative time was 35 [30; 41] minutes. Technical success was achieved in 92% of the patients. A significant improvement in quality of life was observed in most patients, with the median VAS score increasing from 21 [20; 26] to 86 [77; 90] points 3 months after the implantation. Mild stent-related symptoms persisted in 6 patients. Additional interventions were required in 6 patients (8 interventions). In 4 cases, stent encrustations had to be removed endoscopically; in 2 cases, endoscopic correction of stent position was performed; in 2 cases, additional drainage was required due to mucosal hyperplasia at the contact points of the stent ends.

Discussion: Intraluminal nitinol stents demonstrate high clinical efficacy and may serve as a viable alternative to standard drainage systems in patients who are not candidates for reconstructive surgery. Their use is associated with fewer side effects and a significant improvement in quality of life. However, stent implantation carries a risk of complications such as encrustation, migration, and mucosal hyperplasia. Therefore, careful patient selection, adherence to technical standards of implantation, and regular follow-up are essential.

Conclusion: The introduction of MIT nitinol ureteral stents into clinical practice shows promising results in patients with benign ureteral strictures. Further studies involving larger patient cohorts and longer follow-up periods are needed to refine indications and optimize patient management strategies.