Urologiia最新文献

THE AIM OF THE RESEARCH: is to present the features of the technique and results of intestinal reconstruction surgery of ureters.

Materials and methods: From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51+/-3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral - 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones.

Results: The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 +/- 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases.

Discussion: The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner.

Conclusion: Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.

Aim: To evaluate the effect of microsurgical subinguinal varicocelectomy on sperm DNA fragmentation (SDF) in patients with elevated SDF levels (more than 15%) and clinical varicocele.

Materials and methods: A single-center, retrospective, observational, uncontrolled study was carried out. The results of a survey of 33 patients with clinical varicocele, infertility or recurrent miscarriage and sperm DNA fragmentation of more than 15% were analyzed. All patients in 2021-2022 underwent microsurgical subinguinal varicocelectomy at the clinic "Mother and Child Yaroslavl". The level of sperm DNA fragmentation was assessed before and 3 months after varicocelectomy using TUNEL assay based on flow cytometry.

Results: The level of SDF before surgery ranged from 17 to 73% (Me [Q1-Q3]: 32% [21-42]). After 3 months, it ranged from 1 to 27% (14,4% [7,5-17,4]). The differences between the groups were significant (p <0.001). In all patients, SDF levels after varicocelectomy were lower compared to baseline. The differences ranged from 4 to 55% (19,1% [9,5-25,7]). In 21 patients (63.6%) SDF level after treatment did not exceed the upper limit of the reference interval (15%), and in 11 (35.4%) patients the postoperative values were higher than 15%. A significant (p<0.001) positive correlation (r=0.626) was revealed between the preoperative SDF level and the degree of reduction in sperm DNA fragmentation. However, no correlation was found with other preoperative indicators (varicocele degree, patient age, body mass index, side of varicocele).

Conclusion: Performing microsurgical subinguinal varicocelectomy in patients with an increased SDF level (more than 15%) allows reducing SDF within 3 months by an average of 19.1% and achieving normative values in 63.6% of men. The degree of reduction in SDF after varicocelectomy positively correlates with preoperative values.

Purpose: In this study, we compared the effects of a single patient dialysis fluid delivery system (SPDDS) against a continuous dialysis fluid delivery system (CDDS) on inflammatory markers and endotoxemia in a population of patients receiving routine hemodialysis (HD) at Ain Shams University.

Materials and methods: Eighty prevalent HD patients, ages 18 to 60, who were clinically stable and receiving thrice weekly dialysis treatments via an arteriovenous fistula were the subjects of a cross-sectional research. The study excluded patients with double lumen venous catheters used for hemodialysis, acute infections, cancer, and chronic liver disease. Two groups of patients were created by random selection: group I underwent HD using a CDDS water purification system that was implemented at El Demerdash Hospital two years prior, and group II underwent HD using an SPDDS water purification system at Ain Shams University Specialised Hospital.

Results: In both groups, laboratory, inflammatory marker, and demographic data were gathered. Serum samples were taken before and after dialysis to assess the endotoxin levels in each group. Pre-dialysis endotoxin levels were significantly lower in the CDDS group (0.07+/-0.05) compared to the SPDDS group (0.20+/-0.07) with a P value <0.001, and post-dialysis serum endotoxin levels were significantly lower in the CDDS group (0.04+/-0.02) compared to the SDDPS (0.15+/-0.03) with a P value <0.001.

Conclusion: According to our research, the CDDS groups circulating endotoxins had significantly decreased.

The effects of the interaction of optical radiation and biological tissues underlie various optical diagnostics technologies, including laser Doppler flowmetry, diffuse reflection spectroscopy, fluorescent spectroscopy, photodynamic diagnostics (fluorescent cystoscopy), confocal microscopy, optical coherence tomography, etc. The efficiency of these technologies is the subject of study in various fields of medicine, such as dermatology and ophthalmology, anesthesiology and cardiac surgery, in the diagnosis of malignant tumors and others. In the first part of our review, the available data on the feasibility of using laser Doppler flowmetry and diffuse reflection spectroscopy as a diagnostic tool in urological practice are reviewed and systematized.

Aim: To evaluate the automated medical decision support system "Sechenov.AI_nephro" in the treatment of patients with renal parenchymal tumors.

Materials and methods: The beta version of the web-platform "Sechenov.AI_nephro" consists of a neural network based on MONAI (Medical open network for AI) and a web interface, with algorithms classified based on segmentation data in manual mode using the 3D modeling program "Amira". A total of 441 patients with renal parenchymal tumors were included in the multicenter prospective study. Testing was carried out over 12 months in 3 urological centers: 358 (81.2%) patients from I.M. Sechenov First Moscow State Medical University, Moscow; 73 (16.6%) patients from Bashkir State Medical University; and 10 (2.3%) patients from Saratov State Medical University named after V.I. Razumovsky. In all cases, contrast-enhanced computed tomography (CT) was performed preoperatively. DICOM (Digital Imaging and Communications in Medicine) data of each patient's CT was uploaded to the web-platform "Sechenov.AI_nephro" for automatic construction of a 3D model of the tumor. The work of the web-platform "Sechenov.AI_nephro" was evaluated based on a questionnaire completed by surgeons who performed the surgical intervention. The questionnaire consisted of 14 questions, with a scoring system from 1 to 10 points. It was divided into 3 main sections, including first for assessment of the quality of work of the web-platform "Sechenov.AI_nephro"; second for evaluation of the use of the 3D model in communication with the patient, for surgical planning and intraoperative navigation; and third for analysis of the choice of useful data display mode, errors in constructing the 3D model.

Results: The questionnaire was completed in 253 (57.37% of 441) cases. The quality of 3D models was rated 7.8-9.4 points, and the use of the 3D model in communication with the patient, for surgical planning and intraoperative navigation was rated 7.8-9.4 points. The 3D models were constructed correctly in 70% of cases. The area of interest was the useful mode of 3D models display in surgical planning. Incorrectly constructed anatomical elements were veins in 25.5% and the tumor in 26.4% of cases, respectively.

Conclusion: The automated medical decision support system in the treatment of patients with renal parenchymal tumors "Sechenov.AI_nephro" demonstrated satisfactory quality of 3D reconstruction of pathological process. 3D models allow for personalized determination of the surgical tactic for treating patients with renal tumors.

The smoking negatively affects main sperm parameters and male fertility. Men of reproductive age (20-39 years old) make up less than half of male smokers. The decision to stop smoking is a rational element of lifestyle modification for a man planning fatherhood or man who are experiencing infertility. The use of electronic cigarettes (vaping) is often recommended as an alternative and an aid in the conventional cigarette smoking cessation process. In older men, the use of electronic cigarettes promoted as an aid for conventional cigarette smoking cessation, 40% of young vapers had never smoked before. Scientific data on the effect of electronic cigarette aerosol on the male reproductive system and spermatogenesis are currently limited. The analysis of the composition of liquids for electronic cigarettes and the resulting aerosols revealed more than 80 different compounds. This review presents new scientific data on the effect of the main components of electronic cigarette liquid on the male reproductive system and spermatogenesis. The paper presents the results of experimental studies proving the negative effect of electronic cigarette aerosol on the cellular organization of the seminal tubules and the system of hormonal regulation of spermatogenesis. Clinical studies have been analyzed. The results obtained do not allow us to assert that vaping is a safe alternative to traditional smoking in the case of a man planning fatherhood and preparing to conceive a child. The results do not allow us to consider vaping to be perceived as a safe alternative to traditional smoking in the case of a men planning fatherhood and men who are experiencing infertility.

Introduction: The most reliable method for bladder catheterization when necessary is to put a urethral catheter under visual control. However, this requires endoscopic equipment and transportation of patient to a cystoscopy unit or operating room, which is not always possible. To solve these problems, we have developed the optical urethral catheter Visus MG.

Aim: To evaluate the safety and efficacy of a new optical urethral catheter with a portable endoscopic complex.

Materials and methods: The prospective single-center clinical study included men, in whom the first bladder catheterization with a soft urethral catheter was impossible. They underwent insertion of the optical urethral Visus MG catheter under visual control.

Results: A total of 60 men were included in the study. The median age was 70 years, the average prostate volume was 40 cc. Successful repeated catheterization was performed in 57/60 (95%) patients. In 5% cases (n=3), bladder catheterization was unsuccessful due to urethral obliteration. In 53 (88.3%) men, various surgical methods or manipulations were previously performed, including temporary bladder catheterization in most cases (n=16; 30.7%). The cause of failure of primary catheterization were urethral strictures in 19 (31.7%), benign prostatic hyperplasia in 9 (15%), false passage in 10 (16.7%), bladder neck sclerosis in 10 (16.7%), urethal obliteration in 3 (5%), and the foreign body in the urethra in 1 case (1.7%). In 6 (10%) men, there were signs of iatrogenic urethral trauma with urethrorrhagia due to previous attempts of catheterization, which, however, did not prevent a placement of the urethral catheter under vision control in safe manner.

Conclusion: Bladder catheterization with an optical urethral catheter Visus MG with a portable endoscopic complex was successful in 57/60 (95%) patients after failed primary catheterization, which indicates the high efficiency of the method. The advantages of the technology are its portability, mobility and direct visualization of the urethra.

Background: Throughout the course of transplantation oxidative stress is a major mediator of adverse outcome. The major objective of this investigation is to measure the total antioxidant capacity (T-AOC) and its correlation with immunosuppressive drug levels after kidney transplantation.

Method: s: Thirty-five kidney transplanted recipients and thirty-five healthy subjects that matched for age were entered in this study. The obtained data were analyzed using the Statistical Package (SPSS Inc, Chicago, IL, USA). The significance level was set at P<0.05.

Results: In healthy controls, the mean+/-SD for T-AOC was 91.9+/-16.6 (U/ml), that was significantly higher when compared to mean value of 27.3+/-24.1 (U/ml), kidney transplanted recipients (P less or equal 0.01). The mean value of tacrolimus levels was 13.7+/-5.3 (ng/ml). Correlation between tacrolimus trough levels and TAOC was 0.19 (P less or equal 0.14). There were not any significant differences regarding age in cases and controls (P less or equal 42).

Conclusion: The outcomes of this study suggested that within the limited sample size TAOC in kidney transplanted recipient was lower than controls. Further studies associated with TAOC and clinical outcome after kidney transplantation recommended.

Reactive oxygen species are secondary messengers in multiple intracellular and tissue reactions, modulate the activity of mitogenic signaling pathways, and are formed predominantly in the course of metabolic activity. Both direct and indirect data on male reproductive dysfunction associated with SARSCoV-2 are described, as well as its possible pathophysiological and immunological explanations.

Purpose: of the work: to evaluate the dynamics of lipid peroxidation and antioxidant protection in men after SARS-CoV-2 infection while taking an antioxidant complex.

Results: In the observed patients, the components characterizing significant damage to metabolic homeostasis were analyzed in the blood plasma: the state of lipid peroxidation was judged by the level of compounds with double bonds, ketodienes and conjugated trienes, diene conjugates, and TBA-active products in the blood. The intensity of antioxidant defense processes was assessed by the concentrations of -tocopherol and retinol, as well as by the activity of superoxide dismutase. In the prooxidant-antioxidant system, the balance was restored towards antioxidant components in the group of patients after taking the antioxidant complex.

Conclusions: the effectiveness of antioxidant correction largely depends on the degree of protection of the structure and function of cell membranes, as a result, the use of this drug is advisable, since it reduces the level of lipid peroxidation and enhances the antioxidant defense of the body.