Urologiia最新文献

Aim: To improve surgical outcomes in patients with benign prostatic hyperplasia (BPH) by assessing the efficacy and safety of bipolar transurethral resection of the prostate (b-TURP) in comparison with thulium laser enucleation of the prostate (ThuLEP).

Materials and methods: A retrospective and prospective analysis of surgical outcomes was performed in 555 patients with BPH who were examined and operated on between 2018 and 2024. Among them, 301 patients underwent bipolar TURP, and 254 patients underwent transurethral thulium laser enucleation of the prostate (ThuLEP). The mean age of patients was 68.8+/-8.10 years in the b-TURP group and 68.3+/-8.10 years in the ThuLEP group (p>0.05).

Results: The intraoperative blood loss and volume of removed tissue were significantly higher in the ThuLEP group. The incidence of early and late postoperative complications was significantly higher in patients after b-TURP. The need for additional postoperative pharmacotherapy and its duration due to lower urinary tract symptoms (LUTS) were also significantly greater after b-TURP.

Conclusion: Although both techniques provide a comparable and high efficacy in the surgical removal of adenomatous prostatic tissue, their safety profiles differ. Despite effective relief of bladder outlet obstruction, bipolar TURP is inferior to ThuLEP in terms of patient safety and early postoperative recovery.

Relevance: Pyelonephritis is an infectious and inflammatory disease of the kidneys with predominant damage to the mucous membrane of the pelvis and calyces and/or interstitial tissue. In complicated acute pyelonephritis, the frequency of E. coli isolation is 63,3%. Less common pathogens are Proteus mirabilis (6,1%), Pseudomonas aeruginosa (1,3%), Klebsiella pneumoniae (13,5%). Enterobacteriaceae are characterized by high levels of resistance to many antimicrobial drugs (AMPs). Today, the greatest clinical significance is the increase in resistance of enterobacteria strains to modern cephalosporins and carbapenems.

Purpose of the study: To study the level of resistance of pyelonephritis pathogens to antibacterial drugs of various groups, to identify producers of extended spectrum beta-lactamases and carbapenemases among the causative agents of acute secondary pyelonephritis.

Materials and methods: The medical histories of 305 medical histories of patients who were undergoing inpatient treatment at the uronephrological center of the Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk with an established diagnosis: acute secondary pyelonephritis. The material for laboratory research was the average portion of freely released urine obtained after toileting the genital organs, or urine collected by a catheter using a generally accepted method. Identification of microorganisms was carried out using automatic bacteriological analyzers. Antimicrobial susceptibility was tested using the disk diffusion method. Molecular genetic analysis was carried out using the PCR method.

Results and discussion: The resistance of microorganisms that cause acute secondary pyelonephritis to antibacterial drugs of various groups was assessed. The mechanisms of antibiotic resistance of enterobacteriaceae have been studied. A high prevalence of extended spectrum beta-lactamase producers was revealed. In E. coli isolates. genes of the bla CTX-M-1 cluster predominated (34%). Carbopenemase production was detected in 24% of the analyzed E.coli strains. The vast majority of K. pneumoniae strains produced extended-spectrum beta-lactamases of the bla SHV cluster (87.5%). The frequency of carbapenemase production among K. pneumoniae isolates was 68.7%.

Conclusion: If acute secondary pyelonephritis is suspected and empirical therapy is prescribed, assessment of the local resistance phenotype of the leading pathogens is necessary to exclude from the selection of antibacterial agents to which there is a high level of resistance.

Despite the growing popularity and expanding indications for retrograde intrarenal surgery (RIRS) in the treatment of urolithiasis, percutaneous nephrolithotripsy (PCNL) remains the method of choice for removing large kidney stones due to its high efficiency and safety. Modern approaches, such as tubeless or totally tubeless PCNL, allow faster recovery and improve patients postoperative quality of life. However, successful implementation of these procedures requires strict patient selection. The primary criterion is atraumatic nature, an absence of urinary tract infection and residual fragments. To analyze modern instrumental techniques and technologies potentially capable of reducing the incidence of intra- and postoperative complications during tubeless PCNL, we carried out a literature search in PubMed, Scopus, ResearchGate, and eLibrary. The review included articles in Russian and English published between 1973 and 2024. According to the literature, the frequency of tubeless PCNL can be increased by precise, atraumatic transpapillary puncture through the avascular zone. These conditions can be achieved not only by the surgeons experience, but also through the use of new atraumatic instruments for puncturing the collecting system and creating percutaneous access, such as the MG puncture needle, as well as imaging technologies that significantly improve puncture accuracy. To obtain more reliable evidence, prospective randomized studies including patients undergoing tubeless and totally tubeless PCNL are required. CONCLUSION: The use of additional imaging technologies and atraumatic instruments for percutaneous access may reduce the complication rate after tubeless and totally tubeless PCNL. However, further prospective randomized studies are necessary in this field.

Issues of etiology, pathogenesis, and diagnostics of tuberculous bladder lesions were discussed in the first part of the review. The presence of a "small contracted" bladder, regardless of etiology, is an indication for surgical treatment, including tuberculous microcystis. The surgeons main task is to select the optimal surgical approach in each case. An ileal segment is considered the best material for urinary reservoir reconstruction. Supratrigonal cystectomy with augmentation and radical cystectomy with orthotopic reconstruction are the most common procedures for tuberculous microcystis. In the postoperative period, assessment of quality of life and urodynamic parameters are key factors for successful outcomes. To summarize current data on surgical treatment of tuberculous bladder microcystis and to evaluate quality of life and urodynamic parameters after surgery, the publications from Elibrary.ru, PubMed, and Google Scholar were reviewed. This second part of the review highlights surgical treatment options for tuberculous microcystis and presents available data on quality of life and urodynamic outcomes after surgery.

Urinary tract infections (UTIs) remain one of the most common bacterial infections in outpatient practice, particularly among women of reproductive age and pregnant patients. One of the therapeutic options for UTIs is cefixime, a broad-spectrum third-generation cephalosporin. Cefixime demonstrates high antimicrobial activity with a minimal number of adverse effects, which explains the absence of contraindications for its use during pregnancy. Cefixime has high oral bioavailability, is often resistant to -lactamases, and ensures sufficient urinary concentration when administered at 400 mg once daily. Pharmacokinetic parameters remain stable during pregnancy, while preclinical studies indicate extremely low penetration into fetal tissues and breast milk (<1% of the dose). The dispersible formulation Cefixime EXPRESS provides additional benefits for pregnant women due to ease of administration, improved tolerability and adherence. Cefixime EXPRESS in dispersible form represents a modern drug for the treatment of both acute uncomplicated cystitis and acute uncomplicated pyelonephritis, particularly in outpatient settings. It combines proven efficacy with convenient dosing, good tolerability, and a rapid clinical response, making it a reasonable treatment choice, especially when first-line drugs are contraindicated or in cases of resistance to other antibiotics.

Introduction: Benign prostatic hyperplasia (BPH) is an important and urgent public health problem. Prostatic hyperplasia is characterized by epithelial, stromal, and muscular proliferation.

Objective: To conduct a comparative analysis of the results of morphological examination of resected prostate tissue in patients with prostatic hyperplasia with and without testosterone deficiency.

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 deficiency, group II (control) - 117 patients with testosterone levels above 12.1 nmol/L.

Results: In patients with testosterone deficiency, during morphological examination of resected pancreatic tissue samples, prostate hyperplasia had a diffuse stromal character, combined with cystic deformity of the acinuses, with flattened and unclassifying epithelium, against the background of basal cell hyperplasia. In patients with normal Tc levels during morphological examination, during morphological examination of resected pancreatic tissue samples, the hyperplasia in all patients was glandular (epithelial), and the epithelial cells of the acinuses were tall cylindrical, with signs of active secretion.

Conclusion: In hypogonadal men, stromal hyperplasia was detected in most cases (76.1%) in the resected prostate tissue, and in normogonadal patients, hyperplasia was glandular in all cases.

Aim: To investigate the effects of solutions composed of molecules with both chelating and surfactant properties on kidney stones.

Materials and methods: Kidney stones and their fragments were obtained during ureteroscopy and retrograde intrarenal surgery, percutaneous nephrolithotomy, and stone extraction from the kidney performed in patients with urolithiasis. For the experiment, a solution was prepared based on a composition of iminodiacetate derivatives of fatty acid glycerides and iminodiacetate derivatives of polysaccharides. Stones of known mass were processed with this solution, dried, and examined using X-ray diffraction analysis. Qualitative protein analysis (biuret test) was performed on the solution and washout fluid.

Results: Struvite stones (MgNH4PO46H2O) swelled in the solution and disintegrated into small fragments. Proteins and phosphate ions were detected in the prepared solution. Stones composed of crystalline uric acid or its hydrate, as well as hydrated calcium oxalates (whewellite and weddellite), also swelled, with occasional changes in surface structure and color. X-ray diffraction analysis revealed a decrease in the amorphous, presumably protein, component and changes in the relative proportions of crystallohydrates. The presumed mechanism of stone destruction was leaching of the amorphous protein binder between crystalline grains, together with alterations in the crystalline phases.

Conclusion: Complexons with emulsifying properties from the prepared solution penetrate the protein matrix of kidney stones and, together with enhanced water diffusion, cause partial protein extraction, swelling of amorphous and some crystalline phases, and subsequent stone disintegration. These findings highlight the potential of such hybrid compounds for the development of novel methods of treating urolithiasis and warrant further investigation.

The review article reflects current opinion in oxidative stress impact on male fertility, as well as the possibilities of restoring redox balance and normalizing reproductive function by administration of substances with antioxidant properties and products containing polyunsaturated fatty acids. The review covers Russian studies of antioxidant complexes "BESTFertil", which includes L-Carnitine, L-Arginine, Vitamin C and E, Folic Acid, Zinc, Selenium, Glutathione and Coenzyme Q10 and Ginseng Root Extract, as well as "BESTFertil-DHA", supplemented with capsules with Omega-3 polyunsaturated fatty acids. These studies resulted in increase of basic semen parameters - concentration, motility and proportion of normal forms of spermatozoa, as well as in decrease in sperm DNA fragmentation.