Urologiia最新文献

In half of the cases, a decrease in the quantity and/or quality of spermatozoa is the cause of infertility. The pathogenesis of such disorders is multifactorial, often unknown, and data on the treatment efficiency are still contradictory. Based on the recent high-level evidences (randomized studies and meta-analyses), the real clinical efficiency of various surgical and conservative treatment methods for the main clinical forms of male reproductive dysfunction, including hypo- and hypergonadotropic hypogonadism, secretory and obstructive azoospermia, retrograde ejaculation and anejaculation, pathospermia associated with varicocele, and idiopathic forms, is analyzed. An algorithm for managing patients with these disorders is proposed, which can be convenient in the routine practice of a urologists regardless of the level of equipment of a healthcare facility.

Introduction: Percutaneous nephrolithotomy (PNL), being a minimally invasive procedure, is accompanied by damage to blood vessels and renal parenchyma and, as a consequence, impaired renal hemodynamics. In this work we determined the dynamics of the biomarker of acute kidney injury NGAL depending on the deficit of renal function on the ipsilateral side, the type of stone, the number of accesses, the duration of the procedure, and the initial level of NGAL.

Aim: To study the role of NGAL in determining the potential risks of renal parenchyma damage with PNL in adult patients with nephrolithiasis.

Materials and methods: A total of 46 patients in whom the serum concentration of NGAL was determined before and immediately after PNL, as well as 6, 12, 24 and 48 hours later, were included in the study. PNL was performed under endotracheal anesthesia in the prone position using the standard technique with a 24 Fr nephroscope. When creating an additional (more than one) access, a nephroscope with a 16.5 Fr access sheath was used.

Results: Our results showed that the functional state of the renal parenchyma depended to a greater extent on the initial deficit of more than 50% according to nuclear scintigraphy with staghorn stones of 3-4 types, and to a lesser extent on the duration of the procedures, the number of accesses and the presence of bacteriuria.

Conclusion: Determination of NGAL concentration can be a convenient test for assessing the impairment and restoration of the functional state of the renal parenchyma in the early stages after PNL.

Low hydration is a leading risk factor for the formation of any type of urinary stones. The most common recommendation for prevention of urolithiasis is to increase the fluid intake as a way to increase daily diuresis and prevent supersaturation of urine with stone-forming substances. The fluid is consumed not only with drinking and mineral water, but also with other beverages, including citrus and various fruit juices, coffee, tea, wine and beer, which contain not only a liquid, but also a chemicals, nutrients and microelements that can affect its composition and play a significant role in changing the risk of stone formation. Citrus and non-citrus fruits and juices, milk, coffee, tea, carbonated unsweetened beverages, wine, beer and others are associated with a lower risk of kidney stone formation and can be recommended. In contrast, sweetened beverages are associated with a higher risk of urolithiasis. Knowledge of the composition of the urinary stone and metabolic disturbances of the individual patient play a significant role in the selection of recommended beverages. Understanding the importance of the various electrolytes contained in the beverages is crucial to providing patients with an effective non-drug solution in the prevention of recurrent urolithiasis depending on the type of stone. A proper understanding of the possibilities of using various beverages can and should serve as a therapeutic strategy for the prevention and reduction of the risk of urinary stone formation.

Data on the possibilities of using the bioregulatory peptide Prostatex is presented in the literature review, based on results of various studies for different prostate diseases.

Aim: To study the dynamics of cystatin C in patients after procedures on retroperitoneal viscera using laparoscopic and retroperitoneal access.

Material and methods: A prospective study of serum and urine cystostatin C levels in 162 patients with renal cysts using laparoscopic (n=83) and retroperitoneal access (n=79) was carried out. Patients were divided into four groups depending on the duration of the procedure and the gas level. For determination of cystatin C level in serum and urine, flow cytometry was performed using Human Kidney Function Panel 2 Mix and Match Subpanel (for Serum/Plasma Samples).

Results: A significant increase in the serum and urine level of cystatin C in groups 3 and 4 was seen on the 1st day after laparoscopic procedures in case of pneumoperitoneum pressure above 12 mm Hg., regardless of its duration. For retroperitoneoscopic procedures, similar changes were found only in group 4 with a gas pressure above 12 mm Hg and duration of the intervention of more than 30 minutes. By day 3, cystatin C levels returned to baseline values in all groups.

Conclusion: The most significant risk factor for acute kidney injury after laparoscopic and retroperitoneoscopic procedures is the gas pressure. The second most important factor is the duration of the intervention. Pneumoperitoneum has a greater effect on cystatin C levels compared to retropneumoperitoneum.

Introduction: After buccal ureteroplasty of long stricture of ureteropelvic junction and proximal ureter, there is a risk of recurrent stricture and urinary stone formation, requiring endoscopic procedure.

Aim: To evaluate the possibility of performing ureteroscopy (URS) in patients after onlay ureteroplasty, as well as to study its results and efficiency.

Materials and methods: Buccal ureteroplasty was performed in 30 patients who had previously undergone endoscopic and reconstructive procedures on the upper urinary tract. In 18 (60.0%) of them, stricture developed after pyeloplasty, in 10 (33.4%) after retrograde lithotripsy for the upper ureteral stone, in 1 (3.3%) after laparoscopic excision of a parapelvic cyst complicated by an injury of UJO. In addition, in 1 (3.3%) patient, stenosis of the upper third of the right ureter was caused by retroperitoneal fibrosis. The indication for URS in 7 (23.3%) cases was urolithiasis. Three patients had a dense stone measuring 1.0 cm in the lower calyx, three more had a recurrent stone after previous procedures, and one had encrusted nephrostomy. Rigid URS with laser fragmentation was performed in 3 (10.0%) cases. In two patients, the indication for endoscopic procedure was a dense stone in the upper third of the ipsilateral ureter. The patient with encrusted nephrostomy pigtail underwent lithotripsy with drainage removal. Retrograde laser lithotripsy using flexible ureteroscope was performed in 4 patients (13.3%). Rigid URS with buccal graft mucosa biopsy was done in 5 cases (16.7%) 12 and 24 months after reconstruction.

Results: Endoscopic procedures for urolithiasis were effective in all patients. The average time was 45.0+/-28 min. During URS, hematuria developed in 1 of 14 patients at a late stage, but visibility allowed completing an intervention. High fever was observed in 2 patients (14.3%) postoperatively. One of them underwent rigid URS with lithotripsy of incrusted pigtail of nephrostomy tube, and he also had bleeding. Laser lithotripsy using flexible ureteroscope was performed in another case. Both patients had stage II complications according to Clavien, requiring conservative therapy.

Conclusion: After buccal ureteroplasty, URS should not be a routine study, except for patients with recurrent urolithiasis or ureteral strictures.

Aim: To evaluate the efficacy and safety of UroBest complex in sachets for combined therapy of patients with acute cystitis in comparison with products of similar composition.

Materials and methods: The randomized multi-center study included 90 patients with acute cystitis aged 18 to 49 years who were treated at the clinical bases of SRC FMBC, FMBA of Russia, Moscow, Russia, Altai State Medical University and Voronezh State Medical University named after N.N. Burdenko. Patients of all groups received Fosfomycin trometamol in a dosage of 3g once, at night. Depending on the additional drug received, they were divided into 3 groups of 30 patients each. In group 1, they took UroBest 1 sachet daily for 7 days from the first day of therapy, NefroBest-N one capsule 2 times a day for 1 month also from the first day of therapy, in combination with UroBest complex in the first week. In group 2, UroBest 1 sachet daily for 7 days was administered, while in group 3, biologically active supplement (BAA) "Uronext" 1 sachet daily for 7 days was given. The study included 4 control points, where the degree and dynamics of changes in laboratory parameters (urinalysis, complete cell count, urine culture with determination of sensitivity to antibiotics), quality of life according to the questionnaire, and pain intensity according to the visual analogue scale (VAS) were assessed, as well as the drug tolerability based on the analysis of adverse events.

Results: The efficacy and safety data were evaluated. Administration of complex preparations with extracts of medicinal plants as an additional to antibacterial therapy led to significant improvement of all parameters, except for the level of leucocytes in the complete cell count. The most pronounced improvement was observed in groups 1, and lesser improvement was noted in group 2. One patient in group 3 had an adverse event, which was resolved spontaneously.

Conclusion: UroBest has a favorable efficacy and safety profile. According to our experience, combination of UroBest and NefroBest-N complexes leads to more pronounced positive changes in laboratory parameters and patient's condition according to the questionnaires compared to UroBest as monotherapy and, to an even greater extent, to the biologically active supplement UroNext.

Aim: To compare thulium and holmium lasers in the treatment of non-muscle invasive bladder cancer (NMIBC).

Materials and methods: In our work, patients were divided into 3 groups, depending on the treatment method. In the group 1 (n=27, 32.14% of the cohort), thulium laser resection of the bladder was done, while in the group 2 (n=25, 29.76% of the cohort) and group 3 (n=32, 38.10 % of the cohort) holmium laser resection and standard transurethral resection (TUR) were performed, respectively. In the preoperative period, all patients underwent a standard clinical examinations and imaging studies (computed tomography of the thorax, abdomen and retroperitoneal space, magnetic resonance imaging of the pelvis, cystoscopy, cytological examination of urine sediment).

Results: The duration of the procedure was 14.7+/-5.2 minutes for a thulium laser and 16.3+/-5.3 minutes for a holmium laser, compared to 20.5+/-7.4 minutes for standard TUR. The duration of postoperative irrigation after laser resection was lower (4.4+/-1.8, 4.7+/-1.6 and 16.4+/-2.5 hours, respectively) (p<0.001). The period of postoperative catheterization in groups 1 and 2 was 1.5+/-0.08 and 1.6+/-0.08 days, respectively, compared to 2.5+/- 0.13 days in the group 3 (p=0.002). In the group of thulium and holmium laser resection, a higher disease-free survival was demonstrated compared with TUR throughout the entire follow-up period.

Conclusion: When performing laser resection of the bladder wall for NMIBC, a significant lower number of complications and better survival were documented compared to patients who underwent TUR.

In addition to tumor imaging, advanced high-tech PET/CT imaging is increasingly used to elucidate the underlying causes of fever of unknown origin caused by various inflammatory processes, including pyelonephritis. Two clinical cases of whole-body PET/CT with 18F-FDG glucose, which allowed to visualize the molecular and cellular features of acute pyelonephritis as the cause of fever of unknown origin, are presented in the article. The scientifically based mechanisms of this process and the reliability of the results are discussed.

Acute iliopsoas tendinitis (inflammation of the iliopsoas muscle) it is a rare and poorly studied disease. The author, who has his own experience in treating 29 patients with iliopsoas tendinitis (the largest material in Europe) with a mortality rate of 3.4%, analyzed the literature for the last 50 years and presented a review based on 60 literature sources (the experience of surgeons and urologists from Europe, America, Asia, Africa). We have investigated the clinical manifestations, diagnostics and treatment of acute iliopsoitis and determined the main distinct features in comparison to purulent paranephritis. The most typical symptoms of the iliopsoas tendinitis are pain in ilio-inguinal area, lameness, continuous fever, tenderness and palpable infiltrate in the area of the iliac-psoas muscles and psoas-symptom. The most accurate methods in the differential diagnosis with paranephritis are ultrasound, CT and MRI. This study is of importance for practical healthcare, since the differences between the clinical manifestations, diagnosis and treatment of iliopsoas tendinitis and paranephritis are discussed.