Urologiia最新文献

Introduction: As COVID-19-induced disorders wreak havoc on populations worldwide, attention to the rehabilitation of the consequences has focused mainly on vital organ systems (lungs, kidneys, and heart) that are vulnerable to the initial viral attack and contribute to the development of acute pathology associated with this disease. However, we should not lose sight of the fact that COVID-19 affects any cells in the body that express ACE2, including human sperm.

Materials and methods: The results of transmission electron microscopy of the ejaculate of 157 men were analyzed. They were divided into four groups: Group I - 49 patients with idiopathic infertility who had COVID-19, Group II - 42 patients with idiopathic infertility who did not have COVID-19 during the study, Group III - 39 fertile men who had COVID-19, Group IV - 27 fertile men who did not have COVID-19.

Objective: To study the role of sperm mitochondrial dysfunction in the development of male infertility associated with COVID-19.

Results: According to transmission microscopy of the ejaculate, men who brought COVID-19 have severe sperm disorders, such as mitochondrial dysfunction and the presence of residual cytoplasm, which were more often recorded in infertile patients, compared to fertile men.

Conclusions: COVID-19 impairs male reproductive potential and may impair male fertility.

Key aspects of pain syndrome in urology, including its classification, pathogenesis, and current treatment approaches, are discussed in the article. Special attention is given to the phenomenon of chronic pelvic pain, defined as persistent pain lasting at least three months, accompanied by dysfunction of the genitourinary system and emotional disorders. The main pathogenetic mechanisms underlying pain syndrome determine its complex multisystem nature, which requires a comprehensive approach to both diagnosis and treatment. Various etiologies of urologic chronic pain syndrome are described. Particular emphasis is given on urological causes such as bacterial cystitis and interstitial cystitis/bladder pain syndrome (IC/BPS). Clinical phenotypes of IC/BPS are discussed, along with individualized treatment approaches for each phenotype. The impact of pain syndrome in bacterial cystitis on quality of life and the role of phenazopyridine in pain relief are also highlighted. The importance of an interdisciplinary approach and the combination of different therapeutic methods to achieve good outcomes in the management of pain syndrome is emphasized.

Introduction: Unlike other physiotherapy methods, hypoxic therapy has virtually no history of use in urology. We considered it important to evaluate the physiological mechanisms underlying its therapeutic effects in urological patients.

Aim: To assess the efficacy of normobaric interval hypoxic training as an innovative approach to the correction of psychophysiological disorders in patients with chronic prostatitis.

Materials and methods: The study included 36 men divided into three groups. Group 1 (n=12) received standard drug therapy plus 10 sessions of interval normobaric hypoxic training under a "hypoxia-normoxia" regimen (13% O2). Group 2 (n=12) received standard drug therapy plus 10 sessions under a "hypoxia-hyperoxia" regimen (31% O2). Group 3 (n=12) served as the control, receiving drug therapy only. Sessions were carried out weekly, consisting of 5 cycles of 5 minutes each. The effect of hypoxic therapy on patients subjective state was assessed using an asthenic symptom questionnaire before treatment and during the 1st, 5th, and 10th sessions.

Results: The most pronounced positive trends in the dynamics of asthenic symptoms were observed in the "hypoxia-hyperoxia" group: the average total number of complaints decreased almost threefold, while the average severity of complaints decreased by more than twofold. More modest positive changes were noted in the "hypoxia-normoxia" group, where the total number of complaints decreased by less than twofold, and the average severity decreased by about 20%. It should be emphasized that in both groups undergoing hypoxic therapy, highly significant differences were registered across all studied parameters compared with baseline. In the control group, during the same follow-up period, differences compared with baseline were insignificant. The above findings may demonstrate the insufficient efficiency of conventional measures in patients with chronic prostatitis in addressing asthenic and autonomic disorders, which are commonly observed in patients with this condition.

Conclusion: Interval hypoxic training, especially under the "hypoxia-hyperoxia" regimen, effectively reduces asthenic symptoms in patients with chronic prostatitis. This method is recommended as an adjunct to standard therapy to improve quality of life and psychoemotional status. The study supports the potential of hypoxic therapy in urology as a novel non-pharmacological approach with emphasis on psychosomatic aspects of men with chronic prostatitis.

Antimicrobial resistance (AMR) poses a global public health threat and may result in serious economic consequences. Although the treatment regimens for uncomplicated urinary tract infections (UTIs) have remained largely unchanged, they require continuous monitoring due to increasing antimicrobial resistance. The most recent updates of clinical guidelines for the management of uncomplicated UTIs did not revise the list of first-line antibiotics, since no new oral agents are currently available. Single-dose fosfomycin administration has been shown to be as safe and effective as other antibiotics in the treatment of uncomplicated UTIs in women. Fosfomycin therefore remains an adequate empirical treatment option. However, ongoing surveillance of regional antimicrobial resistance is essential to ensure the rational selection of antibiotics for empirical therapy.

Urolithiasis is one of the most prevalent urological disorders and remains among the leading urinary tract diseases worldwide. The risk of developing urolithiasis is influenced by a wide range of factors, and its global prevalence continues to rise, particularly in both developed and developing countries. A deeper understanding of its etiology, including the contribution of bacteria, is of paramount importance, as microorganisms may contribute to recurrent stone formation. This review summarizes current evidence supporting bacterial involvement in urolithiasis. Particular attention is given to the potential role of microorganisms in the pathogenesis of so-called non-infectious stones, as well as to the complex interplay between stone formation and urinary tract infection. The aim of this article is to integrate available data on the association between bacteria and urinary stones, with a focus on the pathophysiology of stone formation and the urinary microbiome in calculi of different chemical compositions.

Introduction: The relevance of complicated urinary tract infections (cUTIs) is determined by their high prevalence, recurrent course, and the frequent resistance of pathogens to standard antibacterial regimens. Therefore, the clinical evaluation of new antimicrobial agents (fortiazinon) is one of the promising directions for improving the treatment of cUTIs.

Materials and methods: A prospective, multicenter, randomized, placebo-controlled clinical trial was carried out in two groups of patients with cUTIs who received either a combination of cefepime with fortiazinon or cefepime with placebo. Cefepime 1 g was administered intravenously or intramuscularly every 12 hours; fortiazinon 600 mg (2 tablets of 300 mg) or placebo (2 tablets) was administered orally every 12 hours immediately after cefepime. The treatment duration was 7 days, with the possibility of extension up to 14 days at the discretion of investigators. A total of 357 patients were included: 180 received cefepime + fortiazinon, 177 received cefepime + placebo. The primary endpoint was the proportion of patients with clinical and microbiological cure at day 21 after completion of treatment. Secondary endpoints included clinical efficacy in subgroups (MITT, mMITT, CE), pathogen eradication in microbiologically confirmed cUTIs, and recurrence rates at days 60 and 90 after therapy.

Results: The primary endpoint was achieved in 136/180 (75.6%) of patients treated with cefepime/fortiazinon and in 90/177 (50.8%) of those treated with cefepime/placebo (difference: 24.7%; 97.5% CI: -14.7; two-sided ANOVA test). Analysis of secondary endpoints revealed significant advantages in clinical cure rates: MITT by 21.7%, mMITT by 21.5%, CE by 18.8%, and pathogen eradication by 13.2%. During follow-up, recurrence rates were significantly lower in the fortiazinon group compared with placebo: at day 60 the rates were 1.1% and 16.0%, and at day 90 they were 2.8% and 21.7%, respectively. Adverse events occurred in 37 (20.6%) patients receiving fortiazinon and in 26 (14.7%) patients in the placebo group (difference was insignificant). The most frequent adverse events were sleep disturbances, elevated alanine aminotransferase activity, and increased serum bilirubin. All adverse events were mild, did not require treatment, and did not lead to discontinuation of therapy.

Conclusion: Cefepime/fortiazinon was significantly superior to cefepime/placebo in the treatment of complicated urinary tract infections and in the prevention of recurrence during follow-up.

Introduction: Existing treatment methods for Peyronies Disease (PD) aim to restore the normal biomechanical functions of the tunica albuginea (TA); however, current data on biomechanical changes in PD, as well as on the biomechanical properties of native human TA, are extremely limited. The aim of our study was to evaluate the biomechanical properties of intact TA and the materials most commonly used for its replacement.

Materials and methods: Samples of the TA were collected from 9 male cadavers aged 20 to 65 years. Rectangular sections of the TA were excised from the dorsal surface of the corpora cavernosa. Fixation of the specimens in formalin was not performed, as this could affect the biomechanical properties of the tissue. Prepared samples were divided into longitudinal and transverse fragments. Pericardial grafts (allograft from cadaveric pericardium; xenograft from bovine pericardium) were prepared similarly. The obtained tissue fragments were subjected to mechanical testing. All tensile tests were conducted using a single-column universal material testing machine, the TA.XTplus Texture Analyzer (Stable Micro Systems Ltd., UK). Interactive stress-strain curves were used for result analysis. The following parameters were determined: stress, strength, strain, sample thickness. The obtained data were subjected to statistical analysis.

Results: Analysis of the obtained data revealed that the stress and strength of longitudinal fragments of TA were statistically significantly higher (p=0,0004 and p=0,0008; Tukeys test) than those for the transverse fragments. This indicates that human TA is anisotropic. Correlation analysis showed a negative correlation between the patient age and the strength (r=-0,49; p<0,05; Spearmans rank correlation). Additionally, a negative correlation was found between the patients age and the thickness of their tunica albuginea (r=-0,56; p<0,05 according to Spearmans test). When comparing human TA with grafts from bovine and human pericardium, it was found that the strength and thickness calculated for human tunica albuginea were statistically significantly higher (p=0,0001; Tukeys test) than those for the grafts.

Conclusions: Human and bovine pericardium grafts significantly differ from healthy TA in terms of stress, elastic modulus, strength, and thickness, which may impact the outcomes of surgical treatment for patients with PD.

Radical cystectomy is recognized as the gold standard in the management of muscle-invasive bladder cancer. However, despite its definitive nature, recurrences of urothelial carcinoma in the upper urinary tract remain an important cause of morbidity and mortality during long-term follow-up. The prognosis of such recurrences is generally poor, largely due to delayed diagnosis. This article presents three clinical cases of upper urinary tract recurrence detected 16-24 months after radical cystectomy. Successful treatment was achieved with radical nephroureterectomy including excision of the adjacent intestinal segment. These cases highlight the effectiveness of this surgical approach for upper tract recurrences following radical cystectomy and emphasize the need to establish criteria to determine whether urothelial tumors in the upper urinary tract represent true recurrences of bladder cancer or previously undiagnosed primary lesions. Further studies are required to develop algorithms for the early detection and management of this relatively rare pattern of disease progression.