Urologiia最新文献

Urinary tract infections (UTIs) are one of the leading causes of extragenital pathology in pregnant women, occurring in to 5-7% of women. Despite the asymptomatic course in many cases, even uncomplicated UTIs carry the risk of complications for both the woman and the fetus due to the high risk of ascending infection. Therefore, timely diagnosis and rational therapy are key to preventing adverse outcomes. The diagnosis is based on characteristic clinical and laboratory signs. The basis for the treatment of UTIs is timely antibacterial therapy (ABT). At the same time, approaches to the empirical selection of a specific drug are identical between different types of infections, due to their etiological similarity. Rational ABT varies depending on the severity of the UTIs. In case of complicated course requiring hospitalization, preference is given to parenteral forms, while in those with uncomplicated UTIs, oral drugs are chosen in order to achieve high compliance. Oral ABT for uncomplicated UTI in pregnant women include nitrofurans, fosfomycin trometamol, and third-generation cephalosporins. Among the latter, cefixime seems to be most rational due to high sensitivity of the main uropathogens (E. coli), high efficiency, safety and compliance with treatment in pregnant women.

Introduction: The standard approach to the treatment of short ureteropelvic junction (UPJ) obstruction is the Anderson-Hynes procedure. Despite its high efficiency and low complication rate, there are ongoing studies which study the modification of the procedure using open, laparoscopic, and robotic approaches.

Aim: To describe a modified pyeloplasty technique with an assessment of the anatomical and functional results in comparison with the Anderson-Hynes procedure.

Materials and methods: The results of 1,768 procedures for short UPJ obstruction and hydronephrosis performed using open (804), laparoscopic (888), and robotic (76) approaches in children and adults from 2000 to 2023 are presented in the article. A technique for horizontal ureteropyeloanastomosis after UPJ resection was developed by V.V. Sizonov and M.I. Kogan. A comparative analysis of the anatomical and functional results of vertical (standard) and horizontal anastomoses of the ureteral pelvis was performed using mathematical methods of the theory of hydrodynamics, and imaging studies after 12 months of follow-up.

Results: Horizontal anastomosis of the renal pelvis and ureter increases the passage of urine by 19.75% compared to vertical anastomosis. Horizontal anastomosis is less tense after resection of the ureteral pelvis. Postoperative dynamics of the anteroposterior size of the renal pelvis after horizontal anastomosis reliably demonstrates accelerated reduction compared to standard technique. Horizontal anastomosis is associated with a significantly higher increase in GFR compared to vertical anastomosis.

Conclusion: The author's technique of horizontal anastomosis between the ureter and pelvis has reliable anatomical and functional advantages over the Anderson-Hynes technique when performing open, laparoscopic and robotic pyeloplasty.

Introduction: Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem, which may have a large impact of quality of life.

Aim: To assess the prevalence of UI in people over the age of 65.

Materials and methods: Participants were 4308 elderly individuals (1292 men and 3016 women) with an average age of 78+/-8 years.

Results: UI was detected in 1953 patients (45,3%), including urgent UI in 25,8%, stress UI in 12,3% and mixed UI in 8,3% cases. There was a clear tendency to higher incidence of all types of UI with age. Our data show the need for mandatory consultation with a urologist for all person over the age of 65.

Introduction: Transurethral resection is the main method for diagnosing and staging bladder cancer, which allows to determine treatment tactics. Tumors located in the area of the ureteric orifice is an important clinical problem.

Aim: To describe our experience in the treatment of ureteral obliterations after transurethral resection of the bladder tumors.

Materials and methods: From 2021 to 2023 in the CDC "Zdorovie" in Rostov-on-Don, a total of 6 patients underwent endoscopic recanalization of the obliteration of the ureteral orifice after transurethral resection of bladder cancer.

Results: The average follow-up period for patients was 6 months. The average duration of the operation was 42 minutes, bladder catheterization 2 days. One of the main criteria for the efficiency of treatment was the absence of upper urinary tract obstruction 3 months after stent removal. In 3 patients, ureteral stents were removed. In two cases, the absence of stricture recurrence was confirmed; in one patient with a stricture of 1 cm in length, a relapse was detected.

Discussion: In this article, we describe a technique for endoscopic treatment of iatrogenic obliteration of the ureteral orifice and intramural part of the ureter, in which a combination of antegrade and retrograde access (Rendez-vous) or "cut-to-the-light" technique allows to restore ureteral patency.

Conclusions: The endoscopic approach in patients with obliteration of the ureteral orifice after transurethral resection of a bladder tumor is an alternative to open or laparoscopic ureteral reimplantation and provides high efficiency with a low percentage of complications.

The article presents a clinical observation demonstrating the functional results of orthotopic bladder plastic surgery according to Studer after radical cystectomy, which demonstrates the progression of chronic kidney disease (CKD) 2.5 years after surgery. According to the literature, patients who survived the early postoperative period with muscle-invasive bladder cancer and no lymph node involvement have a high probability of relapse-free and cancer-specific life expectancy of more than 15 years, but the probability of developing severe renal failure reaches 20%, which reduces the quality and duration of life of such patients. Progression of CKD in patients after orthotopic bladder plastic surgery according to Studer is possible against the background of high intravesical pressure in the emptying phase. According to clinical guidelines, intermittent autocatheterization is indicated for patients with neurogenic bladder dysfunction such as detrusor hypotension and high intravesical pressure during the voiding phase, minimizing the risk of upper urinary tract damage. Standards for managing patients with an orthotopic bladder do not provide such recommendations. Additional studies are needed to determine the advisability of persistent catheterization of an artificial bladder in the absence of residual urine but high intravesical pressure during urination.

Background: Improving the efficiency of treatment and prevention of recurrent lower urinary tract infection (LUTI) is an important problem in modern urology. A significant role is given to the non-antibiotic measures.

Aim: To evaluate the clinical and microbiological efficiency of the drug Urolife-Next in patients with recurrent UTI.

Materials and methods: A total of 70 women with recurrent UTI aged 18 to 55 years (mean 35.1+/-10.1) and symptoms of cystitis were included in the study. After antibacterial therapy, all patients were divided into 3 groups. In the group 1 (n=24), patients took Urolife-Next 1 capsule 3 times a day for 90 days, in the group 2 (n=23) Urolife-Next in the same dose, but for a period of 30 days, while patients of group 3 (n=23) did not receive any treatment. The total follow-up period was 90 days. Frequency and severity of symptoms of recurrent UTI were assessed. The microbiological part of the study included evaluation of the presence and severity of anti-adhesive, anti-biofilm and direct antibacterial effects of the Urolife-Next against uropathogens isolated from urine of patients with exacerbation of UTI.

Results: In group 1, in which patients took Urolife-Next throughout the study, the lowest frequency of relapses was seen. During the 90-day follow-up, recurrences of UTI occurred in only 3 (12.5%) patients in group 1, compared to 18 (78.3%) in group 3. In addition, in the group 1 there was a significantly lower severity of symptoms during exacerbation of cystitis compared to the initial episode, as well as to 3. Urolife-Next showed antibacterial activity against 29 (41.4%) of 70 strains of uropathogens. The minimum inhibitory concentration of Urolife-Next against gram-negative microorganisms was on average 2 times higher than for gram-positive pathogens. A pronounced anti-adhesive activity of Urolife-Next in vitro was also revealed. The maximum anti-adhesive effect was observed 2 hours after the start of the study. By this time, the adhesion index for cultures in the presence of Urolife-Next was 2.3 times lower than the control values for E. coli, 2.5 times for Kl. pneumoniae, and 2.9 times for E. faecalis. Significant antibiofilm activity of Urolife-Next was also noted. The severity of biofilm formation, which was assessed by changes in the optical density of cultures, decreased by 1.3-2.2 times, depending on the type of uropathogens.

Conclusions: The results of the study prove the efficiency of the dietary supplement Urolife-Next for the prevention of recurrences in patients with UTI. Its components (D-mannose, cranberry extract, vitamins D and C, hyaluronic acid, probiotics) influence the main pathogenetic factors.