Urologiia最新文献

The review is devoted to the assessment of the biological diversity of the human urinary tract microflora. The search was performed using the PubMed, List of Prokaryotic Names with Standing in Nomenclature databases. Data on the species of aerobic, facultative anaerobic and obligate anaerobic bacteria described after 2000 were analyzed. It was found that the introduction of improved diagnostic protocols and methodological techniques led to the detection of new species of microorganisms in urine belonging to 14 families (Enterobacteriaceae, Pseudomonadaceae, Weeksellaceae, Flavobacteriaceae, Chromobacteriaceae, Paenibacillaceae, Lysobacteraceae, Bifidobacteriaceae, Actinomycetaceae, Lactobacillaceae, Corynebacteriaceae, Caryophanaceae, Dietziaceae, and Aerococcaceae). Information on the clinical significance and antibiotic resistance of these bacteria is presented.

Renal colic is characterized by acute pain in the lower back. The most common cause of this condition is a stone blocking the outflow of urine from the kidney. Long-term obstruction leads to hypertension of the renal pelvis, which leads to the development of urinoma, is the cause of rupture of the renal pelvis, and in rarer cases to bleeding with stages of subcapsular hematoma. The article presents a case of a 51-year-old patient who was admitted with complaints of intense pain in the lumbar region on the left. The anamnesis included repeated attacks of renal colic, acquired independently. Computed tomography revealed a subcapsular fluid accumulation measuring 5080 mm, probably hematoma. Ultrasound examination confirmed the presence of a subcapsular hematoma. The patient underwent drainage of the upper urinary tract with a ureteral stent. The postoperative period was without surgery. Currently, regression of the subcapsular hematoma is observed.

The goal of vaginal reconstructive surgery is to address pelvic issues. Surgical procedures can greatly enhance the lives of many women by alleviating symptoms and improving their overall well-being. However, there are instances where women experience pelvic dysfunction for the first time - new or worsening symptoms in the pelvic area that emerge following surgery. The purpose of the review is to summarize current knowledge, identify existing gaps and suggest future research directions aimed at minimizing iatrogenic morbidity and improving the quality of life of patients. A search was conducted using PubMed, Scopus, Web of Science, and Cochrane Library databases. The search queries included various combinations of the following keywords: "pelvic floor dysfunction", "urogynecology", "vaginal surgery", "pelvic organ prolapse", "stress urinary incontinence", "overactive bladder", "de novo", "postoperative complications", "urination dysfunction", "dyspareunia", "fecal incontinence", "quality of life", "synthetic mesh", "repair with native tissues" and "results of surgical intervention". The search was limited to English-language publications from January 1, 2014 to December 31, 2024 (including articles published in early 2025). Literature data convincingly indicate that a significant proportion of women who have undergone urogynecological vaginal surgery develop de novo pelvic dysfunctions. The etiology of de novo pelvic dysfunction is complex and multifactorial, including nerve injury, mesh-related complications, altered pelvic floor biomechanics, pre-existing subclinical dysfunction, and psychological factors. Identifying risk factors and implementing strategies to prevent and effectively treat new dysfunction are critical to optimizing surgical outcomes and patient well-being.

Aggressive disease course, recurrences, and deterioration of patients quality of life remain significant challenges in the treatment of bladder cancer. Determining the indications for systemic therapy or radical treatment, the early detection, and the optimal timing for initiating adjuvant therapy are all crucial aspects in the management of urothelial carcinoma. The analysis of the literature on changes in diagnostics and therapeutic approaches to urothelial bladder cancer according to disease stage is presented in the article.

Objective: to assess the incidence of incidental prostate cancer and associated factors after endoscopic enucleation of benign prostate hyperplasia performed by single urologist.

Materials and methods: a retrospective study included 753 patients after endoscopic enucleation of benign prostate hyperplasia performed by single urologist with more than 3000 enucleation experience. Bipolar enucleation was performed in 22,2% of cases and thulium fiber enucleation (ThuFLEP) was performed in 77,8% of cases.

Results: incidental prostate cancer after endoscopic enucleation of benign prostate hyperplasia performed by single urologist was detected in 6,7% cases (51 patients): in 8,4% - after bipolar enucleation, in 5.3%- after ThuFLEP (p=0,141). Patients with incidental prostate cancer were older (median age 71,5 years and 67,0 years, respectively, p<0.001), had smaller prostate volume (68,0 cm3 and 83,0 cm3, respectively, p=0,048), had higher PSA density (0,08 ng/ml/cm3 and 0,05 ng/ml/cm3, respectively, p=0,006). Univariable logistic regression analysis revealed that additional factor increasing the chance of incidental prostate cancer after endoscopic enucleation is lower IPSS values (OR=0,948; 95%CI=0,897-0,999; p=0,045). During the ROC analysis for these parameters, it was shown that the quality of the parameters "age" and "PSA density" as predictors of incidental prostate cancer after endoscopic enucleation is average (AUC 0,662 and 0,624, respectively), while the parameters "prostate volume" and "IPSS" are unsatisfactory (AUC 0,584 and 0,555, respectively). The value of 68,5 years was chosen as the cut-off point for the age of patients: if the patient is older, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 69,6% and 57,4%, respectively. The value of 0,0543 ng/ml/cm3 was chosen as the cut-off point for PSA density: if the PSA density is higher, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 68,2% and 56,1%, respectively.

Conclusions: in the present cohort of patients after endoscopic enucleation for benign prostate hyperplasia, there is a low incidence of incidental prostate cancer (6.7%), which, together with the absence of strong predictors, indicates a full competent examination before planning endoscopic enucleation. Nevertheless, before surgery, it is important to pay attention to such parameters as the older age and higher PSA density associated with a higher chance of incidental prostate cancer.

Aim: To compare the functional outcomes of various surgical procedures, to assess the rate of complications and urination disorders after surgery, and to identify possible risk factors and predictors of unsatisfactory treatment outcomes.

Materials and methods: The functional outcomes of surgical treatment were evaluated in 398 patients with benign prostatic hyperplasia (BPH). Patients were divided into 3 groups depending on the surgical method: bipolar transurethral resection of the prostate, laser enucleation of the prostate, and laparoscopic simple prostatectomy. The groups were comparable in age, comorbidities, and maximum urinary flow rate (Qmax). Prostate volume, total PSA level, and IPSS score differed between groups. They were higher in the group of simple prostatectomy.

Results: Before surgical treatment, 192 (48.2%) patients underwent urodynamic studies including "filling cystometry" and "pressure-flow", to determine the bladder outlet obstruction index (BOOI) and detrusor overactivity (DO), which was confirmed in 82.8% of cases. The mean BOOI value was 72.1. Functional outcomes did not statistically differ between groups at all follow-up points during the first year. After 12 months, the mean Qmax across all groups was 22.3+/-6.4 ml/s, the median IPSS value after the transurethral resection and simple prostatectomy was 3.0 points, while in the enucleation group it was 4.0 points. Transient urinary incontinence after catheter removal was recorded in 46 (11.6%) patients. By 3 months of follow-up, 10 (2.5%) patients had urge urinary incontinence on urodynamic study, requiring conservative therapy with M-anticholinergics or 3-adrenomimetics. De novo stress urinary incontinence was confirmed in 1 (0.3%) patient after transurethral enucleation. Infectious complications (prostatitis, orchiepididymitis) requiring antibiotic therapy occurred in 61 (15.3%) patients. The risk of infectious complications was higher in those with longer operative time (p=0.004), diabetes mellitus (p=0.006), and bacteriuria (p=0.019). All strictures were identified after transurethral procedures, including transurethral resection (1.1%) and transurethral enucleation (6.8%). Patients with urethral strictures more often developed postoperative infectious complications (p=0.008). It was noted that patients with cystostomy tube had a lower frequency of strictures (p=0.076).

Purple urine bag syndrome (PUBS) is an uncommon phenomenon characterized by the purple discoloration of urinary catheter bags. We present a unique case of an 81-year-old male with a history of acute ischemic stroke, initially presenting with a cauliflower-like growth on the distal part of the penis. Subsequent assessment revealed a high-grade dysplasia lesion. During the preparation for partial penectomy, the patient developed PUBS. Urine culture indicated a mixed growth of organisms, promptly treated with intravenous cefuroxime, resulting in the resolution of the purple discoloration. The patient underwent successful partial penectomy and was discharged without complications. This case highlights the rare co-occurrence of PUBS and high-grade dysplasia, emphasizing the importance of comprehensive management in such complex clinical scenarios.

Introduction: Currently, the development of new methods of treatment of benign prostatic hyperplasia (BPH) is continuing, combining the high efficiency of transurethral resection of the prostate, which are safer for elderly patients and provide a high level of quality of life for younger patients. One of these new methods is minimally invasive water vapor thermal therapy.

Aim: To evaluate the efficiency and safety of water vapor thermal therapy in patients with lower urinary tract symptoms (LUTS)/BPH.

Materials and methods: A total of 35 patients with LUTS/BPH who were treated between September 2022 and September 2024 (median follow-up of 12 months) were included in the study. The average age was 68.7+/-1.5 years. The prostate volume did not exceed 80 cc (52.4+/-4.2 cc). The Qmax was 9.3+/-0.7 ml/sec. The postvoid residual volume (PVR) was 73.6+/-12.2 ml. The overall IPSS score was 26.5+/-2.3 and QoL was 4.3+/-0.3. All patients were treated with water vapor thermal therapy according to the standard procedure recommended by the manufacturer (5.7+/-0.72 injections of water vapor into the prostate). The efficacy was evaluated every 3 months after the procedure. Intra- and postoperative complications were assessed on Clavien-Dindo classification.

Results: After 3 months, 97.1% (34 out of 35) of patients had an improvement in objective urination parameters. Qmax and PVR after 3 months increased up to 17.3+/-1.5 ml/sec and 20.8+/-7.2 ml, respectively (p<0.05 compared with baseline values). There was also a significant decrease in IPSS and QoL levels, 8,5+/-1,3 and 2,3+/-0,3, respectively (p<0,05 compared with the baseline). Qmax and PVR continued to improve till the 6 months of follow-up (17.6+/-1.1ml/sec and 14.3+/-0.8 ml, respectively, p<0.05 compared with baseline and after 3 months). There was also a significant decrease in IPSS and QoL to 4.1+/-1.3 and 1.4+/-0.1 points, respectively (p<0.05 compared to 3 months). After that, these values remained stable throughout the follow-up period. The overall efficiency of the treatment (at median follow-up of 12 months) was 88,6%. Perioperative complications occurred in 9 out of 35 patients (did not exceed IIIa according to Clavien-Dindo).

Conclusions: Minimally invasive water vapor thermal therapy is a new effective and safe method of treating patients with LUTS/BPH. After the procedure, there is a significant improvement in lower urinary tract symptoms.

The association of congenital cysts of seminal vesicles with unilateral renal agenesis and obstruction of the vas deferens was first described by A.Zinner in 1914. Later, the combination of these anomalies was called Zinners syndrome. Zinners syndrome occurs in just over 200 cases out of 100,000 patients and includes a triad of symptoms: cystic formation of the seminal vesicle, obstruction of the vas deferens and ipsilateral renal agenesis. Zinners syndrome is most often asymptomatic until the third or fourth decade of life, and symptoms usually appear with the onset of sexual activity. Patients usually have non-specific symptoms such as problems urinating, pain in the perineum, possible hematuria, recurrent urinary tract infections, and painful ejaculation. Infertility caused by obstruction of the vas deferens is also common. The severity of the symptoms is associated with an increase in cyst size. Minimally invasive interventions such as traditional laparoscopy or robot-assisted surgery are safe and effective and should currently be considered the gold standard of treatment. In the framework of this work, we present a clinical case of treatment of a patient with Zinners syndrome.

Autonomous dysreflexia (AD) is a life-threatening condition that occurs in patients with spinal cord injury at the Th6 level and above. As a result of AD, dysregulation of the autonomic nervous system occurs, which leads to an uncoordinated sympathetic reaction, and can result in a potentially life-threatening increase in blood pressure, a hypertensive crisis, and even death. In about 85% of cases of AD, the cause is bladder overdistension. Urologists need to understand the clinical features of this condition and how to help patients with AD.