Urologiia最新文献

Urinary tract infections (UTIs) are among the most common infectious diseases. Antimicrobial therapy is the main component of UTI therapy. Current recommendations suggest the use of nitrofuran derivatives as first-line drugs for the treatment of uncomplicated UTIs. This group of drugs has the following advantages: slow development of resistance and high activity against E. coli. However, for some nitrofurans, it is impossible to obtain data on the prevalence of resistant strains due to the absence of sensitivity interpretation criteria. This review is devoted to the study of correlation of sensitivity data between class I nitrofuran derivatives and the possibility of comparing the activity of nitrofurantoin and furazidine against E.coli.

Introduction: Improving molecular genetic methods for diagnosing polygenic forms of urolithiasis is an urgent task in urology.

Aim: To study the relative expression level of the MGP, UMOD, SPP1, F2, FN1, HAVCR1 genes associated with the development of urolithiasis and the number of proteins encoded by them (Gla protein, prothrombin, fibronectin, osteopontin, uromodulin and TIM-1 protein) in patients with urolithiasis.

Material and methods: Forty-nine people were examined, including 45 patients with urolithiasis and 4 people from the control group, with the average age was 67+/-12 years. Healthy volunteers served as controls. mRNA was isolated from peripheral venous blood. It was reverse-transcribed into cDNA, and the relative expression levels of the target genes were quantified by RT-PCR.

Results: According to the level of expression of the genes MGP, UMOD, SPP1, F2, FN1, HAVCR1 in the blood, clear hiatuses were identified between the values in the control group and in those with urolithiasis, while no differences were found in the quantitative content of their protein products, either in the blood or urine.

Conclusion: In the blood, with a relative level of expression of the gene MGP above 10%, F2 above 0.5%, FN1 above 0.2%, UMOD above 0.04%, SPP1 above 0.001%, HAVCR1 above 0.01%, urolithiasis can be predicted. The specified levels of expression of the genes MGP, UMOD, SPP1, F2, FN1, HAVCR1 in the blood allow reliable identification of patients with urolithiasis in comparison with the quantitative content of protein products of these genes in the blood and urine.

Tuberculosis remains a significant public health issue worldwide. In 2022, over 45 000 new tuberculosis cases were registered in Russia, corresponding to an incidence rate of 31.0 per 100 000 population. Among genitourinary tuberculosis, bladder involvement accounts for 10.6-52.3%. The clinical presentation of tuberculous cystitis mimics that of typical cystitis. Lack of specific symptoms, combined with insufficient clinical suspicion among phthisiatrists, often leads to delayed diagnosis and treatment, so that irreversible morphological changes have occurred in the bladder wall. This process manifests as persistent impairments of both the storage and voiding phases and significantly diminishes quality of life. The so-called small contracted bladder represents the end-stage of bladder involvement and is universally considered an indication for surgical intervention. A literature search was carried out in Elibrary.ru, PubMed, and Google Scholar to compile data on tuberculous bladder involvement leading to the development of a small, contracted bladder. This review covers the etiology, pathogenesis, and classification of bladder tuberculosis, and summarizes current diagnostic approaches.

Introduction: Endoscopic enucleation of the prostate is the standard surgical treatment for patients with BPH >80 cc. Despite its efficiency, the incidence of stress urinary incontinence (<6 months) and urethral stricture remains significant at 16.6-29.4% and 1.7-6.5%, respectively. The use of smaller instruments can potentially reduce the rates of these complications.

Aim: This study aims to evaluate the efficiency and safety of minimally invasive laser enucleation of the prostate (MiLEP) using a thulium fiber laser (TFL).

Materials and methods: A prospective study was initiated in March 2024. The inclusion criteria were severe lower urinary tract symptoms (IPSS >20) and/or Qmax <15 ml/s or the necessity for bladder drainage. MiLEP was performed using 22 Ch resectoscope and TFL FIBERLASE U1 and FIBERLASE U-MAX (NTO IRE-Polus, Russia) with the following settings: 1.5 J and 50-55 Hz and 1.7-2 J and 40-45 Hz (DissectPulse). MiLEP technique was en bloc no-touch enucleation with early apical release. Peri- and early postoperative outcomes and complication rates were assessed.

Results: MiLEP was performed in 15 patients with a median age of 67 years (IQR 62.5; 69.5), prostate volume of 61 cc (IQR 46.5; 65.5), and IPSS score was 25.5 (IQR 23.3; 27), Qmax was 5.3 ml/s (IQR 4.5; 9.3). The median duration of the procedure was 42 min (IQR 37; 55), enucleation was 25 min (IQR 21; 28), and morcellation was 7.5 min (IQR 4; 8). Enucleation efficiency was 1.2 g/min (IQR 1; 1.5) and morcellation efficiency was 5.3 g/min (IQR 4.6; 7.7). The median hemoglobin drop was 6.5 g/l (IQR 1.5; 12.8) and the mass of removed tissue was 34 g (IQR 25; 42). The median catheterization and hospitalization time were 2 days (IQR 2; 2.8) and 3 days (IQR 3; 6), respectively. After 1 month, the median IPSS score was 5 (IQR 4; 6; < 0.001), Qmax was 18.7 ml/s (IQR 18; 21; < 0.001). Complications were observed in 5 (33.3%) patients (grade I according to Clavien-Dindo). Stress urinary incontinence occurred in 2 (13.3%) patients on the first day after catheter removal, but in none at 1 month after MiLEP.

Conclusion: Minimally invasive enucleation of the prostate with a thulium fiber laser can be considered an effective and safe surgical treatment option for patients with BPH.

Introduction: According to international studies, the prevalence of uric acid stones in 2023 was 8-10% worldwide. Uric acid stones are considered high-risk for symptomatic recurrence. Uric acid constitutes a frequent component of urinary calculi and may promote calcium oxalate stone formation.

Aim: To assess the prevalence of "pure" and mixed uric acid and urate salt stones among urinary calculi in the Novosibirsk Region.

Materials and methods: We evaluated 987 urinary stones from patients with urolithiasis in the Novosibirsk Region. Data for the period 2020-2023 were provided in anonymized form by INVITRO laboratory. We determined the prevalence of single-component and mixed urinary stones containing uric acid and its salts, alone or in combination with other minerals, stratified by sex and age.

Results: Uric acid stones were identified in 119 cases (80 men, 39 women), accounting for 12.06% of all analyzed stones. Pure uric acid stones presented as anhydrous uric acid in 1 case and as uric acid dihydrate in 4 cases. The majority (n=114) were mixed stones of anhydrous uric acid and uric acid dihydrate. Uric acid stones occurred nearly twice as often in men as in women (80 vs. 39). The prevalence of uric acid stones was highest in men aged 31-70 years and in women aged 41-70 years, declining thereafter in both sexes. Mixed uric acid/urate stones (ammonium urate, sodium urate) were found in 15 patients (10 men, 5 women), representing 1.5% of all urinary stones. In women, these types were found at ages 51-70. In men, the most common type was anhydrous uric acid + sodium urate (8 cases), occurring equally in all age groups above 31 years. One stone comprised anhydrous uric acid + ammonium urate (age 41-50). Calcium oxalate combined with uric acid and urate salts in two- and multi-component stones was observed in 99 cases, predominantly in men (58 cases). Overall, calcium oxalate with uric acid and its salts in various combinations accounted for 10.03%.

Conclusion: A study of regional stone-forming patterns is essential for planning healthcare at both national and regional level. The prevalence of uric acid stones underscores the need for widespread implementation of oral dissolution therapy and effective metaphylaxis for uric acid urolithiasis. The frequent co-occurrence of calcium oxalate with uric acid warrants comprehensive metabolic evaluation of patients with pure uric acid stones and mixed uric acid/urate stones. Identifying concomitant metabolic disorders in patients with predominately uric acid stones requires tailored urinary pH targets during oral dissolution therapy to minimize conditions favoring precipitation of uric acid salts and phosphate crystallization.

Introduction: Currently, benign prostatic hyperplasia is a highly relevant problem. The main treatment methods are transurethral bipolar resection of the prostate (TURis) or transurethral bipolar enucleation (TUEB). One of the most serious complications during these procedures is bladder explosion.

Aim: To investigate the clinical conditions that create the risk of bladder explosion, to develop a surgical strategy for managing this complication, and to analyze the composition of the gas mixture formed intraoperatively in the bladder during transurethral procedures on the prostate.

Materials and methods: Procedures were performed under spinal anesthesia. The PLASMA system was used for transurethral plasma enucleation and transurethral plasma resection, including a 26 Fr plasma resectoscope (Olympus), and a high-frequency generator ESG-400. Plasma electrodes were used as following: Plasma-Needle for incision, Plasma-TUEB Loop for enucleation, and Plasma-Large Loop for resection. Normal saline was used as the irrigation fluid. TUEB and TURis were performed by standard technique. At the end of the procedure, the gas sample was aspirated through the inflow channel of the resectoscope using a Jan syringe. Gas composition analysis was carried out by gas chromatography on a GC-2014 chromatograph (Shimadzu, Japan) in a physico-chemical analysis laboratory.

Results: In addition to carbon monoxide and carbon dioxide, methane was detected in the gas sample; this formed an explosive mixture that ignited upon contact with the hot loop of the resectoscope.

Conclusions: Bladder explosion occurs during TUR in patients with large prostates and is independent of equipment settings. Management strategy depends on the size of the bladder rupture. To prevent bladder rupture, continuous evacuation of intravesical gases is required by advancing the resectoscope to the gas pocket and allowing fluid drainage, as well as careful monitoring of electrode activation when working at the bladder neck at the 12 oclock position, and use of a morcellator to evacuate adenomatous tissue after enucleation.

A stricture of fossa navicularis is a significant challenge due to the complexity of surgical reconstruction which should provide good aesthetic and functional outcomes.

Aim: To evaluate the efficiency and safety of transurethral ventral augmentation urethroplasty in men with stricture of fossa navicularis.

Materials and methods: A prospective study of treatment outcomes of 9 patients with stricture of fossa navicularis who were admitted at V.M. Buyanov City Clinical Hospital from 2021 to 2024, was carried out. The inclusion criterion was the presence of an isolated urethral narrowing in the fossa navicularis, which was urodynamically significant. All patients underwent transurethral ventral urethrotomy of the narrowed segment using a lance scalpel with optical control of the depth of incision. Subsequently, a triangular oral mucosa graft was harvested and fixed using the "inlay" technique with 4 deep sutures (monocryl 4-0) in and 5 sutures along the ventral semicircle of the meatus. The urethral catheter was removed on days 12-14 in order to restore spontaneous voiding.

Results: The mean age of patients was 63.4 years. The follow-up period ranged from 6 to 38 months. The etiology was balanitis xerotica obliterans (BXO) in 5 cases, unknown in 2, and iatrogenic stricture in 2 patients. Labial mucosa was used as a graft in 6 men, and buccal mucosa in 3 cases. No intra- or postoperative complications were observed. Preoperatively, average maximum urine flow rate was 5.8 ml/sec, IPSS score 20.5 points. After surgical treatment, the average Qmax was 15 ml/sec, and the IPSS score was 13. No patient reported urine splashing.

Discussion: All patients experienced the satisfaction with both functional and aesthetic outcomes. The surgeon's subjective assessment of the convenience and the cosmetic result of using labial and buccal grafts favored labial mucosa. It seems to be preferable both due to the lesser thickness of the graft, which facilitates the technical manipulations, and in terms of preserving the buccal mucosa in patients with BXO for possible subsequent reconstructions.

Conclusions: The transurethral augmentation repair using oral mucosa is an effective and safe method for treatment of stricture of fossa navicularis.

Aim: To evaluate the effect of a drug based on bovine testicular polypeptides (Testiwell) on sperm parameters and sperm DNA fragmentation index in patients with idiopathic male infertility.

Materials and methods: A total of 100 men with a diagnosis of infertility were included in the study. They received Testiwell intramuscularly once a week for 10 weeks. Before and after treatment, basic sperm parameters according to WHO criteria and sperm DNA fragmentation index using the TUNEL method were assessed. Statistical analysis included Shapiro-Wilk, Wilcoxon, paired Student's t-test, and McNemar's test.

Results: The median age of patients was 32 years. Significant improvement was noted in the proportion of morphologically normal sperm (p<0.001), concentration of morphologically normal sperm (from 1.16 to 1.55 million/ml, p=0.048). A decrease in sperm DNA fragmentation index was observed (from 20.8% to 17.8%, p<0.001), a reduction in the frequency of oligozoospermia from 34% to 22% (p=0.0047), and a decrease in the proportion of patients with increased DNA fragmentation index from 79% to 67% (p=0.0013). In patients with oligozoospermia at baseline, the median increase in concentration was 142%, while in those with asthenozoospermia an increase in motility by 77% was seen, and in men with high levels of DNA fragmentation, a decrease in DNA fragmentation index by 15.5% was found.

Discussion: Testiwell demonstrated the ability to positively influence not only quantitative but also qualitative sperm parameters, including morphology and sperm DNA fragmentation. Proposed mechanisms of action include regulation of protamination, reduction of apoptosis, and immunologically mediated effects on sperm maturation. The obtained data are consistent with previously described effects of polypeptide drugs in preclinical models and expand the possibilities of using the Testiwell for various forms of male infertility, including assisted reproduction techniques failures.

Conclusion: Testiwell significantly improves morphological and molecular parameters of spermatogenesis in patients with male infertility. It can be used both in the basic therapy of idiopathic infertility and, possibly, in cases of miscarriage and inefficiency of assisted reproduction techniques.

Introduction: Disturbances due to the novel coronavirus infection (COVID-19) caused economic, physical and psychological damage to the population of the whole world. The number of people who have suffered SOVID-19 is growing, and there is a number of negative consequences are documented for many organs and systems of the body, including reproductive.

Aim: To study the pathomorphological changes in ejaculate revealed by transmission electron microscopy in patients who have had COVID-19.

Materials and methods: The results of the electronic transmission microscopy of ejaculate 157 men were analyzed. They were divided into four groups. In group 1, there were 49 patients with idiopathic infertility who suffered COVID-19, group II included 42 patients with idiopathic infertility without prior of history of COVID-19, group III consisted of 39 fertile men who have had COVID-19, while in group IV there were 27 fertile men without prior of history of COVID -19.

Results: In most cases, pathological changes detected during morphological examination of patients before and after inclusion in the study were detected in the head of the sperm, which were resulted in a small specific gravity, but 12 months after infection with SARS-CoV-2, the percentage of acrosome changes increased in groups I and III. Moreover, combined pathological changes in the acrosome were recorded.

Conclusions: Thus, transmission electron microscopy revealed morphometric sperm disorders that were associated with energy processes in the cell, which naturally should be taken into account when rehabilitation of reproductive men who have had SARS-COV-2. In addition, in patients of SARS-COV-2, a severe cell pathology was noted, due to the residualization of the cytoplasm and the pathology of mitochondria.

Introduction: Oncological diseases of the anogenital zone in men have become increasingly relevant in recent years. It is associated with the increasing incidence, subtle clinical manifestations, and difficulties in establishing a diagnosis, requiring, in most cases, histological examination, since the diagnostic capabilities of non-invasive methods, unfortunately, are limited. Precancerous conditions, both associated with the human papillomavirus (HPV) and HPV-negative, occupy a special place among penile oncological disorders, timely diagnosis of which is extremely important.

Aim: To determine the frequency of precancerous and malignant diseases of the penis in the general structure of anogenital dermatoses in men, as well as to describe their main clinical features.

Materials and methods: The results of a survey of 160 men aged 18 to 86 years with various dermatoses of the anogenital zone who seek medical help in dermatological or urological departments are presented in the article.

Results: Various forms of penile squamous cell carcinoma were detected in 17 (10.6%), and precancerous conditions were detected in 21 (13.1%) cases. Among the latter, HPV-associated subtype of penile intraepithelial neoplasia (bowenoid papulosis, Bowen's disease, erythroplasia of Queyrat) was diagnosed in 19 (11.8%) patients. Objective symptoms were characterized by a variety of morphological and clinical manifestations. The list of incorrect clinical diagnoses which patients are followed with included banal balanoposthitis, lichen sclerosis, psoriasis, lichen planus, leukoplakia, and papillomatous nevus, which are characterized by a recurrent course and low efficiency of therapy. Histological examination was required to confirm the diagnosis of squamous cell carcinoma and precancerous diseases.

Conclusions: The oncological alertness of urologists and dermatologists in patients with chronic recurrent processes of the external genitalia is justified. If there is any doubt, tissue biopsy for morphological diagnostics should be done.