Urologiia最新文献

This review is devoted to specific features of diagnosis and treatment of non-gonococcal urethritis caused by intracellular microorganisms. Using modern literature data and the up-to-date clinical guidelines, an analysis of changes in the epidemiological structure and resistance of intracellular pathogens in non-gonococcal urethritis has been carried out. The current principles of diagnosis and treatment of non-gonococcal urethritis are reviewed, with a discussion of the place of new molecular genetic methods for detecting the resistance of some intracellular pathogens (Mycoplasma genitalium) in routine clinical practice. Treatment regimens proposed by various clinical guidelines are compared and critically appraised in the review. Both clinical data and the results of in vitro studies on the efficiency of various drugs against certain intracellular pathogens of urethritis are presented.

Currently, the problem of antibiotic resistance is of great relevance to society not only for medical, but also for social and economic reasons. Infections caused by multidrug-resistant pathogens have a longer course, more often require hospitalization, and increase the risk of mortality. The antimicrobial resistance is most relevant for hospitals in the case of the development of nosocomial infections. However, in recent years in Russia and Europe, resistant microorganisms have become more often found in patients with community-acquired urinary tract infections. In this review, we present data from two recent large Russian studies on antibiotic resistance of community-acquired strains of uropathogens and a microbiological study carried out in Switzerland to study the antimicrobial activity of furazidin, soluble furazidin, nitrofurantoin and ciprofloxacin. For the first time, an evaluation of the antimicrobial activity of soluble furazidin allowed to explain the high clinical efficiency of furazidin potassium, documented in trials and real clinical practice. This study, in line with Russian data, indicates the high activity of nitrofurans against Escherichia coli, the main causative agent of UTI.

The literature review dedicated to a problem of using various types of water for the primary and secondary prevention of urolithiasis is presented. According to the one of the oldest hypotheses, water with different characteristics may contribute to urinary stone formation. The role of hard or soft water in the development of kidney stones is still controversial. Currently, it can be convincingly stated that there is no association between water hardness and the occurrence of urolithiasis. The hardness of drinking water is not a major factor contributing to the urinary stone disease, and this situation is confirmed by many domestic and foreign studies. Understanding the importance of the various electrolytes contained in water is critical to providing patients with an effective non-drug solution for the prevention of recurrent urolithiasis. When characterizing water, it is necessary to consider the level of calcium, magnesium and bicarbonate. Education in the use of various drinks, primarily tap, bottled, and mineral water, can and should serve as a therapeutic strategy for preventing and reducing the risk of urinary stones.

The article presents a clinical case of endoscopic treatment for a foreign body in the prostate gland with a mine-explosive wound.

Objective: to evaluate the effectiveness of the recommended modes of laser lithotripsy in clinical practice by analyzing the necessity of changing laser radiation parameters during percutaneous nephrolithotripsy (PCNL), ureterolithotripsy (URS) and retrograde intrarenal surgery (RIRS).

Materials and methods: a prospective non-randomized clinical study was conducted from October 2023 to December 2023. Patients who underwent surgical procedures for urinary stones using a Thulium fiber laser at the Clinic of Urology of Sechenov University were included. Data on localization, size and radiological density of the stones, initial parameters of laser radiation, presence or absence of mode change were recorded. Statistical data was processed using IBM SPSS Statistics software, version 26.0.0.0.0.

Results: 90 patients were included in the study. Laser radiation mode change was recorded in 38% of cases when performing RIRS, in 25% - during PCNL, and in 24% - during URS. A significantly higher total energy consumption at comparable volumes and radiological density of the stones was registered in the group of mode change at RIRS. In the URS group the results suggest that the laser radiation mode change depends on the volume and density of urinary stones.

Discussion: the need for intraoperative change of laser radiation modes in 31% of all observations may indicate that the existing optimal modes for stone destruction in clinical practice may be suboptimal. New studies of the structure and mechanical properties of urinary stones, assessment of their porosity, hardness, size and properties of crystals, as well as the use of Artificial Intelligence for automatic set up of laser radiation parameters for higher efficiency of lithotripsy.

Conclusion: In addition to linear size and radiologic density urinary stones have a whole complex of morphometric and physicochemical characteristics, so the laser lithotripsy parameters preset should be viewed only as a guideline, while effective settings are to be selected intraoperatively considering urologists knowledge of laser radiation physical properties.

The intrarenal reflux is caused by impaired emptying of the renal pelvis, that leads to increased intrarenal pressure. Increased pelvis pressure can be the result of a variety of states. The most common causes are acute upper urinary tract obstruction or overfilling of the pelvis during retrograde intrarenal surgery (RIRS) or retrograde pyelography. In rare cases, it is due to impaired neuromuscular tone of the upper urinary tract that leads to hyperkinetic state. We have presented case with a 73-year-old patient with intrarenal reflux into the peripelvic renal cysts. Since no such cases were found in the literature, this observation is unique.

Introduction: Horseshoe kidney is often associated with ureteropelvic junction obstruction and nephrolithiasis. Retrograde intrarenal surgery (RIRS) is becoming one of the main treatment options for large stones in such patients.

Aim: To study the results of RIRS in patients with horseshoe kidney.

Materials and methods: Between November 2016 and April 2021, 12 patients with stones in horseshoe kidney underwent RIRS in our clinic. There were 9 men and 3 women. The average age of the patients was 44.5+/-12.0 years, the size of the stone was 1.6 cm. In 9 patients, a solitary pelvic stone with a size of up to 2.0 cm was diagnosed, while in the remaining cases pelvic and lower calyx stones were found. In 7 (58.3%) patents, the stone was localized on the right, in 5 (41.7%) on the left side. Two patients had previously undergone unsuccessful percutaneous nephrolithotomy due to the impossibility of puncture of the collecting system. In addition, one patient underwent extracorporeal shock-wave lithotripsy. In all cases, RIRS was performed 2 weeks after ureteral prestenting. After removing the endoscope, a ureteral access sheath was insereted along the guidewire. A flexible ureteroscope was advanced into the collecting system, and an inspection was performed. When a stone was localized in the lower calyx, a Dormia basket was used to relocate it into the pelvis for more convenient lithotripsy and to avoid trauma to the distal part of the endoscope. Due to poor passage of fragments in horseshoe kidney, they were removed as much as possible after lithotripsy and a ureteral stent was put.

Results: In all cases, RIRS with laser lithotripsy was done. The average operation time was 75+/-28 minutes. There were no intraoperative complications; postoperative fever was observed in 2 (16.7%) cases. After lithotripsy, all fragments were removed in 9 (75.0%) patients. In 3 (25.0%) patients, residual fragments were found. Repeated RIRS was performed in two cases; one patient refused repeat procedure. The efficiency of RIRS in patients with horseshoe kidney after two sessions was 91.7%.

Conclusion: Flexible RIRS with laser lithotripsy allows to remove stones in horseshoe kidney with high efficiency and a minimal rate of complications.

Introduction: Several techniques are used for laser enucleation of benign prostate hyperplasia, including two- and three-lobe enucleation, enucleation of all lobes in a single block (en-bloc), and enucleation of all nodes in a single block without longitudinal incisions (total en-bloc).

Aim: A prospective and retrospective analysis of the results of two-lobe, en-bloc, and total en-bloc using thulium fiber laser enucleation of the prostate (ThuFLEP) techniques was performed.

Method: s. The study included a retrospective and prospective comparative analysis of the peri- and postoperative results of ThuFLEP using several techniques. Patients with benign prostatic hyperplasia causing bladder outlet obstruction (IPSS>20, Qmax<15) were undergone to ThuFLEP from January 2015 to May 2022. All patients were examined prior to and 1, 3, and 6 months after the procedure. In the pre- and postoperative period, the age of the patients, prostate volume, level of prostate-specific antigen, functional parameters (IPSS, post-void residual, Qmax, and QoL), the stress urinary incontinence were evaluated. In addition, the following intraoperative parameters were assessed: duration of the procedure, enucleation rate, morcellation rate, and mass of enucleated tissue.

Results: We found 450 patients who underwent thulium fiber laser enucleation of prostate hyperplasia (ThuFLEP). Three laser enucleation techniques were used, including two-lobe (n=148; group A), en-bloc (n=150; group B), and total en-bloc without longitudinal incision (n=152; group C). The mean prostate volume was comparable between groups. The mean operation time for the total en-bloc technique (group C) was less compared to the other two techniques (58.9+/-30.1 vs. 68.8+/-30.6 for group A and 67.4+/-30.1 min for group B, respectively; p<0.005). The mean enucleation rate in group C was higher compared to groups A and B (2.3+/-0.78 vs. 1.9+/-0.74 and 1.9+/-0.69 g/min, respectively; p<0.005). The mean morcellation rate in all three groups was comparable (2.8+/-1.7, 3.0+/-1.1, and 2.9+/-2.1 g/min; p>0.05). After 6 months, there were no differences in functional results, according to the IPSS, PVR, Qmax, and QoL.

Conclusion: The two-lobe, en-bloc, and total en-bloc techniques were comparable in functional results and the complication rate. Total en-bloc enucleation showed the higher enucleation efficiency.

Objective: The purpose of this study was to evaluate the effectiveness of the drugs Solifenacin and Vesusten in relation to the treatment of neurogenic bladder overactivity in multiple sclerosis (MS).

Materials and methods: A prospective, single-site, single-center, placebo-controlled, parallel-group, comparative clinical trial was conducted. The study included 41 MS patients of both sexes aged 18-50 years with urodynamically confirmed detrusor overactivity. Data were obtained by completing a voiding diary. Clinical data were assessed before taking the drugs, during a monthly course of therapy and after a month of observation after the end of treatment. The results were processed by nonparametric methods of statistical analysis.

Results: Both drugs are effective in patients with MS to correct neurogenic bladder overactivity. At the same time, in comparison with Solifenacin, Vesusten showed better clinical efficacy in relation to clinical manifestations of overactive bladder (OAB). Pollakiuria and urgency also decreased significantly. The best profile of maintaining the therapeutic effect was observed with Vesusten in relation to the frequency of urinary incontinence and OAB syndrome. The results of the study established that Solifenacin and Vesusten can cause adverse events, the frequency and nature of which correspond to the data declared by the manufacturers.

Discussion: Considering the clinical features of MS, the priority in treatment, in addition to effectiveness, is maximum conservative therapy. The currently recommended therapy for neurogenic bladder overactivity is limited to the use of M-anticholinergics and intradetrusor administration of botulinum toxin type A drugs. At the same time, multiple side effects of such treatment are observed with a high frequency. The emergence of a new effective therapeutic agent is a promising direction for the treatment of neurogenic bladder overactivity in patients with MS.

Conclusions: Both Solifenacin and Vesusten are effective therapeutic options for the management of neurogenic bladder overactivity in MS. However, Vesusten has a more significant therapeutic profile, expressed in the correction of pollakiuria, urge incontinence and urgency. After completion of therapy, Vesusten, in comparison with Solifenacin, demonstrates the retention of a strong therapeutic effect. Based on the combination of various assessment parameters of a voiding diary, Vesusten is a priority therapeutic agent that determines the best quality of life profile for patients with MS.

Introduction: According to the literature of recent years, there has been an increased interest in non-oncological diseases of the bladder, between which differential diagnostics have to be carried out in order to determine a plan for the diagnosis and treatment of patients with these nosologies. There are often certain difficulties in the differential diagnosis of some forms of viral cystitis and leukoplakia OBJECTIVE: to determine pathomorphological criteria for the differential diagnosis of leukoplakia and chronic recurrent papillomavirus cystitis.

Materials and methods: The prospective study included 85 sexually active patients aged 20-45 years, who were divided into two groups depending on the etiological factor. Patients of group I (n=70) - with chronic recurrent cystitis (CRC) of papillomavirus (PV) etiology, group II (n=15) - with leukoplakia. All patients were examined in accordance with the recommendations of the European Association of Urology (EAU) and the Russian Society of Urology (ROU); an additional endoscopic examination of the bladder (cystoscopy) was performed, followed by a morphological examination of the bladder biopsy.

Results: A morphological examination of biopsy tissue in all patients of group I revealed koilocytic transformation of the urothelium combined with non-keratinizing metaplasia of the urothelium, and in patients of group II, in all cases, keratinizing metaplasia of the urothelium with hyperkeratosis was detected.

Conclusion: Morphological examination is the gold standard in differential leukoplakia and chronic recurrent papillomavirus cystitis.