Urologiia最新文献

Introduction: Ewing's extraosseous sarcoma of the genitourinary system is an extremely rare disease. There are sporadic publications about the genitourinary sarcomas. We present a case of a primitive neuroectodermal pelvic tumor with bladder invasion in a 58-year-old man. Initially, he was admitted with complaints of intense lower abdominal and right lumbar pain, severe dysuria, macrohematuria, weight loss (by 15 kg in 6 months) and general weakness. Previously, a nephrostomy tube was put due the right hydronephrosis. Nephrostomy output was up to 100-150 ml per day, and glomerular filtration rate was estimated within 5 ml/min. According to MRI data, the extra-organ pelvis tumor with bladder invasion along the right posterolateral wall was diagnosed. Cystoprostatectomy, right nephroureterectomy and left ureterocutaneostomy were performed. In the postoperative period, the patient firstly manifested neurological symptoms (paresis). According to the brain CT, two lesions of the right frontal and left parietal regions were found (most likely metastases of the primary tumor). Late admission and disseminated tumor with local invasion and brain metastases, right terminal hydronephrosis, anemia due to pronounced macrohematuria and decrease of the body weight determined an unfavorable outcome.

Conclusions: Our case report allows us to remind urologists about the presence of orphan oncological diseases with an extremely aggressive course. In-depth diagnosis requires the use of immunohistochemical methods, and the treatment of such patients should be based on a multidisciplinary approach.

Aim: To study obstetric outcomes and urological complications using various diagnostic criteria for asymptomatic bacteriuria (AB) in pregnant women.

Materials and methods: A multicenter, retrospective, non-interventional, descriptive, parallel-group study was carried out. A total of 225 pregnant women with AB aged 18 to 45 years were included. They underwent bacteriological examination of urine. After the examination, patients were divided into 5 groups. Group 1 (n=82) included patients with 1 urine culture and antimicrobial treatment. Group 2 (n=57) included patients with 2 urine cultures and antimicrobial treatment. Group 3 (n=16) included patients with positive criteria for bacteriuria, but who refused treatment. In group 4 (n=51), there were women with uncomplicated pregnancy. Group 5 (n=19) included patients with bacteriuria, which did not meet the criteria for AB (<105).

Results: Based on the results of 225 patients (average age 28+/-5.5 years), preterm birth occurred significantly more often in all groups when AB was detected, regardless of treatment, in comparison with a normal pregnancy. In patients of groups 2, 3, 5, preeclampsia was significantly more common. There were no significant differences in complications such as arterial hypertension and amnionitis. Urological complications. The degree of AB and administration of treatment did not affect the incidence of pyelonephritis or obstetric outcomes. However, in group 1 there was a weak tendency towards a more frequent development of pyelonephritis in the 3rd trimester.

Bladder cancer (BC) is a severe, and in some cases disabling disease for which no active detection strategy has been developed. It requires careful differential diagnosis, and is associated with a high risk for recurrence and progression. The choice of optimal treatment of non-muscle-invasive bladder Cancer (NMIBC) can reduce the rate of recurrence and improve oncologic outcomes. The development of the Vesical Imaging Reporting and Data System (VI-RADS) protocol, which has high sensitivity and specificity for assessing the degree of tumor invasion into the detrusor, has been changing the paradigm for primary surgical treatment. The use of new protocol VI-RADS for MRI and intraoperative protocols DEpth of Endoscopic Perforation (DEEP) determine the treatment tactics. Frequency of detrusor presence after en bloc resection is 96-100%. The absence of circulating tumor cells in the peripheral bloodstream during en bloc resection compared to classic transurethral resection (TUR) has been proven. Safety profile and morphologic specimen are better with use of laser energy. Repeat TUR after en bloc resection if there was a negative surgical margin and detrusor was present in the specimen is left to the discretion of the physician. The pathomorphological study after en bloc resection of the bladder allows a more precise staging and may influence on treatment tactics for bladder cancer. En bloc transurethral resection can be recommended as a standard procedure for diagnosis and treatment of NMIBC.

Up to a quarter of all hospitalized patients undergo bladder catheterization, regardless of the department profile. Injuries related to this procedure represent up to 32% of all urethral injuries and may compromise or worsen the patients treatment. The most frequent causes of iatrogenic injury in this context are unintentional balloon inflation in the urethra or the creation of a false passage. The purpose of our work was to identify the most effective methods to prevent these injuries. Articles containing the following information were selected: iatrogenic injuries of the urethra, the effectiveness of injury prevention methods, various devices and drugs. The work also included reviews evaluating the effectiveness of various catheterization techniques and data on the significance of the type and material of the catheter. We reviewed about 20 papers that discussed the frequency of iatrogenic injuries, their early and long-term consequences and ways to prevent them. Urethral strictures are the most common complication of catheterization in the long-term period (78%). The remaining 22% had no consequences. Most researchers agree that the most effective way to prevent injury is the correct catheter insertion technique and the use of additional assets in the form of anesthetic gels-lubricants. In cases of difficult catheterization, modified techniques with different types of catheters can help: catheters with a curved tip or made of more rigid materials. Safety valves that prevent the balloon inflation in the urethra, or visus catheters that help to detect and solve the problem safely, can prevent a traumatic effect. As a result of our work we have found several approaches to reduce the frequency of injuries. The most accessible and easiest way is to follow the catheterization algorithms, the second and important way is to use proper premedication in the form of gels with anesthetics. In cases of complex catheterization, use a Coude or silicone catheter, and in cases that do not allow catheterization without visual control, use visus catheters.

Aim: To evaluate the microbial spectrum of urine before and after transurethral resection of prostate (TURP) in patients with postoperative infectious complications.

Materials and methods: A single-center retrospective observational study between 2016 and 2023 was carried out. Patients who developed urinary tract infections (UTIs) after mono- or bipolar TURP during the hospitalization were included. Bacteriological examination of urine obtained before procedure and after the manifestation of UTI was done in accordance with the Guidelines. In the presence of suprapubic or urethral catheter, the drainage was previously replaced with further microbiological study. The level of significant bacteriuria was more or equal 103 CFU/ml, with a level of significant leukocyturia more or equal 10 per field of view. Statistical analysis was carried out using IBM SPSS Statistics 23.0.

Results: Bacteriuria was not detected in 77.9% of cases of UTIs after TURP. At the same time, according to the preoperative examination in 76.2% of these patients, there was no bacteriuria more or equal 103 CFU/ml. In 17 of 122 men (13.9%) without bacteriuria at baseline, microorganisms were isolated after the development of UTIs. A decrease in bacteriuria level was noted in only 19 of 29 patients (65.5%) who had a positive urine culture before TURP. Only in 4 out of 10 cases of persistent bacteriuria the same microorganism was isolated, while in the remaining 6 cases the initial spectrum was replaced by another bacteria.

Conclusion: Our data indicate a low detection rate of microorganisms in urine of patients with UTIs after TURP using a standard bacteriological study. The data indicate that the standard antibiotic prophylaxis regimen and ongoing anti-infective measures are partly effective in reducing a narrow range of aerobic microorganisms detected preoperatively using standard media, which, however, does not exclude the development of an infectious process.

Introduction: Metastatic castration-resistant prostate cancer (mCRPC) is the most severe form of prostate cancer, developing in about 30% of patients; standard approaches of its treatment often remain ineffective. The development of theranostics principle and the discovery of the prostate-specific membrane antigen (PSMA) make it possible to implement a new approach in the treatment of patients with mCRPC - PSMA-targeted therapy. It is based on the use of a specific radionuclide (alpha or beta-minus emitter) associated with a ligand (radioligand) that binds to PSMA and has a targeted effect on tumor cells. One of the advantages of this technique in mCRPC is simultaneous diagnostics and treatment of the disease (the basic principle of the theranostics). The high specificity of PSMA-targeted therapy in combination with increased expression of PSMA by cancer cells allows to treat numerous distant metastases, slowing down the progression of the disease and improving the patients condition.

Aim: Review of the main approaches to the use of PSMA and radionuclides to treat patients with mCRPC as part of PSMA-targeted therapy.

Conclusions: The most preferred method to treat patients with mCRPC is --radionuclide therapy, since --radiation isotopes have a "crossfire effect" and relatively low toxicity and are available for use. The most optimal radionuclide from the group of -emitters is lutetium-177 - 177Lu (PSMA radioligands: 177Lu-PSMA-617 and 177Lu-PSMA-I&T). Despite the large number of --radionuclide therapy advantages, it is also possible to use -radionuclide therapy; actinium-225-225Ac (PSMA radioligand: 225Ac-PSMA) therapy is more toxic to the body, however, it can be considered as a second line or escape medication for patients with mCRPC and previous ineffective --therapy.

Introduction: The treatment tactics of patients with recurrent urethral stricture requires an integrated approach. An increase in the treatment efficiency is possible not only through improvements in surgical technique, but also by influencing the pathogenetic mechanisms of the formation of urethral stricture and stimulating regeneration.

Aim: To evaluate the efficiency of reconstructive procedures using platelet-rich plasma in patients with recurrent urethral stricture.

Materials and methods: A comparative analysis of the results of surgical treatment of patients with recurrent urethral stricture with and without the use of platelet-rich plasma, who were treated at the University Clinic of Urology of Russian National Research Medical University named after N.I. Pirogov, was carried out. A total of 60 patients were included in the study. They were divided into the control (n=30) and the main group (n=30). There were no differences in length, median age, and localization of urethral stricture. The median maximum urinary flow rate preoperatively was 4.7 ml/s (1.7-11). According to etiological factors, there were 45 iatrogenic (75%), 7 traumatic (11.7%), 2 infectious strictures (3.3%) and 6 patients with hypospadias (10%).

Results: In the main group, end-to-end anastomotic urethroplasty was performed in 17, augmentation urethroplasty in 9, multi-stage urethroplasty/perineal urethrostomy in 4 cases. In the control group, end-to-end anastomotic urethroplasty was done in 24, augmentation urethroplasty in 4, multi-stage urethroplasty in 2 patients. Efficiency in the main group was 93.3%. In 2 cases, recurrence of the stricture was seen. In the control group, the efficiency was 76.7%. There were 7 recurrences. The median period of catheterization was 14 and 7 days in the control and experimental groups, respectively. The frequency of infectious complications (urethritis, epididymitis, infected wound) was 6 times lower in the main group. Median Qmax in the control group during follow-up was (min-max) 19.85 ml/sec (9-23.8), compared to 24 ml/sec (10-40) in the main group.

Conclusion: A combination of urethroplasty with a use of platelet-rich plasma improves the treatment outcomes of patients with recurrent urethral stricture. Reducing the length of bladder catheterization due to the stimulation of regeneration and the organization of the extracellular matrix allows to reduce the frequency of recurrence by 3 times. A decrease in the frequency of infectious complications also improves the results of surgical treatment, reduces the risk of recurrence and improves the quality of life of patients.

Retrograde intrarenal surgery (RIRS) is a type of endoscopic intervention on the kidneys performed using a semi-rigid or flexible fiber optic endoscope. RIRS is recommended by national clinical guidelines for stone management sized up to 20 mm. However, like any other surgical intervention, RIRS is associated with the risk of complications. Complications affect the patients quality of life, and cause additional costs determined by prolonged hospital stay and subsequent treatment. This systematic review is devoted to the complications of RIRS, methods of their prevention and treatment, which should make possible to increase the effectiveness and safety of care for patients with urolithiasis.

Actuality. The incidence of urinary stone disease (USD) of the Russian Federation population has increased by approximately in 34,1% with manifestation at the age of 40 to 50 years. There is a high probability of recurrence with up to 50% experiencing a recurrence within 5 years. Despite the existing advances in the field of metaphylaxis of USD, surgical reinterventions are still performed.

Materials and methods: A total of 300 patients with urolithiasis were performed ureteroscopic interventions at S.S. Yudin City Clinical Hospital between September 2021 and November 2022. Depending on the episode of calculus formation, patients were divided into two groups - 184 (61.3%) patients with a first episode of USD and 116 (38.7%) cases of recurrence urolithiasis. All patients underwent multispiral computed tomography without the introduction of a contrast agent. To assess pain in renal colic, a visual analogue scale, a numeric pain rating scale and a faces pain scale were used.

Results: The median duration of surgery was 30 min in group 1 and 40 min in group 2. Long-term drainage of the urinary tract after removal of the calculus with internal ureteral stent was in 45 (24.5%) individuals of group 1 and in 43 (37.1%) individuals in group 2. Complications were assessed using PULS (Postureteroscopic Lesion Scale), Satava scale and Clavien-Dindo classification. There were no complications in 98,4% cases in patients with a first episode of USD and in 93,1% in patients with recurrence urolithiasis (p=0,03) due to Clavien-Dindo classification, in 97,8% and 87,9 % respectively (p=0,0007) due to Satava scale. The median time period for stent removal in group 1 was 4 days, and for group 2 - 15 days.

Conclusion: Ureteroscopic surgeries for patients with recurrent urolithiasis were associated with an increased risk of complications that require long-term drainage and endoscopic reinterventions and hospitalizations. Low patient compliance leads to development of recurrence urolithiasis.

Introduction: Radiation therapy is one of the main methods of treating pelvic malignant tumors, which provides good oncological results. Specific features of the pelvic anatomy may result in various radiation injuries of adjacent organs, which are complicated by genitourinary fistulas, post-radiation fibrosis with the formation of hydronephrosis, microcyst, reducing the quality of life.

Aim: To describe the relevance and importance of the correct choice of surgical treatment in patients with post-radiation urinary tract injuries.

Materials and methods: The group of irradiation injuries of the urinary tract included 60 patients aged 39-65 years. 19 (31.7%) women with various post-radiation ureteral injurie, who underwent reconstructive surgery using isolated bowel segments, were included in the study group.

Results: Substitution of the ureter by intestinal segment in patients with extensive post-radiation ureteral strictures provides good functional results. During follow-up computed tomography, an absence of urinary tract obstruction was confirmed in 16 (84.2%) patients, while in 3 (15.8%) cases an obstruction was diagnosed, followed by nephrectomy due to loss of function in 1 woman (5.3%). When assessing renal function using the dynamic nuclear scintigraphy, improvement in function was revealed in 14 (73.7%) patients, stabilization in 2 (10.5%), deterioration in 3 (15.8%). Histological examination revealed that inflammatory infiltration and the absence of a clear margins of the stricture area were more pronounced in patients who had had internal ureteral stent prior to reconstruction. A number of clinical cases demonstrating the treatment tactics of this group of patients is presented in the article.

Conclusion: Based on the extensive experience of two centers and long follow-up, we suggest scientifically proven approach to surgical treatment of radiation injuries of the urinary tract, the implementation of which will significantly improve medical and social rehabilitation.