Urologiia最新文献

Background: The correlation between inguinal hernia and benign prostatic hyperplasia (BPH) is well known. Minimal invasive simple prostatectomy (MISP) may be method of choice for surgical treatment of BPH with volume more than 80 cc. Literature review has revealed retrospective studies of laparoscopic or robot-assisted radical prostatectomy with simultaneous inguinal hernia repair and acceptable complication rate. Open simple and radical prostatectomy provide the same results. Similar studies for MISP have not been found.

Aim: To evaluate the rate of complications of simultaneous laparoscopic hernioplasty of inguinal hernia and MISP compared to MISP alone.

Materials and methods: The data of 79 patients, who underwent MISP, were analyzed retrospectively. The two groups were formed. In the group I, only MISP (n=34) was performed. In the group II, MISP and simultaneous inguinal hernia repair (n=17) were done, including three bilateral and other unilateral procedure. Three patients in group II additionally underwent simultaneous cystolithotomy. The same surgical approach was used for both groups. The Fishers exact test was used for statistical analysis.

Results: There were no significant differences (p>0.005) in mean age of patients (68 vs. 71 years), volume of blood loss (416 vs. 238 ml), duration of procedure (190 vs. 221 min) and complications rates (11.7% vs. 5.8%) between two groups. The mean prostate volume was 128 cc in both groups.

Conclusions: Simultaneous MISP and laparoscopic inguinal hernioplasty in patients with BPH does not result in higher complication rate compared to MISP.

Background: Prostate extract has pronounced anti-inflammatory and anti-androgenic properties, which contribute to a reduction in the volume of the prostate and an improvement in urination. Alpha-adrenoblockers, in turn, exert a relaxing effect on the smooth muscles of the bladder and prostate, thereby facilitating the urination. The combined use of these two drugs may provide a synergistic effect, leading to a pronounced improvement in quality of urination and accelerates recovery in patients after transurethral resection of the prostate. This approach may be more effective than using only one of these drugs.

Aim: To investigate the efficiency and safety profile of the prostate extract in combination with tamsulosin in patients after transurethral bipolar resection of the prostate.

Materials and methods: A total of 147 patients with benign prostatic hyperplasia (BPH) of stage II without severe concomitant diseases were included in the clinical study. The age of the men ranged from 48 to 81 years (61.7+/-1.4). All patients underwent transurethral bipolar resection of the prostate. Patients were randomized into two groups. In the main group, men received from the first postoperative day a combination of prostate extract with an alpha-adrenoblocker (prostate extract in powder 50 mg in terms of water-soluble peptides 10 mg and tamsulosin hydrochloride 0.4 mg) in the form of suppository after spontaneous bowel evacuation or enema daily for 30 days (n=70). In the control group, only alpha-adrenoblocker (tamsulosin 0.4 mg once a day for 30 days) in the postoperative period was given (n=77).

Results: In the main group, there was a reduction in the mean total IPSS score by 34.5% (p <0.05), and improvement in quality of life by 52% (p <0.05). The maximum urine flow rate increased by 69% (p <0.05), and the average urine flow rate increased by 94.6% (p<0.05). The positive effect on erectile function was 17.8% (p <0.05).

Conclusions: Our data allow to recommend this drug in the combined treatment of patients with benign prostatic hyperplasia (BPH) after transurethral resection of the prostate to restore urination function and improve quality of life.

Aim: To study the features of the clinical manifestations, diagnosis and treatment of children with bladder hernias.

Materials and methods: A total of 8 children with bladder hernias were observed, including five patients with inguinal hernias of the bladder and two with femoral hernias. One girl had a perineal bladder hernia. To verify the diagnosis, clinical and laboratory examinations, ultrasound and Doppler examination of the scrotum, bladder catheterization, cystoscopy and cystography, intravenous urography, CT, and morphological studies of the surgical specimen were used. In this article, we presented four clinical cases.

Results: Difficulties in diagnosing bladder hernias in children, especially when they are incarcerated, are associated with atypical clinical manifestations, which mimic an incarcerated inguinal hernia. In 5 children with inguinal and two children with femoral hernia of the bladder, the diagnosis was not correctly made before the surgical procedure. In two cases, there was bladder damage during intervention. Combined surgical procedure with abdominal and herniotomy approaches allowed to perform radical procedures for both inguinal and femoral hernias of the bladder. A girl with a perineal hernia of the bladder complicated by urolithiasis was undergone to anterior colporrhaphy and posterior colpoperineorraphy with a removal of bladder stones.

Conclusions: Bladder hernias in children are always sliding and are rare. Clinically, bladder hernias in children mimic an incarcerated inguinal hernia. Correct diagnosis of bladder hernias is difficult. No child with inguinal and femoral bladder hernias was correctly diagnosed before surgical intervention. Abdominal and herniotomy approaches can be the method of choice for femoral hernias of the bladder. With perineal hernia of the bladder, anterior colporrhaphy and posterior colpoperineorraphy are indicated.

Schwannoma is a benign tumor arising from the peripheral nerve sheaths and consisting of highly differentiated Schwann cells, which under physiological conditions produce the essential component of nerve fibers myelin. Frequent localization of neoplasms are areas with developed and abundant nerve supply - the head, neck, limbs, less often its occur in the chest, mediastinum, retroperitoneum, adrenal glands, organs of the gastrointestinal tract, cases of schwannoma of the penis and vulva are also described. In clinical practice, extratesticular schwannoma of the scrotum is extremely rare, when analyzing literary sources, descriptions of only isolated observations were found. Scrotal schwannoma is often associated with systemic pathology - neurofibromatosis type 2 or schwannomatosis, isolated development of the tumor is rather considered an exceptional event. In this article, we present a description of a clinical case of multiple large scrotal schwannoma in a 45-year-old man who underwent surgical treatment with excision of the tumor in 2011. During the period 2011-2024, the patient had no relapse of the disease, the quality of life was high and the prognosis was favorable.

Objective: to assess the needs and attitudes of urologists regarding the use of technologies related to artificial intelligence, particularly the web platform "Sechenov.AI_nephro", in the surgical treatment of patients with renal parenchymal neoplasms.

Materials and methods: a qualitative study was conducted through in-depth interviews. A questionnaire was developed for the interviews, including 14 categories of questions covering various aspects of the use of artificial intelligence (AI) aimed at optimizing preoperative planning for patients with renal parenchymal neoplasms. The study involved 8 urologists with extensive experience in the surgical treatment of patients with renal parenchymal neoplasms.

Results: the survey results highlight the growing interest in the implementation of AI technologies in medical practice.

Conclusion: in-depth interviews among urologists in Russia showed that there is a high interest in AI developments in urological practice. At the same time, successful integration of technologies requires overcoming several obstacles, including training specialists and ensuring data security. The "Sechenov.AI_nephro" platform has the potential to become an important tool in optimizing preoperative planning, but its success will depend on the readiness of physicians for new technologies and support from the medical community.

Introduction: Obstructive type of urination requires accurate and timely diagnosis to prevent complications and improve the quality of life of patients. Traditional diagnostic methods such as uroflowmetry, although they remain the standard, have their limitations. In this context, videography of urine stream followed by image analysis is a more cost-effective and promising approach that allows for a more detailed picture of urination, accessible not only to urologists, but also to patients.

Aim: To establish the possibility of recognizing and classifying graphs of the urination using neural network and machine learning technologies.

Materials and methods: This retrospective study involved 152 male patients aged 19 to 87 years who underwent examination and treatment at the MC Medassist clinic from June 2024 to January 2025. There were 43 patients (28%) with obstructive type of urination, 39 patients with benign prostatic hyperplasia, 4 patients with urethral stricture, and 109 patients (72%) with normal urination. The diagnostics algorithm included a general urinalysis, kidney and bladder ultrasound and/or MRI of the prostate, as well as uroflowmetry. The neural network architecture was designed based on the Keras framework of the Python programming language.

Results: Three studies with obtained data were carried out, which differed in the architecture of the neural network and the methods of preparing the initial data. The average area under the ROC curve for a network with random image feed averaged 0.5 for both the training and test samples. For a network with linear feed of the entire data set, it was 1 for the training and test samples. A neural network with three inputs differing in two-threshold binarization ranges showed a result of 0.9 for the training and 0.7 for the test sample.

Discussion: An important aspect of this study is the possibility of using neural networks to process large amounts of video data. Automating the analysis of images of urine stream allows not only to reduce the time required for diagnosis, but also to identify hidden patterns that may be overlooked during visual assessment by a specialist. The study of methods for analyzing video recordings of urination based on artificial neural network technologies and machine learning algorithms can become the basis for creating new diagnostic tools that will increase the speed of diagnosis, accelerate drug research, and monitor patients with chronic diseases.

Conclusion: Despite the current limitations, this study confirms that the use of neural networks and machine learning in urology has significant potential and can become the basis for the development of new diagnostic tools that can improve the efficiency of medical care, and thereby improve the quality of life of patients.

Aim: To compare the incidence of postoperative stress urinary incontinence (SUI) in patients with benign prostatic hyperplasia after three different techniques of thulium fiber laser prostate enucleation (ThuFLEP): two-lobe, enucleation of all lobes in a single block (en-bloc) and enucleation of all lobes in a single block without additional longitudinal incisions (total en-bloc).

Materials and methods: A retrospective and prospective comparative analysis included 472 patients, who were undergone to three different techniques of ThuFLEP. The surgical interventions were performed by three experienced surgeons from January 2015 to May 2023. The incidence of postoperative stress urinary incontinence (SUI), risk factors for SUI, and the rate of improvement in patients with SUI were evaluated. The patients were examined pre- and postoperatively.

Results: Logistic regression analysis was used to assess the effect of two main predictors, surgical technique and prostate volume, on the SUI after the surgical procedure. The postoperative SUI developed in 49 (10.4%) patients. After 6 months, SUI persisted in only 6 (1,3%) cases. Uni- and multivariate analysis of these predictors was performed. Depending on the technique of laser enucleation, the incidence of SUI reached 13.9% after the two-lobe technique, 12.4% after the en-bloc technique, and 5.4% after the total en-bloc technique. In addition, the total en-bloc technique proved an earlier restoration of urinary continence after laser enucleation. Uni- and multivariate analysis showed the significant influence of the surgical technique on the SUI (p=0.013 for the univariate analysis, p=0.046 for the multivariate analysis).

Conclusions: We confirmed the significant reduction of the postoperative SUI in the first six months when used the total en-bloc technique with additional beneficial effect on early recovery of urinary continence.

Introduction: Sexual dysfunction is extremely common in the world. The frequency of erectile dysfunction can approach 50%, while ejaculation disorders more than 30%. The patients sexual well-being is an integral part of general health and can correlate with the risk of developing diseases of organs and systems. Currently, the most common assessment of individual aspects of sexuality at the time of the inspection by clinical interview is, however, the issue of determining all the components of the sexual function throughout the life of the patient is acutely. To solve this problem, M.I. Kogan was developed and published in 2009 an Integral assessment of male sexuality (IAMS).

Aim: To determine the validity and reliability of the questionnaire of sexual functioning of men.

Materials and methods: The study consists of 209 men. Of these, 43 healthy people aged 31.0 [26; 36] years; 57 people aged 63.0 years [59.0; 67.0] with benign prostatic hyperplasia (BPH); and 109 people aged 64.0 years [61.0; 68.0] with verified prostate cancer (PCa). Age in healthy men ranged from 18 to 52 years, while men with BPH it was 49-71 and in those with PCa 47-70 years. In the whole cohort, 78.0% were married, 13.9% were divorced, but had sexual relations out of marriage, and 8.1% were lonely. 136 men (65.0%) had children. All men filled in IAMS.

Results: The Alpha Kronbach coefficient exceeded 0.6 for all three versions of the questionnaire and groups of men, while for all examined, as well as patients, exceeded 0.9. The highest values were obtained for a group of patients, as well as for all examined, which confirms the reliability of the questionnaire. Lower values for healthy persons can be explained by a small number. All correlation coefficients were positive and significant at a high level (p<0.001), which indicates that the increase in the sum of points for each component means an increase in the level of male sexuality and confirms the validity of the questionnaire. The level of sexuality of patients was much lower compared to healthy men (p<0.001). Among healthy people, the majority had a normal level of sexuality (62.8%), while 23.3% were hyposexual and 14% were hypersexual. In the group of patients, hyposexuality was prevalent (74.1%), while normal sexuality was seen only in 18.7%, and hypersexuality in 7.2%. Thus, the results of all calculations confirm the validity and reliability of this questionnaire. IAMS not only gives an integral assessment of a mans sexuality at the time of contacting a urologist, but also quantitatively determines the type of sexuality, which is a reflection of the innate qualities of the male body throughout his sexual life.

Conclusions: IAMS is valid and reproducible questionnaire for an integral assessment of male sexuality, which is possible to use in epidemiological and clinical studies in the future.

Background: Progression of metastatic prostate cancer after castration resistance is one of the main challenges in prostate cancer therapy. 177Lu-PSMA-617 has been recently investigated in castration resistant metastatic prostate cancer.

Objectives: To systematically evaluate the efficacy and safety profile of 177Lu-PSMA- 617.

Patients and methods: A systematic review and meta-analysis was conducted according PRISMA principles. From initial 261 results, 3 randomized controlled trials met our inclusion criteria. The primary outcome of this study was oncological response and side effects. RevMan 5,4 software was applied in this systematic review and meta- analysis.

Results: A total of 1071 patients were included in the pooled analysis. 670 (62,6%) patients received 177Lu-PSMA-617. Progression-free survival was significantly better with a hazard ratio of 0,72 (p= 0,00001). 50%>PSA reduction reported in 75 (63%) vs. 45/121 patients (37,2%) (p=0,0001). Total adverse events recorded in 572 / 627 (91,2%) developed AEs, vs. 204 / 290 (70,3%) (p = 0,00001). Fatigue was reported in 306/647 (47,3%) patients vs 88/310 (28,4%) (p=0,00001). And constipation in 110/549 (20%) vs 24/225 (10,7%) (p=0,003). Both thrombocytopenia and leucopoenia were marginally significantly higher in 114 / 647 (17,6%) vs 19 / 310 (6,1%) (p=0,08) and 81 / 647 (12,5%) vs 13 / 310 (4,2%) (p=0,10), respectively.

Conclusion: 177Lu-PSMA-617 results in significant reduction in PSA and improves the progression-free survival. It can cause tolerable side effects, mainly fatigue, constipation, thrombocytopenia and leucopoenia.