Urologiia最新文献

This review is devoted to the pathogenetic basis and clinical results of the use of a new domestic innovative drug Vesusten, which is based on polypeptides made of animal bladder tissue, for the treatment of patients with overactive bladder. Data are given regarding the epidemiology, pathogenesis factors and current treatment methods. The mechanisms of peptide regulation of physiological processes in humans are also described. The basic principles of the use of bioregulatory peptides for therapeutic purposes. The results of preclinical and clinical studies of the drug Vesusten are discussed in detail.

Introduction: Erectile dysfunction is often a consequence of stressful situations, lack of adequate sleep and rest, and sedentary lifestyles. The profession of locomotive engineer implies the presence of these negative factors, which in addition provoke high blood pressure and the development of hypertension.

Materials and methods: A total of 85 patients of the urological and therapeutic departments of the "Clinical Hospital "Russian Railways Medicine" in the city of Barnaul", working as locomotive drivers or assistant drivers, were examined. 65 men with erectile dysfunction and hypertension of 1-2 stages (all received antihypertensive therapy) were randomly divided into 3 groups: in the group 1, an activator of endogenous nitric oxide synthase (NOS) was added to the treatment of hypertension; in group 2, a combination of an endogenous NOS activator and a phosphodiesterase-5 inhibitor (PDE-5) was used. Patients of group 3 did not receive additional treatment. The efficiency of treatment was assessed using markers of endothelial dysfunction, including plasminogen activator inhibitor type 1 (PAI-1), endothelin-1 (ET-1), homocysteine, high-selective C-reactive protein (hs-CRP). In addition, the International Index of Erectile Function and male copulatory function scores were filled out. Moreover, laser doppler flowmetry (LDF) with determination of blood flow in penile vessels was done. Follow-up examination was carried out after 2 and 4 months. Twenty of the persons were healthy and referred to the control group.

Results: There were no significant changes in markers and LDF values after 2 months in groups 1 and 3. In group 2, ET-1 and hs-CRP returned to the reference limits, which indicated a decrease in ischemia. After 4 months, there was an improvement in hemodynamics and marker values in group 2. The mean blood flow increased in group 1, while hs-CRP returned to the reference limits. In patients of group 2, a higher total IIEF and male copulatory function scores was documented. In group 3, there was no improvement.

Conclusion: The combination of hypotensive drugs, PDE-5 inhibitor and NOS activator showed the best effect, improving blood flow, reparative properties of endothelium with preventing of thrombus formation. Treatment with an NO synthase activator partially eliminates pathological processes in the endothelium.

Aim: To assess the possibility of interpreting machine learning models to predict the early results of laparoscopic nephron-sparing surgery (NSS) in kidney tumors with consideration of surgical learning curve.

Materials and methods: The results of 320 consecutive laparoscopic NSS in patients with localized kidney tumors, performed by 4 surgeons, were analyzed. The construction of a machine learning model taking into account surgical learning curve was carried out based on the extreme gradient boosting (eXtreme Gradient Boosting). To identify significant factors and interpret the prognostic ability of the model, the SHapley Additive exPlanations method was used with a calculation of the Shapley value. Three groups of factors were chosen as an array of input data. The first group included demographic and clinical characteristics of patients, such as age, gender, Charlson comorbidity index, body mass index, preoperative glomerular filtration rate (GFR). In the second group, there were morphometric indicators of the kidney tumor, including RENAL. Nephrometry Score, PADUA (Preoperative Aspects and Dimensions Used for an Anatomical), C-index (Centrality index score), absolute tumor volume, localization of the tumor in relation to the kidney surface. In addition, factors associated with surgical learning curve, such as case number and perioperative results last 10 procedures, were analyzed. The target variables were duration of the procedure, warm ischemia time, and postoperative GFR after 24 hours.

Results: The SHAP method allows a visual interpretation of a machine learning algorithm based on the extreme gradient boosting for individual prediction of early perioperative outcomes of laparoscopic NSS in patients with renal tumors. For the calculated new features "complexity", "slope angle" and others using the SHAP method, the high significance in building predictive models for target variables was confirmed, and an interpretation of the influence of specific features on the target variable in the constructed machine learning models was also given.

Conclusion: The SHAP method showed good practical results that coincide with the observations of specialists. The use of such solutions will allow in the future to introduce machine learning models to form clinical decision support systems.

A clinical case that demonstrates the development of human papilloma virus (HPV)-associated penile intraepithelial neoplasia (PIN), namely the erythematous form of bowenoid papulosis in a young patient, as well as a delay in making a correct diagnosis due to incorrect diagnostic tactics and low alertness of doctors regarding oncologic diseases, is presented in the article. Penile intraepithelial neoplasia is the histological term for precancerous lesions of the penis. Timeliness is important in the diagnosis of PIN, since currently there is a high morbidity and mortality associated with the progression to squamous cell penile carcinoma. From the morphologic and pathogenetic standpoints, HPV-negative (differentiated) and HPV-positive subtypes of PIN are divided. The latter includes Bowenoid papulosis, erythroplasia of Queyrat and Bowen's disease. It is important to carry out a differential diagnosis between these lesions, since the rate of development of penile cancer for erythroplasia of Queyrat is 30%, for Bowen's disease is 5% and for bowenoid papulosis is 1%.

The article presents historical aspects of the activities of Ya.B. Zeldovich - the author of a non-invasive method for recognizing intraperitoneal injuries of the bladder.

Aim: To investigate the factors influencing the choice of penile prosthesis and to evaluate the results of surgical treatment of patients suffering from erectile dysfunction (ED).

Materials and methods: Surgical results of penile prosthesis implantation in 348 patients were reviewed. The analysis included such factors as age, weight, height, body mass index (BMI) and the type of prosthesis.

Results: It was found that younger patients who tended to have an active lifestyle preferred three-piece prostheses, while older patients tended to favor one-piece prostheses. Weight, height and BMI do not affect the development of ED. A direct correlation between low patient height and increased risk of prosthesis failure and subsequent complications was found. When the patient was circumcised, there were no infections or mechanical failure after implantation.

Discussion: Our results emphasize the importance of an individual approach to the selection of a penile prosthesis, taking into account the physical characteristics and preferences of each patient. Such a factor as short stature is associated with a more limited space for placing the prosthesis pump, which requires consideration when selecting a prosthesis and preparing it for implantation during procedure. Young patients usually choose three-piece prostheses owing to their ability to enlarge the penis during sexual intercourse and to reduce its rigidity and size after sexual intercourse. For older patients, one-piece prostheses are the primary choice due to the age-related surgical risks and affordability of this type of prosthesis.

Conclusions: Our results show the importance of further investigation and taking into account all the different factors that influence the development of ED and the outcome of penile prosthesis implantation.

Varicocele is one of the main causes of male infertility. Microsurgical varicocelectomy leads to improved sperm parameters and increased fertility, however, 80% of patients with varicocele are not infertile, and spontaneous pregnancy occurs only in 36.4-65% of cases after varicocelectomy. This fact leads to the need for careful selection of infertile men with varicocele for surgical treatment. The literature review is devoted to the possibilities of proteomic analysis of sperm in men. Modern "omics" methods, in particular proteomics, are quite promising in the diagnosis of male infertility. Considering the important role of seminal plasma in the natural process of fertilization, much attention is paid to the study of its proteins. The few published studies showed that changes in seminal plasma proteins of patients with varicocele are observed not only in case of pathospermia, but also with normozoospermia, which may indicate a greater sensitivity of proteomic analysis in determining the effect of varicocele on spermatogenesis and sperm function compared to a standard sperm analysis. Since varicocele is a complex disease with various pathogenetic mechanisms that can cause infertility, the paradigm-shifting approach using post-genomic technologies may provide a more thorough understanding of the effector pathways, as well as predicting of treatment outcomes.

Introduction: Recurrence of non-muscle-invasive bladder cancer (NMIBC) occurs in 70% of cases, and the risk of progression to muscle-invasive bladder cancer is 20%. Intravesical BCG therapy is indicated in order to increase relapse-free survival in patients with intermediate and high-risk NMIBC. We carried out a survey of Russian urologists on the use of intravesical BCG therapy in the treatment of NMIBC, and also presented the regulatory framework for the use of BCG for the treatment of bladder cancer.

Aim: To evaluate the use of intravesical BCG therapy among urologists of the Russian Society of Urology.

Results: According to the results of a survey of 145 urologists, 46 (32%) do not prescribe BCG therapy to patients with NMIBC. Most of them (63%) have more than 10 years of experience. The main reasons why urologists do not recommend BCG therapy are the lack of conditions (74%), an absence of the drug (20%), fear of adverse reactions or development of tuberculosis infection of themselves and medical staff (2%), absence of recommendations for BCG therapy from an oncological dispensary (2%). The most commonly prescribed drugs for intravesical instillation areImuron-vac (69%), Uro-BCG-medac (29%), OncoTICE BCG (2%). Only 8% of doctors did not report difficulties during therapy. The most common reason for the refusing from BCG therapy was the lack of conditions in the medical facilities.

Conclusions: According to the survey, one third of doctors do not prescribe BCG therapy due to the lack of conditions or a shortage of the drug. An increase of relapse-free survival of patients with NMIBC is possible by providing conditions for intravesical immunotherapy.

Sclerosing oleogranuloma of the penis is a rare benign condition characterized by the formation of rough and dense infiltrates in the male genital area following injection of foreign materials under the skin for the purpose of augmentation. It predominantly affects males of reproductive age. Diagnosis is based on patients history, examination and histological findings. Treatment involves excision of the granuloma and affected tissues with surgical margins followed by reconstruction of the penis and scrotum. A clinical case of the treatment of giant oleogranuloma of the penis and scrotum in a 21-year-old man clinically manifested by painful multiple lesions under the skin with ulceration along the coronal sulcus, pain, deterioration of the quality of life and cosmetic issues is presented in the article. For surgical treatment, the one-stage Sapozhkov-Reich procedure was performed for the first time at the urology department of the Republican Hospital named after V.A. Baranov, Petrozavodsk. Keywords: sclerosing lipogranuloma of the penis, sclerosing lipogranuloma of the scrotum, penis augmentation, injections into the penis, vaselinome, one-stage Sapozhkov-Reich procedure Author contributions. Simanov R.N. - idea, concept and design of writing the article, literature review, collection and processing of information and materials, description of a clinical case, analysis of patient carts, surgical treatment, writing text and preparing illustrative materials for publication; 60% of the work. Malyshev E.V. - surgical treatment, collection and processing of information, description of a clinical case; 20% of the work. Smirnova D.V. - collection and processing of clinical data, assistance in writing an article, preparation of a description of histological examination and micropreparations, creation of microphotographs, preparation of illustrative materials for publication; 20% of the work.