Urologiia最新文献

Male infertility may be a consequence of various diseases, many of which can be detected during examination. Modern methods of treating male infertility are diverse and include drug and non-drug therapy, diet therapy, and also a combination therapy that combines them, and therefore choosing the optimal approach to each patient is an absolutely important task. We have analyzed the literature on approaches to treating patients with different hormonal status, which allows us to conclude that hormonal therapy in certain cases has a positive effect on spermatogenesis parameters and increases the chance of pregnancy, but at the same time, it is necessary to systematize the available data to identify typical patient models for conservative therapy of male infertility.

The literature review is devoted to the study of the mechanisms of vitamin D involvement in the regulation of the immune response to infection, as well as the relationship between serum vitamin D levels and urinary tract infections (UTI) for women. Currently, the mechanisms of vitamin Ds involvement in the regulation of innate immunity have been reliably established , as well as the immune response of lymphoid tissue associated with the intestine , in response to the introduction of infection. Vitamin D is also involved in the modulation of the adaptive human immune system, which provides acquired anti-infective immunity, however, despite the fact that some mechanisms of this interaction have already been studied, the available data are still insufficient to draw unambiguous conclusions about the role of vitamin D in all infections. However, the obtained convincing evidence of a relationship between low serum vitamin D levels and a higher frequency of more pronounced UTIs in women allows us to consider vitamin D as a new independent predictor of UTIs. In addition, clinical studies that have compensated for vitamin D deficiency in women with UTIs demonstrate a pronounced preventive effect of such complementation in recurrent UTIs. Given the urgency of the problem of vitamin D deficiency and urinary tract infections, there is still a need to continue conducting high-level clinical trials in this area.

Aim: To assess the resistance to the mechanical compression of single and tandem stents.

Materials and methods: An in vitro model of the ureter using a silicone tube connecting the proximal and distal reservoirs was assembled. The proximal reservoir was sealed and connected to a pressure gauge. Stents were placed sequentially in the lumen of the tube. A part of the model of ureter was passed through a compression platform which had a length of 4 cm, a bending angle of 35-40 and the ability to apply variable pressure. Five different 7 Ch polymer ureteral stents were tested in single and tandem manner. The compression force was applied and measured at the level of the compression platform. A criterion of stent failure was an increase of the pressure in proximal reservoir over 20 cm H2O with irrigation of saline at a rate of 30 ml/hour.

Results: Measurements were performed in 11 variants, including without a stent, with single stent (5) and with tandem stents (5). Polyurethane stents showed the least resistance to mechanical compression. In case of tandem stenting, all stents demonstrated an increase in resistance to compression compared to a single stent.

Conclusions: Polymer stents are more resistant to mechanical compression compared to polyurethane ones. Tandem stenting can be an effective tool to counteract the compression by the tumor.

Ureteral stricture is a significant issue which requires surgical reconstruction in most cases. The main determining factors for the reconstruction type are the length and location of the stricture. The individual steps for each procedure are significantly different, thus the scenario is predetermined regardless of intraoperative data. Preoperative assessment of the stricture length is based on X-ray data. However, it is not always correct and surgeon may encounter a situation where the planned reconstruction turns out to be suboptimal. This clinical case demonstrates intraoperative conversion from planned augmentation to end-to-end anastomosis after longitudinal incision of the ureter and visual assessment of the stricture length.

Background: The efficiency of surgical treatment of stress urinary incontinence (SUI) in women is 77-85%, and in nearly 15% of cases repeated procedures are required.

Aim: To present the experience of our center in the treatment of recurrent SUI in women and to evaluate the efficiency of repeated interventions.

Materials and methods: The retrospective study included women with recurrent SUI. They underwent to mid-urethral sling procedure or Burch colposuspension. The preoperative data, objective assessment of urinary incontinence and previous interventions were analyzed. Postoperatively, the presence of SUI, the degree of urinary incontinence and the quality of life were assessed. Data on additional surgical procedures was collected at a follow-up visit.

Results: A total of 179 patients underwent correction of SUI. Data on 10 patients with recurrent SUI were included. The age of the women was from 32 to 74 years (median 65 years, IQR 28), and one of them had a hysterectomy. Before our interventions, 9 patients underwent a single surgical procedure for SUI and one had previously had three interventions in other clinics. In general, there were 12 previous operations, including urethropexy with tension-free vaginal tape-obturator (TVT-O) (7/12), urethropexy with tension-free vaginal tape (TVT) (1/12), laparoscopic Burch colposuspension (1/12) and urethropexy with a synthetic loop with unspecified approach (3/12). At the time of the first examination, the women used 2-6 pads per day. The following types of treatment were performed in our center: 5 patients underwent retropubic urethropexy with tension-free vaginal tape (TVT) and 4 patients had laparoscopic Burch colposuspension. In addition, 2 simultaneous laparoscopic revision of the Retzius space and TVT under laparoscopic guidance were performed as well as one simultaneous open Burch colposuspension and TVT. The median follow-up after surgery was 6 months. In two out of 10 patients (after primary TVT and TVT-O), laparoscopic Burch colposuspension was not effective. A recurrence of SUI was detected in the postoperative period. Then, the patients underwent revision of the Retzius space and TVT under laparoscopic guidance and open Burch colposuspension and TVT, respectively. Postoperatively, urinary continence was restored. Complete urinary continence (0 pads per day) was achieved in 50% of cases (6 out of 12 procedures). In three women (25%) mild SUI remained (2-4 points on the ICIQ-SF, 1 safety pad per day); at the same time, they noted a significant improvement in their quality of life. Thus, repeated interventions were effective in 75% of cases (9 out of 12). According to the evaluation of urination disorders (UDI-6), five patients had minor symptoms (1-3 points). Most of them complained of frequent urination that did not affect the quality of life.

Conclusions: The efficiency of surgic

Aim: To present a view on the problem of postcoital cystitis, the technique and results of extravaginal urethral transposition using the method we developed.

Materials and methods: From 2005 to 2025, extravaginal urethral transposition was performed in 602 patients aged 18 to 61 years (average 26.7+/-1.3 years) at the Urology Clinic of the I.I. Mechnikov North-Western State Medical University. In all cases, the method developed at the clinic (patent No. 2408296 dated 10.01.2011) was used. It involves complete mobilization of the urethra and its placement in the submucosal tunnel into the clitoris area, where it is brought out through a separate incision and fixed with interrupted sutures. The posterior wall of the urethra is captured in the suture when closing the vaginal incision, which makes the urethra more securely fixed in a new place. Urethro-hymenal adhesions are necessarily excised.

Results: Early postoperative complications occurred in 17 (2.8%) patients. In the late period from 6 to 192 months (mean 38 +/- 2 months), 435 (72.3%) women were examined. Complete recovery occurred in 339 (77.9%), while significant improvement was noted in 66 (15.2%) cases. In 30 (6.9%) patients, urethral transposition was ineffective, and reintervention was successful in 10 patients. A positive result was achieved in 415 (95.4%) women.

Discussion: In all patients, the meatus was in the same place above the introitus and was never located inside it. There was no ectopia/dystopia in relation to the vagina. The abnormality was that in patients with postcoital cystitis, both tubes, urethral and vaginal, were located low, but at the same level. The external opening of the urethra and the introitus, without changing their position in relation to each other, were located under the pubis or even behind it. Obviously, the transformation of the urogenital sinus into the vestibule of the vagina occurred, and the urethra and vagina did not completely emerge from under the pubis behind it. This can be called sub-symphyseal or retro-symphyseal urethro-vaginal dystopia.

Conclusions: Retro-symphyseal urethro-vaginal dystopia should be considered as a mild urogenital malformation, but sufficient to become the anatomical basis for the development of postcoital cystitis. This anomaly and frequent episodes of cystitis after sexual intercourse are indications for surgical intervention. The best results are achieved with proper selection of patients and compliance with all technical features of the extravaginal transposition of the urethra developed in our clinic.

Introduction: Lower urinary tract infections (UTIs) affect nearly two-thirds of all women during their lifetime, and many suffer from recurrent infections. There are evidence-based guidelines from several international societies and RSU for the evaluation and treatment of UTIs; however, adherence to these guidelines is not always optimal.

Aim: To study the immediate outcomes of treating acute uncomplicated cystitis in working-age women living in a large industrial city under unfavorable environmental and climatic conditions.

Materials and methods: A multicenter, randomized, open-label study was carried out in 4 outpatient clinics in Perm involving 440 women with acute uncomplicated cystitis. Depending on the treatment, the patients were divided into 4 groups. The main drug was the antibiotic fosfomycin trometamol, which was given at a single dose of 3 g to all 440 patients. In the group 1, monotherapy with fosfomycin trometamol was used. Patients in groups 2-4 received basic antibacterial therapy (3 g of fosfomycin trometamol), supplemented with symptomatic and herbal remedies. In the group 2, drotaverine was used at 80 mg 3 times a day for 2 days, in the group 3 phenazopyridine at a dose of 200 mg 3 times a day for 2 days was given, while in the group 4, Canephron N at 2 tablets 3 times a day for 6 days was administered. The symptoms of cystitis were assessed using the ACSS scale, visual analog scale (VAS) of pain, urinalysis with microscopic examination of urinary sediment, bacteriological examination of urine and other methods. The results were assessed after 6, 12, 24, 48 hours, 3 and 6 days.

Results: The sensitivity of microorganisms to fosfomycin in bacteriological studies was 97.2%. In group 1, recovery was achieved in 92.5%, improvement in 6.6%, and the bacteriological cure was 95.3%; however, the ACSS and VAS scales indicated insufficiently rapid elimination of pain and other symptoms. In the group 2, improvement in results was insignificant. However, results were significantly better in groups 3 and 4, with rapid resolution of pain, dysuria, and other symptoms. In group 3, recovery was achieved in 97.3%, bacteriological cure and disability period were 96.8% and 5.1+/-0.5 days, respectively. In group 4, recovery was observed in 96.4%, bacteriological cure was 96.6%, and disability period was 5.2+/-0.4 days, respectively. In total, for 440 patients, when using fosfomycin trometamol, recovery occurred in 95.2%, improvement in 4.6%, bacteriological cure was 96.4%, side effects of fosfomycin trometamol were noted only in 1.1% of cases.

Conclusions: Currently, even in unfavorable environmental and climatic conditions, fosfomycin trometamol remains a highly effective and safe antibacterial agent for the treatment of acute uncomplicated cystitis. It is recommended to combine the use of fosfomycin trometamol with a urinary analgetic dr

Age is a non-modifiable risk factor for the development of benign prostatic hyperplasia (BPH). The algorithm of drug treatment of BPH is well known. From the perspective of modern patient-oriented medicine, when evaluating the efficiency of treatment, the subjective assessment by the patient, including satisfaction with the therapy, are important. Predictors of patients' dissatisfaction with drug therapy and low adherence to treatment are the persistence of lower urinary tract symptoms, especially nocturia, as well as the presence of erectile dysfunction. It is recommended to integrate the evaluation of treatment satisfaction into routine clinical practice, which will improve the quality of medical care. We have presented a literature review of satisfaction with drug therapy in elderly and senile patients with BPH, according to modern literature. The literature sources for 2018-2023 in the databases Springer, PubMed, eLibrary, Cyberleninca in Russian and English on the subjective assessments by patients of the older age of the treatment of BPH were analyzed.

About 30 million cases of urinary tract infections (UTI) are registered annually in the Russian Federation. An important feature of UTI is the tendency for their recurrent course, which significantly worsens the quality of life of patients. In addition, it increases the number of cases of temporary disability, which determines the socio-economic significance of UTI. Normalization of the human immune status plays an important role in the prevention of relapses of chronic diseases. Superlymph is a natural complex of natural antimicrobial peptides and cytokines, which are universal stimulants of the immune system secreted by leukocytes of the peripheral blood of pigs. In addition to the immunomodulatory effect, Superlymph has antiviral, antimicrobial and fungicidal properties. A review of data from 7 clinical studies of the use of Superlymph in patients with chronic cystitis with a total number of more than 800 participants is presented in the article. The results demonstrated that the drug Superlymph allows to relieve more effectively symptoms of exacerbations of chronic cystitis, increases the duration of the relapse-free period, improves microcirculation of the urethra and vagina, and reduces the severity of inflammation in the bladder.

Urolithiasis (kidney stone disease) remains a significant healthcare challenge worldwide due to its increasing prevalence and high recurrence rates. The rising incidence of urolithiasis can be attributed to the widespread use of advanced imaging techniques, such as computed tomography, as well as the growing prevalence of metabolic syndrome and shifts in lifestyle and dietary habits. Consequently, there has been an increase in endourological procedures for the management of kidney and ureteral stones. The primary clinical goal in treating patients with urolithiasis - achieving a stone-free status - equires the integration of highly skilled techniques and innovative technologies. This literature review, conducted within the framework of the RSF grant, aims to analyze the latest advancements in the diagnostics and surgical treatment of urolithiasis, focusing on improving treatment efficacy and long-term outcomes.