Urologiia最新文献

The main changes and additions to the clinical guidelines "Urinary Incontinence" (2024) are presented in the review. Certain changes to the guidelines "Urinary Incontinence" developed by the Russian Society of Urologists (RSU) and approved by the Ministry of Health of the Russia became possible thanks to the work of the expert Councils, which include the national leading specialists dealing with the problem of urination disorders. The inclusion of the Russian drug in the clinical guidelines will allow regulating the prescription of bladder polypeptides (Vesusten) in the routine clinical practice of a urologist and will help a wider range of patients receive pathogenetic therapy for OAB/urgent urinary incontinence.

Background: Prostate cancer (PCa) is the second most common cancer worldwide. Current methods of definitive treatment of PCa provide good recurrence-free survival in patients with low and intermediate risk of progression, and yet about a third of men will face the local recurrence in the next 10 years of life. Today, there is a great need to find optimal technologies for treating local relapses of PCa.

Aim: To analyze the efficiency and toxicity of salvage high dose-rate (HDR) brachytherapy in the treatment of local recurrences of prostate cancer after various types of primary treatment.

Materials and methods: A total of 98 patients with local relapse of PCa after various types of radical treatment were included in the study. The age of the patients was on average 68 years (minimum 53 years, maximum 84 years) [95% CI = 66.9-69.7 years]. Recruitment of patients was carried out from January 2015 to December 2022 at the Federal State Budgetary Institution Russian Scientific Center for Radiology of the Ministry of Health of Russia. After a comprehensive examination, all patients underwent salvage HDR brachytherapy. The study included 34 patients after radical prostatectomy and 64 patients after radiation treatments (EBRT, brachytherapy).

Results: The median follow-up was 36 months (3-84 months). Depending on the previous treatment, the patients were divided into 2 groups. Group I (n=34) included patients after radical prostatectomy, while in group II (n=64) there were men after radiation treatment (EBRT, brachytherapy). The 5-year PSA-progression-free survival in group I was significantly higher than in group II and was 88.2 and 67.2%, respectively (p=0.023). The incidence of late genitourinary toxicity of grades 1, 2, 3 in both groups was 22.4, 10.2, and 4.1%, respectively, and late gastrointestinal toxicity of grades 1 and 2 were 10.2 and 1%, respectively. Severe complications of grades 2 and 3, both from the urinary system and from the rectum, were observed only in group II.

Conclusion: HDR brachytherapy is an effective salvage treatment option for local relapses of PCa after previous radiation and surgical treatment.

Fat necrosis is a benign inflammation of adipose tissue, which is associated with sterile saponification, due to impaired blood supply. At the same time, differential diagnostics with malignant neoplasms and tumor relapses is extremely difficult due to the similar features according to imaging studies (ultrasound, CT, MRI, PET/CT). We present a clinical case of fat necrosis, confirmed by the immunohistochemical study, simulating recurrent kidney cancer. The patient underwent partial nephrectomy for renal cell carcinoma. After 6 months, radiological signs of tumor recurrence were detected in the resection area, due to which patient underwent laparoscopic nephrectomy. Immunohistochemical study indicated fat necrosis.

The placement of penile implants is recognized as an effective method of treating severe erectile dysfunction (ED), with high satisfaction rates among patients and their partners. However, like any surgical procedure, it is not without the risk of complications. A rare clinical case of protrusion of the reservoir of a penile implant into the bladder is presented in the article. This complication carries the risk of losing all components of the implant, as well as serious consequences for the patient's health. A brief review of the literature devoted to this complication is also provided.

Mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are increasingly used to treat kidney stones. There is still debate in the literature regarding the efficiency and safety of these surgical procedures. AIM: To carry out a systematic review of the results of mini-PCNL and RIRS. A search of publications in the PubMed, Scopus, and Web of Science databases for the past 10 years was carried out to identify all studies that compared the results of mini-PCNL and RIRS. The following parameters were assessed: number and age of patients, stone size, presence of a lower-pole stone, duration of the procedure, complications according to the Clavien-Dindo classification, efficiency of the procedure, and length of hospital stay. A total of 21 publications with comparative analyze of various variables for mini-PCNL and RIRS for kidney stones larger than 10 mm were found. The difference in the duration of the procedure between mini-PCNL and RIRS was 2.34 min, in the length of hospital stay 1.62 days. The relative risk (RR) of developing complications according to Clavien-Dindo grades I-III during mini-PCNL compared to RIRS was 1.16 (95% CI 0.88-1.53, p=0.2929), and the probability of SFR was 1.08 (95% CI 1.05-1.12). The analysis showed that RIRS is associated with a shorter duration of procedure and length of hospital stay compared to mini-PCNL. The results were statistically significant regardless of stone size. For stones larger than 15 mm, mini-PCNL provides a slight advantage in efficiency compared to RIRS, and for stones larger than 25 mm, mini-PCNL is more preferable than RIRS, although the results do not differ significantly.

Overactive bladder (OAB) is a common lower urinary tract disorder characterized by urgency, increased frequency, and, in some cases, urinary incontinence. Although antimuscarinic drugs (M-anticholinergics) or 3-adrenergic agonists as monotherapy provides relief to some patients, moderate treatment efficiency and tolerability often require drug switching (in case of side effects) or combination therapy (due to insufficient efficiency). The aim of this review was to analyze the combined use of mirabegron (3-adrenergic agonist) and solifenacin (M-anticholinergic or muscarinic receptor antagonist), focusing on clinical trials, safety issues, and practical aspects. The combination therapy showed superior efficacy compared to monotherapy and an acceptable safety profile, making it a viable treatment strategy for patients with OAB who do not achieve optimal outcomes with a monotherapy.

Introduction: The pathogenesis of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) is quite complex and may be associated with overactive bladder (OAB). Alpha-1-blockers are not effective enough to resolve irritative LUTS caused by OAB. According to recent studies, regulatory polypeptides of the bovine urinary bladder (Vesusten) have shown their efficiency in patients with OAB.

Aim: To evaluate the efficiency and safety of combination therapy of LUTS caused by BPH with alpha-1-blockers and Vesusten in comparison with standard monotherapy with alpha-1-blockers.

Materials and methods: An open, prospective, randomized, single-center study was carried out. In the main group, patients received Vesusten intramuscularly 3 times a week (a total of 10 doses) and an alpha-1-adrenoblocker daily, while in the control group patients received alpha-blockers as monotherapy. Uroflowmetry and ultrasound parameters, IPSS and OAB-q questionnaires, as well as adverse events (AE) were assessed.

Results: A total of 100 patients were included in the study, 93 of whom completed the protocol. The baseline characteristics of the groups were comparable, all patients received selective alpha-adrenoblockers (silodosin or tamsulosin) before inclusion in the study. The IPSS change in the main group was -2.43, compared to -0.38 in the control group (p<0.001). OAB-q parameters also significantly improved in the main group (-2.89 vs. -0.12; p<0.001). There was a significant decrease in the frequency of urinations per 72 hours in the group of combination therapy (-3 vs. -0.17 in the monotherapy group; p<0.001). Also, the voided volume significantly increased in the main group by an average of 27.4 ml (p<0.001), and the postvoid residual volume decreased by an average of 10.7 ml. Qmax and Qave significantly improved in the main group (+1.7 ml/s and +1.5 ml/s vs. +0.1 ml/s and +0.1 ml/s in the control group, respectively; p<0.001). A total of 17 mild AEs associated with intramuscular administration of Vesusten were recorded.

Conclusions: The addition of Vesusten to alpha-blockers in patients with LUTS and OAB caused by BPH significantly reduced irritative symptoms according to questionnaires, uroflowmetry and postvoid residual volume. Only mild local AEs were observed that did not require discontinuation of therapy.

Introduction: Currently, percutaneous nephrolithotomy (PCNL) is a first-line treatment method for large and staghorn kidney stones. Predicting the efficiency of the performed surgical procedure is relevant at the stage of preoperative counseling of patients.

Aim: To develop a universal nomogram for predicting the efficiency of mini-PCNL taking into account the baseline characteristics and features of the patient.

Materials and methods: A total of 251 patients with kidney stones who underwent mini-PCNL in the prone position according to the standard method through a single access were included in the study. The preoperative characteristics of patients and their impact on the outcome were evaluated. An achievement of the stone-free rate (SFR) was assessed by the computed tomography (CT).

Results: The analysis revealed factors significantly influencing the achievement of the SFR, such as stone volume >1.39 cm3 (p=0.001), stone area >189.03 mm2 (p=0.001), distance from the lowest point of the Th12 to the lower part of the lower pole calyx (T12-LP) <85.81 mm (p=0.050), distances from the lower calyx to the most cranial part of the iliac crest (ICLP) >49.1 mm (p=0.029), stone size >18.2 mm (p=0.001), number of involved calyxes >3 (p=0.001), number of involved calyxes for staghorn stones >4 (p=0.001), and staghorn stone (p=0.001). Correlation, logistic regression, and ROC analysis were performed for these factors. The area under the curve (AUC) was 0.897. A nomogram has been developed. The sensitivity of the model is 94.4%, specificity is 59.2%, and overall accuracy is 84.4%. A certificate of state registration of a computer program in the IBM SPSS Statistics syntax language "A model for predicting the SFR of mini-PCNL in patients with kidney stones" was obtained.

Conclusion: The nomogram developed on the basis of our data showed a high predictive ability in relation to the SFR with sensitivity of 94%. This nomogram is easy to use and interpret, which makes it convenient for routine practice, however, external validation is necessary to objectify the predictive ability.

Aim: To discuss the feasibility, safety, and efficiency of conventional laparoscopic partial nephrectomy (LPN) for patients with renal hilar tumors.

Material and methods: A single-center retrospective comparative study of perioperative results included 166 patients who have undergone LPN. Patients were divided into two groups. In the group 1, there were 44 patients with hilar tumor of any R.E.N.A.L. index, while the control group consisted of 122 patients with cortical tumors of R.E.N.A.L. >7. Perioperative factors and results were studied and compared. The rate and structure of intra- and postoperative complications, reasons for conversion, volume of blood loss and ischemia time, duration of the procedure and length of stay, as well as changes of glomerular filtration rate and creatinine were assessed.

Results: There were no conversions to open approach or nephrectomy, as well as positive surgical margins. The RENAL score was higher for hilar tumor group (9 vs 8; p<0.001). No significant difference was obtained according to the frequency of complications, blood loss volume, warm ischemia time and length of stay (p>0.05 for all values). The average drop of hemoglobin level and glomerular filtration rate were also similar (p>0.05 for all values). Therefore, there were no any significant differences between groups except for three parameters. Among all patients with left-sided hilar tumors transmesocolic approach was used more often (31.6% vs 6.8%; p=0.025). Unlike standard procedures, about a third of hilar interventions were completed without renorrhaphy (8.2% vs 27.3% for the control and main groups, respectively; p=0.001). In the group 1, benign lesions were identified in 20.5%, while in the control group in 4.9% cases (p=0.002).

Conclusion: Our study showed that conventional LPN is safe and efficient procedure even in cases of "complex" renal hilar tumors.