Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-101-110
N. D. Ushakova, E. Frantsiyants, D. A. Rozenko, N. Popova, E. A. Marykov, A. D. Rozenko
Introduction. The development of a malignant tumor naturally affects renal function. During tumor formation, the renal tissue is destructed either by direct invasion into the parenchyma, or by mechanical change in the renal architecture caused by compression of the renal parenchyma, collecting ducts, tubules, and nephrons. In addition, a tumor can secrete biologically active substances, which have an indirect negative influence the functional state of the organ. Currently, it has been established that kallikrein-kinin and renin-angiotensin-aldosterone systems play an important role in the development of nephropathy of various genesis. At the same time, these systems' role in the development of renal function disorders in the setting of tumor damage has not yet been studied.Purpose of the study. To study changes in the components of the kallikrein-kinin and renin-angiotensin-aldosterone systems in the case of localized kidney cancer.Materials and methods. Forty-five patients diagnosed with T1N0M0 kidney cancer and 13 relatively healthy patients without cancer were examined. The determination of the components of the systems under study was carried out by the kinetic method after chromatography of blood plasma and urine using DEAE-Sephadex A-50 (Amersham Biosciences Corp., Sweden). The indices of angiotensin-1, renin, aldosterone, and cortisol were studied by an indirect method of radioimmunoassay. Statistical processing was carried out using Statistica 8.0 software (StatSoft Inc., IBM Corp., USA) by means of the Student-Fisher test (p < 0.05).Results. The development of kidney cancer is accompanied by a 2.3-fold increase in the activity of kallikrein and other trypsin proteases with a significant deficiency of their inhibitors (p < 0,05). Against this background, there is a 1.3-fold decrease in the cortisol/renin ratio from a 2.9-fold and 2.3-fold increase in the values of the renin/angiotensin-I and cortisol/angiotensin-I interaction ratios, respectively, compared with the normal values of these indicators (p < 0,05).Conclusions. Renal cell carcinoma is accompanied by trespassing of local metabolism with the formation of tubulointerstitial dysfunction and a shift of the proteinase-inhibitory balance towards proteolytic activation.
{"title":"The functional state of the kallikrein-kinin and renin-angiotensin-aldosterone systems in patients with localized kidney cancer","authors":"N. D. Ushakova, E. Frantsiyants, D. A. Rozenko, N. Popova, E. A. Marykov, A. D. Rozenko","doi":"10.21886/2308-6424-2021-9-4-101-110","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-101-110","url":null,"abstract":"Introduction. The development of a malignant tumor naturally affects renal function. During tumor formation, the renal tissue is destructed either by direct invasion into the parenchyma, or by mechanical change in the renal architecture caused by compression of the renal parenchyma, collecting ducts, tubules, and nephrons. In addition, a tumor can secrete biologically active substances, which have an indirect negative influence the functional state of the organ. Currently, it has been established that kallikrein-kinin and renin-angiotensin-aldosterone systems play an important role in the development of nephropathy of various genesis. At the same time, these systems' role in the development of renal function disorders in the setting of tumor damage has not yet been studied.Purpose of the study. To study changes in the components of the kallikrein-kinin and renin-angiotensin-aldosterone systems in the case of localized kidney cancer.Materials and methods. Forty-five patients diagnosed with T1N0M0 kidney cancer and 13 relatively healthy patients without cancer were examined. The determination of the components of the systems under study was carried out by the kinetic method after chromatography of blood plasma and urine using DEAE-Sephadex A-50 (Amersham Biosciences Corp., Sweden). The indices of angiotensin-1, renin, aldosterone, and cortisol were studied by an indirect method of radioimmunoassay. Statistical processing was carried out using Statistica 8.0 software (StatSoft Inc., IBM Corp., USA) by means of the Student-Fisher test (p < 0.05).Results. The development of kidney cancer is accompanied by a 2.3-fold increase in the activity of kallikrein and other trypsin proteases with a significant deficiency of their inhibitors (p < 0,05). Against this background, there is a 1.3-fold decrease in the cortisol/renin ratio from a 2.9-fold and 2.3-fold increase in the values of the renin/angiotensin-I and cortisol/angiotensin-I interaction ratios, respectively, compared with the normal values of these indicators (p < 0,05).Conclusions. Renal cell carcinoma is accompanied by trespassing of local metabolism with the formation of tubulointerstitial dysfunction and a shift of the proteinase-inhibitory balance towards proteolytic activation.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133953652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-111-121
B. Shaparov, S. Kapranov, A. Kamalov, V. Karpov, A. G. Zlatovratskiy
Introduction. Super-selective prostatic arteries embolization (PAE) is a modern minimally invasive surgical method for the treatment of benign prostatic hyperplasia (BPH). PAE is included in the Russian clinical guidelines for the BPH treatment and approved for use in the United States and European countries.Purpose of the study. To analyze the most common PAE-associated complications and to develop preventive arrangements.Materials and methods. During the period from 2013 to 2020, PAE as the main method of BPH treatment was used in 168 patients with an average age of 69.3 ± 8.1 (53-82) years. All patients underwent two-day antibiotic prophylaxis before the operation and lasted 7-10 days. For catheterization of the prostatic arteries, 2.0-2.8 Fr microcatheters and 4-5 Fr microconductors were used. For embolization, hydrogel microspheres with a diameter of 100-300 µm and 300-500 µm were used, as well as poly polyvinyl alcohol (PVA) microparticles with a diameter of 100-500 µm.Results. Bilateral PAE was successfully performed in 146 cases; unilateral PAE was performed in 22 patients due to anatomical features. Seventeen (10.1%) PAE from the orifice, super-selective PAE was performed in 67 (39.9%) cases, the PErFecTED embolization was performed in 84 (50.0%) patients. The most common complication was acute urinary retention (AUR) in 28 (16.6%) patients: trocar cystostomy was required in 11 (6.5%) patients, AUR was resolved using conservative therapy in 17 (10.2%) patients. In 23 (14.2%) cases, complications associated with unintentional embolization of the anastomoses of the prostate arteries were identified: rectal pain and/or the appearance of blood in the stool in 19 (11.3%) patients, the appearance of trophic ulcers on the glans penis in 5 (2.8%) patients. In addition, several adverse events that were not complications were noted: postembolization syndrome in 50 (29.7%) patients, and worsening of LUTS in 41 (24.4%) patients. Seven (4.1%) patients had acute epididymitis; 4 (2.4%) patients had a hematoma at the puncture site.Conclusion. PAE can cause a limited number of complications. It is necessary to unify the system for reporting PAE complications. Antibiotic prophylaxis is recommended. The use of visualization and X-ray navigation methods make it possible to make the PAE safer. The PErFecTED technique in combination with small particle sizes increases the risk of complications. The surgeon's experience and proficiency in special surgical techniques are essential. The transradial approach is promising, but further observation and an increase in patient samples are required. The question of choosing the optimal embolization drug continues to be relevant.
{"title":"Super-selective prostatic arteries embolization in patients with benign prostate hyperplasia: prevention and treatment of complications","authors":"B. Shaparov, S. Kapranov, A. Kamalov, V. Karpov, A. G. Zlatovratskiy","doi":"10.21886/2308-6424-2021-9-4-111-121","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-111-121","url":null,"abstract":"Introduction. Super-selective prostatic arteries embolization (PAE) is a modern minimally invasive surgical method for the treatment of benign prostatic hyperplasia (BPH). PAE is included in the Russian clinical guidelines for the BPH treatment and approved for use in the United States and European countries.Purpose of the study. To analyze the most common PAE-associated complications and to develop preventive arrangements.Materials and methods. During the period from 2013 to 2020, PAE as the main method of BPH treatment was used in 168 patients with an average age of 69.3 ± 8.1 (53-82) years. All patients underwent two-day antibiotic prophylaxis before the operation and lasted 7-10 days. For catheterization of the prostatic arteries, 2.0-2.8 Fr microcatheters and 4-5 Fr microconductors were used. For embolization, hydrogel microspheres with a diameter of 100-300 µm and 300-500 µm were used, as well as poly polyvinyl alcohol (PVA) microparticles with a diameter of 100-500 µm.Results. Bilateral PAE was successfully performed in 146 cases; unilateral PAE was performed in 22 patients due to anatomical features. Seventeen (10.1%) PAE from the orifice, super-selective PAE was performed in 67 (39.9%) cases, the PErFecTED embolization was performed in 84 (50.0%) patients. The most common complication was acute urinary retention (AUR) in 28 (16.6%) patients: trocar cystostomy was required in 11 (6.5%) patients, AUR was resolved using conservative therapy in 17 (10.2%) patients. In 23 (14.2%) cases, complications associated with unintentional embolization of the anastomoses of the prostate arteries were identified: rectal pain and/or the appearance of blood in the stool in 19 (11.3%) patients, the appearance of trophic ulcers on the glans penis in 5 (2.8%) patients. In addition, several adverse events that were not complications were noted: postembolization syndrome in 50 (29.7%) patients, and worsening of LUTS in 41 (24.4%) patients. Seven (4.1%) patients had acute epididymitis; 4 (2.4%) patients had a hematoma at the puncture site.Conclusion. PAE can cause a limited number of complications. It is necessary to unify the system for reporting PAE complications. Antibiotic prophylaxis is recommended. The use of visualization and X-ray navigation methods make it possible to make the PAE safer. The PErFecTED technique in combination with small particle sizes increases the risk of complications. The surgeon's experience and proficiency in special surgical techniques are essential. The transradial approach is promising, but further observation and an increase in patient samples are required. The question of choosing the optimal embolization drug continues to be relevant.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128453875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-127-132
V. Dudarev, V. Startsev, A. Khaustov, A. Koshmelev
Traumatic dislocation of the penis is one of the rarest types of genital trauma. This type of injury is accompanied by a violation of the integrity of the skin and the penile ligamentous apparatus, with the dislocation of the penis into the scrotum under the skin of the thigh, or the area of the pubic joint. The low occurrence frequency of such injuries and the small number of observations described in the literature entails the absence of generally accepted treatment tactics for this category of patients. The article describes a clinical case of successfully treated traumatic dislocation of the penis with penile transposition into the pubic joint area and the formation of subcutaneous urinary leakage after late treatment of the patient for medical care.
{"title":"Dislocation of the penis: a rare case of genital trauma","authors":"V. Dudarev, V. Startsev, A. Khaustov, A. Koshmelev","doi":"10.21886/2308-6424-2021-9-4-127-132","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-127-132","url":null,"abstract":"Traumatic dislocation of the penis is one of the rarest types of genital trauma. This type of injury is accompanied by a violation of the integrity of the skin and the penile ligamentous apparatus, with the dislocation of the penis into the scrotum under the skin of the thigh, or the area of the pubic joint. The low occurrence frequency of such injuries and the small number of observations described in the literature entails the absence of generally accepted treatment tactics for this category of patients. The article describes a clinical case of successfully treated traumatic dislocation of the penis with penile transposition into the pubic joint area and the formation of subcutaneous urinary leakage after late treatment of the patient for medical care.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"8 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123690038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-30-39
S. Gamidov, T. Shatylko, A. Tambiev, A. Tokareva, V. Chagovets, T. Bitsoev, N. Starodubtseva, A. Popova, V. Frankevich
Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods.
{"title":"Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest","authors":"S. Gamidov, T. Shatylko, A. Tambiev, A. Tokareva, V. Chagovets, T. Bitsoev, N. Starodubtseva, A. Popova, V. Frankevich","doi":"10.21886/2308-6424-2021-9-4-30-39","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-30-39","url":null,"abstract":"Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117084176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-122-126
B. Guliev, D. M. Ilyin, Zh. P. Avazkhanov
A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.
{"title":"Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture","authors":"B. Guliev, D. M. Ilyin, Zh. P. Avazkhanov","doi":"10.21886/2308-6424-2021-9-4-122-126","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-122-126","url":null,"abstract":"A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114144584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-133-141
G. Makarov, V. Sizonov, V. Orlov, V. V. Vigera
Extravesical ureter ectopia is a rare cause of urinary incontinence. We are reporting a case of a 3-year-old girl with urinary incontinence. The girl was observed and treated for recurrent urinary tract infection (UTI) against the background of left-side duplication of the upper urinary tract and vesicoureteral reflux (VUR). Two-time endoscopic treatment using a dextranomer/hyaluronic acid allowed to eliminate VUR on both sides and achieve stable clinical and laboratory remission of UTI. After potty training, the child had a constant drip of urine along with normal urination. The examination revealed extravesical ureter ectopia of the left duplicated kidney upper pole and a bladder space-occupying mass with hyperdensive inclusions in the projection of the vesical trigone on the left, which we regarded as a result of the migration of the implant and the appearance of histopathological changes in it. The presence of a bladder space-occupying mass determined the choice of the surgical technique in favor of the formation of a ureterocystoanastomosis with a duplicated ectopic ureter and the removal of a bladder space-occupying mass. When managing patients after endoscopic treatment of VUR, it should be considered the possibility of morphological changes in the bulking agent due to the accumulation of calcium and uric acid salts.
{"title":"Extravesical reimplantation of an extravesical-ectopic ureter from the upper pole of a duplicated kidney","authors":"G. Makarov, V. Sizonov, V. Orlov, V. V. Vigera","doi":"10.21886/2308-6424-2021-9-4-133-141","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-133-141","url":null,"abstract":"Extravesical ureter ectopia is a rare cause of urinary incontinence. We are reporting a case of a 3-year-old girl with urinary incontinence. The girl was observed and treated for recurrent urinary tract infection (UTI) against the background of left-side duplication of the upper urinary tract and vesicoureteral reflux (VUR). Two-time endoscopic treatment using a dextranomer/hyaluronic acid allowed to eliminate VUR on both sides and achieve stable clinical and laboratory remission of UTI. After potty training, the child had a constant drip of urine along with normal urination. The examination revealed extravesical ureter ectopia of the left duplicated kidney upper pole and a bladder space-occupying mass with hyperdensive inclusions in the projection of the vesical trigone on the left, which we regarded as a result of the migration of the implant and the appearance of histopathological changes in it. The presence of a bladder space-occupying mass determined the choice of the surgical technique in favor of the formation of a ureterocystoanastomosis with a duplicated ectopic ureter and the removal of a bladder space-occupying mass. When managing patients after endoscopic treatment of VUR, it should be considered the possibility of morphological changes in the bulking agent due to the accumulation of calcium and uric acid salts.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116905828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.21886/2308-6424-2021-9-4-40-50
E. A. Kiprijanov, P. A. Karnaukh, I. Vazhenin, E. Mozerova, A. Vazhenin
Introduction. Modern radiological treatment options for patients with localized prostate cancer (PCa) have several advantages and allow achieving high rates of biochemical control.Purpose of the study. To compare immediate, proximate, and long-term results of low-dose Iodine-125 brachytherapy (I-125 BT) and robotic stereotactic radiotherapy (SBRT) in patients with localized low- and intermediate-risk PCa.Materials and methods. The study included 296 patients with localized low- and intermediate-risk PCa. I-125 BT and SBRT were performed in 208 and 88 patients, respectively. All patients with an intermediate-risk PCa were prescribed neoadjuvant androgen-deprivation therapy (NADT) with luteinizing hormone-releasing hormone analogues (LHRH) for 4-6 months. Only radiation treatment was used for low-risk PCa. As a result, two groups and four subgroups of patients were formed depending on the treatment method. The immediate, proximate, and long-term results of radiation treatment methods were studied in groups and subgroups.Results. No complications were recorded during brachytherapy I-125. Radiation cystitis grade 1 and radiation rectitis grade 1 were diagnosed after SBRT in 16.6% and 4.0% of cases, respectively. In the only I-125 BT subgroup, the PSA level during the year decreased from 8.3 to 1.1 ng/ml, in the SBRT subgroup — from 7.5 to 0.8 ng/ml. In the case of combined treatment, PSA decreased from 1.2 to 0.93 ng/ml and from 4.5 to 0.5 ng/ml, respectively. Changes in prostate volume, residual volume, and urinary quality (I-PSS) were comparable in all subgroups. Five-year cancer-specific survival and overall survival in the group of patients after SBRT was 100%, after I-125 BT — more than 90%.Conclusion. Radiation treatment options for patients with localized PCa are safe. Conducting NADT does not significantly reduce the prostate volume and does not affect the indicators of urodynamics. High rates of cancer-specific five-year survival rate testify to the effectiveness of the evaluated treatment options.
{"title":"Iodine-125 brachytherapy and robotic stereotactic radiotherapy — treatment options for patients with localized prostate cancer","authors":"E. A. Kiprijanov, P. A. Karnaukh, I. Vazhenin, E. Mozerova, A. Vazhenin","doi":"10.21886/2308-6424-2021-9-4-40-50","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-40-50","url":null,"abstract":"Introduction. Modern radiological treatment options for patients with localized prostate cancer (PCa) have several advantages and allow achieving high rates of biochemical control.Purpose of the study. To compare immediate, proximate, and long-term results of low-dose Iodine-125 brachytherapy (I-125 BT) and robotic stereotactic radiotherapy (SBRT) in patients with localized low- and intermediate-risk PCa.Materials and methods. The study included 296 patients with localized low- and intermediate-risk PCa. I-125 BT and SBRT were performed in 208 and 88 patients, respectively. All patients with an intermediate-risk PCa were prescribed neoadjuvant androgen-deprivation therapy (NADT) with luteinizing hormone-releasing hormone analogues (LHRH) for 4-6 months. Only radiation treatment was used for low-risk PCa. As a result, two groups and four subgroups of patients were formed depending on the treatment method. The immediate, proximate, and long-term results of radiation treatment methods were studied in groups and subgroups.Results. No complications were recorded during brachytherapy I-125. Radiation cystitis grade 1 and radiation rectitis grade 1 were diagnosed after SBRT in 16.6% and 4.0% of cases, respectively. In the only I-125 BT subgroup, the PSA level during the year decreased from 8.3 to 1.1 ng/ml, in the SBRT subgroup — from 7.5 to 0.8 ng/ml. In the case of combined treatment, PSA decreased from 1.2 to 0.93 ng/ml and from 4.5 to 0.5 ng/ml, respectively. Changes in prostate volume, residual volume, and urinary quality (I-PSS) were comparable in all subgroups. Five-year cancer-specific survival and overall survival in the group of patients after SBRT was 100%, after I-125 BT — more than 90%.Conclusion. Radiation treatment options for patients with localized PCa are safe. Conducting NADT does not significantly reduce the prostate volume and does not affect the indicators of urodynamics. High rates of cancer-specific five-year survival rate testify to the effectiveness of the evaluated treatment options.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133227191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-23DOI: 10.21886/2308-6424-2021-9-4-147-155
D. Rogozin
The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published according to the SCImago Journal Rank (SJR). As a result, we formed a list of 10 articles published in the III quarter (July — September) of 2021. The review included articles concerning the following issues: the ability of oocytes to repair damaged DNA-chains of sperm cells, the effectiveness of ICSI in AZF-c microdeletions, the advanced paternal age, artificial intelligence in reproductive clinics, genetic causes of infertility, the effect of surgical treatment of varicocele concerning DNA fragmentation, the role of ICSI in the frequency of chromosomal abnormalities in offspring, the safety of COVID-19 vaccination for spermatogenesis, as well as the novel WHO 6 manual for semen investigation.
{"title":"Male fertility: a review of the publications July — September 2021","authors":"D. Rogozin","doi":"10.21886/2308-6424-2021-9-4-147-155","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-147-155","url":null,"abstract":"The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published according to the SCImago Journal Rank (SJR). As a result, we formed a list of 10 articles published in the III quarter (July — September) of 2021. The review included articles concerning the following issues: the ability of oocytes to repair damaged DNA-chains of sperm cells, the effectiveness of ICSI in AZF-c microdeletions, the advanced paternal age, artificial intelligence in reproductive clinics, genetic causes of infertility, the effect of surgical treatment of varicocele concerning DNA fragmentation, the role of ICSI in the frequency of chromosomal abnormalities in offspring, the safety of COVID-19 vaccination for spermatogenesis, as well as the novel WHO 6 manual for semen investigation.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121842534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-23DOI: 10.21886/2308-6424-2021-9-4-87-94
A. E. Osadchinskiy, I. S. Pavlov, S. Kotov
Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postop
{"title":"Justification of vacuum prophylaxis as part of the penile rehabilitation in patients after nerve-sparing radical prostatectomy","authors":"A. E. Osadchinskiy, I. S. Pavlov, S. Kotov","doi":"10.21886/2308-6424-2021-9-4-87-94","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-87-94","url":null,"abstract":"Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postop","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"46 36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127714770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-23DOI: 10.21886/2308-6424-2021-9-4-13-20
V. B. Berdichevsky, B. A. Berdichevsky, A. V. Romanova, F. R. Rasulov, A. A. Naletov, S. V. Khilkevich, E. .. Gutrova, A. L. Boldyrev, M. A. Korabelnikov
Introduction. The incorporation of combined positron emission tomography-computed tomography (PET-CT) into clinical practice has significantly expanded the understanding of the pathogenesis of many diseases. Evidence-based data on the diagnostic efficacy in infectious and inflammatory diseases is increasing, making this imaging method very promising. Purpose of the study. To study the diagnostic efficacy of 18F-FDG PET-CT in various chronic inflammatory diseases of kidneys and bladder.Materials and methods. A retrospective study of the results of whole-body 18F-FDG PET-CT in 45 patients was carried out. Patients underwent an investigation at various times after surgical treatment of localized oncology of the anogenital zone at the T1N0M0 stage without the involvement of the genitourinary system. It was found that 24 patients had a history of chronic pyelonephritis and 21 patients had manifestations of radiation cystitis. Repeated PET/CT scans were performed after a course of therapy for inflammatory urological diseases to assess the treatment results of the underlying pathology.Results. The latent course of chronic renal failure was accompanied by a diffuse decrease in 18F-FDG metabolism in the renal parenchyma with its partial recovery after etiotropic therapy and urine sanitation. Hypermetabolism of 18F-FDG was detected in the bladder wall during manifestations of radiation cystitis, which was leveled during therapy and relief of urinary syndrome manifestations. Bacterial and radiation inflammation differed in molecular-cell responses to the pathogen, while the results of urinalysis, indicating the effectiveness of the treatment, coincided with the visual and digital indicators of the restoration of adequate energy metabolism in the studied tissues.Conclusions. Metabolism of 18F-FDG in the kidneys and bladder can objectively reflect the nature of inflammation and complement the data on the effectiveness of the treatment.
{"title":"IPET-CT in inflammatory diseases of kidneys and bladder: diagnostic efficacy","authors":"V. B. Berdichevsky, B. A. Berdichevsky, A. V. Romanova, F. R. Rasulov, A. A. Naletov, S. V. Khilkevich, E. .. Gutrova, A. L. Boldyrev, M. A. Korabelnikov","doi":"10.21886/2308-6424-2021-9-4-13-20","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-4-13-20","url":null,"abstract":"Introduction. The incorporation of combined positron emission tomography-computed tomography (PET-CT) into clinical practice has significantly expanded the understanding of the pathogenesis of many diseases. Evidence-based data on the diagnostic efficacy in infectious and inflammatory diseases is increasing, making this imaging method very promising. Purpose of the study. To study the diagnostic efficacy of 18F-FDG PET-CT in various chronic inflammatory diseases of kidneys and bladder.Materials and methods. A retrospective study of the results of whole-body 18F-FDG PET-CT in 45 patients was carried out. Patients underwent an investigation at various times after surgical treatment of localized oncology of the anogenital zone at the T1N0M0 stage without the involvement of the genitourinary system. It was found that 24 patients had a history of chronic pyelonephritis and 21 patients had manifestations of radiation cystitis. Repeated PET/CT scans were performed after a course of therapy for inflammatory urological diseases to assess the treatment results of the underlying pathology.Results. The latent course of chronic renal failure was accompanied by a diffuse decrease in 18F-FDG metabolism in the renal parenchyma with its partial recovery after etiotropic therapy and urine sanitation. Hypermetabolism of 18F-FDG was detected in the bladder wall during manifestations of radiation cystitis, which was leveled during therapy and relief of urinary syndrome manifestations. Bacterial and radiation inflammation differed in molecular-cell responses to the pathogen, while the results of urinalysis, indicating the effectiveness of the treatment, coincided with the visual and digital indicators of the restoration of adequate energy metabolism in the studied tissues.Conclusions. Metabolism of 18F-FDG in the kidneys and bladder can objectively reflect the nature of inflammation and complement the data on the effectiveness of the treatment.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130435786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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