Pub Date : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-32-43
S. Kapranov, A. G. Zlatovratskiy, V. Karpov, B. Shaparov, A. Kamalov
Introduction. Pelvic arteries have various anatomy and anastomoses with other branches of the internal iliac artery (IIA). This explains the technical complexity of identification and catheterization of prostatic arteries (PA), as well as the possibility of complications associated with non-target embolization of prostatic artery anastomoses.Purpose of the study. To analyze the most common variants of prostate blood supply and evaluate the effectiveness of methods for identifying prostatic arteries.Materials and methods. The study included 168 patients treated from 2013 to 2021. For catheterization of the prostatic arteries, 4 – 5 Fr microconductors and 2 – 2.8 Fr microcatheters were used. For embolization, hydrogel microspheres with a diameter of 100 – 300 µm and 300 – 500 µm were used, as well as PVA microparticles with a diameter of 100 – 500 µm. Preoperatively multi-sliced computed tomography (MSCT) angiography of the pelvic organs was performed to determine the type of prostatic angioarchitectonics.Results. The use of preoperative MSCT angiography in combination with intraoperative digital subtraction angiography made it possible to determine the variations of prostatic artery divergence and identify their anastomoses in 100% of patients (336 pelvic sides). One prostatic artery was detected in 91.4% (307) of the pelvic sides. two independent pAs in 8.6% (29) of cases. Symmetrical anatomy of the prostatic arteries on both sides was revealed in 14.3% (24) patients, the remaining 85.7% (144) patients showed asymmetry on both sides. The absence of prostatic arteries anastomoses was detected in 75.5% (254) of the pelvic sides, and in 24.4% (82) of the pelvic sides, anastomoses were detected. Interlobar intraprostatic anastomoses were found in 10.1% (34) of the pelvic sides, communication with a. dorsalis penis was detected in 8% (27) of cases, with rectal arteries in 5.3% (18) of the pelvic sides and with urinary bladder arteries in 3.6% (12) of cases. Based on the analysis of the small pelvis angioarchitectonics in 168 patients, an anatomical classification of the prostatic arteries anatomy was proposed.Conclusion. Super-selective embolization of the prostatic arteries is a contemporary minimally invasive method of prostatic hyperplasia treatment with a high safety profile. The pelvic arteries have extremely various anatomy, as well as anastomoses with other branches of the internal iliac artery, which complicates the implementation of super-selective embolization of prostatic arteries. The combination of preoperative MSCT and intraoperative digital subtraction angiography makes it possible to identify the prostatic artery and its anastomoses in most cases.
{"title":"Types of the prostate blood supply during super-selective embolization of prostatic arteries","authors":"S. Kapranov, A. G. Zlatovratskiy, V. Karpov, B. Shaparov, A. Kamalov","doi":"10.21886/2308-6424-2021-9-3-32-43","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-32-43","url":null,"abstract":"Introduction. Pelvic arteries have various anatomy and anastomoses with other branches of the internal iliac artery (IIA). This explains the technical complexity of identification and catheterization of prostatic arteries (PA), as well as the possibility of complications associated with non-target embolization of prostatic artery anastomoses.Purpose of the study. To analyze the most common variants of prostate blood supply and evaluate the effectiveness of methods for identifying prostatic arteries.Materials and methods. The study included 168 patients treated from 2013 to 2021. For catheterization of the prostatic arteries, 4 – 5 Fr microconductors and 2 – 2.8 Fr microcatheters were used. For embolization, hydrogel microspheres with a diameter of 100 – 300 µm and 300 – 500 µm were used, as well as PVA microparticles with a diameter of 100 – 500 µm. Preoperatively multi-sliced computed tomography (MSCT) angiography of the pelvic organs was performed to determine the type of prostatic angioarchitectonics.Results. The use of preoperative MSCT angiography in combination with intraoperative digital subtraction angiography made it possible to determine the variations of prostatic artery divergence and identify their anastomoses in 100% of patients (336 pelvic sides). One prostatic artery was detected in 91.4% (307) of the pelvic sides. two independent pAs in 8.6% (29) of cases. Symmetrical anatomy of the prostatic arteries on both sides was revealed in 14.3% (24) patients, the remaining 85.7% (144) patients showed asymmetry on both sides. The absence of prostatic arteries anastomoses was detected in 75.5% (254) of the pelvic sides, and in 24.4% (82) of the pelvic sides, anastomoses were detected. Interlobar intraprostatic anastomoses were found in 10.1% (34) of the pelvic sides, communication with a. dorsalis penis was detected in 8% (27) of cases, with rectal arteries in 5.3% (18) of the pelvic sides and with urinary bladder arteries in 3.6% (12) of cases. Based on the analysis of the small pelvis angioarchitectonics in 168 patients, an anatomical classification of the prostatic arteries anatomy was proposed.Conclusion. Super-selective embolization of the prostatic arteries is a contemporary minimally invasive method of prostatic hyperplasia treatment with a high safety profile. The pelvic arteries have extremely various anatomy, as well as anastomoses with other branches of the internal iliac artery, which complicates the implementation of super-selective embolization of prostatic arteries. The combination of preoperative MSCT and intraoperative digital subtraction angiography makes it possible to identify the prostatic artery and its anastomoses in most cases.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128644016","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 : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-5-11
M. Akimenko, O. Voronova, T. Kolmakova
Introduction. The high prevalence of renal diseases caused by urinary tract obstruction led to the need for experimental research of compensatory and pathological processes with kidney injury. It is also of relevance to study key mechanisms providing a compensatory function of the contralateral kidney for early diagnosis, treatment, and prognosis of obstructive renal diseases.Purpose of the study. To examine epithelial nephron cells phenotype dynamics changes in contralateral kidney using unilateral ureteral obstruction experimental model.Materials and methods. Model of unilateral ureteral obstruction was established using adult rabbits. The studies were carried out on days 7, 14 and 21 of complete obstruction of the left ureter. Immunophenotyping was performed on contralateral kidney tissue samples using epithelial (cytokeratin 7, E-cadherin) and mesenchymal (vimentin, α-smooth muscle actin) markers.Results. The contralateral kidney under additional load can maintain the morphological and functional characteristics of the nephron for a long time. The first transmogrify signs in the nephron epithelium phenotype were detected by day 21 as the diffuse appearance of mesenchymal marker vimentin with unaltered visualization of epithelial phenotype markers.Conclusion. The results obtained allow us to assume that the compensatory reserve of the contralateral kidney is gradually decreasing when the duration of the obstruction increases. Thus, the likelihood of developing negative disorders increases.
{"title":"The changes of the tubular epithelium phenotype in the contralateral kidney nephrons while developing unilateral ureteral obstruction: an experimental study","authors":"M. Akimenko, O. Voronova, T. Kolmakova","doi":"10.21886/2308-6424-2021-9-3-5-11","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-5-11","url":null,"abstract":"Introduction. The high prevalence of renal diseases caused by urinary tract obstruction led to the need for experimental research of compensatory and pathological processes with kidney injury. It is also of relevance to study key mechanisms providing a compensatory function of the contralateral kidney for early diagnosis, treatment, and prognosis of obstructive renal diseases.Purpose of the study. To examine epithelial nephron cells phenotype dynamics changes in contralateral kidney using unilateral ureteral obstruction experimental model.Materials and methods. Model of unilateral ureteral obstruction was established using adult rabbits. The studies were carried out on days 7, 14 and 21 of complete obstruction of the left ureter. Immunophenotyping was performed on contralateral kidney tissue samples using epithelial (cytokeratin 7, E-cadherin) and mesenchymal (vimentin, α-smooth muscle actin) markers.Results. The contralateral kidney under additional load can maintain the morphological and functional characteristics of the nephron for a long time. The first transmogrify signs in the nephron epithelium phenotype were detected by day 21 as the diffuse appearance of mesenchymal marker vimentin with unaltered visualization of epithelial phenotype markers.Conclusion. The results obtained allow us to assume that the compensatory reserve of the contralateral kidney is gradually decreasing when the duration of the obstruction increases. Thus, the likelihood of developing negative disorders increases.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128671247","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 : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-70-78
A. Tsukanov, D. Akhmetov, A. Novikov, N. A. Negrov, A. R. Putintseva, S. P. Semikina
Introduction. Incrustation and biofilms formation on the surface of ureteral stents are still the most significant complications of internal drainage of the upper urinary tract. There are much researchers conducted to combat these complications. The lack of a solution to this problem affects the ultimate results of treatment and economic losses. The issue of impact by physical methods on the ureteral stent, particularly the use of extracorporeal ultrasound acoustic exposure remains, promising and poorly covered.Purpose of the study. To determine the optimal application points of extracorporeal acoustic exposure by the low-frequency ultrasonic amplitude-modulated signal on a ureteral stent in an experiment.Materials and methods. The original device was designed. The main principle of its operation is the generation of an amplitude-modulated ultrasonic signal in two modes: pulsed and permanent. A sexually mature mongrel dog was an experimental animal. The ureteral stent was placed by laparotomy and cystotomy. Intraoperatively, the emitter of the developed device was applied to the skin of the animal, according to the previously indicated topographic and anatomical landmarks. At the same time, an ultrasonic wave noise analyzer was applied through the laparotomy wound to the appropriate level of the ureter. Measurements of ultrasound intensity indicators were performed three times in two operating modes of the device.Results. Pulsed mode: for the ureteral upper third, the highest ultrasonic intensity (123.67 dB) was achieved along the posterior axillary line. For the ureteral middle third, the best ultrasound intensity (115 dB) was obtained by the posterior axillary line. For the ureteral lower third, the highest ultrasound intensity (113.67 dB) was noted along the middle axillary line.Permanent mode: the best ultrasonic intensity in the projection of the ureteral upper, middle, and lower thirds was achieved along the posterior axillary line and was 118.67 dB, 117 dB and 116.67 dB, accordingly. However, there was an excessive heat effect, manifested by hyperemia and hyperthermia of the animal's skin, fascicular muscle contractions during the instrument functioned in the permanent mode, which can potentially lead to thermal burns and intolerance to the procedure.Conclusion. The pulsed mode of the device function is most safe. The optimal application points of the instrument emitter for the ureteral upper and middle thirds is the posterior axillary line, and for the ureteral lower third is the middle axillary line.
{"title":"Extracorporeal ultrasound exposure by the low-frequency acoustic amplitude-modulated signal on a ureteral stent for preventing its incrustation: experimental determination of optimal application points","authors":"A. Tsukanov, D. Akhmetov, A. Novikov, N. A. Negrov, A. R. Putintseva, S. P. Semikina","doi":"10.21886/2308-6424-2021-9-3-70-78","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-70-78","url":null,"abstract":"Introduction. Incrustation and biofilms formation on the surface of ureteral stents are still the most significant complications of internal drainage of the upper urinary tract. There are much researchers conducted to combat these complications. The lack of a solution to this problem affects the ultimate results of treatment and economic losses. The issue of impact by physical methods on the ureteral stent, particularly the use of extracorporeal ultrasound acoustic exposure remains, promising and poorly covered.Purpose of the study. To determine the optimal application points of extracorporeal acoustic exposure by the low-frequency ultrasonic amplitude-modulated signal on a ureteral stent in an experiment.Materials and methods. The original device was designed. The main principle of its operation is the generation of an amplitude-modulated ultrasonic signal in two modes: pulsed and permanent. A sexually mature mongrel dog was an experimental animal. The ureteral stent was placed by laparotomy and cystotomy. Intraoperatively, the emitter of the developed device was applied to the skin of the animal, according to the previously indicated topographic and anatomical landmarks. At the same time, an ultrasonic wave noise analyzer was applied through the laparotomy wound to the appropriate level of the ureter. Measurements of ultrasound intensity indicators were performed three times in two operating modes of the device.Results. Pulsed mode: for the ureteral upper third, the highest ultrasonic intensity (123.67 dB) was achieved along the posterior axillary line. For the ureteral middle third, the best ultrasound intensity (115 dB) was obtained by the posterior axillary line. For the ureteral lower third, the highest ultrasound intensity (113.67 dB) was noted along the middle axillary line.Permanent mode: the best ultrasonic intensity in the projection of the ureteral upper, middle, and lower thirds was achieved along the posterior axillary line and was 118.67 dB, 117 dB and 116.67 dB, accordingly. However, there was an excessive heat effect, manifested by hyperemia and hyperthermia of the animal's skin, fascicular muscle contractions during the instrument functioned in the permanent mode, which can potentially lead to thermal burns and intolerance to the procedure.Conclusion. The pulsed mode of the device function is most safe. The optimal application points of the instrument emitter for the ureteral upper and middle thirds is the posterior axillary line, and for the ureteral lower third is the middle axillary line.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115135734","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 : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-107-117
S. Popov, I. Orlov, I. Pazin, M. Perfilyev
Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.
{"title":"Nephrostomy-free percutaneous nephrolithotripsy: intraoperative hemostasis methods of the percutaneous tract","authors":"S. Popov, I. Orlov, I. Pazin, M. Perfilyev","doi":"10.21886/2308-6424-2021-9-3-107-117","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-107-117","url":null,"abstract":"Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130474895","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 : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-62-69
A. I. Khotko, D. N. Khotko, V. Popkov, A. I. Tarasenk
Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.
{"title":"Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy","authors":"A. I. Khotko, D. N. Khotko, V. Popkov, A. I. Tarasenk","doi":"10.21886/2308-6424-2021-9-3-62-69","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-62-69","url":null,"abstract":"Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"292 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127961331","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 : 2021-10-05DOI: 10.21886/2308-6424-2021-9-3-127-134
N. Gadzhiev, D. S. Gorelov, A. O. Ivanov, I. Semenyakin, I. E. Malikiev, V. Obidnyak, Ya. I. Kryuchkovenko, S. Petrov, V. Grigoriev
Urolithiasis is currently one of the most urgent problems in the world. Every eleventh worldwide inhabitant suffers from this disease. Previously, the only way to get rid of kidney stones and the urinary tract was open surgery, which was characterized by high trauma. Over the past decades, the development of technologies has made a significant contribution to the development of new methods of urolithiasis treatment. One of these methods is extracorporeal shock wave lithotripsy (ESWL). The first lithotripter Dornier HM-1 was produced in 1980. Subsequent models have got many changes, both in terms of ergonomics and power. The researchers noticed that the efficiency of stone crushing in the Dornier HM-1 lithotripter was higher than in newer models since the lower power provided the less intensive formation of cavitation bubbles that prevent the effective transit of subsequent waves through the stone. Nowadays, a new method of remote stone crushing is being developed based on low-amplitude high-frequency technology combined with ultrasonic propulsion, which is the main difference from traditional shock-wave lithotripters. The new technology of stone crushing is called «burst wave lithotripsy» (BWL). Currently, the data have been obtained that this method is more effective in terms of crushing quality and less traumatic.
{"title":"Burst wave lithotripsy – the new evolution stage of extracorporeal shock-wave lithotripsy","authors":"N. Gadzhiev, D. S. Gorelov, A. O. Ivanov, I. Semenyakin, I. E. Malikiev, V. Obidnyak, Ya. I. Kryuchkovenko, S. Petrov, V. Grigoriev","doi":"10.21886/2308-6424-2021-9-3-127-134","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-3-127-134","url":null,"abstract":"Urolithiasis is currently one of the most urgent problems in the world. Every eleventh worldwide inhabitant suffers from this disease. Previously, the only way to get rid of kidney stones and the urinary tract was open surgery, which was characterized by high trauma. Over the past decades, the development of technologies has made a significant contribution to the development of new methods of urolithiasis treatment. One of these methods is extracorporeal shock wave lithotripsy (ESWL). The first lithotripter Dornier HM-1 was produced in 1980. Subsequent models have got many changes, both in terms of ergonomics and power. The researchers noticed that the efficiency of stone crushing in the Dornier HM-1 lithotripter was higher than in newer models since the lower power provided the less intensive formation of cavitation bubbles that prevent the effective transit of subsequent waves through the stone. Nowadays, a new method of remote stone crushing is being developed based on low-amplitude high-frequency technology combined with ultrasonic propulsion, which is the main difference from traditional shock-wave lithotripters. The new technology of stone crushing is called «burst wave lithotripsy» (BWL). Currently, the data have been obtained that this method is more effective in terms of crushing quality and less traumatic.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124005650","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 : 2021-07-10DOI: 10.21886/2308-6424-2021-9-2-100-110
S. Shkodkin, M. Pokrovsky, S. Krasnyak, A. Polichuk, S. Chirkov, O. Churikova, N. A. Kpavtsova
Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.
{"title":"Treatment of overactive bladder symptoms in women with Diunorm®: preliminary results report","authors":"S. Shkodkin, M. Pokrovsky, S. Krasnyak, A. Polichuk, S. Chirkov, O. Churikova, N. A. Kpavtsova","doi":"10.21886/2308-6424-2021-9-2-100-110","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-2-100-110","url":null,"abstract":"Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114579170","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 : 2021-07-10DOI: 10.21886/2308-6424-2021-9-2-25-33
V. P. Glukhov, A. V. Ilyash, V. Mitusov, D. O. Kubasov, A. V. Pilieva, Y. Khoronko, M. Kogan
Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.
{"title":"Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention","authors":"V. P. Glukhov, A. V. Ilyash, V. Mitusov, D. O. Kubasov, A. V. Pilieva, Y. Khoronko, M. Kogan","doi":"10.21886/2308-6424-2021-9-2-25-33","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-2-25-33","url":null,"abstract":"Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125987461","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 : 2021-07-10DOI: 10.21886/2308-6424-2021-9-2-111-124
B. Guliev
Urinary fistulas after partial nephrectomy are rare complications of this operation. There are various reasons for their development, prevention and treatment. This review analyzes the results of the cases' prevalence of urine leakage after partial nephrectomy with various approaches, occurrence's predictors of urinary fistulas, possible ways of their intraoperative prevention and treatment methods. The obtained data show that the size of tumors, their endophytic nature and proximity to the kidney pelvicalyceal system, as well as suturing of its defect, can be predictors of the development of urinary fistulas (UFs). Some authors point to the influence of long ischemia time and high blood loss on the occurrence of UFs. The main method of treating UFs is ureteral stenting or percutaneous drainage of the kidney pelvicalyceal system. For long-term persistent UFs, the method of choice can be simultaneous introduction of 2 stents, retrograde or percutaneous injection of fibrin glue, percutaneous cryoablation of the UFs.
{"title":"Urinary fistulas after partial nephrectomy in renal cell carcinoma","authors":"B. Guliev","doi":"10.21886/2308-6424-2021-9-2-111-124","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-2-111-124","url":null,"abstract":"Urinary fistulas after partial nephrectomy are rare complications of this operation. There are various reasons for their development, prevention and treatment. This review analyzes the results of the cases' prevalence of urine leakage after partial nephrectomy with various approaches, occurrence's predictors of urinary fistulas, possible ways of their intraoperative prevention and treatment methods. The obtained data show that the size of tumors, their endophytic nature and proximity to the kidney pelvicalyceal system, as well as suturing of its defect, can be predictors of the development of urinary fistulas (UFs). Some authors point to the influence of long ischemia time and high blood loss on the occurrence of UFs. The main method of treating UFs is ureteral stenting or percutaneous drainage of the kidney pelvicalyceal system. For long-term persistent UFs, the method of choice can be simultaneous introduction of 2 stents, retrograde or percutaneous injection of fibrin glue, percutaneous cryoablation of the UFs.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129464623","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 : 2021-07-10DOI: 10.21886/2308-6424-2021-9-2-142-149
D. Rogozin
The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were 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, a list of 10 works published in the first quarter (January - March) of 2021 was formed. The review included articles related to the following issues: sperm DNA fragmentation, the use of testicular spermatozoa in ART programs (assisted reproductive technologies), advanced paternal age, the role of the human papillomavirus for male fertility, hormonal modulation by clomiphene, the risk of birth defects in children in ART programs, andrological examination of patients with CFTR gene mutations. And also, an analysis of the new clinical guidelines of the American Urological Association (AUA) was carried out.
{"title":"Male fertility: a review of the publications from January - March 2021","authors":"D. Rogozin","doi":"10.21886/2308-6424-2021-9-2-142-149","DOIUrl":"https://doi.org/10.21886/2308-6424-2021-9-2-142-149","url":null,"abstract":"The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were 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, a list of 10 works published in the first quarter (January - March) of 2021 was formed. The review included articles related to the following issues: sperm DNA fragmentation, the use of testicular spermatozoa in ART programs (assisted reproductive technologies), advanced paternal age, the role of the human papillomavirus for male fertility, hormonal modulation by clomiphene, the risk of birth defects in children in ART programs, andrological examination of patients with CFTR gene mutations. And also, an analysis of the new clinical guidelines of the American Urological Association (AUA) was carried out.","PeriodicalId":345779,"journal":{"name":"Vestnik Urologii","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115413743","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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