[Experience of using Experience of using NefroBest-N for rehabilitation of patients undergoing radical laparoscopic cystectomy].

AIM: To evaluate the efficacy and safety of NefroBest-N in patients undergoing to the radical cystectomy with neobladder formation. MATERIALS AND METHODS: A total of 60 patients with invasive bladder cancer aged 56 to 75 years, treated at A.I. Burnazyan SRC FMBC and at the M.A. Podgorbunsky Kuzbass linical Hospital of Emergency Medical Care in 2022, were included in randomized multicenter parallel group study. All patients underwent radical cystectomy with a formation of Studer neobladder. The main group included those who received the drug NefroBest-N, 1 capsule 2 times a day for 90 days. In the control group, only symptomatic therapy according to current standards was administered. The study consisted of a screening period of up to 4 days (Visit 1) and a period of 90+2 days to evaluate the efficiency of therapy, including 3 visits: day 14 (Visit 2), 30+2 days (Visit 3) and 90+2 days (Visit 4). Laboratory examination and imaging studies included biochemistry panel (urea, creatinine, K, Na, CRP), urinalysis (presence of mucus, leukocytes), urine culture (bacteriuria), physical examination, renal and neobladder ultrasound with determination of postvoid residual volume. In addition, evaluation of the quality of life was also performed. RESULTS: Evaluation of efficacy and safety of NefroBest-N was carried out. Administration of NefroBest-N resulted in a more rapid improvement of urinalysis, including a significant decrease in severity of leukocyturia and amount of mucus. In addition, degree of bacteriuria was reduced according to the urine culture. The quality of life was also improved. CONCLUSION: NefroBest-N has a favorable efficacy and safety profile. According to our experience, NefroBest-N significantly reduces recovery time and improves the quality of life of patients who have undergone radical cystectomy with a neobladder formation.

[Use of urethral stents for urethral strictures].

Urethral stents have been popular in urology since the early 1980s and are used in the treatment of urethral stricture. The literature review presents data on the introduction into urological practice and the use of urethral stents in urethral strictures.

[Vacuum interference therapy in the complex treatment of patients with chronic bacterial prostatitis]. / Vakuum-interferentsterapiya v kompleksnom lechenii patsientov s khronicheskim bakterial'nym prostatitom.

Taking into account the complex etiology and pathogenesis of chronic prostatitis, a large number of complications including the reproductive function impairment, the developing new effective methods of treating this pathology remains highly relevant. OBJECTIVE: Scientific substantiation of combined electric vacuum exposure in patients with chronic bacterial prostatitis (CBP). MATERIAL AND METHODS: The 90 patients with CBP aged 27-55 years were examined and were divided into 3 equal groups by the method of simple randomization. Patients of the main group received vacuum interference therapy procedures, the comparison group received interference therapy without vacuum exposure, and the control group received only standard drug therapy that was also prescribed in the first two groups. The effectiveness of therapy was assessed before, immediately after and 6 months after using the NIH-CPS, IPSS, QOL scales, trans-rectal ultrasound examination of the prostate gland, bacteriological examination and microscopy of a native preparation of prostate secretion and uroflowmetry. RESULTS: An improvement in the clinical symptoms of CBP was found largely in the groups receiving physiotherapy. In the main group there was a more significant volume decrease in the inflammatory-altered prostate gland (by 31.5%), in the comparison group the volume of the prostate gland decreased by 14%, and in the control group - by 9.6% that indicates the most pronounced anti-inflammatory effect of electro-vacuum actions. In the main group, there was also a more pronounced positive dynamics of dysuric disorders' indicators and maximum urination rate compared to the comparison and control groups. CONCLUSION: A higher clinical efficacy of vacuum interference therapy in patients with CBP (93.3%) has been proven compared with interference therapy (80.0%) and standard therapy (66.6%). The data obtained confirm the advantages and usage prospects of the combined physiotherapeutic effects.

[Comparative analysis of clinical features of robotic-assisted and laparoscopic partial nephrectomy].

INTRODUCTION: Kidney cancer (mostly renal cell carcinoma) is one of the ten most commonly diagnosed malignant tumors among men and women. Due to the widespread use of computer tomography and magnetic resonance imaging, the proportion of early-stage kidney cancers has increased. Currently, treatment options for stage 1 kidney cancer are radical nephrectomy, partial nephrectomy, and active surveillance. Among organ-preserving intervention, three main techniques can be distinguished: open surgery, minimally invasive surgery and ablation methods. To date, robotic-assisted procedures have occupied their place among minimally invasive interventions. AIM: To carry out a comparative analysis of two methods of organ-preserving treatment of kidney tumors, namely robot-assisted and laparoscopic partial nephrectomy. MATERIALS AND METHODS: A retrospective comparative analysis of two groups of patients with kidney tumors who underwent robotic-assisted or laparoscopic partial nephrectomy during the period from 2012 to 2019 was performed. RESULTS: There were no differences between two groups in age, mean score on the RENAL nephrometry scale, preoperative creatinine levels, tumor size, and duration of warm ischemia. However, duration of surgery, the volume of blood loss, serum creatinine after surgery, the length of stay, the use of the technique of early unclamping of the renal artery, the use of technique "off-clamp" and the proportion of exophytic tumors with growth were significantly different between patients of two groups. CONCLUSION: We believe that the robotic system is intuitively convenient for performing partial nephrectomy, allowing the treatment of potentially more complex cases and expanding the indications for organ-preserving procedures.

[Complete penile rehabilitation of a patient with microphallia after correction of bladder exstrophy].

Bladder exstrophy is a complex of urogenital malformations, varying in severity from epispadias to classical bladder exstrophy. The main aim of correcting bladder exstrophy in childhood is to achieve urine continence with the prevention of upper urinary tract disorders and to provide penile reconstruction. However, by the time of puberty, it is not always possible to achieve optimal anatomical features of the penis, and usually, by the end of puberty, the penile length is no more than 7 cm, which subsequently leads to psychosocial and sexual problems during puberty. Neither patient, nor urologist in most cases do not satisfy final result of the treatment of exstrophy and a number of epispadias forms. A clinical case of the surgical rehabilitation of a patient after undergoing multi-stage surgical treatment for a congenital malformation of the genitourinary system is presented in the article. MATERIALS AND METHODS: At the admission, the size of the penis was 3 cm (microfallia), urethral meatus was located in the area of the penoscrotal junction. From 2016 to 2019, the patient underwent neofallos formation, urethroplasty, and implantation of prostheses in the neophallos. RESULTS: According to the results, urinary and sexual function was completely restored, as well as anatomical relationships and dimensional parameters of the genitals.

[Decellularized cadaveric human artery for substitution of connective tissue and smooth muscle defects on the example of tunica albuginea of penis (experimental work)]. / Ispol'zovanie detselliuliarizirovannoi trupnoi arterii cheloveka dlia zameshcheniia defektov soedinitel'notkannykh i gladkomyshechnykh struktur na primere belochnoi obolochki polovogo chlena (éksperimental'naia rabota).

AIM: To analyze experimentally the outcomes of xenotransplantation (cadaveric artery, decellularized cadaveric artery) for tunica albuginea defects repair. MATERIAL AND METHODS: The study included 60 chinchilla rabbits. Rabbits underwent local replacement of tunica albuginea. Animals were divided into 2 groups (group 1 - human cadaveric artery, group 2 - decellularized cadaveric artery). The result was considered after 7, 14 and 30 days postoperatively. RESULTS: Tendency to stasis, sludge-phenomenon and ultimately development of fibrosis of transplantation area were histologically observed in group 1 after 30 days. In group 2 luminal surface of decellularized artery was smoothed, fibrin and blood elements were absent. In group 1 mean level of C-reactive protein was 3.86±0.43, 1.17±0.2 and 0.73±0.16 mg/L after 7, 14 and 30 days respectively. In group 2 the same values were 0.33±0.03, 0.23±0.03 and 0.11±0.02 mg/L. Differences were significant (t =-46.28, t = -25.95, t = -14.84; p<0.0001).

[Buccal mucosa substitution urethroplasty in a patient with an extensive urethral stricture].

Urethral strictures are one of the most common reasons to see a urologist and are considered a socially significant disease. Management of urethral strictures is one of the challenging issues in urology. The article presents a case of a patient with extensive iatrogenic stricture of the penile urethra. The patient underwent penile augmentation urethroplasty using buccal mucosa resulting in the restoration of the whole length of the urethral lumen and non-obstructive urination according to uroflowmetry findings.

[Penile revascularization using laparoscopic mobilization of the inferior epigastric artery].

The article presents a case of successful penile revascularization using laparoscopic mobilization of the inferior epigastric artery in a 35 y. o. patient with penile arteriovenous insufficiency.

[Stepwise correction of urethrovesical anastomotic stenosis and severe incontinence (a clinical case report)].

The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.

[Comparative effectiveness of Marmar technique and laparoscopic clipping of testicular vein in surgical treatment of varicocele in athletes].

INTRODUCTION: Varicocele is one of the most common diseases among men and a proven cause of male infertility, which is directly proportional to its clinical prominence. The aim To evaluate the immediate and long-term outcomes of different surgical methods to treat varicocele in athletes. MATERIALS AND METHODS: A total of 165 athletes were treated for varicocele. Of them, 82 patients (group 1) underwent varicocele surgery using Marmar technique and 83 patients (group 2) were treated by laparoscopic clipping of testicular vein (endoscopic analogue of Ivanissevitch open surgery). RESULTS: The incidence of postoperative complications and relapse at 6 months after surgery in groups 1 and 2 was 1.2% and 8.4%, and 4.9 and 14.5%, respectively. The study findings showed a statistically significant (p<0.05) improvement in the spermogram parameters in both groups compared with preoperative values. CONCLUSIONS: The length of hospital stay and postoperative rehabilitation period were shorter in patients after Marmars varicocelectomy than in patients of group 2. Besides, Marmar technique for varicocele was cost-effective and justified.

[Pathogenesis of adhesions formation after intraabdominal operations].

The article describes the pathogenesis of adhesions formation after intraabdominal operations. Described predisposing factors leading of which is mechanical trauma, resulting from the use of surgical instruments, rough manipulations during surgery, damage to the mesothelium by dry gauze etc, which cause the adhesions. The pathogenesis of adhesions formation after intraabdominal surgery is presented in outline form, which described the changes occurring in the body starting with combination of predisposing factors and ending with the development of adhesions with blood vessels by 7-12 days after surgery. At the genetic level predisposition to adhesions formation and development of adhesive disease is treated as a manifestation of rapid acetylation phenotype, in which the intensity of fibrin formation exceeds normal rate of its catabolism. Thus, according to modem concepts, adhesive disease is a separate nosologic unit that dictates the necessity of its detailed study, development and introduction new universal methods of preventing the adhesions formation after intraabdominal operations.

[Peyronie's disease: comparative results of conservative treatment].

Long-term clinical experience with conservative treatment of Peyronie's disease has demonstrated that clinical efficacy of this therapy comprises maily anesthesia while erectile problems are not solved. Introduction of the drugs into the fibrous plaque is not adequate and hard to perform. Some drugs affect only some components of pathogenesis. For stabilization of the process it is recommended to use transdermal electrophoresis or phonophoresis. The search for new effective drugs and methods continues.