[Predictors of bladder neck contracture after transurethral procedure on the prostate].

The development and widespread implementation of modern endourological procedures for the treatment of benign prostatic hyperplasia (BPH) has led to a significant reduction in postoperative complications, but these interventions are associated to an increase of bladder neck contracture (BNC) rate. Various data on the frequency, pathogenesis, and risk factors for the development of BNC after endourological interventions are presented in the literature review. The prevalence of BNC after transurethral procedures depending on the type of energy used reaches up to 10%. Risk factors of BNC included the presence of chronic prostatitis and urinary tract infections, as well as small volume BPH. The age, cardiovascular diseases, type 2 diabetes, obesity, and a long-term smoking are considered as additional risk factors. A detailed study of the risk factors for BNC will further minimize BNC rate after transurethral procedures, thus improving the quality of life of patients.

[Predictors of fertility recovery in subfertile men after varicocelectomy].

INTRODUCTION: Varicocelectomy does not always lead to semen improvement and male fertility recovery. OBJECTIVES: Analysis of total progressive motile sperm count (TPMSC) predictive role in fertility recovery of subfertile man after varicocelectomy in combination with other predictors. MATERIALS AND METHODS: This prospective, open, multi-center study comprises 93 men from infertile couples with clinical varicocele who underwent microsurgical (inguinal or subinguinal) varicocelectomy. The changes in the standard semen analysis studied according to WHO 2010 Standards. We also evaluated spontaneous pregnancy rates. A discriminant analysis was carried out with step-by-step selection to identify reliable predictors of pregnancy after varicocelectomy. An increase in TPMSC by at least 12.5 million was considered as a good effect of varicocele repair (reference values for the number and progressive sperm motility according to WHO 2010: 39 million x 0.32 (32%) progressively motile). Patients were divided into 3 groups in regards of direction and degree of semen changes: group I included 48 patients with increase of TPMSC more or equal 12.5 million, group II comprised 20 patients with mild increase in TPMSC (0.1 - 12.5 million) and the III group comprised patients without any effect (TPMSC did not change, or became less than preoperative one) after varicocelectomy. The initial clinical characteristics of patients in the groups were compared. RESULTS: A significant effect was observed in 52% of cases (n=48), a mild favorable effect in 21% (n=20), and no effect in 27% (n=25). Spontaneous pregnancy rates (in 1 year after varicocele repair) were higher in patients of group I than that of groups II and III: 46%, 10% and 12%, respectively (p<0.05). The initial clinical characteristics between groups were comparable (p>0.05). In group I, the initial semen analysis parameters were significantly better than in group II and worse than in group III: the median and 25% -75% of the quartiles for TPMSC were 15 (1-44), 0 (0-8) and 54 (19-100) million, respectively (for all p<0.001). According to discriminant analysis significant predictors of pregnancy after varicocelectomy were an increase of TPMSC, male age and the initial total sperm motility. The predictive accuracy of the prognostic model with these three predictors was 84%, specificity was 87%, and sensitivity was 76%. CONCLUSIONS: The odds of fertility recovery after varicocelectomy has a U-shaped relationship: it is higher in patients with moderate semen quality impairment and it decreases in patients with initially low, and, conversely, high sperm count and motility. An increase in TPMSC by 12.5 million or more is a highly significant indicator of fertility recovery, because in this case the odds of spontaneous pregnancy can reach 50%. Predictors of fertility recovery after varicocelectomy are an increase of TPMSC, male age and the preoperative total motility.

[Significance of definition category of complexity of urinary stones in the systematization of complications of endosopic surgery of urolitiasis].

AIM: To determine the complexity of urinary stones from the standpoint of endoscopic surgery in order to create the standard for the postoperative course of endoscopic surgery for urolithiasis. MATERIAL AND METHODS: A total of 1317 endoscopic operations (PNL, URS), performed for upper urinary tract stones, were analyzed. Treatment results of 290 patients were studied prospectively, taking into account a stone density, determined by MSCT using HU scale. In 1027 patients, results were studied retrospectively, with a consideration of stone quantitative characteristics, size and shape. RESULTS: According to the study, stone density does not have a significant impact on the frequency and severity of complications and the efficacy of endoscopic treatment for urolithiasis. The number of stones, their size and stereometric configuration have a significant influence on the surgical procedure. From the position of endoscopic interventions, single upper urinary tract stones were determined as "simple", while multiple and staghorn stones were considered as "complexed" cases. CONCLUSION: The "standard of the postoperative period" of endoscopic surgery for urolithiasis created with a consideration of specific features of endoscopic surgery for urolithiasis and the complexity of urinary stones is proved to be objective. Any deviation in the postoperative period from the standard course should be regarded as a complication and it is necessary to systematize them according to the Clavien-Dindo classification.

[EVALUATION OF THE EFFICACY OF STANDARD PERCUTANEOUS NEPHROLITHOTRIPSY IN STAGHORN AND MULTIPLE NEPHROLITHIASIS].

In staghorn and multiple nephrolithiasis, method of choice for removing kidney stones is percutaneous nephrolithotripsy (PCNL). However, it may be accompanied by the leaving off of stones or fragments in pyelocaliceal system. The study was aimed to the evaluation of possibilities of the standard PCNL in terms of complete removal of staghorn and multiple kidney stones. Percutaneous nephrolithotripsy was made by a single access using standard method in 99 patients with staghorn and multiple kidney stones. The average age of the patients ranged from 9 to 61 (34.4±3.2) years. Staghorn stones were found in 80 (80.8%) patients, staghorn stones with multiple stones - in 19 (19.2%) patients. Stone size ranged from 18 to 94 (49.6±2.3) mm. The use of standard PCNL to remove staghorn and multiple kidney stones as monotherapy has allowed complete removing of the stones in 74 (74.7%) patients. The average length of stay of patients in hospital after surgery was 5.9±0.3 bed-days (2 to 31), medium time for removal of drains after surgery - 4.3±0.7 days. Intraoperative blood loss was observed in 11 (11.1%) patients, its volume ranged from 150 to 1130 (407.2±28.8) ml. In 8 (8.1%) cases, bleeding regarded as a complication, because it required replacement therapy. Postoperative complications were observed in 19 (19.2%) patients, of which 8 (8.1%) had bleeding, and 11 (11.1%) had exacerbation of urinary tract infection. Thus, the standard PCNL as monotherapy in staghorn and multiple nephrolithiasis serves as alternative method for removing stones. The results of treatment depend on the size and stereometric configuration of staghorn stones. The most common causes of residual stones are inaccessibility of calyx by endoscope and intraoperative bleeding.

[Assessment of the specific characteristics of urethral stricture according to records of medical republican institution of Uzbekistan].

Urethral stricture in men is a common disorder, negatively affecting the health and therefore the quality of patients life. The aim of the study was to evaluate the nature of the stricture in various segments of male urethra and the incidence rate of urethral stricture in the Republic of Uzbekistan. The study presents the analysis of medical records of 195 men (mean age 40,6+/-13,1 years) who underwent urethroplasty in the Republican Specialized Centre of Urology between February 2013 and March 2015. 46.7% and 53.3% of patients had anterior and posterior urethral strictures, respectively. The most common causes of stricture were trauma (38.5%) and infections (22.6%); 18% of strictures were considered idiopathic, 19% - iatrogenic. In 13.3% of cases, stricture located within the pendulous urethra, in 42.7% - within the bulbar urethra, in 32% - within the posterior urethra. In 28.7% of patients the length of the stricture was more than 6 cm, in 25.6% - 2 cm or less.

[Development and clinical testing of the Russian version of the Acute Cystitis Symptom Score - ACSS].

The Acute Cystitis Symptom Score - ACSS was originally developed in the Uzbek language and has demonstrated high reliability and validity. The study was aimed to develop a Russian version of the ACSS questionnaire and evaluate its psychometric properties. Translation and adaptation of the ACSS questionnaire containing 18 questions, 6 of them - for the typical symptoms of acute cystitis (AC), 4 - for the differential diagnosis; 3 - for the quality of life, and 5 - for the conditions that may affect the choice of treatment, were performed according to the recommendations developed by the Mapi Research Institute. Study involved 83 Russian-speaking women (mean age, 35.6 ±13.7 years); 38 (45.8%) patients were in the main group (patients with AC), and 45 (54.2%) - in the control group (without AC). Medical examination and appropriate treatment of the respondents were conducted in accordance with approved standards. After completing the course of therapy, 19 (50%) patients of the main group came for the control examination. There was statistically significant difference in the scores obtained in the two groups. Score profiles positively correlated with the results of laboratory tests (rho = 0.26-0.48). Cronbach's alpha for the Russian version of the questionnaire was 0.86 (95% CI, 0.81-0.91), area under the curve in the ROC analysis was 0.96. The results of testing the Russian version correspond to those of the original version. The Russian version of the ACSS questionnaire has high. reliability and validity, and can be recommended for clinical research and diagnosis of primary AC, and dynamic monitoring of the effectiveness of the treatment of the Russian-speaking population of patients.

[Intraoperative complications of endoscopic removal of stones from the upper urinary tract].

Using a large clinical material, retrospective analysis of the frequency, nature and causes of intraoperative complications occurring in the process of endoscopic removing stones from the upper urinary tract was performed. In 2008-2010 three trained surgeons with experience in endoscopic surgery of nephrolithiasis over 20 years performed 1027 operations in RSCU (Tashkent, Uzbekistan). The data were also compared with results of similar interventions which were performed by the same surgeons before 1997 during the development of the method.

[Postoperative infectious-inflammatory complications of endoscopic surgery for urolithiasis].

Retrospective analysis of 1027 percutaneous radioendoscopic surgeries for upper urinary tract stones was performed. Postoperative acute pyelonephritis was the most common complication (11.2%), the frequency of which was significantly dependent on the presence of source of infection in the urinary tract, and the frequency of intra- and postoperative complications. When performing PPN, patients with urolithiasis and with the presence of the initial infection in the urinary tract, intra- and postoperative complications should be referred to the group of patients with a high risk of postoperative infectious and inflammatory complications. The analysis showed that the development of acute pyelonephritis after PPN increases the cost of treatment by 25%.

[Modification of the test pressure-flow for evaluation of detrusor contractility in absence of urination]. / Modifikatsiia issledovaniia davlenie-potok dlia otsenki kontraktil'nosti detrusora pri otsutstvii mocheispuskaniia.

The aim of the study was design and validation of the test for examination of detrusor contractility in the absence of urination. The method consists in registration of detrusor pressure in maximal speed of urinary flow in the course of artificial urination using Foley's catheter. Urethral resistance was modeled by raising drainage up to 40 cm above the level of the symphysis which was adjusted and found optimal in 48 of 179 examinees. The method allowed to select patients with infravesical obstruction (IVO) and normal detrusor contractility (n = 36) as well as patients with hypocontractility without IVO (n = 12). The test "pressure-flow" in artificial urination evaluates detrusor contractility in patients unable to urinate. The test distinquishes patients with normal detrusor contractility and those with different degree of its impairment. This is important in assessment and prognosis of deficient urination.