[Clinical experience with reusable and single use flexible ureterorenoscopes].

INTRODUCTION: Flexible ureterorenoscopy (fURS) has become one of the most frequent procedures in urology in recent years. The main problem on the way of the spread of flexible ureterorenoscopy in everyday urological practice all over the world is the fragility of endoscopes. MAIN AIM: To evaluate the potential use of reusable and single-use ureterorenoscopes for kidney stones. MATERIALS AND METHODS: The analysis included 30 patients who underwent of retrograde intrarenal surgery (RIRS) for kidney stones. The patients were divided into two groups. I gr. - RIRS was performed with a reusable flexible ureterorenoscope Flex XC "Karl Storz" (Germany) (n=20), II gr. - a single-use flexible ureterorenoscope PU3022 "Pusen" (China) (n=10) was used. Lithotripsy was performed with a Lumenis Pulse 100H holmium laser (Israel, USA). RESULTS: The age of patients, size and density of stones in I gr. and II gr. were comparable (42.5+/-16.9 vs 50+/-10.07 (years); 8.5+/-2.9 vs 10+/-2.5 (mm); 1248+/-315.3 vs 1376+/-223.3(HU+). Intraoperative complications were noted: in the I gr. - migration of stone fragments and bleeding; in the II gr. - migration of a fragment of stone. The time and efficiency of the operation of I gr. and II gr. were 75+/-39.9 vs 82.5+/-45.7 (min); 18 (90%) vs 9 (90%), respectively. Additional shock wave lithotripsy was required in 2 cases in the I gr., and more frequent usage stent was noted in the II gr. 10 (100%). In I gr. 5 (25%) patients had signs of inflammatory complication and 1 (5%) patient needed a change of antibiotics, after operation. The acute pyelonephritis was indicating in 2 (20%) patients of II gr. in the same period. DISCUSSION: The use of access sheath was in all patients of II gr. and in 14 (70%) cases of I gr. In 1 case of the II gr. it was not possible extract of a stone fragment from the lower calyx due to the thickness of the intrument. The possibility of bending was higher for the "Karl Storz" ureterorenoscope due to smaller diameter of the instrument. One of the disadvantages of reusable flexible ureterorenoscope is the fragility of the instrument. In our research, the repair of the instrument was required after 12 manipulations. CONCLUSION: The use of smaller instruments, the use of new digital imaging, the mobility of devices, allows performing interventions simultaneously by two surgeons, achieving the greatest fragmentation or evacuation of fragments of stones with good visualization, as well as using methods of drainage-free lithotripsy ("tubless").

[Evaluation of the efficacy of dapoxetine in primary and secondary forms of premature ejaculation].

OBJECTIVE: to compare the efficacy of dapoxetine in treatment of primary and secondary premature ejaculation. MATERIALS AND METHODS: The study included 60 patients with premature ejaculation (PE). Depending on the form of premature ejaculation they were divided into two groups: 27 patients with primary PE (group 1) and 33 patients with secondary PE (group 2). Patients were recommended to take dapoxetine 30 mg 1 hour before intercourse. A follow-up visit was scheduled on day 30 after receiving the drug. The intravaginal ejaculation latency time (IELT) and the Premature ejaculation diagnostic tool (PEDT) score were evaluated before dapoxetine was given and after 30 days from the start of the study. The significance of differences between baseline and follow-up values were compared using Wilcoxons test. In both groups, the proportion of patients with an incomplete response (IELT less than 2 minutes, PEDT more than 10) to symptomatic therapy with dapoxetine was evaluated. The proportion of patients with incomplete response to therapy was compared using the chi-square test. RESULTS: The median IELT among all patients before starting therapy was 63 seconds (interquartile interval [IQR]: 28.75-94). After one month of therapy median IELT increased to 119 seconds (IQR: 58.75-321.75). Median PEDT score was 16 (IQR: 13-19) at baseline and 7 (IQR: 4-12) at follow-up. In group 1, the median IELT increased from 57 to 83 seconds (p = 0.02088), and in group 2, the median IELT increased from 70 to 173 seconds (p<0.00001). The mean PEDT score decreased to 7 in both groups (p<0.00001). Incomplete response to therapy was observed in 66.7% of patients in group 1 and in 39.4% of patients in group 2. The difference between two groups was statistically significant (p=0.035456). CONCLUSION: Symptomatic therapy with dapoxetine has a positive effect on the intravaginal ejaculation latency time and patient satisfaction in both primary and secondary premature ejaculation. However, the incidence of incomplete response to therapy is higher in patients with primary premature ejaculation, which may be due to characteristic differences in the pathogenesis of primary and secondary premature ejaculation.

[Our experience of holmium laser enucleation of the prostate].

INTRODUCTION: Surgical treatment of benign prostatic hyperplasia (BPH) is influenced by a rapidly growing number of technologies. AIM: To determine the surgical potential of holmium laser enucleation of the prostate (HoLEP) and the rate of postoperative complications during the learning curve. MATERIALS AND METHODS: A total of 98 patients undergoing HoLEP in the surgical department of the Clinical Hospital "Mother & Child" during the period from January 2018 to May 2020 were included in the study. HoLEP was performed by a single surgeon with previous experience in transurethral procedures. The criteria for inclusion in the study group were as follows: moderate-to-severe lower urinary tract symptoms, prostate volume > 40 cm3, maximum flow <15 ml/sec, the volume of residual urine > 50 ml. The exclusion criteria were the following: inflammatory process in the lower urinary tract, genitourinary malignancy, previous urinary tract interventions. The evaluated criteria included age, prostate size, International Prostate Symptoms Score (IPSS and QoL), bladder diary, PSA, uroflowmetry, total operative time, length of catheterization, complications according to the Clavien-Dindo Classification, and length of stay. RESULTS: During pathologic study, two cases of incidental prostate cancer (2.1%) were detected. The relationships between the prostate size and operative time (p<0.05), operative time and length of stay (p<0.05) were found. The total rate of complications was 16.3%. There were no complications more or equal IIIb according to the Clavien-Dindo Classification. The most dangerous complications were injuries of the bladder wall and ureteral orifice (31.25% and 18.75% among all complications, respectively). DISCUSSION: It should be considered that a large "middle lobe" is associated with a high risk of injury of the ureteral orifices. In our series, there were 5 cases of bladder tamponade, while bladder injuries during the morcellation developed in the first 10 patients. CONCLUSION: HoLEP is a reasonable alternative to TURP for surgical treatment of BPH and is considered a safe procedure for patients taking anticoagulant and antiplatelet drugs. Past experience of TURP allows to learn the technique faster and to reduce the number of complications.

[The use of ultrasound imaging in minimally invasive percutaneous nephrolithotomy. Can we completely abandon fluoroscopy?]

AIM: To determine the possibility of performing minimally invasive percutaneous nephrolithotomy (PCNL) under ultrasound guidance with the use of X-ray during the access tract formation. MATERIALS AND METHODS: The results of 102 mini-PNL procedures, performed by a single surgeon during the period 2018-2019, were analyzed retrospectively. In the beginning, ureteral catheter Ch5 was put into an ipsilateral ureter. Further, a puncture of the collecting system was performed with an advancement of the guidewire. At the next stage, a dilation of tract was done using X-ray guidance for the safe formation of the working channel, followed by holmium lithotripsy. At the end a nephrostomy or JJ-stent was left. RESULTS: The mean age of the patients was 53.13+/-12.9, while average BMI was 29.3+/-6.5. In total, there were 44.1% of women. The average stone size was 20.7+/-10.9 mm; 45.1% of stones were left-sided. Staghorn stones accounted for 15.7% of cases and hydronephrosis was found in 18.6% of patients. The time for creating renal access, dilation of the nephrostomy tract, total operative time and fluoroscopy time were: 19.6+/-13.1, 7.7+/-4.2, 107.7+/-49.9, 57.1+/-41.2 minutes, respectively. In the Group I there were 32 (31.4%) patients undergoing to PCNL under X-ray guidance, while in Group II (n=70, 68.6%) combined US+/-X-ray control was used. The patients age (52.2+/-12.6 vs 53.6+/-13.2, p<0.05) and the stone size (20.6+/-8.9 vs 20.7+/-10.4, p=0.30) were comparable in both groups. There were slightly shorter access time and the total operative time in group II compared with group I (20.6+/-12.3 vs 19.2+/-13.5, p=0.27; 108.1+/-43.3 vs 106.9+/-53.2, p=0.25 respectively). In total, hematocrit level decreased by 4.5% and blood transfusions was done in 3 patients. Postoperative complications developed in 9 cases in both groups (according to the Clavien-Dindo classification, all complications were grade I-II). The stone-free rate (SFR) was 87.2%, and a second-stage was required in 2 cases. DISCUSSION: The use of ultrasound guidance improves visualization of the collecting system and contributes to the creation of an optimal renal access. It significantly reduces the radiation exposure to the patient and the operating team. We were able to puncture the collecting system in all cases. SFR after PCNL under ultrasound guidance was 88.6%, which is comparable to the results of conventional PCNL with X-ray navigation. CONCLUSION: PCNL can be performed effectively and safely under ultrasound guidance, which reduces the number of renal punctures and lowers the complication rate. However, this technique also has disadvantages, including longer puncture time in morbidly obese patients without hydronephrosis. With growing experience, the number of unsuccessful kidney punctures decreases, as well as operative time. The use of fluoroscopy during dilatation of the nephrostomy tract allows for preventing additional injuries of the collecting system.

[Open and laparoscopic Boari distal ureteroplasty technique: a comparative analysis of efficiency and safety].

INTRODUCTION: Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis. OBJECTIVE: to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches. MATERIALS AND METHODS: In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months. RESULTS: Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period. CONCLUSION: Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.

[Experience of using fosfomycin for the treatment of acute uncomplicated cystitis in women in postpartum period].

AIM: To determine whether fosfomycin can be used in treatment of women with acute uncomplicated cystitis in the postpartum period. MATERIALS AND METHODS: The results of treatment of acute uncomplicated cystitis in 51 patients in the postpartum period were retrospectively evaluated. All patients received a single dose 3 g of fosfomycin. RESULTS: In order to determine clinical efficiency, in all cases laboratory tests were performed prior to and 3 days after treatment. A degree of pain syndrome, the number of voids and urgent episodes were also evaluated. Urine culture was studied before and 7 days after taking fosfomycin. There was a decrease in the number of leukocytes and erythrocytes in urine, number of voids, including urgent episodes. A normalization of urine flora after a single dose of the fosfomycin was noted. DISCUSSION: In our research in the repeated analysis of urine culture, the number of bacteria was lower than 104 in all cases, and there was also decrease in the number of voids and intensity of pain syndrome. CONCLUSION: The treatment of acute uncomplicated cystitis in women in the early postpartum period has its own characteristics. A single dose of fosfomycin allows to avoid long-term use of the antibiotic and to continue breastfeeding, which is required for the treatment of this disease in lactating women. One of the medicine used in AAC is Fosfomycin Esparma, which has a high safety profile. The use of high-quality antibacterial therapy in these patients to give possibility to avoid complications.

[The impairment of the blood flow in renal parenchyma in patients with urinary stone disease after different treatment methods].

Disturbances of urinary flow result in an increase in intrapelvis pressure and a decrease in the kidneys ability to filter urine. The impairment of the blood flow in renal parenchyma represents one of the causative factors. Compensatory mechanisms in case of prolonged occlusion include collecting system dilation as well as pyelorenalis reflux. These changes lead to urine circulation via glomerular and tubular apparatuses, the interstitial tissue and lymphatic vessels and lead to the pyelovenous reflux. The results of studies dedicated to impairment of blood flow in the kidney parenchyma during the ureteral occlusion and in different types of the surgical treatment of urolithiasis are presented in the article.

[Time to recurrence after complete removal of calculi from different parts of the urinary system. five-year follow-up study].

INTRODUCTION: The usage of minimally invasive technologies (MIT), such as: extracorporeal shock wave lithotripsy (ESWL), transurethral ureterolithotripsy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PNL), allows to remove the stones from the calyx and pelvis system with 71- 96% of patients, and those from the ureter in 96.2% cases. However, a high incidence of stone recurrences (35-75%) demands the necessity of repeated lithotripsies and the search of the most appropriate methods of lithotripsy for reduction this indicator. The main goal. To determine the number of patients with recurrence of stone formation during five years after different types of lithotripsy in different parts of the urinary system. MATERIALS AND METHODS: The results of the process were analyzed with 491 patients, who had been devided into two groups: group I - 358 patients suffering from the concrements of the ureter; group II - 133 patients having stones in kidney. RESULTS: According to the age criterion, the sample data did not differ from each other (50 years for both groups (p=0.576). The initial number of lithotripsies with complete removal of stones was 80.7% in group I and 70.7% in gr. II, the repeated lithotripsy with usage of the same method was 5.9% and 12.8%, respectively. The usage of an additional method in repeated lithotripsy was necessary in 13.4% and 16.5% of cases respectively. There were differences between the sizes of stones in groups (p<0.0001), besides both groups showed the difference in recurrence time of stone formation (p=0,014). In gr. I weak negative correlation (-0.28) between age and time of recurrence was revealed. The age difference between men and women in both groups (p=0.00001 and p=0.0492, respectively) was found. There occurred differences in the size of stones in men and women groups (p=0.0000001 and p=0.0000001, respectively) and in the time of recurrence between men and women in I gr. (p=0.043). Most of stones were compose of CaOx, the second most important element was Uric Acid. All this testifies to peculiarities of the diet in the region of residence of the patients under control - the Republic of Bashkortostan, where people generally use meat and milk products. DISCUSSION: The usage of MIT opened the possibility of complete stone removal from the urinary system with the most sparing technique. The lithotripsy of stones with any composition having been conducted, additional stone crushing is carried out with 21-59% of patients within 5 years. The investigation of patients detected a great number of recurrences of stones in the kidney stones group. CONCLUSION: 1. After lithotripsy the recurrences during two years did not exceed 4,2% with patients in gr. I and 8,2% in gr. II patients. 2. Significant dependence of recurrent stone formation of gender composition was identified in gr. I and the time of recurrence was less in women. 3. The quantity of CaOx urolithiasis corresponds to global indicators. However, a large number of stones with Uric Acid in the composition indicates possible peculiarities of the patients diet. 4. The highest number of recurrences were in patients with CaOx (42.3%) and CaOx with CaF in the composition (23.1%), and in third place were patients with uric acid stones (19.2%).

[Experience with radical surgery for muscle-invasive bladder cancer in patients with end-stage chronic kidney disease].

The article outlines the experience with radical surgical treatment of muscle-invasive bladder cancer in two patients with dialysis-dependent end-stage chronic kidney disease. The authors describe diagnosis and surgical technique in this category of patients.

[MARKERS OF KIDNEY DAMAGE AND NEPHROPROTECTIVE THERAPY IN RADICAL CYSTECTOMY].

The comparative analysis of changes of the functional (osmolar clearance and fractional excretion of urea) and structural (NGAL, ß2-microglobulin in the blood plasma, and NGAL, ß2-microglobulin, microalbumin in the urine) biomarkers of kidney damage before and at various stages after radical cystectomy was performed. The study included patients with T2N0M0 stage bladder cancer. The main group consisted of 37 patients receiving nephroprotective treatment (N-acetylcysteine), the comparison group--31 patients receiving background therapy. It was revealed that severity of kidney dysfunction and the incidence of chronic kidney disease in the long-term period after surgery decreased in the main group.

[Effects of indol-3-carbinol and epigallocatexin-3-gallate on alteration and reparation in affected urethra of experimental animals].

The effects of indol-3-carbinol and epigallocatexin-3-gallate on alteration and reparation in the urethra were studied in 30 male Shinshilla rabbits. From the observation day 2 the rabbits were fed with indol-3-carbinol and epigallocatexin-3-gallate in addition to standard diet. Microcirculation was assessed with a laser analyzer of capillary circulation LAKK-01 which detected earlier recovery of microcirculation in the group of the animals fed with indol-3-carbinol and epigallocatexin-3-gallate. Thus, antioxidant and antiproliferative properties of indol-3-carbinol and epigallocatexin-3-gallate improve alteration and reparation in affected urethra due to development of soft elastic connective tissue with better capillary circulation.

[Thickening phalloplasty with application of allogenic transplant].

Sixteen patients have undergone thickening phalloplasty with allogenic transplant alloplant. As the result of phalloplasty penis thickness increased by 16.7%. Fifteen (93.8%) patients were satisfied with a new size of the penis, one patient (6.3%) was disappointed. Three patients had infectious complications. The transplant showed excellent engraftment. Thus, allogenic transplant alloplant is an appropriate biomaterial for thickening phalloplasty.