[The use of laser doppler flowmetry to assess the microcirculation of the kidney before and after percutaneous nephrolithotomy].

AIM: To evaluate intraoperative changes in renal microcirculation during percutaneous nephrolithotomy (PCNL), as well as its dynamics in the early postoperative period. MATERIALS AND METHODS: A total of 240 patients treated in the Urology Clinic of the Saratov State Medical University in 2021-2022 were included in the study. All patients underwent PCNL. In the first group (n=105) the standard PCNL through 30 Ch access was done. In the second group (n=135), the procedure was performed through an access of 16 Ch. Intraoperatively, intrapelvic pressure was evaluated according to the authors method, which consists in direct measurement in the collecting system during the procedure, allowing for a faster and more accurate assessment. Prior to surgery, Doppler mapping of the renal blood flow was performed, and indirect registration of the microcirculation index (MCI) was done directly on the operating table using laser Doppler flowmetry (LDF). The diagnostic study was performed at the point of intersection of the 12th rib and the psoas muscle, both on the ipsilateral and contralateral side. In addition, during the procedure, a registration of MI of the mucosa of the calyceal fornix accessible in the direct vision through the access tract for 4 minutes was carried out twice. RESULTS: The index of microcirculation (IM) in the fornix of the upper calyx before the fragmentation of the stone in the 1st group of patients was 26.67+/-4.7 pf.u. compared to 25.4+/-5.9 pf.u. in the second group. At the same time, the value recorded on the skin was 13.08+/-1.2 pf.u. in the first group compared to 13.1+/-0.77 pf.u. in the second group (p>0.05). During the initial registration, the PM immediately after stone fragmentation was 19.5 +/- 1.2 pf.u, while on the overlying skin it was 11.2 +/- 0.9 pf.u. In the contralateral kidney area, IM was 10.2+/-0.9 pf.u. In the case of an intraoperative increase in intrapelvic pressure, IM was 22.3+/-1.6 pf.u. compared to 12.1+/-0.7 pf.u on the skin. The dynamics of IM on the skin tended to further decrease and returned to normal values of 10.3 +/- 0.7 pf.u on the 3rd day. When intraoperative intrapelvic pressure exceeded the normal value, IM by the 5th day was 10.1+/-0.4 pf.u. When determining the correlation of IM with RI of the ipsilateral kidney, a direct moderate correlation was revealed (r=+0.516). CONCLUSION: The measurement of microcirculation in the intra- and postoperative period allows to assess changes in the intrarenal microcirculation both directly and indirectly. This method can be used as an additional tool for assessing obstructive changes and the activity of pyelonephritis. A significant correlation between IM and RI indicates that functional changes in the renal and skin microcirculation tend to develop simultaneously.

[The efficiency of combined regimens for the treatment of urinary tract infections in women using the herbal drug Canephron N].

INTRODUCTION: Currently, empiric antibiotic therapy is considered the standard for acute cystitis. However, additional treatment may be required to alleviate the patient's condition and shorten the time to subjective recovery. AIM: To evaluate the efficiency of the combined administration of fosfomycin trometamol and herbal drug Canephron N in comparison with a single oral dose of fosfomycin trometamol in women with uncomplicated bacterial cystitis. MATERIALS AND METHODS: A randomized, comparative, open-label study was carried put between January 2018 and June 2019. The study included 112 women with symptoms of acute uncomplicated cystitis, who were randomized between two groups in a 1:1 ratio. In the main group, patients received a single oral dose of fosfomycin in combination with Canephron N (2 tablets t.i.d. for 2 weeks), while in the control group patients received only a single dose of fosfomycin (3 g). Symptoms were assessed using the Russian version of the Acute Cystitis Symptom Score (ACSS), completed daily for a week. Also, all patients underwent urine analysis on the 1st, 3rd, 5th and 7th days of therapy. The mean time to complete recovery based on the ACSS questionnaire and the time to resolution of pyuria were compared using the Mann-Whitney U test. Comparison of the proportion of patients with complete cure, according to the questionnaire, or with the elimination of pyuria was carried out using the chi-square test. RESULTS: The final analysis included 46 patients who received fosfomycin in combination with Canephron and 47 patients who received fosfomycin as monotherapy. In the group of combination therapy, patient-reported complete recovery (assessed by the ACSS questionnaire) was seen on average after 1 day, while in patients treated with monotherapy, the median time to subjective recovery was 3 days (p=0.00012). A significant difference between the groups in the proportion of patients with complete resolution of symptoms of acute cystitis was observed on days 1, 2, and 3 (p<0.05). The therapy was well tolerated in both groups. The most frequent adverse events were dyspepsia (8.7% in the combination group compared to 6.4% in the control group) and headache (in 4.3% and 6.4% of patients, respectively). CONCLUSION: the combined use of fosfomycin trometamol and the herbal drug Canephron N allows to reduce the duration of symptoms in patients with acute cystitis, thereby accelerating return to their usual lifestyle patterns.

[Erectile function after corporoplasty in patients with peyronies disease].

PURPOSE: To evaluate erectile function in patients with Peyronies disease (PD) who underwent corporoplasty. MATERIALS AND METHODS: A total of 374 patients who underwent corporoplasty by a single surgeon during 1996-2016 were analyzed. In all cases IIEF questionnaire was evaluated pre- and postoperatively. Intracavernous injection test and penile doppler ultrasonography were performed if required. Median follow-up was 9.5 years. Analysis of risk factors for erectile dysfunction (ED) before and after corporoplasty was performed. RESULTS: Prevalence of risk factors for ED in our sample has greatly increased during follow-up. At the last follow-up visit 285 patients were sexually active. Evaluation of patient satisfaction with the quality of erections has shown that 139 patients were fully satisfied (48.8%), 84 patients were somewhat satisfied (29.5%) and 62 patients were not satisfied with their erectile function (21.7%). According to IIEF questionnaire, 105 patients (36.8%) had no ED (> 26 points); 74 patients (26%) had mild ED; 67 patients (23.5%) had mild-to-moderate ED; 21 patients (7.4%) had moderate ED; and 18 patients (6.3%) had severe ED. However, a causal relationship between ED and treatment of Peyronie's disease was found not in all cases. Seven patients had infrequent sexual intercourse (1-2 per month) and 50 patients had no sexual activity. DISCUSSION: At long term after corporoplasty some patients experience ED, though causality between ED and PD treatment couldnt be confirmed in all such cases. It should be noted that we have found an increase in prevalence of independent risk factors for ED during follow-up period. These patients could possibly benefit in terms of quality of life if they underwent penile prosthesis placement during primary surgical treatment for PD. However, some patients had no sexual activity due to causes unrelated to ED. CONCLUSION: Not all patients with PD are satisfied with their sexual functioning after corporoplasty. However, ED after surgical management of PD is not always a consequence of surgery itself.

[The role of drug therapy in the management of varicocele].

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

[A look at the problem of surgical treatment of renal cel carcinoma in the aspect of biomolecular diagnosis and assessment of renal function].

The article reviews the domestic and international literature on the issues of biomolecular diagnosis of acute renal injury in the perioperative period in patients with renal cell carcinoma (RCC). Emerging opportunities for early detection of tumors make even more relevant the use of minimally invasive interventions. Of equal importance is the assessment of renal function in patients with diagnosed RCC and the prediction of acute renal injury and progression of chronic kidney disease in the postoperative period. The authors performed a systematic search for preclinical and clinical studies to identify the main trends and achievements in the field of biomolecular diagnosis of RCC and renal injury allowing the individual approach to choosing surgical treatment, improve the survival and quality of life of the patient and improve the functional state of the renal parenchyma.

[Salvage external beam radiation therapy for prostate cancer recurrence after high-intensity focused ultrasound ablation].

The article outlines oncological and functional outcomes of salvage external beam radiation therapy after HIFU-ablation in 49 patients. The study determined overall and relapse-free survival, compared the rates of adverse events stratified by CTCAE, erectile function and continence scores assessed by questionnaire survey. Univariate and multivariate analysis of risk factors for failure of salvage radiation therapy after prostate HIFU-ablation were conducted. In univariate analysis the level of prostate-specific antigen (PSA) prior to radiotherapy, the risk group, PSA nadir after radiotherapy, PSA nadir greater than 0.2 ng/mL and the time to nadir after salvage therapy were predictors of failure. There were no serious gastrointestinal side effects. The most frequent urinary adverse event was urgency. The difference in the rates of urinary incontinence before and 1 year after radiotherapy was not statistically significant. The study confirmed the appropriateness of radiotherapy after HIFU-ablation. Radiation therapy can be considered as a treatment option for prostate cancer recurrence after HIFU-ablation.

[The influence of alternating magnetic field on in vitro litholysis of uroliths in blemaren water solutions].

THE AIM OF THE RESEARCH: increase of efficiency of urolith in vitro solution using water Blemaren medication solutions after their exposure to 2 Hz alternating magnetic field. MATERIALS AND METHODS: water solution of Blemaren medication with pH=6,15 in concentrations corresponding to single portion of medication (1 tablet m=3,5282 g per 250 ml of water) and uroliths (oxalates, urates including uncommon xanthine calculi). Composition of calculi was determined by means of X-ray tests and IR spectroscopy. Photometry of Blemaren with saluted portion of calculi was conducted. RESULTS: it was established that in the Blemaren solutions which had been previously exposed to 2 Hz alternating magnetic filed during one hour the solution process is 1.92 - 2 times more effective than in common water solutions. Discussion - in control solutions pH values increased 5.65 - 6.8 times in the course of time, whereas in the Blemaren solutions exposed to alternating magnetic field pH values remained virtually unaltered during the whole experiment. CONCLUSION: there were detected significant differences in pH values of Blemaren solutions and its solvent properties between solutions which were exposed to alternating magnetic filed and those which were not.

[Three-year results of the treatment of localized prostate cancer using high-intensity focused ultrasound].

The study was aimed to the assessment of the effectiveness of treatment for prostate cancer using high-intensity focused ultrasound on the basis of clinical, radiation, laboratory data, and results of morphometric and immunohistochemical study of postoperative prostate biopsies. 112 sessions of HIFU-ablation of the prostate in 112 patients with localized prostate cancer were performed. Average number of impulses of action--634 +/- 176, the average volume of tissue exposed--34.6 +/- 15.2 cm3 per 1 session. The operative time ranged from 90 to 165 min (mean 125 min). The postoperative hospital stay ranged from 7 to 14 days (average 10 +/- 0.8 days). Intraoperative complications during HIFU-ablation were not observed. The average level of prostate-specific antigen 1,5 months after surgery was 0.7 (0.12-3.67) ng/ml. Minimum level of prostate-specific antigen was reached 20 +/- 2 weeks after treatment, and the average level was 0.26 +/- 0.01 ng/ml. 6 months after, prostate volume decreased by an average of 49%; 10-12 months after intervention, prostate volume was 6.5 +/- 2.2 cm3. Morphological analysis after treatment included studies with standard and immunohistochemical staining using the following antibodies: PCNA, Bcl2, AMACR, E-cadherin, ANDR. Recurrence-free course was observed in 96 (85.8%) patients. Recurrences were detected in 16 (14.2%) patients, with biochemical progression in 11 (9.82%) patients. Local recurrence (morphologically confirmed) was diagnosed in 5 (4.46%) patients.

[The treatment of prostatic adenoma by local hyperthermia]. / Lechenie adenomy predstatel'noi zhelezy lokal'noi gipertermiei.

A total of 116 patients aged 51-84 with prostatic adenoma were exposed to local hyperthermia (LHT) using "Thermex II" generator (Thechnorex, Israel). The analysis of the results involved 4 patient groups: group 1 (34 patients) had nycturia > 3 times, residual urine > 50 ml, uroflowmetry index > 8 ml/s; group 2 (47 patients) had marked symptoms, nycturia < 3 times, residual urine < 50 ml, uroflowmetry index 3-7 ml/s; group 3 (2 patients) had cystostomy drainage; group 4 (2 patients) had acute uresis disorders. The response of the patients was registered by subjective complaints, residual urine, uroflowmetry index, pre- and after-treatment size of the prostate 1 and 6 months following a session of local hyperthermia. A positive effect was achieved in 70% of the patients. LHT proved effective in a compensated and subcompensated stages of the disease and in case of small-size adenoma nodes.