[Sacral magnetic stimulation in overactive bladder syndrome: comparative analysis of protocols with a frequency of 1 and 5 Hz]. / Sakral'naya magnitnaya stimulyatsiya pri sindrome giperaktivnogo mochevogo puzyrya: sravnitel'nyi analiz protokolov s chastotoi 1 i 5 Gts.

Peripheral magnetic stimulation (pMS) has shown its effectiveness in the treatment of lower urinary tract symptoms, such as symptoms of an overactive bladder (OAB). The perineal region (pelvic floor) and the sacral roots area (projection S3 of the root) are used as the locus of stimulation. The published literature presents protocols with different parameters of stimulation, while each of them reliably demonstrates clinical efficacy, however, no comparative studies have been found to select priority stimulation modes when analyzing available sources. OBJECTIVE: To compare the efficacy and safety of different frequency - 1 and 5 Hz - modes of sacral MS in patients with symptoms of OAB. MATERIAL AND METHODS: A single blind prospective randomized comparative clinical study included 59 patients with OAB symptoms. The patients were divided by simple randomization into the group 1 (n=30), which received MS 3 times a week for 5 weeks with a frequency of 1 Hz per sacral root area (S2-S4), and the group 2 (n=29), in which stimulation was performed at a frequency of 5 Hz, while the remaining parameters and duration of therapy were identical to group 1. RESULTS: Sacral pMS with different frequency modes (1 and 5 Hz) is reliably equally effective against the clinical symptoms of OAB, which is confirmed by the absence of significant intergroup differences. In patients receiving MS with a frequency of 5 Hz, there was a more pronounced increase in maximum cystometric capacity, normalization of the maximum and average urine flow velocity and regression of the residual urine volume (p<0.001, p=0.007, p=0.011 and p=0.012 compared with group 1). The greatest difference in indicators was observed in the increase in the maximum cystometric capacity - +31±25 ml at MS with a frequency of 1 Hz and +109±96 ml at MS with a frequency of 5 Hz (p<0.001). MS is a safe procedure and is well tolerated by patients. CONCLUSION: pMS when exposed to the area of S2-S4 roots for 20 minutes 3 times a week with a course for 5 weeks is reliably effective against the clinical symptoms of OAB at different frequency modes (1 and 5 Hz). At the same time, MS with a frequency of 5 Hz may have an advantage over stimulation of 1 Hz in terms of its effect on urodynamic parameters (maximum cystometric capacity, peak and average urine flow velocity and residual urine volume), which may be associated with a large inhibitory effect on detrusor.

[Vaginal access pelvic organ prolapse repair at the high-volume center: evolution of implants from XL to XS].

INTRODUCTION: The use of large vaginal meshes for the treatment of pelvic organ prolapse (POP) combined with insufficient surgeon experience are the important risk factors for serious postoperative complications. AIM: To find the most safe and effective method of surgical treatment of POP. MATERIALS AND METHODS: To evaluate the efficiency of surgical techniques, a retrospective study of 5031 medical records from an electronic database was carried out. As the primary endpoint, we assessed the duration of the procedure, the volume of blood loss and the length of stay. As a secondary endpoint, the number of intra- and postoperative complications was assessed. In addition to objective data, we assessed subjective measures using the validated PFDI20 and PISQ12 questionnaires. RESULTS: The best results in terms of blood loss were shown by unilateral hybrid pelvic floor reconstruction and three-level hybrid reconstruction (33+/-15 ml and 36+/-17 ml, respectively). Patients who underwent the three-level hybrid pelvic floor reconstruction technique had the highest result: 33+/-15 points of the PISQ12 questionnaire, 50+/-28 points of the PFDI20 questionnaire, which was significant in comparison with other techniques (p<0.001). The number of postoperative complications was also significantly lower for this procedure. CONCLUSION: Three-level hybrid pelvic floor reconstruction is a safe and effective technique for the treatment of pelvic organ prolapse. In addition, this procedure can be done in a specialized hospital with the appropriate skills of surgeons.

[Safety of mesh with fluoropolymer coating during intra-abdominal placement in large animals: results of the pilot study]. / Bezopasnost' setchatykh endoprotezov s ftorpolimernym pokrytiem: rezul'taty pilotnogo issledovaniya.

OBJECTIVE: When performing laparoscopic intraperitoneal hernioplasty (IPOM), endoprostheses made of fluoropolymers are often used. However, there is no data in the literature on the intra-abdominal use of inexpensive polyester prostheses with a fluoropolymer coating compared to composite implants. Thus, the aim of the pilot study was a preliminary assessment of the safety profile of FTOREX mesh endoprostheses during intra-abdominal placement in large animals. MATERIAL AND METHODS: 6 endoprostheses were installed laparoscopically intraperitoneally in each of the 3 pigs: 1) FTOREX; 2) FTOREX with a layer of carboxymethylcellulose; 3) REPEREN-16-2; 4) SYMBOTEX; 5) VENTRALIGHT ST; 6) decellularized pork peritoneum. Fixation was performed with a herniator, transfascial sutures were not used. Relaparoscopy was performed after 45 days, and withdrawal from the experiment was performed after 90 days. Performance characteristics, signs of deformation and retraction, parameters of spike formation were evaluated. RESULTS: All the animals survived, no complications were observed. There were no clinical manifestations or behavioral reactions indicating the presence of adhesions. The most convenient to use were the SYMBOTEX and FTOREX implants (5.0 points each). By the end of the experiment, deformation and retraction were noted in both variants of the FTOREX implants and the REPEREN prosthesis. These changes were completely absent only when using the SYMBOTEX endoprosthesis. According to the number of implants with adhesions, by the end of the observation, both variants of FTOREX prostheses occupied an intermediate position between the Reference (the worst indicator) and VENTRALIGHT ST (the best indicator). However, both FTOREX endoprostheses showed the best performance among all implants in the integral assessment of adhesions, as well as in terms of parameters such as the area and appearance of adhesions, and in terms of the strength of the joints, they were second only to the VENTRALIGHT ST endoprosthesis (0.67 vs. 0.5 points). During the study, there was no reliable dependence of deformation, retraction and adhesion formation indicators on the type of implant. CONCLUSION: The results of the pilot study showed that all the implants used did not cause any clinically significant adverse reactions or complications. FTOREX endoprostheses with their intraperitoneal installation have anti-adhesive properties that are not inferior to VENTRALIGHT ST or SYMBOTEX composite implants. However, having less rigidity, they are more often deformed and subjected to retraction.

[Histological changes in intraperitoneal onlay mesh (IPOM) with synthetic and biological meshes. Results of the chronic experiment]. / Gistologicheskie izmeneniya pri intraperitoneal'noi plastike (IPOM) sinteticheskimi i biologicheskimi endoprotezami. Rezul'taty khronicheskogo eksperimenta.

OBJECTIVE: The objective of the study was to analyze histological changes in the site of the meshes FTOREX, FTOREX coated with carboxymethylcellulose, Ventralight ST, Symbotex, REPEREN-16-2 and decellularized porcine peritoneum on the parietal peritoneum of the pig. MATERIAL AND METHODS: At laparoscopy, 6 different meshes were placed intraperitoneally in each of the 3 pigs. After 90 days, the animals were taken out of the experiment. After staining with hematoxylin and eosin, quantitative morphometry and counting the number of vessels and cells in the interstitium in the areas of the mesh and peritoneum were performed. An immunohistochemical study with an antibody to pancytokeratins assessed the state of the initial peritoneum and neoperitoneum. RESULTS: According to morphological characteristics, the meshes were divided into 3 groups: 1) with fluoropolymer coating FTOREX, 2) Ventralight ST and Symbotex, 3) REPEREN and decellularized peritoneum. In group 1, the surface area of the mesh threads was optimal in terms of the arrangement and arrangement of the threads relative to each other. This contributed to the formation of a relatively dense fibrous framework and a place to preserve the underlying peritoneum involved in the formation of the neoperitoneum. Despite the smallest surface area of the threads, in group 3, the greatest fibroblastic reaction was noted. Inflammatory changes were the least pronounced in group 1. They were the greatest in group 3, where there was a pronounced leukocyte reaction, combined with the processes of metaplasia, the development of fibrinoid necrosis, and the progression of the secondary inflammatory process. In group 1, the optimal ratio of newly formed vessels was noted, in group 2 - veins prevailed over arteries, in group 3 - the number of vessels was minimal. Immunohistochemical study showed that in group 1, mesothelial cells covered almost the entire surface of the implant, and there were also areas of preserved basic peritoneum. In group 2, mesothelium also covered most of the surface of the meshes, but the underlying peritoneum was absent. In group 3, on the contrary, a significant number of extended areas not covered with mesothelium were revealed. CONCLUSION: The conducted morphological and morphometric study showed that the most balanced ratio of the components of the newly formed fibrous tissue and blood vessels is observed when using implants with a fluoropolymer coating FTOREX. At the same time, the remaining basic peritoneum actively participated in the formation of the neoperitoneum. The Ventralight ST and Symbotex meshes also contributed to the formation of a full-fledged fibrous tissue and adequate vascular proliferation, however, they prevented the preservation of the underlying peritoneum, which practically excluded its participation in the formation of the neoperitoneum. The REPEREN mesh and decellularized porcine peritoneum led to the least balanced cell and vascular proliferation and the greatest fibroplastic reaction, which could further negatively affect the state of the formed scar.

[Challenges in the clinical diagnosis and treatment of encrusted cystitis].

Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.

[Cellular regulation of the lower urinary tract as a cause of the bladder overactivity and reduced efficiency of pharmacotherapy].

Overactive bladder (OAB) is a polyetiological nosology. Its symptoms are often characterized not only with detrusor hyperactivity, but also with the increased sensitivity of afferent fibers, which is clinically manifested as urgency. In addition, the disorders at the level of receptors expression and the synthesis of mediators lead to the development of bladder pain syndrome (BPS), which also significantly reduces the quality of life of patients. In recent years, the experimental animal studies achieved significant progress in understanding of the pathogenesis of lower urinary tract dysfunction. In particular, the broad understanding of the sensor properties of urothelium was obtained, which significantly increased the popularity of the urothelial theory of the development of idiopathic detrusor hyperactivity, as well as hypersensitivity and bladder pain. According to this theory, the pathological release of biologically active substance in the transitional epithelium in response to an extension of the bladder wall leads to clinical manifestations of the described conditions. In addition, due to the studies of the properties of receptors, ion channels, and mediators, the suggestion about the reduced efficiency of muscarinic receptor antagonists have been made in a large number of patients. Besides the acetylcholine control of the lower urinary tract, more and more attention is paid to other significant mechanisms of pathological conditions. The purpose of this part of the lecture is to systematize the available materials of basic research on the functioning of the lower urinary tract at the cellular level, as well as the mechanisms of action and questions of the effectiveness of pharmacological therapy for urinary disorders.

[Characteristics of the neural regulation of the lower urinary tract as a cause of the development of an overactive bladder: current state of the problem].

An overactive bladder (OAB) is a constellation of lower urinary tract symptoms, including urgency, increased frequency of urination during the day and/or night (nocturia), and, in some cases, urge incontinence. This syndrome can be caused by different conditions, and currently no universal pathogenetic treatment has been developed. In addition, there are virtually no Russian-language publications providing information on the neurophysiology and neuroanatomy of the lower urinary tract. At the same time, the importance of this topic can hardly be overestimated. Often, a patient with a neurogenic dysfunction of the lower urinary tract has different comorbidities, which requires to deeply understand the mechanisms of development of certain symptoms. Considering an absence of clear data about the peripheral bladder innervation, role of the structures of the central nervous system and importance of neurotransmitters, it is rather difficult to provide high-quality specialized care. However, in recent years, a lot of new facts and theories have been described in basic researches. This lecture is dedicated to the current data on the pathogenesis of OAB. The purpose of the lecture is to summarize the results of fundamental and clinical studies on the pathogenesis of OAB.

[Metaphylaxis of urolithiasis: new look, modern approach, implementation in a mobile application].

AIM: To analyze the sub-segment of mHealth devoted to assessing of the risk of recurrent stone formation and metaphylaxis of stone formation. To design a smartphone application (app.) in Russian language for urolithiasis patients. MATERIALS AND METHODS: Three working groups of urologists from three St. Petersburg clinics searched for downloadable medical applications relevant to the above requirements. After searching and analyzing existing medical applications, the most acceptable design and structure of our own application were identified. RESULTS: The developed "Urolithiasis" application is available for free download in Russian language versions in App Store (Apple, Inc.) and Google Play (Android market, Google, Inc.). It features the following sections: 1) "Take the test" (personalized calculation of the risk of kidney stone recurrence and providing relevant recommendations using ROKS nomogram), 2) "Water" (with reminders to drink water and automatic logging of the water intake), 3) "Food" (Nutrition facts on the content of calcium, oxalate, purine, protein, citrate and calories in common foods), 4) "My doctor" (in the future this option will allow for on-line communication with a patients physician), 5) "Feedback" (if the patient does not find the desired product or has a question - this section is for him/her). CONCLUSIONS: The smartphone application "Urolithiasis" in Russian may be recommended to patients with urolithiasis for improving the effectiveness of metaphylaxis.

[Functional results of partial nephrectomy for kidney tumors].

The aim of the investigation was to analyze functional results of organ-sparing operations using radioisotopic method in combination with the investigation of serum creatinine in 31 patients. The data obtained suggest that the functional results of organ-sparing operations for neoplasms of the kidney directly depend on the time of warm renal ischemia. Warm ischemia about 15 minutes long is able to result in an ultrastructural damage of the nephron and decreased filtration level by 20-30%. A sudden change of serum creatinine on the next day after operation can be taken as a long-term prognostic factor of the kidney function. If the suggested time of stopped renal blood flow is more than 10-15 minutes, local hypothermia is advisable to protect the kidney.