[Development of purulent-destructive forms of acute pyelonephritis in patients with a history of new coronavirus infection Covid-19].

INTRODUCTION: Since 2019, more than 600 million cases of the new coronavirus infection Covid-19 have been reported worldwide. According to various studies, the development of a systemic inflammatory response and "cytokine storm" play an important role in the pathogenesis of kidney damage, which leads to impaired microcirculation, increased thrombus formation and the development of ischemic areas in the parenchyma. AIM: To study the frequency and possible causes of purulent forms of pyelonephritis in patients who have had a new coronavirus infection Covid-19. MATERIALS AND METHODS: The prospective and retrospective study included the results of 403 patients with acute non-obstructive pyelonephritis in the pre-Covid period and those with a history of a new coronavirus infection. RESULTS: In patients with acute non-obstructive pyelonephritis without past urological history who had a new coronavirus infection, an increase in purulent-destructive forms from 5.0 to 17.0% was noted. One of the reasons is increased antibiotic resistance and the emergence of pan-resistant uropathogens due to irrational use of antibacterial drugs. CONCLUSION: The use of reserve antibacterial drugs in patients with acute pyelonephritis as empirical therapy and anticoagulants in order to improve microcirculation and prevent thrombosis is pathogenetically justified.

[The influence of pyelovenous reflux on the development of acute pyelonephritis in an experimental model].

INTRODUCTION: currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux. THE PURPOSE OF THE STUDY: to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora. MATERIALS AND METHODS: 32 mature female rabbits of the "White Giant" breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3. RESULTS: Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3. CONCLUSIONS: pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.

[Efficacy and safety of intermittent catheterization for acute urinary retention: a prospective comparative randomized study].

OBJECTIVES: of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events. MATERIALS AND METHODS: 129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently. MAIN OUTCOME MEASURES: Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed. RESULTS: Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) - within 2 days, and in 13 (50%) - within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patients age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I. CONCLUSION: Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patients social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.

[Mean features of the nephron- sparing surgery in older patients with localized renal cell carcinoma].

BACKGROUND: Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients. OBJECTIVE: To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients MATERIALS AND METHODS: From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula. RESULTS: Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients from 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4-66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months. CONCLUSION: Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.

[The problem of antibiotic resistance in patients with urinary tract infection].

OBJECTIVE: To analyze the incidence and resistance of microorganisms to antibacterial drugs isolated in urine cultures of patients with urinary tract infections from 2012 to 2019. MATERIALS AND METHODS: In the Pirogov City Clinical Hospital No1 and in the Bauman City Clinical Hospital No 29 analyzed the results of 15083 urine cultures in 12554 patients from 2012 to 2019. RESULTS: Enterococcus faecalis (41%), Escherichia coli (36.4%), Klebsiella pneumonia (23.4%) and Proteus mirabilis (7.6%) predominate in the occurrence of complicated UTIs. the number of strains resistant to certain groups of antibacterial drugs increased: mesitillin-resistant staphylococci (+ 4%), producers of -lactamases (+ 19.8% (for E. coli) and + 34.7% (for Klebsiella pneumoniae)), vancomycin-resistant enterococci (+ 1.89%), carbapenemase producers (+ 32.9%). A high level of resistance among Enterococcus faecalis strains to ciprofloxacin (23.1%) and gentamicin (38.4%) was revealed. Among strains of Escherichia coli, an increase in resistance to ampicillin (85.7%), ceftazidime (66.7%), ciprofloxacin (54.1%) and nitrofurantoin (42.9%) was noted. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, there is a significant increase in resistance to all antibacterial drugs used. Separately, one can note a sharp (27.1%) increase in resistance to carbapenems. A high level of resistance was found in Proteus mirabilis to ciprofloxacin (66.7%), ampicillin (75%). There is an increase in resistance of Pseudomonas aeruginosa to ciprofloxacin (66.7%), meropenem (50%). There is a high level of resistance for Acinetobacter baumannii to amikacin (94.9%), imipenem (92.3%), ceftazadime (100%), ciprofloxacin (100%), tigecycline (53.6%). Relatively high sensitivity remains to polymyxin E (88.9%). CONCLUSIONS: The results of our analysis demonstrate a rapid increase in resistance to most antibacterial drugs among community-acquired and hospital-acquired strains.