[Extravesical reimplantation of heavily-dilated ureters according to Bradi technique].

INTRODUCTION: Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented. MATERIALS AND METHODS: The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width. RESULTS: No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring. CONCLUSION: The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.

[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.

[Correction of incontinence during radical prostates-tomy].

Postoperative stress urinary incontinence has a significant effect on reducing the quality of life of patients undergoing radical prostatectomy. This review discusses the existing methods for correcting this condition, described in the world literature and which to one degree or another improve the quality of life of patients in this category. Analysis of present data shows that currently there are 4 main basic techniques during radical prostatectomy, which allow to statistically significantly improve of functional results. In particular, usage of this methodic allows reducing the frequency and degree of postoperative incontinence: 1) preservation of neurovascular bundles, 2) anterior and/or posterior reconstruction of the fascial spaces of the pelvis, 3) preservation of the maximum length of the membranous urethra, 4) reconstruction of the bladder neck. Preservation of the neurovascular bundles, anterior and/or posterior reconstruction of the pelvic fascial spaces have already proven themselves as effective techniques currently used by many surgeons. In contrast, the clinical utility of reserve the maximum possible length of the membranous urethra and reconstructive surgery of the bladder neck are relatively new techniques. Their clinical usefulness, as well as safety, continues to be studied.

[Morphological evidence of the ischemic nature of the prostatic fibrosis in the classical chronic pelvic pain syndrome / IIIB chronic prostatitis].

AIM: To examine the structure of the prostate tissue in patients with III B chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: The study analyzed transrectal fine-needle biopsy specimens of 10 patients with the verified diagnosis of chronic pelvic pain syndrome/category III B chronic prostatitis (CPPS/IIIB CP) according to the National Institutes of Health classification. Tissues were examined using light and electron microscopy, and immunohistochemical study of the expression of CD31, CD34, NSE and S-100 markers. RESULTS: All biopsy specimens of all patients showed fibroplastic changes of the prostate tissue most markedly pronounced in the stroma and muscle fibers in the form of total fibrosis, myofibril atrophy, and extracellular lipofuscin deposition. The examination revealed a significant reduction in the density of microcirculatory bed vessels and arteriolar luminal stenosis, a reduction in the number of nerve fibers, and compression of their fibrous tissue. No inflammatory changes were found in the prostate. DISCUSSION: In patients with CPPS/IIIB CP, the changes in the prostate at the microscopic and ultrastructural levels are characteristic of severe chronic tissue hypoxia, which leads to the development of fibrosis resulting in stenosis of microcirculatory bed vessels and degenerative changes in nerve fibers and cells. No signs of an inflammatory reaction in the examined tissue were established. CONCLUSION: Changes in the prostate tissue in CPPS/IIIB CP suggest the presence of chronic pelvic ischemia and exclude its association with inflammation as the main pathological process.

[Bacterial prostatitis: epidemiology and etiology].

Prostatitis is considered as heterogeneous group of the diseases attracting broad interest of researchers worldwide. The acute and chronic stages of the process, as particular categories of bacterial prostatitis, remain in the realities of modern practical and scientific urology with lively discussions. Despite a large number of domestic and international publications, consensus on many topical issues of bacterial prostatitis is currently not achieved. The true incidence and prevalence of bacterial prostatitis in various regions of the world has not been finally determined. The exhaustive data concerning the etiological structure, mechanisms of development and persistence of the inflammatory process in the prostate tissue are not presented. At the same time, new risk factors that can influence the development and progress of these diseases are identified and discussed. Researchers review algorithms for examining patients, obligate spectrum of diagnostic methods, as well as the desirability of using the newest investment means necessary for the successful verification of the diagnosis taking into account the development of modern medical technologies. This review describes in detail the various aspects of the epidemiology and etiology of bacterial prostatitis, based on an analysis of major literature sources in conjunction with its own scientific facts.

[The effiectiveness of extracorporeal shock wave lithotripsy in treating proxima ureteral stones].

Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of -blockers in stimulating residual stone clearance after ESWL. AIM: To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance. MATERIALS AND METHODS: ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. RESULTS: Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. CONCLUSION: Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

[Association of lower urinary tract symptoms and testosterone deficiency in men with type 2 diabetes].

INTRODUCTION AND OBJECTIVES: Type 2 diabetes mellitus, as a chronic systemic metabolic disease, is widely spread in the population of middle- aged men. Previously it has been proven the link between the presence of type 2 diabetes and the development of lower urinary tract symptoms in men. At the same time, middle-aged men are characterized by the appearance and progression of benign prostatic hyperplasia. MATERIAL AND METHODS: We performed a study of middle-aged men with type 2 diabetes to determine the interrelation of micturition disorders with deficiency of serum testosterone, in respect that the pathophysiology of prostatic hyperplasia is regarded as dysmetabolic dyshormonal state. The prospective study examined 112 men with type 2 diabetes randomized by the level of total testosterone. Lower urinary tract symptoms were assessed by I-PSS questionnaire. The study of serum total PSA, uroflowmetry, transrectal prostate ultrasonography were performed. RESULTS: As a result of the study the association between the severity of type 2 diabetes mellitus and the decrease in total testosterone levels was determined. The relationship of testosterone deficiency and the frequency of the presence and severity of lower urinary tract symptoms were demonstrated. The dependence of the prostate hyperplasia risks progression with the level of serum testosterone was found. CONCLUSIONS: The association of testosterone deficiency with frequency and severity of lower urinary tract symptoms, partially related with benign prostatic hyperplasia and clinically defined detrusor cistopathy, has been proven. Further clinical studies are needed to determine the pathophysiological and pathomorphological features of type 2 diabetes, which determines the development of detrusor cistopathy and late onset hypigonadism.

[Extracorporeal and contact lithotripsy for large ureteral stones].

Expert panels of AUA and EAU defined highly effective approaches to surgical treatment of ureterolithiasis and recommended extracorporeal and contact lithotripsy as the main options. Therapeutic strategy for ureteral stones measuring less than 10 mm is clearly defined and supported by the Russian Society of Urology. At the same time, the views of researchers on the management of large ureteral stones vary. This literature review provides information on the results of extracorporeal shock-wave lithotripsy and contact ureterolithotripsy of large stones located in various parts of the ureter. Besides, the article outlines the results of treating ureterolithiasis using the second line surgical modalities.

[Periprostatic inflammation as a risk factor for the development of vesico-urethral stenosis after radical prostatectomy].

This article presents results of a study conducted to identify the causes of stenosis in the region of vesico-urethral anastomosis (VUA) after radical prostatectomy (RP). Tissue specimens from removed prostates were evaluated in 115 prostate cancer patients with a favorable postoperative period (group 1) and 5 patients who develop VUA stenosis between 6 months to1 year after RP. It was found that in the group 1 inflammatory infiltration did not basically affect tumor growth zones, was mild and did not spread beyond the prostate. Patients of the group 2 had maximum inflammation, with the inflammatory infiltration localized in the prostate regions, both affected and not affected by the tumor, and periprostatically. Taking into account more severe inflammatory response in the prostate with extracapsular extension of the process and the involvement of periprostatic structures in patients who developed VUA stenosis after RP, compared to those without VUA stenosis, we can consider this phenomenon as a risk factor for stenotic complications in the vesico-urethral segment after RP.

[Penile dimensions in type 2 diabetes].

The current literature provides a wide range of publications on the anthropometry of the penis specifying the relationship between penile dimensions and sex hormones, weight, height and erectile function. But most of the studies involved healthy volunteers or young patients with erectile dysfunction. Our study was conducted in patients with type 2 diabetes. Penile measurements obtained in the present study were compared those of the average Russian man. The patients were divided into groups with preserved and impaired erectile function. Erectile function was also studied relative to the variability of penile dimensions. The effect of DM duration on erectile function was defined. Comparative analysis revealed the relationship between penile anatomical dimensions and erectile function. We studied the effect of type 2 diabetes on the anatomical dimensions and elasticity of the penis, established the relationship between penile dimensions and elasticity of the penis. The correlation between the severity of erectile dysfunction and serum testosterone levels on one side, and penile dimensions on the other was found. The effect of penile dimensions on erectile function in DM patients was also examined. Determining penile dimensions and their variability due to various pathological conditions or processes, may eventually lead to better result of ED management.

[The features of erectile dysfunction in type 2 diabetes and serum testosterone deficiency].

The current literature is lacking sufficient coverage of the relationship between erectile dysfunction (ED) and diabetes mellitus (DM), and age-related hypogonadism. At the same time, the mutual impact of cardiovascular and endocrine systems on men erectile function and the resulting damage of male sexual organs are being studied and debated. This prospective, randomized, simple comparative study examined the erectile function of 131 men with type 2 DM and age-related hypogonadism, tested the effects of DM on serum testosterone, formed an idea of possible relationship between DM, severity of ED and testosterone levels, degree of endothelial dysfunction and the involvement of the testicles. The study results showed the impact of testosterone level on the compensation of DM and frequency of ED. Correlations were observed between testosterone levels, peak systolic velocity of blood flow in the of capsular arteries of testes and testicular size. The interrelation between testicular size, reduction of testicular blood flow, and DM-related endothelial dysfunction and variability of serum testosterone levels was found. The findings suggest the need for revising existing reference ranges for serum testosterone upward to 15 nmol/L.

[Problems of testosterone deficiency and erectile dysfunction in men (literature review)].

In recent years, treatment of men with testosterone deficiency has become an important part of andrological and urological practice. Clinical manifestations of testosterone deficiency syndrome are usually diverse. Testosterone deficiency and erectile dysfunction often occur against the background of some systemic diseases, and sometimes are markers or predictors of these diseases. It is important that erectile dysfunction and testosterone deficiency syndrome are closely interrelated, and the correction of these conditions requires account of specific treatment of both diseases.

[The role of endothelial dysfunction in the pathogenesis of non-inflammatory form of chronic abacterial prostatitis].

The evaluation of some indicators of blood proteolytic systems and their role in the development of endothelial dysfunction in noninflammatory form of chronic prostatitis abacterial (CAP III B) was performed. The association between the activity of blood proteolytic systems and endothelial damage in patients with CAP III B was examined. Indicators of blood kallikrein-kinin system and renin-angiotensin system (activity of kallikrein, alpha1-proteinase inhibitor, alpha2-macroglobulin, total argininesterase activity, activity of angiotensin converting enzyme, prekallikrein content) were evaluated in 32 patients with CAP III B before and after occlusive bronchial test. It was established that a violation of endothelium-dependent vasodilation is accompanied by an imbalance of pro- and antiproteolitic blood systems.

[Comparative analysis of the efficacy and safety of percutaneous nephrolithotomy for staghorn calculi].

The widespread introduction of percutaneous nephrolithotomy has led to a significant narrowing of the traditional indications for surgery for staghorn calculi. We analyzed the efficacy and safety of percutaneous nephrolithotomy, depending on the stage ofstaghorn nephrolithiasis. In a period of 2008-2011, 120 patients with staghorn calculus underwent percutaneous nephrolithotomy. Data from spiral computed tomography were used in planning the surgical approach. In the preoperative period, staghorn calculi SN1-SN2 were diagnosed in 31.7% of patients (Group 1), and complex forms of stones corresponding SH3-SN4--in 68,3% (Group 2). The between-group analysis showed that the average time of surgery was significantly (p < 0,01) higher in patients in Group 2, the same group reported more frequent blood loss requiring to stop operation, as well as hyperthermia, hypotension during surgery, but the difference was not significant compared to Group 1 (p > 0,05). Conversion to open surgery was required in 2,6 and 2,7% of patients in Group 1 and Group 2, respectively. Application of PNL allowed to completely remove SN1-SN2 calculi in 94,7% of cases in Group 1, but similar result was achieved only in 63.4% of cases in most difficult group of patients with SN3-SN4.

[Neurophysiologic evaluation of patients with chronic prostatitis (III B chronic pain syndrome)].

The article presents the results of neurophysiological examination of 32 patients with noninflammatory form of abacterial chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS III B). Intramuscular electromyography was performed, right and left bulbocavernous reflex and cortical somatosensory evoked potentials during stimulation of n. pudendus were evaluated. It is shown that there is a high frequency of abnormal neurophysiological patterns in the absence of clinical neurological disease in patients with CP/CPPS III B. In this case, the pain as the main symptom was not associated with prostate disease. It is suggested that some patients with a diagnosis of CP/CPPS III B have neurological pathology that not manifested at the time of the examination.

[X-ray phase analysis of stag-horn concrements in citizens of south Russia].

It is known that recurrent nephroliths form in about half of the operated patients within 5 years after operation while 60% of all recurrences occur 3 years after removal of the primary concrement. To prevent recurrent nephroliths, it is important not only to detect metabolic disturbances but also to investigate chemical composition of uroliths. Mineral composition of 112 stag-horn concrements from patients living in the south of Russia was studied with x-ray phase analysis which showed that 62.9% concrements had mixed composition. Compared to patients with primary stag-horn nephrolithiasis, patients with recurrent one more often had calcium-phosphate and calcium-oxalate concrements than urate concrements. Chemical composition of the concrements depended on features of the relief of the region where the patients live. Newly established mineral characteristics of stag-horn concrements in the citizens of south Russia should be taken into consideration both in surgical treatment and follow-up of such patients.

[Estimation of renal function reserve in percutaneous nephrolithotomy of coral nephrolithiasis].

From November 2010 to December 2011, 56 patients with coral nephrolithiasis underwent percutaneous nephrolithotomy. To assess the renal function before surgery and before discharge (6 to 7 days after surgery), glomerular filtration rate (GFR) by Cockcroft-Gault equation was defined. Preoperative renal functional reserve was evaluated by method using a single oral loading of protein drugs. 46.4% of patients have decreased GFR before surgery, and before discharge the proportion of such patients was 39.3%. In 80% of patients with reduced GFR, postoperative filtering function of the kidneys in response to a protein load was increased, but did not reach the pre-operative no-load values, and in 7.5% of cases corresponded to a load indicators. Filtering function of the kidneys before discharge below baseline and load levels was observed only in 8.9% of cases. The data obtained in most cases allowed to predict GFR decline in the postoperative period in patients with coral nephrolithiasis. 87.5% of patients before surgery were characterized by the absence of renal functional reserve, but in 28.6% of patients in the postoperative period there was an increase in GFR, indicating the positive impact of endoscopic percutaneous nephrolithotomy on the functional state of the kidneys in the immediate postoperative period.

[Whether dyslipidemia plays the pathogenetic role in the development of noninflammatory chronic prostatitis/chronic pelvic pain syndrome?].

The study examined symptomatology in 74 patients with chronic abacterial prostatitis. The features of blood lipid metabolism in inflammatory and noninflammatory forms of disease are redefined. Dynamic characteristics of arterial blood flow in the prostate gland of patients with chronic abacterial prostatitis are determined. Comparative analysis between groups revealed significant differences in some indices of blood lipid profile, and arterial flow velocity parameters of the prostate in patients studied; correlations between the intensity of pain, the type of dyslipoproteinemia and arterial ischemia of the prostate are shown. The feasibility of analysis of the blood lipoprotein spectrum in the differential diagnosis of inflammatory and noninflammatory forms of chronic abacterial prostatitis is demonstrated.

[Arterial blood flow in the prostate in the syndrome of chronic pelvic pain/chronic prostatitis].

Causes and mechanisms of chronic pelvic pain/chronic prostatitis (CPP/CP) syndrome are not well investigated yet. It is suggested that pain in an inflammatory form of this syndrome may be due to tissue inflammation. In the non-inflammatory form pain may result from neurogenic factors. Standard diagnostic methods in the absence of inflammation often fail to detect pathological changes in the prostate. We made duplex mapping of the prostate and obtained quantitative characteristics of arterial hemodynamics of the prostate. Control values of arterial prostatic blood flow were developed after examination of healthy volunteers. These values were compared with similar values of arterial blood flow in CPP/CP syndrome. We found a significant decrease of the peak systolic velocity in patients with non-inflammatory CPP/CP syndrome. There is a direct correlation between intensity of pain syndrome and peak systolic velocity of arterial blood flow. Thus, pain may arise from chronic prostatic ischemia.