[Clinical case: bladder necrosis after prostate embolization in a patient with prostatic hyperplasia].

This article describes a clinical case of bladder necrosis developed after X-ray endovascular embolization of prostatic arteries of a 62-year-old patient with a verified diagnosis of BPH (benign prostatic hyperplasia). The complication resulted in the necessity of urgent surgical intervention, namely, laparotomy, cystprostatectomy and bilateral percutaneous nephrostomy. In the early postoperative period the patient had intense cutting pain in the left side of the abdomen. Examination revealed the inflow of small intestinal contents through the pelvic drainage, which was the reason for relaparotomy, abdominal cavity revision, uturing the small intestine perforation, suturing the small intestine pre-perforation, sanation and drainage of the abdominal cavity in an emergency procedure. The patient was discharged in a satisfactory condition under the supervision of a urologist by m/w on the 36th day after endovascular embolization of prostatic arteries. The eight months after discharge, the patient underwent a successful Brickers operation on creating an alternative urinary diversion route at the First Sechenov Moscow State Medical University of the Russian Federation.

[Serum testosterone and testicular hemodynamics before and after infection with SARS-COV-2 (pilot study)].

INTRODUCTION: The current epidemiological situation dictates a detailed study of the effect of a new coronavirus infection (SARS-CoV-2) on various anatomical, histological, physiological and biochemical parameters of the human body, which has become an integral part of many medical research, including urology, andrology, endocrinology. OBJECTIVE: To study serum testosterone levels and testicular hemodynamics before and after infection with SARS-CoV-2. MATERIALS AND METHODS: 20 patients were examined, before and after suffering SARS-CoV-2 infection (who fell ill at the beginning of 2020). Average age 37.8 years (min=27, max=50). The level of total testosterone (s) in the blood serum and hemodynamic parameters of the testicles (maximum and minimum blood flow velocity and resistance index) were studied. RESULTS: When studying the level of s 3 months after the transferred SARS-CoV-2, its decrease from the initial value was noted (r=0.47; p=0.35), and after 6 months (r=0.98; p<0.007) there was no recovery of the target level of Ts before infection with SARS-CoV-2. Regarding the hemodynamics of the testicles, there was also a decrease in Vmax and Vmin, and an increase in RI, which indicates a deterioration in the blood flow of the testicles (p<0.001). CONCLUSION: SARS-CoV-2 affects the level of Ts in the blood serum and the parameters of the hemodynamics of the testicles. The extent to which SARS-CoV-2 affects patient performance depends largely on the severity of the disease and to a lesser extent on baseline performance.

[Risk factors for complications of ureterolithotripsy].

AIM: to determine main risk factors for complications of ureterolithotripsy. MATERIALS AND METHODS: a retrospective analysis of the results of 545 ureteroscopies performed in 506 patients with ureteral stones over the past 7 years at the urological clinic named after M.F. Vladimirsky was carried out. The relationship between preoperative and intraoperative factors and complications of ureterolithotripsy was analyzed. RESULTS: The overall complication rate was 22.4%. The risk of intraoperative complications was proved to increase (p<0.05) along with the stone size, location in proximal ureter, stone impaction for more than 3 weeks and the degree of hydronephrosis. No preoperative stenting or nephrostomy tube prior to ureteroscopy was associated to an increased risk of intraoperative complications (RR=2.88; p=0.03). Patients with preoperative drainage of upper urinary tract has lower probability of intraoperative complications (OR=0.35; p=0.03). The risk of developing stricture and ureteral obliteration in uncomplicated ureteroscopy was minimal (RR=0.008, p=0.0001). Small ureteral perforation and pronounced mucosal inflammation around the stone have the similar influence on the risk of complications, which was more than 7.5 times (p=0.0001) higher than in uncomplicated ureteroscopy. Large ureteral perforation was associated with the highest risk of stricture formation and ureteral obliteration, which was 64 times (p=0.0001) higher than in uncomplicated ureteroscopy. CONCLUSION: The rate of complications of ureterolithotripsy directly depends on the following factors: size and location of the stone, the stone impaction, pre- and intraoperative (nephrostomy tube) drainage of the upper urinary tract, the degree of hydronephrosis, level of bacteriuria and intraoperative trauma complications.

[Autologous kidney transplantation after ureter avulsion during ureterolithotripsy].

Currently, when performing ureterolithotripsy in patients with proximal ureteral stones, urologist should be ready for intraoperative complications and be able to use various methods to diagnose them. Ureteral avulsion is an extremely rare, but the most serious complication of endoscopic procedures. Clinical observation of autologous kidney transplantation performed after ureteral avulsion with good functional and clinical results is presented.

[Bilateral acute purulent destructive pyelonephritis after retrograde ureteroscopy and lithotripsy].

The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.

[An adaptation of the CLAVIENDINDO classification of complications for contact ureterolithot- ripsy].

AIM: to study an adaptability of the Clavien-Dindo classification of complications for contact ureterolithotripsy. MATERIALS AND METHODS: A total of 506 patients with ureteric stones who were undergone 545 endoscopic interventions in the Urologic Department of "MONIKI" named after M.F. Vladimirsky were included in retrospective analysis. RESULTS: Complications of grade 1, II, IIIa and IIIb were noted in 39 (7.1%), 24 (4.3%), 15 (2.8%) and 14 cases (2,6%), respectively. Among the complications of grade IVa, an acute pyelonephritis was complicated by the septic shock. The complication of grade IVb developed in 1 case (0.2%). There were no complications of Grade V. The Clavien-Dindo classification allows to grade only postoperative complications and attempts to adapt it for the assessment of intraoperative complications can lead to the distortion of study results. CONCLUSION: The uncontrolled use of the Clavien-Dindo classification in all areas of surgery can lead to a decrease in its accuracy, thereby reducing its value as fairly universal tool. In our opinion, a further work aimed to the development of strict criteria for the different grades of complications of the Clavien-Dindo classifications is needed. We believe it is possible and necessary to develop a single tool for the assessment of complications of typical interventions within a single surgical area.

[Complications of contact ureteral lithotripsy].

Shows the current real time terminology and variants of systematization and grading of complications of contact ureteral lithotripsy (CULT). Research papers related to complications of CULT published over the last three decades were analyzed. Currently there is no clear terminology, classification, systematization and grading of CULT complications. The terms used are deficient because they do not adequately characterize specific complications of CULT. For example, some researchers define a complete ureteral avulsion as a defect at two levels, but others interpret it as a defect of the ureter at only one level. And the use of such terms as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureter wall. Therefore, these conditions are complications not of CULT but of the ureteral wall perforation. Presently, the classical classification of CULT cannot be adequately used, since it is low-structured. Universal instruments (PULS, Satava, Clavien-Dindo) have low specificity and sensitivity to CULT complications and limited possibilities of their application. Both developers of different scales of systematization of CULT complications (PULS; Satava; Clavien-Dindo) and EAU consider further international randomized studies warranted for their greater integration and adaptation.

[Questions of terminology, systematization and grading of complications of contact ureteral lithotripsy].

AIM: To investigate the advantages and disadvantages of the current variants of systematization and grading of complications of contact ureteral lithotripsy (CULT) and develop a working classification of CULT complications. MATERIALS AND METHODS: The study analyzed results of 545 fluoroscopy-guided endoscopic procedures performed at the MRRCI Clinic of Urology from 2008 to 2015 in 506 patients with ureterolithiasis. RESULTS: The proposed and implemented classification and terminology of CULT complications unifies the diagnostic and management algorithm. This tool is more systematic and structured than the classical classification and universal methods of systematization and grading of CULT complications (classifying CULT complications in "major" and "minor", PULS scale, Satava and Clavien-Dindo grading systems). Given the lack of clear grading of ureteral rupture, it was divided into amputation (two-level rupture) and avulsion (one-level rupture). Using such term as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureteral wall. Therefore, these conditions are complications not of CULT, but of the ureteral wall perforation. The ureteral perforation was classified into macro- and micro-perforation. CONCLUSION: The existing terminology, classification and grading of the CULT complications should undergo a more detailed analysis. None of the existing classifications of CULT complications afford them to be fully staged and systematized. The working classification of complications of CULT developed at the M.F. Vladimirsky MRRCI Clinic of Urology warrants a multi-center prospective study to validate it and investigate its effectiveness.

[EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF A SOLITARY KIDNEY].

The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (p<0.0001), and the baseline urodynamics of the upper urinary tract (p<0.0001). The rates of complications (32.3%) and auxiliary procedures (16.1%) were relatively low, due to the usage of pre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (p<0.0001), they had increased time of lithotripsy (p=0.013), more sessions (p<0.0001), complications (19.4%, p=0.043) and auxiliary manipulation (9.7%). Nevertheless, the duration of stay in hospital in the postoperative period did not correlate with the size of calculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.

[FEATURES OF PERCUTANEOUS NEPHROLITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF SOLITARY KIDNEY].

The article describes the results of percutaneous nephrolithotomy (PCNL) in 49 urolithiasis patients with a solitary kidney. In 44 (89.8%) patients the calculi were located in the kidney, in 5 (10.2%) patients - in the upper third of the ureter. The calculi were single (18; 36.7%), multiple (14; 28.6%) or stag-horn (17; 34.7%). Efficiency of PCNL estimated immediately after surgery and at the end of the third month of observation was 75.5 and 93.9%, respectively. Stone size (p=0.594), the baseline state of urodynamics of the upper urinary tract (p=0.205) did not affect the renal clearance at PCNL. Enlargement of initial calculus size positively correlated with the number of required treatment sessions (p=0.013), duration of surgery (p<0.0001), and the length of postoperative hospital stay (p<0.0001). Complications were common (44.9%), but the auxiliary manipulations were performed infrequently (26.5%). No associations were found between the size of calculus, the number of complications and secondary manipulations (p=0.361). No correlations were found between the clinical form of a solitary kidneywith urolithiasis and the occurrence of complications during the treatment course (p=0.121), as well as between the presence of complications and the cause of the "loss" of the contralateral kidney (p> 0.05). Thus, percutaneous nephrolithotripsy is a highly effective method modality of treatment of solitary kidney urolithiasis. Appropriate selection of indications and contraindications for PCNL, preoperative preparation, surgical technique, postoperative patient management are of great importance.

[The efficacy of isometric training during hospitalized rehabilitation in patients with myocardial infarction]. / Effektivnost' izometricheskikh trenirovok na statsionarnom étape reabilitatsii bol'nykh infarktom miokarda.

The study included 57 patients with myocardial infarction who underwent isometric exercise tests on days 10 and 30 of hospitalization. The patients of the main group had isometric exercise tests by using a key expander for 20 days between the first and second exercise tests. The tests were performed in 4 stages, each lasting 5 days. The patients from the control group had no tests. The study had indicated that isometric exercise tests performed in the hospital treatment period enhance the patients' tolerance to static exercise and they are sufficiently effective despite its short duration.