[Prevention of the development of catheter-associated urinary system infections in the early postoperative period].

BACKGROUND: Bladder catheterization is a common medical manipulation that is associated with the risk of complications, including catheter-associated urinary tract infection (CAUTI), which accounts for 80% of all nosocomial infections of the urological profile. AIM: To evaluate the combined use of the biologically active additive Uronext and ceftriaxone in the prevention of the development of CAUTI in the early postoperative period in 120 patients aged 20-80 years with a Foley indwelling catheter. MATERIALS AND METHODS: The patients were divided into 2 groups: in group I (n=60), D-mannose with cranberry extract and vitamin D3 as part of Uronext dietary supplement was administered orally in the form of sachets 48 hours before surgery and after surgery until urethral catheter was placed, as well as intravenous ceftriaxone 1000 mg 2 hours before surgery and in the postoperative period within 7 days. In group II (n=60), ceftriaxone monotherapy was prescribed in a similar way. RESULTS: According to the results of bacteriological examination of the removed urinary catheter on 3-7 days in Uronext group, bacterial growth was absent in 40 patients (66.67%, p<0.05), versus 23 cases (38.33%) in the control group. CONCLUSIONS: The data obtained confirm the efficiency of the use of the biologically active additive Uronext in combination with an antibacterial drug, which allows to recommend this scheme in patients with an indwelling urinary catheter for the prevention of the development of CAUTI.

[Evaluation of the efficiency and safety of the dispersed form of sildenafil (50 mg) in males with erectile dysfunction].

INTRODUCTION: The erectile dysfunction is defined as an inability to achieve or maintain an erection sufficient for sexual intercourse lasting more than 3 months. According to literature, about 90 million men worldwide suffer from erectile dysfunction of different severity. AIM: To evaluate the efficacy and safety of the dispersed form of sildenafil ("Ridzhamp" 50 mg), compared with the standard tablets of sildenafil (50 mg). MATERIALS AND METHODS: The study included 60 men aged 27 to 67 years (average age 40.2 years) with moderate erectile dysfunction (11-15 points according to IIEF-5). In group I (n=30), patients took a dispersible form of the drug sildenafil, 50 mg ("Ridzhamp") 60 minutes before sexual intercourse; in group II (n=30), a standard form of the drug sildenafil was prescribed at a dosage of 50 mg, 60 minutes before sexual intercourse. RESULTS: Positive dynamics according to IIEF-5 score was found in all the study groups. In group I, IIEF-5 score increase by 53.85%, while in group II by 50% (p<0.05). The average onset of erection in group I was 45+/-2.2 min, while in group II it was 51+/-1.9 min. In the main group (group I) one patient (3.33%) complained of persistent headache after taking the drug, and therefore refused the therapy. In the comparison group (group II) one patient (3.33%) reported dyspeptic disorders while taking the drug, 1 patient (3.33%) reported dizziness. All patients in the main group noted the convenience of taking the "Ridzhamp". CONCLUSIONS: Our results indicate the comparable efficiency of the dispersed form of sildenafil (group I) and the standard tablet form of the drug (group II). All patients in the main group (group I) noted a faster onset of erections, as well as the convenience of "Ridzhamp" and the ability to take the drug without water intake.

[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.

Comparative assessment of the results of detection of СagА-positive strains of Helicobacter pylori by molecular-genetic and immunochromatographic methods in different biological materials.

A comparative analysis of the detection of CagA-positive strains of H. pylori by immunochromatographic and molecular genetic methods was carried out. We used H. pylori strains isolated from individuals with diseases of the gastrointestinal tract. The immunochromatographic method was implemented using a developed experimental model of an immunochromatographic test system for detecting the H. pylori CagA protein in various biological materials. Determination of the pathogenicity gene cagA of H. pylori was carried out using the «Helikopol SA¼ test system («Litekh¼, Russia). The assessment of the comparability of the results of detecting CagA-positive strains of H. pylori was carried out using statistical methods: Monte-Carlo, calculation of the chi-square test (χ2) and Kendall's τ-b and Somer's d coefficients. Statistical analysis was performed using the software packages «Microsoft Office Excel¼, «Statistica 10.0¼, «WinBUGS 1.4.0.¼ The study showed the absence of a statistically significant difference and the presence of a direct strong correlation between the results of detecting CagA-positive strains by molecular genetic and immunochromatographic methods, which indicates that these methods provide similar results in identifying highly pathogenic strains of H. pylori.

[Ureteral obstruction and segmental ureteral stents].

Currently, various types of stents are widely used in urological practice. One of the indications is the presence of upper urinary tract strictures. The factors leading to the development of strictures can be endogenous and exogenous, iatrogenic and non-iatrogenic, benign and malignant. After open, laparoscopic and X-ray-endoscopic procedures a double-J stent is usually placed or, less often, nephrostomy tube. It should be noted that both methods have certain side effects and may affect the patient's quality of life. To reduce the stent-related symptoms and increase their tolerability, various modifications of ureteral stents have been developed. In this article, we analyze the publications devoted to the most commonly used segmental stents without renal and bladder coils, such as Memokath, Uventa, Allium, Memotherm and nitinol stents manufactured by MIT LLC.

[Laparoscopic partial nephrectomy using a technology of augmented reality: new vector of the development of operative urology?]

AIM: to evaluate the efficiency and usefulness of augmented reality (AR) technology using HoloLens glasses for laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: From July to December 2019, a total of 5 patients with localized kidney cancer (cT1aN0M0) underwent AR-assisted LRP. The mean RENAL score was 6 points (5-8). Preoperatively, all patients underwent contrast-enhanced multispiral computed tomography (MSCT). The three-dimensional reconstructions of the kidney, tumor, part of the abdominal aorta with the renal artery and its branches, part of the inferior vena cava with the renal vein were segmented with color coding and connected into a single virtual 3D model, which was loaded into the program in order to display image in AR glasses. The duration of surgery and thermal ischemia, type and frequency of intraoperative complications, as well as the time spent on preparing the 3D model and the Microsoft HoloLens device were evaluated. To assess the feasibility of using AR technology intraoperatively, a Likert scale was filled out by the surgeon. RESULTS: It took 10 (9-11) hours to prepare the model, including time to optimize the model and to set up its display and interactions. The setup of HoloLens required an average of 7.8 (5- 12) min. The total duration of the operation and the period of warm ischemia was 108 (90-120) and 20 (15-25) min, respectively, while intraoperative blood loss was 160 (110-250) ml. In all cases, a negative surgical margin was found. The surgeon who performed all the operations assessed the use of AR technology with the HoloLens device as highly beneficial in all clinical cases. CONCLUSION: The use of AR technology with a HoloLens holographic device during LPN can lead to improved treatment outcomes.

[Complications after PCNL: diagnosis and management].

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

[Efficiency and safety of phenazopyridine for treatment of uncomplicated urinary tract infection: results of multi-center, randomized, placebo-controlled, clinical study].

AIM: to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. MATERIALS AND METHODS: A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. RESULTS: All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups. CONCLUSION: The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.

[Design and materials for ureteral stents: past, present and future].

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

[Dynamics of crystallogenic properties of the oral fluid and periodontal status when using toothpaste with fluoride]. / Dinamika kristallogennykh svoistv rotovoi zhidkosti i sostoyaniya parodonta pri ispol'zovanii zubnoi pasty s ftorom.

The aim of the study was to assess the efficacy of parodontax complex anti-inflammatory toothpaste with fluorine for treatment of moderate catarrhal gingivitis. MATERIAL AND METHODS: Within 6 weeks a group of students was observed, which was divided into 2 subgroups depending on the activity of the carious process and with characteristic changes in crystalloscopy of the oral fluid. Clinical trials of parodontax anti-inflammatory toothpaste with fluorine were conducted. The properties declared by the manufacturer were evaluated using clinical, biochemical, laboratory studies, and criteria-based assessment of crystalloscopic features of the oral fluid. RESULTS: The study revealed a statistically significant correlation of the cleaning ability of the hygiene product and crystalloscopic properties of saliva and changes in the clinical picture of chronic catarrhal gingivitis. With the inclusion of a comprehensive anti-inflammatory toothpaste containing fluorine and natural herbal extracts, a shift in the acid-base balance of the oral fluid to the alkaline side was recorded. CONCLUSION: The improvement in the oral hygiene indices and the resolution of inflammatory processes in periodontal tissues prove the efficacy of comprehensive treatment of chronic gingivitis including parodontax toothpaste.

[Imidafenacin for treatment of overactive bladder and urgent urinary incontinence: the results of open-label multicenter randomized controlled clinical trial].

INTRODUCTION: The analysis of the results of a multicenter, open, randomized comparative phase III clinical trial on the use of imidafenacin for treating patients with OAB was carried out. A clinical study was conducted according to GCP standards in 12 urological centers of the Russian Federation with the support of company AO "R-Pharm". MATERIALS AND METHODS: A total of 296 patients (men and women) aged from 18 to 65 years with OAB and urgent urinary incontinence were included in the study. All patients were randomized into two groups. In Group 1 (n=148) patients received -cholinoblocker imidafenacin 1 tablet (0,1 mg) twice a day. Group 2 patients (n=148) were prescribed a comparison drug tolterodine 1 tablet (2 mg) twice a day, as well. The duration of treatment was 12 weeks. RESULTS: The analysis of results showed a significant decrease in the OAB symptoms in both groups. In Group 1 a decrease of episodes of urge urinary incontinence was more pronounce compared to Group 2, as well as amount of day-time and night-time of episodes of urge urinary incontinence by the 2nd, 4th, 8th and 12th weeks of treatment in comparison with baseline scores. There were no differences between two groups in the severity of reducing average urinary frequency per day. Reducing the severity of urinary disturbances in patients of both groups was accompanied by an improvement in the quality of life. There was a significant and similar decrease in the average total score of both OAB Awareness Tool and EQ-5D questionnaires. Tolerability of treatment was satisfactory in both groups and there were no differences in the adverse events in Group 1 and 2. CONCLUSION: Imidafenacin showed high clinical efficacy for treating patients with OAB, which is not inferior, and in some values, is superior in comparison to tolterodine. Both drugs had a similar safety and tolerability profile.

[The role of laparoscopic salvage lymphadenectomy in patients after initial extended lymphadenectomy for prostate cancer].

This work presents results of the analysis of safety and efficacy of laparoscopic superextended lymphadenectomy, which was performed in patients with clinical progression (the presence of lesions in the lymph nodes of the pelvis and beyond) after undergoing prostatectomy. A feature of the work is that these patients initially extended lymphadenectomy was performed. Clinical detection of foci was carried out by 11C-PET/ CT. Laparoscopic salvage lymphadenectomy appears to be the safe method of performing surgery. When monitoring patients there was evaluated the effectiveness of the operation - the percentage of patients with marked regression and stabilization of markers (PSA), duration of remission. The analysis of the data attempted to determine the predictors of non-response patients after salvage lymphadenectomy.

Results of surgical treatment for stress urinary incontinence in prostate cancer patients after radical prostatectomy using modified version of transobturator synthetic sling.

Approximately 6-9% of prostate cancer patients suffering from incontinent of urine after radical prostatectomy are in need of surgical correction of this condition after failure of conservative treatment for 12 months. The study involved 65 patients who were divided into 2 groups of follow-up. Group №1 (n = 31) - patients with mild urinary incontinence, group №2 (n = 34) - patients with medium (moderate) urinary incontinence. Follow-up median of the group №1 was 36 months, an average of 39.5 (12-84) months. Follow-up median of the group №2 was 36 months, an average of 41.65 (12-84) months. The overall efficiency of surgery in both groups was 84% and 82.4%.

[Minimally invasive surgery with therapeutic effect in cancer patients].

During recent years ablative technologies have become very popular in tumor treatment. They are used in treatment for inoperable primary and metastatic tumors of the liver and the lung and also localized renal tumors of small sizes. The most studies on thermoablation in oncology are focused on the evaluation of tissue destruction and optimization of physical mechanisms, while potential mechanisms of immune response in thermoablation are still far from understanding. This study shows that with thermoablation of tumor within one month after the procedure the formation of a protective immune response is observed by increasing the content of activated T-helpers and cytotoxic T-lymphocytes.

[The comprehensive approach to ensure the quality of forensic medical examination of a cadaver].

The objective of the present work was to estimate the effectiveness of the comprehensive monitoring system designed to enhance the quality of forensic medical expertise for determining the cause of death in the hanging cases. It was shown that the practical application of the algorithmization and automated quality control system improves the effectiveness of forensic medical examination of the cadavers in the hanging cases. The system performs the control, directing, and teaching functions. Moreover, it allows to estimate the completeness of the examination of the cadaver.

[LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER].

Radical cystectomy is the standard method for treatment of muscle-invasive and locally advanced bladder cancer. Several less invasive approaches have been suggested recently, including totally laparoscopic radical cystectomy and robotic cystectomy. However despite significant improvements in surgical techniques the overall occurrence of perioperative complications is still high. Analysis of the literature data and comparison of these data with the results of our study was performed with respect to perioperative complications after radical cystectomy and oncological outcomes. In most of the studies, operating time during laparoscopic cystectomy was longer than that of open approach. Despite that, there was no influence of type of surgery on intraoperative complications. Major complication rates were similar between all groups. However laparoscopic cystectomy had lower rate of minor complications compared to open cystectomy. Laparoscopic cystectomy is safe and associated with lower blood loss, decreased postoperative ileus and lower length of stay compared with open radical cystectomy. Laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications. Moreover, if performed following the oncologic principles of open surgery, our results and literature data suggest that LRC is safe and determines non-inferior long-term cancer control compared with open surgery.

[Comparative analysis of histological and long-term oncological outcomes after radical prostatectomy in patients matching johns hopkins and the royal marsden hospital criteria for active monitoring].

A retrospective comparative analysis of results of treatment of patients with prostate cancer who met the most stringent (Johns Hopkins - JH; 74 patients) and the most mild (Royal Marsden Hospital - RMH; 263 patients) selection criteria for the management according to the strategy of active monitoring was performed. Significant differences in the frequency of detection of adverse histological features and biochemical recurrence-free survival after radical prostatectomy in patients eligible for JH and RMH criteria were not identified. Extracapsular extension occurred in 2.7 and 4.9% (P=0,33), seminal vesicle invasion - in 1.4 and 2,6% (P=0.43), positive surgical margins - in 6, 8 and 7.2 % (P=0.56) Gleason score increase - at 6.8 and 9.1 % (P=0.49), respectively. Five-year disease-free survival rates were 95.7 and 95,8% (P=0.41). Regardless of the protocol selection for active monitoring, precise examination of patients and staging of the disease are absolutely necessary, as well as the future well-designed studies on the comparative analysis of the effectiveness of active monitoring and early curative treatment in the settings of national health care.

[Testicular germ cell tumors, the state of diagnostics and staging in Saint-Petersburg].

In the last 25 years germ cell tumors have become one of the few cancers with high cure rate. However, there is a lack of information on testicular germ cell tumors in the male population and even among general practitioners leading to late or false diagnoses. The shortening of timespan between the first clinical signs appearance and diagnoses can result in earlier diagnosis, fewer therapy interventions and better overall survival rates.

[Physico-chemical characteristic of medicinal preparations for intrabladder electrophoresis in patients presenting with bladder diseases (an experimental study)].

The physico-chemical characteristic of medicinal preparations used for the treatment of various bladder diseases is provided including their electrophoretic activity and the ability to penetrate into bladder tissues, e.g. during electrophoresis. The optimal parameters of intracavitary electrophoresis are considered.

[Nocturia in elderly patients].

This study demonstrates a comparative assessment of the causes of nocturia in young and elderly patients with overactive bladder (OAB). We used the database of 245 patients over 18 years (117 men, 128 women) with OAB (more than 8 micturition per day), with presence or absence of urgent urinary incontinence and nocturia (an average of 2.5 episodes per night). All the patients had to complete a diary within 3 days indicating the time of the urge to urinate, urine volume per micturition and sleep time (when the patient is actually asleep before waking time). These patients were divided by sex and also into three age groups: younger than 60 years, 61-69 years and over 70 years. A diary was used to determine the nocturia index, nocturnal polyuria index, index of nocturnal bladder capacity. The most obvious reason for nocturia in patients with OAB was the polyuria and reduced nocturnal bladder capacity, which are not dependent on age. In young patients (< or = 60 years) nocturia was the result of the decrease of nocturnal bladder capacity and was evaluated by IBC. For the patients older than 70 years, the most common cause of nocturia was nocturnal polyuria, which was estimated by the index of nocturnal polyuria.