[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

Primary myxoid leiomyosarcoma of renal pelvis: Case report and literature review.

Leiomyosarcoma arising from renal pelvis is a very rare disease. A patient was admitted to hospital with left renal colic due to nephrolithiasis, with a filling defect in renal pelvis that was considered to be a blood clot. Diagnosis of leiomyosarcoma was made after visual inspection and biopsy of the exophytic lesion. Laparoscopic radical nephrectomy was performed, histological and immunohistochemical investigation confirmed leiomyosarcoma with mixomatoid component. No adjuvant treatment was performed, the patient remains healthy 5 years after surgery without recurrence. Herein we provide literature review, discussion of the diagnosis and treatment scenario of the patient with renal pelvis leiomyosarcoma.

[Ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of infravesical obstruction in men with benign prostatic hyperplasia].

RELEVANCE: Benign prostatic hyperplasia (BPH) is one of the most common urologic diseases of males. In patients who failed drug therapy of lower urinary tract symptoms (LUTS) caused by BPH, the most important indication for surgery is the presence of infravesical obstruction (IVO). IVO is detected by pressure-flow studies and is characterized by high detrusor pressure with decreased urinary flow rate. The invasiveness and high cost of this investigation has stimulated a search for non-invasive techniques that could reliably characterize the presence of IVO secondary to BPH. AIM: To determine the value of ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of IVO in men with BPH. MATERIALS AND METHODS: Seventy-six men with moderate and severe LUTS secondary to BPH underwent a comprehensive urological examination, including a clinical history, digital rectal examination, International Prostate Symptom Score (I-PSS), serum prostate-specific antigen (PSA), various ultrasound indicators of the prostate and urinary bladder, uroflowmetry and a pressure/flow study. RESULTS: Infravesical obstruction (IVO) was detected in 73.1% of men with BPH. IVO was found to have the strongest correlation with ultrasound signs of the intravesical prostatic protrusion (IPP, r = 0,667, p <0,05) compared with the prostate volume, prostate transition zone volume, prostate transition zone index, prostatic urethral angle, urethral length of the transition zone, estimated prostate circumference, prostate peripheral zone thickness, residual urine volume, weight of urinary bladder, the thickness of the detrusor, maximum and average urine flow rates and I-PSS score. The incidence of IVO increased in parallel with the increase of IPP. We established a cut-off value for IPP of 10 mm for the diagnosis of IVO with a sensitivity of 68.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 53.3%. CONCLUSION: The ultrasound findings of IPP measuring more than 10 mm strongly correlates with the IVO in men with LUTS and BPH as compared with other ultrasound parameters of the prostate, urinary bladder and urinary flow rates. The IPP is anatomical parameter that do not require urination, and is easily detected by both transabdominal and transrectal ultrasound. However, at the PPI values less than 10 mm, the main method for detecting IVO remains the pressure/ flow study.

[Intravesical prostatic protrusion in diagnosing infravesical obstruction in men with benign prostatic hyperplasia].

Infravesical obstruction (IVO) is an important characteristic of the functional state of male lower urinary tract. It is believed that IVO confirmed by pressure-flow study findings warrants switching from a medical to surgical management of lower urinary tract symptoms (LUTS). Intravesical prostatic protrusion (IPP) is a new indicator for detecting IVO secondary to benign prostatic hyperplasia (BPH). This indicator has several advantages over other non-invasive methods for evaluating IVO. The initial findings on the relationship between IPP and IVO suggest the feasibility of its clinical use as a screening tool in men with obstructive voiding symptoms.

[Transabdominal and transrectal ultrasound assessment of intravesical prostatic protrusion].

RELEVANCE: Benign prostatic hyperplasia (BPH) is one of the most common urological diseases among men. Despite the noticeable positive effects of pharmacotherapy on the quality of urination in BPH, the presence of an intravesical obstruction (IVO) leads to discontinuation of conservative treatment in favor of surgical interventions. One of the features of prostate enlargement is the degree of its intravesical growth (intravascular prostatic protrusion, IPP). According to some studies, IPP value of 10 mm or more is indicative of IVO in virtually all men. AIM: To compare transabdominal and transrectal ultrasound measurement of IPP in men with BPH. MATERIALS AND METHODS: The study comprised 108 men aged 69+/-10 years (43 to 93 years) with lower urinary tract symptoms and BPH. Patients underwent a standard urological examination. The shape of the prostate, prostate volume and the measurements of the IPP were assessed using transabdominal and transrectal ultrasound. RESULTS: The IPP measurements obtained using transabdominal and transrectal ultrasound were 9.8+/-5.7 mm (1.1 to 28 mm) and 9.3+/-5.3 mm (0.5 to 26 mm), respectively. The IPP measurements evaluated by transabdominal and transrectal ultrasound were found comparable regardless of the prostate volume. CONCLUSION: Similar results in assessing PPI by both ultrasound modalities allow them to be used equally effectively.

[High doses of trospium chloride in patients with idiopathic overactive bladder. Data of large-scale, multicenter observational program Resource].

PURPOSE: Evaluation of the efficacy and safety of different doses of trospium chloride in patients with idiopathic overactive bladder. MATERIALS AND METHODS: Large-scale observational program "Resource" included 669 patients with idiopathic OAB - 359 women and 310 men. At the first visit, all patients were assigned to use of trospium chloride at a standard dose of 45 mg per day. The results of treatment were evaluated during follow-up visits at 3, 6, 9 and 12 weeks. Depending on the results of examination, the dose was reduced in the presence of adverse events and increased in case of insufficient treatment effects. RESULTS: After 12 weeks, 102 patients have been receiving the drug at a dose of 30 mg/day, 241 - at a dose of 45 mg/day, 257 - at a dose of 60 mg/day, and 22 - at a dose of 75 mg/day. CONCLUSIONS: Individual approach to the selection of doses of trospium chloride in patients with idiopathic OAB can be quite effective and safe measure to achieve optimal clinical outcome with a good safety profile.

[NERVE GROWTH FACTOR IN THE URINE OF PATIENTS WITH IDIOPATHIC DETRUSOR OVERACTIVITY AND OVERACTIVE BLADDER WITHOUT DETRUSOR OVERACTIVITY].

The purpose was to determine the concentration of the neurotrophin nerve growth factor in urine to assess its possible role as a marker in the diagnosis of various forms of overactive bladder. The study included patients with urinary frequency and urgency: 21 patients with idiopathic detrusor overactivity, 18--with overactive bladder without detrusor overactivity and 11 healthy volunteers (control group). The level of nerve growth factor in the urine was determined in all participants of the study by the enzyme immunoassay (ELISA). In the control group the average ratio of nerve growth factor level to the level of urine creatinine was 0.2 ± 0.06, in patients with overactive bladder without detrusor overactivity -0.33 ± 0.06 (p > 0.05). In patients with idiopathic detrusor overactivity the rate was significantly higher and amounted to 6.04 ± 0.9 (p < 0.05). Therefore, measurement of the concentration of nerve growth factor in the urine may be used for differential diagnosis of the presence or absence of detrusor overactivity in patients with overactive bladder.

[INJECTION OF BOTULINUM TOXIN TYPE A IN THE BLADDER DETRUSOR AND SUBMUCOSA IN PATIENTS WITH OVERACTIVE BLADDER WITHOUT DETRUSOR OVERACTIVITY].

The objective of the study was to compare the efficacy and safety of injections of botulinum toxin type A in the submucosal layer of the bladder and in detrusor in patients who were refractory to anticholinergic therapy of overactive bladder without detrusor overactivity. 100 U botulinum toxin type A was diluted in 10 ml of 0.9% saline and injected with 0.5 ml (5 units) of this solution in 20 points of the bladder (the back and side walls except Letto triangle). In twenty-two patients (the first group) botulinum toxin was injected into the submucosal layer of the bladder, while in 34 patients (second group) - into the detrusor. In the first group after 1 and 3 months 3 (14%) patients and after 6 months 2 (9%) patients had positive treatment outcomes (improvement of symptoms in more than 50%). In 22 (65%) of the 34 patients of the second group positive results were observed at 1 and 3 months and in 17 (50%) - at 6 months. After 9 months, all patients had a relapse of urgent and frequent urination. Difficulties in emptying the bladder were observed in three (9%) of the second group patients who had to resort to periodic self-catheterization for 2-20 weeks. The obtained results allow us to state that the injections of 100 U of botulinum toxin type A in the submucosal layer of the bladder are ineffective in patients with overactive bladder without detrusor overactivity, whereas injections in the detrusor lead to a statistically significant improvement in symptoms of urgent and frequent urination for 6 months.

[Pilot experience in using adjustable suburethral sling in the treatment of anatomic stress urinary incontinence in females].

Adjustable suburethral prolen sling (Agency for Medical Innovations) was set up during surgery via transobturatory approach in 21 females with stress urinary incontinence (SUI). Mean age of the patients was 58.5 years (32-76 years). Only 3 (14%) women failed to retain urine on postoperative day 1, the other 18 of 21 (86%) women no longer showed SUI. Obstructive urination was observed in 4 of 21 (19%) patients, residual urine was present in 3 of these 4 patients (120, 170 and 220 ml). Correction of the sling position was made in early postoperative period in 7 (33.3%) patients. Under local anesthesia of the paraurethral channels with 0.5% novocain solution, the sling was displaced in the direction from the urethra to obturatory opening in 3 women with residuary SUI, from the urethra to the vagina - in 4 women. After regulation of the sling position all the patients retained urine and had no residual urine after urination. Thus, the suburethral prolen sling the position of which can be adjusted in early postoperative period is an effective method of treating females with anatomic SUI.

[Temporary stent--CoreFlow Soft Stent--for diagnosis of the causes of incomplete bladder emptying in men with neurological diseases].

The new device--CoreFlow Soft Stent--was used for diagnosis of causes of incomplete bladder emptying (IBE) in 19 men with neurogenic diseases. Group 1 consisted of 8 men with IBE and prostatic adenoma. Group 2 consisted of 11 men with IBE but no prostatic adenoma. The CoreFlow Soft Stent comprises an introducer and a stent. Different active lengths of the stent are available to match it to the length of the prostatic urethra. The stent has an anchoring balloon situated in the bladder and a second anchor located distally to the external sphincter. CoreFlow was introduced in a similar way as an ordinary Foley catheter. The bladder was filled with 200 ml of saline solution through the introducer and the stent. The introducer part was then separated from the stent part positioned in the prostatic urethra. The stent part is connected to the integral "pull-thread" device which runs through the urethra ending outside the meatus. Reposition of the stent using the special thread opens the striated urethral sphincter. Out of 8 patients with prostatic adenoma and neurogenic diseases 4 could urinate with the stent part positioned in the prostatic urethra indicating that prostatic adenoma was the cause for IBE. These patients have undergone TUR. The other 4 patients of group 1 and 11 patients of group 2 could urinate only using Valsalva manoeuvre and after reposition of the stent for opening the striated urethral sphincter. This allowed us to conclude that these 15 patients suffered from detrusor underactivity. Our experience indicates that CoreFlow Soft Stent is a simple device for diagnosis of the causes of IBE in men with neurogenic diseases.

[Botulinum A toxin in the treatment of patients with detrusor external sphincter dyssynergia and neurogenic low detrusor contractility].

AIM: To investigate safety and efficacy of botulinum A toxin external urethral sphincter injection in the treatment of patients with detrusor external sphincter dyssynergia (DSD) and neurogenic low detrusor contractility (DC). MATERIAL AND METHODS: The study included 21 patients with DSD and 27 patients with low DC between 17 and 73 years of age. The diagnostic scheme consisted of voiding diary for 72 hours, laboratory tests, ultrasound investigation with measurement of residual urine volume, urodynamic investigation and neurologic examination. 100 units of botulinum A toxin (botox, allergan) were injected into external urethral sphincter paraurethrally in women and transurethrally in men. RESULTS: 6 months after the toxin injection good results were achieved in 6 out of 9 DSD patients with spontaneous micturition; physiologic micturition was restored in 5 out of 8 patients who had performed intermittent self catheterization and in 3 out of 4 patients with suprapubic fistula and urethral catheter. As for patients with neurogenic low DC, good results were achieved in 6 of 8 patients who had had spontaneous micturition; physiologic micturition was restored in 13 out of 14 patients who had performed intermittent self catheterization and in 3 out of 5 patients with suprapubic fistula and urethral catheter. There were neither complications nor side effects. CONCLUSION: Botulinum A toxin external urethral sphincter injection demonstrated high efficacy in patients with DSD and neurogenic low DC.