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1.
Urologiia ; (5): 31-36, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808629

RESUMO

THE AIM: To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo". MATERIALS AND METHODS: A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). RESULTS: In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. CONCLUSIONS: Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.


Assuntos
Cálcio/análise , Tomografia Computadorizada por Raios X/métodos , Ácido Úrico/análise , Cálculos Urinários/química , Cálculos Urinários/diagnóstico por imagem , Urolitíase/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Cálculos Ureterais , Adulto Jovem
2.
Khirurgiia (Mosk) ; (10): 69-74, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626242

RESUMO

Varicose veins of lower extremities, varicocele and varicose dilation of pelvic veins including ovaricovaricocele are the most common non-inflammatory diseases of venous system. The same mechanisms determined varicose dilatation regardless localization of the vein. First of all, these are wall weakness and valvular insufficiency combined with hereditary collagen fiber defectiveness in case of undifferentiated connective tissue syndrome. Imbalance between different types of collagen in vascular wall (especially types I and III) also results wall weakness. Other important mechanisms are smooth muscle cells dysfunction followed by excessive intracellular synthesis and intramuscular fibrosis and imbalance of protease system due to overproduction of metalloproteinases. We consider that different forms of varicose veins (varicose veins of lower extremities, varicocele, ovaricovaricocele) may be unified within one pathology (varicose vein disease).


Assuntos
Varizes/fisiopatologia , Veias/fisiopatologia , Colágeno/fisiologia , Dilatação Patológica , Humanos , Extremidade Inferior , Masculino , Varizes/etiologia
3.
Urologiia ; (4 ()): 7-11, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535791

RESUMO

Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.


Assuntos
Cálculos Renais/terapia , Fotocoagulação a Laser/instrumentação , Terapia a Laser , Litotripsia a Laser/instrumentação , Túlio , Urologia , Humanos , Litotripsia a Laser/métodos , Masculino , Próstata/patologia , Próstata/cirurgia , Cálculos Ureterais/terapia , Cálculos da Bexiga Urinária/terapia , Neoplasias da Bexiga Urinária/terapia
4.
Urologiia ; (4): 105-111, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535815

RESUMO

OBJECTIVE: to develop optimal techniques of en-bloc resection of large non-muscle invasive bladder tumors, determine the proper method of specimen extraction and assess the quality of specimens obtained by different techniques. MATERIALS AND METHODS: A total of 12 patients with primary cT1 bladder cancer underwent transurethral en-bloc resection between January 2018 and March 2019 were enrolled into the study. Tumor size ranged from 3.5 cm to 6.2 cm. For removal and extraction of large bladder tumors using thulium fiber en-bloc laser three different techniques were developed: "swiss cheese technique", "crown and root technique" and "three steps technique" technique". The main pathologic criteria used for assessment of removal technique were tumor grade (G), depth of invasion (T), presence of carcinoma in situ (CIS), variant histology (VH), lymphovascular invasion (LVI), presence of detrusor muscle. Additional criteria were horizontal and vertical resection margin, subclassification of T1-stage and presence of focal necrosis in tumor. RESULTS: Among the techniques developed and tested, the best quality of specimens for morphological evaluation was obtained using the combined "crown and root technique". First step is electroresection of the exophytic part of the tumor into pieces, and the next step is en-bloc laser resection (using thulium fiber or holmium laser) of the tumor base. Overall, the quality of all specimens obtained using three techniques met the current requirements of pathologic study. SUMMARY: En-bloc resection techniques of large bladder tumors allow obtaining specimen suitable for proper morphological evaluation and correct tumor staging. Further studies are required to evaluate the impact of these techniques on long-term results of treatment options.


Assuntos
Lasers de Estado Sólido , Neoplasias da Bexiga Urinária , Humanos , Estadiamento de Neoplasias , Túlio
5.
Urologiia ; (3): 43-49, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356012

RESUMO

BACKGROUND: Rowatinex is a combined drug based on plant terpenes which provides diuretic, anti-inflammatory and antispasmodic effect. A use of herbal preparation Rowatinex in patients with urinary stone disease after extracorporeal shock-wave therapy (ESWL) is analyzed in the article. AIM: To clarify the efficiency of the drug Rowatinex in patients with urinary stone disease after ESWL. MATERIALS AND METHODS: All patients were divided into two groups depending on therapy administered after ESWL. In main group (n=150) patients received Rowatinex, while in control group (n=70), antispasmodics were administered. Spontaneous passage of fragments was observed in 104 patients in main group (69.3%) and 30 patients in control group (42.9%). RESULTS: When studying the effect of therapy on the changes of complete blood count, biochemical panel and daily excretion of some substances (magnesium, uric acid, calcium, etc) there were no significant differences between main group and control group. All values were normal. It was estimated that increase in diuresis during use of Rowatinex contributes to effective and rapid passage of stone fragments. In addition, there was a decrease in leukocyturia in both groups. CONCLUSION: Drug Rowatinex allows to reduce the time to spontaneous passage of fragments after ESWL, intensity of pain syndrome and leukocyturia as well as to increase in daily diuresis. This is not accompanied by the development of complications and side effects which allows to administer Rowatinex for a long time as part of complex medical expulsive therapy and use it for recurrence prevention of urinary stone disease. Effect of Rowatinex didnt depend on the stone composition.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Cálculos Renais , Litotripsia , Terpenos , Cálculos Urinários , Terapia Combinada , Humanos , Cálculos Renais/terapia , Terpenos/uso terapêutico , Cálculos Urinários/terapia
6.
Urologiia ; (1): 56-62, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184019

RESUMO

INTRODUCTION: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS: In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION: According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.


Assuntos
Imageamento Tridimensional , Neoplasias Renais , Laparoscopia , Cirurgia Assistida por Computador , Adulto , Idoso , Feminino , Humanos , Rim , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Néfrons
7.
Urologiia ; (1): 126-130, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184030

RESUMO

In the article the main mechanisms of molecular pathogenesis of urinary tract urothelial carcinoma are presented. Two different molecular pathways that determine the development of non-invasive and invasive urothelial carcinoma, the immunohistochemical spectrum of stem markers and aspects of the carcinogenesis of multifocal and recurrent tumors are considered.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Sistema Urinário , Neoplasias Urológicas , Biomarcadores , Carcinoma de Células de Transição/genética , Humanos , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/genética
8.
Urologiia ; (2): 40-49, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162900

RESUMO

The fundamental question about the origin of cancer stem cells of urothelial carcinomas with luminal remains open. So far, no convincing evidence has been found to determine whether these events occur in a single cell, presumably basal, or are realized in different precursor cells of the urothelium. The potential of a number of potential stem markers as cancer stem cells in urothelial carcinomas and their prognostic significance are currently being investigated. AIM: Our aim was to carry out a comparative analysis of the expression of stem markers in the molecular subtypes of urothelial carcinomas, including ALDH1A1, CXCR4, CD24, CD82, CD105, CD133, NANOG, OCT4 and SOX-2. In addition, the relationship between the pattern of expression and the pathological features of the tumor was determined. PATIENTS AND METHODS: Surgical specimens from 196 patients with a diagnosis of urothelial carcinoma of the renal pelvis and bladder were studied. Immunohistochemical study was performed on paraffin sections using the standard protocol. Antibodies against ALDH1A1, CD82, CD133, CXCR4, NANOG, OCT4, SOX2 ("Abcam"), CD24, CD105 ("Invitrogen"), CD31, CD34 ("Novocastra") were used. RESULTS: The stem cell markers used in the study were expressed in all molecular subtypes of urothelial carcinoma and there were no differences in frequency and intensity of expression between different phenotypes. However, the frequency and intensity of expression of the markers correlated with the tumor stage and the grade of cellular anaplasia. CONCLUSION: Our results confirm that cancer stem cells with basal phenotype are not an exclusive subpopulation in urothelial tumors. Other progenitor cells with the immunophenotype of intermediate and/or umbrella cells can serve as cancer stem cells. These features of the expression in cancer stem cell markers will allow to develop new approaches to the treatment of urothelial carcinomas.


Assuntos
Biomarcadores Tumorais/biossíntese , Carcinoma de Células de Transição/metabolismo , Células-Tronco Neoplásicas/metabolismo , Neoplasias Urológicas/metabolismo , Urotélio/metabolismo , Carcinoma de Células de Transição/patologia , Humanos , Imuno-Histoquímica , Células-Tronco Neoplásicas/patologia , Prognóstico , Neoplasias Urológicas/patologia , Urotélio/patologia
9.
Khirurgiia (Mosk) ; (1): 89-94, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30789615

RESUMO

Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE: Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS: Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS: According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS: The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.


Assuntos
Prostatectomia/educação , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/educação , Simulação por Computador , Educação/normas , Humanos , Curva de Aprendizado , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Modelos Educacionais , Equipe de Assistência ao Paciente/normas , Prostatectomia/instrumentação , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Realidade Virtual
10.
Urologiia ; (6): 48-53, 2019 12 31.
Artigo em Russo | MEDLINE | ID: mdl-32003167

RESUMO

INTRODUCTION: Early diagnosis of renal cell carcinoma (RCC) is extremely difficult, due to the late development of clinical manifestations. The study of the aberrant expression of tumor-associated antigens and a production of autoantibodies to these proteins seems promising and novel method for RCC diagnosis. AIM: To evaluate the possibility of using arrestin-1 (Arr-1), recoverin (Rec) and autoantibodies against arrestin-1 (AAA1) and recoverin (AAR) as a kidney tumor biomarker. MATERIALS AND METHODS: Primary kidney tumors and metastases of 62 patients were investigated. For immunohistochemical studies, tissues were incubated with polyclonal antibodies against Rec and Arr1 as the main antibodies. Detection of AAR and AAA-1 in the serum of patients was performed using Western Blot analysis according to a standard protocol. RESULTS: Among 62 tumors, renal cell carcinoma (RCC) constitutes 50 cases (86.4%), and oncocytoma was diagnosed in 12 patients (19.4%). In 11 (22%) cases of RCC, distant metastases were detected. Positive expression of Rec was observed in almost 71% of all types of kidney tumors. In 61.3% of patients with RCC, Arr-1 expression was seen. In the serum, AAR was found only in 1 patient (1.6%) with RCC. However, unlike AAR, AAA-1 in the serum of patients was observed much more often (75.8%). CONCLUSION: According to our data, the presence of AAA1 in the serum, unlike AAR, can be considered as an early kidney tumor biomarker. The high expression of recoverin and arrestin-1 in kidney tumors suggests the use of these proteins in future as a marker for the diagnosis or even as a potential target for immunotherapy.


Assuntos
Arrestinas , Biomarcadores Tumorais , Carcinoma de Células Renais , Neoplasias Renais , Recoverina , Arrestinas/sangue , Biomarcadores Tumorais/análise , Carcinoma de Células Renais/sangue , Carcinoma de Células Renais/diagnóstico , Humanos , Neoplasias Renais/sangue , Neoplasias Renais/diagnóstico , Recoverina/sangue
11.
Urologiia ; (6): 150-155, 2019 12 31.
Artigo em Russo | MEDLINE | ID: mdl-32003187

RESUMO

Delayed ejaculation is a form of sexual disorders, which is characterized by constant or intermittent delays or absence of ejaculation and orgasm, despite normal sexual arousal and erectile function. Delayed ejaculation is one of the most studied and rare types of male sexual dysfunctions, which leads to depression, anxiety, and often is a reason of low self-esteem, reduced satisfaction of a man with his partner, and worsening of relationships between partners. In some cases, delayed ejaculation and anejaculation cause infertility. Current views on epidemiology, diagnostics and treatment strategy of delayed ejaculation are presented in the article.


Assuntos
Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Ejaculação , Humanos , Masculino , Orgasmo , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia
12.
Urologiia ; (5): 74-80, 2018 Dec.
Artigo em Russo | MEDLINE | ID: mdl-30575354

RESUMO

AIM: Experimental evaluation of the efficacy and safety of lithotripsy using a new pulsed thulium fiber laser operating at a wavelength of 1.94 microns, peak power of 500 watts (maximum average power of 50 watts) by comparing it with a holmium laser operating at a wavelength of 2.1 microns (average maximum power 100 W and 120 W). RELEVANCE: The proportion of minimally invasive surgery in the management of urolithiasis, including retrograde intrarenal surgery, is steadily growing. The most appropriate tool for stone destruction is a laser. To date, the gold standard of minimally invasive surgical treatment of nephrolithiasis is holmium laser lithotripsy, which uses a laser on yttrium-aluminum-garnet activated by holmium ions (Ho: YAG) operating at a wavelength of 2.1 m. However, in recent years, lasers on a Tm-activated fiber with a wavelength of 1.94 m have become increasingly popular since the water absorption coefficient for the Tm radiation of a fiber laser is 5.5 times higher than for a Ho: YAG laser and in 2.2 times higher than for the Tm: YAG laser. This difference may translate into greater effectiveness and speed of stone crushing, which in turn leads to shorter operating time. MATERIALS AND METHODS: This article describes physical foundations of holmium and thulium laser radiation, the mechanisms of stone fragmentation, data from a series of experiments comparing the efficiency and safety of ex-vivo lithotripsy using a holmium solid-state laser with a wavelength of 2.1 m and a thulium fiber laser with a wavelength of 1.94 m. RESULTS: The study findings suggest that the STA IRE-Polyus thulium fiber laser operating at a wavelength of 1.94 microns and a maximum power of 500 watts has several advantages over the holmium laser in the stone fragmentation in urological practice. CONCLUSION: The results of the experimental work allow us to conclude that the use of a thulium fiber laser operating at a wavelength of 1.94 m and a maximum peak power of 500 W enables highly effective and safe lithotripsy.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Hólmio , Humanos , Túlio
13.
Urologiia ; (5): 94-99, 2018 Dec.
Artigo em Russo | MEDLINE | ID: mdl-30575358

RESUMO

Nowadays, various laparoscopic instruments for tissue dissection and vessel coagulation are available. However, there are ongoing studies dedicated to "ideal" type of energy suitable for this aim. Laser radiation has been used for many years in medical practice and it is established as reliable and effective method in surgical armamentarium. The ability to provide highly precision and well-controlled action on the tissues, improved hemostasis, easy adaptability to fiber-optic and minimally invasive delivery systems, as well as the possibility of facilitating complex dissection made lasers an important tool for surgeons. The mechanism and methods of laser energy using in urology have been studied since 1980s, but there is still no consensus on the optimal type of laser and its settings during urological surgeries, which determines the importance of further researches dedicated to this promising form of energy.


Assuntos
Laparoscopia , Terapia a Laser , Fotocoagulação a Laser , Procedimentos Cirúrgicos Urológicos
14.
Urologiia ; (5): 100-105, 2018 Dec.
Artigo em Russo | MEDLINE | ID: mdl-30575359

RESUMO

In the Russian Federation, a proportion of bladder cancer in the overall structure of malignant tumors is about 2.8% and among oncological diseases of genitourinary system its incidence is second only to prostate cancer. Bladder cancer ranks as ninth most prevalent in males and as eighteens in females. The most important issue is to determine a recurrence rate of non-muscle invasive bladder cancer, which can reach 80%. In this regard, currently, all over the world much more attention is paid to studying and creation of early detection, including non-invasive, which will be reliable in the early stages. It can possibly lead to a reduction the number of cystoscopy and become as "golden" standard of non-invasive diagnosis bladder cancer.


Assuntos
Neoplasias da Bexiga Urinária , Cistoscopia , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Federação Russa
15.
Urologiia ; (5): 146-152, 2018 Dec.
Artigo em Russo | MEDLINE | ID: mdl-30575366

RESUMO

Urolithiasis is a widespread chronic disease; its prevalence has been steadily increasing over the past 50 years. Urolithiasis accounts for a large proportion urologic diseases, exceeded only by urinary tract infections and diseases of the prostate. Urate urolithiasis refers to a type of urolithiasis, characterized by the formation of kidney stones consisting of uric acid or its salts. In populations of industrialized countries, uric acid is the second or third most frequently occurring stone-forming substance. The article summarizes the data on the global prevalence of both urolithiasis as a whole and urate urolithiasis in particular. The authors provide a detailed overview of the formation of the current concept of the urate urolithiasis pathogenesis and the management of the disease. The main focus is placed on the possibilities and the role of litholytic (stone-dissolving) therapy for urate urolithiasis and the mechanisms of the action of citrate preparations.


Assuntos
Cálculos Urinários , Urolitíase , Tratamento Conservador , Humanos , Ácido Úrico
16.
Urologiia ; (3): 58-62, 2018 Jul.
Artigo em Russo | MEDLINE | ID: mdl-30035420

RESUMO

RELEVANCE: Acute uncomplicated lower urinary tract infections (AULUTI) are one of the most common diseases in urological practice. The management of cystitis is commonly based on antibacterial therapy. Despite the high efficiency, inadequate prescription of antibiotics leads to an increase in microorganisms resistance. In light of these matters, the selection of antibacterial agents to which the sensitivity of bacteria is the highest is becoming increasingly challenging. AIM: To estimate the spectrum and local sensitivity of E. coli in patients with AULUTI. MATERIALS AND METHODS: The present study analyzed the results of bacterial culture sampled from 45 patients with AULUTI. The mean age of the patients was 44+/-17 years. All bacterial cultures were obtained in out-patient settings in the framework of a multicenter initiative study on the prevention of recurrent AULUTI with d-mannose. RESULTS: Microbiological studies of the urine of patients with AULUTI revealed the growth of E. coli in concentrations ranging from 104 to 107 CFU/ml. Assessment of sensitivity demonstrated 100% sensitivity of Escherichia coli to fosfomycin trometamol. CONCLUSION: According to the findings of microbiological studies, the patients with the AULUTI retain the highest sensitivity level of E.coli to phosphomycin trometamol, which allows it to be used as a first-line drug.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Trometamina/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Doença Aguda , Adulto , Antibacterianos/administração & dosagem , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Testes de Sensibilidade Microbiana , Resultado do Tratamento , Trometamina/administração & dosagem , Infecções Urinárias/microbiologia
17.
Urologiia ; (3): 83-87, 2018 Jul.
Artigo em Russo | MEDLINE | ID: mdl-30035424

RESUMO

INTRODUCTION: Some authors consider HoLEP a new gold standard for the surgical management of prostatic hyperplasia. The increasing utilization of holmium enucleation has led to the development of various modifications of this treatment modality, including the so-called enucleation as a single piece (HoLEP en bloc), which reduces the operative time and, according to some authors, facilitates acquiring new surgical technique by surgical trainees. AIM: To compare the effectiveness and safety of the traditional HoLEP and HoLEP en bloc. MATERIALS AND METHODS: The study comprised 227 BPH patients aged from 53 to 86 years old (mean - 61.38+/-5.09 years). HoLEP en bloc was performed in 114 patients, of whom 39 patients had prostate volume (Vpr) less than 80 cm3, and in 75 patients it was more than 80 cm3. The standard HoLEP was performed in 113 patients, of whom 41 patients had Vpr less than 80 cm3, and in 72 patients it was more than 80 cm3. RESULTS: Enucleation time: HoLEP - 48+/-12 min, HoLEP en-bloc - 35+/-10; morcellation time: HoLEP - 20+/-3 min, HoLEP en-bloc - 16+/-12; duration of urinary bladder drainage by a urethral catheter: HoLEP - 58+/-3 h, HoLEP en-bloc - 41+/-2; length of hospital stay: HoLEP - 5.93+/-0.39 days, HoLEP en-bloc - 4.45+/-0.35; bladder tamponade, urethrocystoscopy and coagulation of bleeding vessels: HoLEP-3, HoLEP en-bloc-1; infectious-inflammatory complications (prostatitis): HoLEP-3, HoLEP en-bloc-2; acute urinary retention, stress urinary incontinence: HoLEP-6, HoLEP en-bloc-2; stress urinary incontinence: HoLEP - 5, HoLEP en-bloc - 2. CONCLUSION: En bloc holmium enucleation of the prostate results in the reduction of enucleation and total operative time compared with traditional HoLEP due to the fast identification of the surgical capsule and the right layer. Using this technique can improve the effectiveness of learning holmium laser enucleation of the prostate by surgical trainees.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Hólmio , Humanos , Terapia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/patologia , Hiperplasia Prostática/patologia , Ressecção Transuretral da Próstata/instrumentação , Resultado do Tratamento
18.
Urologiia ; (3): 134-140, 2018 Jul.
Artigo em Russo | MEDLINE | ID: mdl-30035434

RESUMO

The article presents a rare case of urinary bladder reconstruction using thoracodorsal revascularized autograft in a patient with a bladder injury resulting from a road traffic accident. The area and size of the thoracodorsal flap (2215 cm) were determined using a 500 ml latex model of the bladder. The autograft was revascularized through external iliac vessels. From the thoracodorsal autograft, the dome was formed with the dermal part inward, which was fixed along its circumference to the bladder edges with 3/0 prolene sutures. The muscular part of the thoracodorsal flap was fixed along the perimeter to the remaining aponeurosis and covered by a free expanded cutaneous autograft. The surgery resulted in a newly constructed neobladder of sufficient volume (250-300 ml) with elements of the patients own bladder (posterior wall and neck) while sparing the patient from a cystostomy and improving his quality of life.


Assuntos
Retalho Miocutâneo/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Acidentes de Trânsito , Adulto , Humanos , Masculino , Retalho Miocutâneo/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento , Bexiga Urinária/lesões
19.
Urologiia ; (2): 130-133, 2018 May.
Artigo em Russo | MEDLINE | ID: mdl-29901308

RESUMO

Endoscopic enucleation of the prostate (EEP) techniques such as HoLEP (holmium laser enucleation of the prostate), ThuLEP (thulium laser enucleation of the prostate) and electroenucleation (mono- or bipolar) are highly effective and safe. They have been endorsed by the latest version of the European Association of Urology guidelines as an alternative to not only open adenomectomy but also transurethral resection of the prostate (EAU Guidelines on Treatment of Non-neurogenic Male LUTS 2018). Therefore, many urologists face the possibility of replacing the treatments of BPH. In this article, we analyze the history of EEP techniques, both their pros and cons and, what are they today - just a popular trend or a new standard procedure for the surgical treatment of BPH?


Assuntos
Terapia a Laser/métodos , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Ureteroscopia/métodos , Humanos , Masculino
20.
Urologiia ; (2): 147-153, 2018 May.
Artigo em Russo | MEDLINE | ID: mdl-29901311

RESUMO

Currently, transurethral resection of a bladder tumor (TUR) is the gold standart treatment for non-muscle invasive bladder cancer (NMIBC). Standard TUR for a bladder wall tumor has a high recurrence rate, which is caused mainly by malignant cell implantation during the surgery. Besides, specimens obtained with conventional TUR are insufficient for accurate pathological staging. The non-conformity of the standard TUR with the established oncological principle of dissecting through normal tissue prompted a search for the optimal surgical modality. En-bloc resection of the bladder wall tumor has been proposed as an alternative method for surgical management of NMIBC. This technique involves the resection of bladder tumor through the underlying muscle layer as a single piece thus providing high quality material for subsequent morphological study and reducing the risk of metastasizing by implantation of malignant cells. This paper presents an analysis of relevant research literature published in the last twenty years, describes all currently existing techniques of the bladder tumor resection using a variety of energy sources, including laser.


Assuntos
Terapia a Laser/métodos , Neoplasias da Bexiga Urinária/cirurgia , Feminino , Humanos , Masculino , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia
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