[Infectious factor in transuretral surgery of benign prostate hyperplasia: a systematic review and meta-analysis]

PURPOSE

To assess postoperative bacteriuria and infectious complications in terms of antibiotic prophylaxis (ABP) regimens, preoperative urine bacterial status and total prostate-specific antigen (PSA) level in patients with benign prostate hyperplasia (BPH) undergoing transurethral prostate surgery.

MATERIALS AND METHODS

The PubMed, ClinicalKey, Google Scholar and the Cochrane bibliographic databases were searched from 1992 to 2022. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and inverse variance method was used to calculate mean difference (MD) with 95% confidence interval (CI). Primary outcome was the development of asymptomatic bacteriuria, secondary - development of infectious complications.

RESULTS

This meta-analysis showed that ABP significantly decreased level of postoperative bacteriuria and infection complications. This meta-analysis was in favour of prolonged ABP ( more or equal 3 days) in lowering postoperative infectious complications rate compared to short regimens ( less or equal 24 hours). Preoperative bacteriuria was not significantly associated with postoperative bacteriuria level and infectious complications. Mean preoperative PSA level significantly differed in patients with and without postoperative bacteriuria.

CONCLUSION

This meta-analysis demonstrated significant gaps in the knowledge of perioperative bacterial status and antibiotic prophylaxis strategies efficacy in the group of patients undergoing transurethral prostate surgery. There is no consensus on optimal ABP regimen. Most of included studies had significant heterogeneity. Further studies are required.

[The results of the multicenter prospective comparative study of Androgel in men with endogenous testosterone deficiency and lower urinary tract symptoms, associated with benign prostate hyperplasia (POTOK)]

AIM

To evaluate the efficacy and safety of using Androgel in men with endogenous testosterone deficiency and lower urinary tract symptoms (LUTS), associated with benign prostatic hyperplasia (BPH) in routine clinical practice.

MATERIALS AND METHODS

The multicenter, prospective, comparative study "POTOK" included 500 patients aged over 50 years with biochemical signs of testosterone deficiency (morning total testosterone concentration <12.1 nmol/l) and LUTS/BPH (International Prostatic Symptoms Score [IPSS] score of 8-19). The recruitment and monitoring of patients was carried out in 2022 in 40 clinics in Russia. Depending on the therapy, all patients were divided into two groups. The physician's decision to prescribe a specific drug (according to the approved patient information leaflet), as well as the subsequent follow-up scheme and therapy, was made a priori and independently of patient. In the first group (n=250) alpha-blockers and Androgel were prescribed, while in the second group (n=250) patients received monotherapy with alpha-blockers. The follow-up duration was 6 months. The efficiency of the therapy was evaluated after 3 and 6 months according to IPSS, symptoms of androgen deficiency (AMS and IIEF scores), uroflowmetry (peak flow rate, total urination volume), ultrasound study (postvoid residual and prostate volume). Safety was assessed by the total number of adverse events, stratified by severity and frequency. Statistical analysis was carried out using IBM SPSS 26.0.

RESULTS

According to the primary end-point (IPSS score), there were significant differences between groups 1 and 2 after 3 months (11 vs. 12 points, p=0.009) and 6 months of therapy (9 vs. 11 points, p<0.001). There were also significant differences in the severity of symptoms of androgen deficiency after 3 and 6 months of therapy according to AMS score of 35 vs. 38 points (p<0.001) and 28 vs. 36 points (p<0.001), respectively. According to IIEF, all domains (erectile and orgasmic functions, libido, sexual satisfaction with and general satisfaction) were better in group 1 (p<0.001). After 6 months, uroflowmetry values also differed. In group 1 Qmax was 16 ml/s compared to 15.2 ml/s in group 2 (p=0.004); postvoid residual was 10 ml vs. 15.5 ml, respectively (p=0.001). The prostate volume in group 1 after 6 months of treatment was significantly lower (39.5 cc) compared with group 2 (43.3 cc; p=0.002). During the study, 18 mild AEs, 2 moderate AEs, and 1 severe AE were identified without significant differences between the groups (p>0.05).

CONCLUSION

The results of study "POTOK" showed greater efficacy and comparable safety of alpha-blockers in combination with Androgel compared with monotherapy with alpha-blockers in men with LUTS/BPH and endogenous testosterone deficiency in routine clinical practice. The increase in serum testosterone concentrations to normal values in patients with age-related hypogonadism favorably influence on the severity of LUTS and the potentiate the effect of the standard monotherapy with alpha-blockers.

[Cytological examination of urine in the differential diagnosis of recurrent lower urinary tract infection]

INTRODUCTION

A diagnosis and treatment of recurrent lower urinary tract infection (UTI) in women is still one of the unresolved problems of urology. The proper identification of the etiological factor determines the treatment tactics. Therefore, the most urgent issue of recurrent lower UTI is the differential diagnosis of the causative pathogens.

MATERIALS AND METHODS

A cytological study of urine was performed in 151 patients with recurrent lower UTI, who, according to the results of bacteriological and PCR studies of urine, were divided into three groups, depending on the etiological factor. The group 1 (n=70) included women with recurrent lower UTI of bacterial etiology, while in group 2 (n= 70) papillomavirus etiology was found, and in group 3 (n=11) candida species were the causative pathogens. The age of the patients ranged from 20 to 45 years (32.3+/-7.8).

RESULTS

In the majority of patients with recurrent lower UTI of bacterial etiology, the cytological features were represented by leukocytes, plasma, epithelial cells and bacteria in combination with actively phagocytic macrophages. In group 3, in addition to a large number of leukocytes (neutrophils) and epithelial cells, Candida mycelium was found. In group 2, signs of bacterial inflammation were minimal, while a predominance of lymphocytes, epithelial cells, and the presence of single neutrophils was seen. With papillomavirus lesions of the bladder, urothelial cell dystrophy with the presence of koilocytes developed.

CONCLUSIONS

A cytological examination of urine can confirm the etiology of the recurrent lower UTI and be an evidence-based criterion in the differential diagnosis of bacterial, candidiasis, and papillomavirus infection. Total transformation of the urothelium and vacuolization of urothelial cells, as well as an excess of lymphocytes in the urine in the absence of neutrophils, are the characteristic features of viral recurrent lower UTI.

[Extended culture study as a keypoint to rethinking antibiotic therapy for chronic bacterial prostatitis]

OBJECTIVE

To juxtapose the microbiological efficacy of standard and targeted antibiotic therapy (ABT) based on the comparison of the results of extended bacteriology of biomaterial in patients suffering chronic bacterial prostatitis (CBP) before and after treatment.

MATERIALS & METHODS

STUDY DESIGN

single-centre observational comparative study. Sixty patients with CBP aged 20 to 45 years were included in the study. All patients underwent an initial examination: questioning, Meares-Stamey 4-glass test, extended bacteriology of biomaterial samples, and determination of antibacterial susceptibility (ABS). After the initial examination, the patients were randomly assigned to two groups (30/30 patients). In group (G) 1, antibacterial drugs were prescribed following the EAU guidelines on Urological Infections (monotherapy), in G2, focusing on the results of ABS (mono or combination therapy). Evaluation of the treatment effectiveness and control bacteriology were carried out three months after therapy.

RESULTS

In G1 vs G2, nine vs ten aerobes and eight vs nine anaerobes were identified in the expressed prostate secretion, respectively. The microbial load of the samples in more or equal 103 CFU / ml was established in G1 vs G2 for five vs ten aerobes and seven vs eight anaerobes, respectively. The highest ABS of bacteria was determined to moxifloxacin, ofloxacin, and levofloxacin. Cefixime was the most active against anaerobes. After treatment, no significant changes in the bacterial spectrum were observed in both groups. A more reliable decrease in the frequency of microorganism identification and the microbial load of the samples was observed in patients with G2 after the targeted ABT.

CONCLUSION

Targeted ABT based on extended bacteriology can be considered an effective alternative to standard guideline-approved ABT for the treatment of CBP.

[Asymptomatic bacteriuria in pregnant women the normal condition of healthy women urine]

OBJECTIVE

to study the dynamics of the microbiota of a freshly excreted middle portion of urine in primigravida at different times of all three trimesters of pregnancy.

MATERIALS AND METHODS

A single-center prospective observational cohort study was conducted with a consecutive enrollment of 30 women at different gestational ages: I - 8-12 weeks, II - 22-24 weeks, III - 30-32 weeks. A midstream specimen of morning vesical urine was taken for the study, then it was cultivated using nutrient media for aerobic and anaerobic microorganisms under appropriate conditions. Statistical analysis was performed using SPSS ver.26 (IBM SPSS Inc., Chicago, IL, USA).

RESULTS

The freshly released middle portion of urine in all 30 observations in the I-III trimesters contains aerobic-anaerobic associations of microorganisms. Coagulase-negative staphylococci, Enterococcus spp., Corynebacterium spp., Lactobacillus spp., Eubacterium spp. prevail in the urine during pregnancy. The E. coli, Candida spp. detection frequency decreases by the third trimester, but Lactobacillus spp. detection frequency rises. Significant differences in the detection frequency were found only in Propionibacterium spp. and Lactobacillus spp. The average level of bacteriuria in most cases is 102-103 CFU/ml with significant differences only in E. faecium, Lactobacillus, Propionibacterium spp. in the III trimester.

DISCUSSION

The study of urine at different times of all three trimesters of pregnancy refutes the previous ideas about asymptomatic bacteriuria. The urine microbiota in primigravida during pregnancy has wide spectrum and quite stable until delivery. Such bacteriuria can be considered asymptomatic, but it is a consequence of a healthy state and it is not a disease or its predictor.

CONCLUSION

The term asymptomatic bacteriuria is not correct in the context of risk factor of urinary tract infection in pregnant women.

[Long-term inflammatory and neoplastic reaction of prostate tissues during its transurethral infection with uropathogens: evaluation of the results of animal model study]

INTRODUCTION

There is no convincing evidence of the persistence of acute or the development of chronic bacterial-induced prostatic inflammation in the long term when infected with various titers of the uropathogen. Along with this, controversial data are presented on the relationship between post-infectious chronic inflammation and neoplastic changes in prostate tissues.

OBJECTIVE

To carry out, based on the experimental data: 1) assessment of the degree of bacterial contamination and the severity of histological changes in prostate tissues on the 60th follow-up day in case of transurethral infection with various uropathogens in titers of 102,3,5 CFU/ml; 2) fundamental comparative analysis between the indicators of the inoculated test-titer and microbial load with the severity of histological changes in prostate tissues; 3) verification of neoplastic transformations in the prostate tissues during a long-term persistent bacterial-induced inflammatory process.

MATERIALS AND METHODS

Animal studies were conducted using FELASA protocols. Laboratory animals: 14 New Zealand rabbits. Tested uropathogens: aerobes - E. coli, S. haemolyticus, anaerobes - P. niger. Titers: 102,3,5 CFU/ml. Uropathogen inoculation technique: topical transurethral.

RANDOMIZATION

all laboratory animals were divided into 5 groups according to the uropathogen (4 experimental, 1 control). Follow-up period: 60 days. Sacrification and autopsy of the animals were performed on day 60. Biopsies were taken from various parts of the prostate, as well as from the bladder neck and the edge of the membranous urethra. Cultural, histological and immunohistochemical (expression of p53 and Ki-67) studies of prostate tissues were conducted. Statistical data processing was performed using the GraphPad Prism 9.0 program (GraphPad Software Inc., Graphpad Holdings LLC, San Diego, CA, USA) applying descriptive and non-parametric statistics.

RESULTS

Two individuals infected with S. haemolyticus + P. niger had a lethal outcome. The contamination of prostate tissue was determined in all cases of infection. In 88.9% of the cases, an increase in tissue microbial load was determined compared to the initial titer. Multivariate analysis of culture study values revealed the presence of intragroup differences in prostate contamination only between infection with E. coli 103 CFU/ml and E. coli 105 CFU/ml (p=0.006), as well as intergroup differences between infection with E. coli 105 CFU/ml and P. niger 105 CFU/ml (p=0.013). The histological study revealed moderate proliferative inflammation after inoculation with 102,3,5 CFU/ml in the E. coli and S. haemolyticus groups. In the case of S. haemolyticus, it was more pronounced due to the presence of persistent alterative lesion foci; in the P. niger group, mild proliferative transformations were observed in prostate tissues in all cases. The immunohistochemical study of changes determined p53 expression (10.0%) in some areas of the glandular epithelium of prostate glands (but without a positive internal control) only in case of infection with E. coli 105 CFU/ml. Areas of glandular epithelium with Ki-67 expression ( less or equal 25.0%) were visualized in all tested groups, mainly at titers of 103 and 105 CFU/ml, but the severity of proliferative activity was not high (1+). There were no foci of prostate tissue with simultaneous nuclear activity of p53 and Ki-67.

CONCLUSION

Proliferative inflammation of different intensity in prostate tissues was observed after sixty days. Its severity was mainly determined by the type of infecting agent (S. haemolyticus > E. coli > P. niger) and was not dependent on the inoculated titer and the subsequent microbial load of prostate tissues. No areas of neoplastic transformation of prostate tissues were reliably identified in the case of a bacterial-induced inflammatory process in the estimated follow-up period.

[Comparative analysis of patients with spongy urethral strictures undergoing multistage urethroplasty or permanent urethrostomy]

INTRODUCTION

Deciding on the optimal surgical method for treating complex spongy urethral strictures is a challenging clinical task.

PURPOSE OF THE STUDY

To determine the clinical differences between patients undergoing multistage urethroplasty and permanent urethrostomy.

MATERIALS AND METHODS

Two groups of patients were formed for the analysis: group I - 73 patients who underwent multistage urethroplasty; group II - 48 patients underwent permanent urethrostomy. The differences between groups were studied according to the following clinical parameters: age, body mass index, duration of the disease, previous treatment, etiology, length and localization of strictures, complications of stricture disease, concomitant diseases, urine flow parameters, the presence of early postoperative complications, and recurrence of strictures.

RESULTS

Patients of group I compared to group II are significantly younger (43.0 vs 59.6 years; p<0.0001). They have fewer idiopathic strictures (8.2 vs 31.3%; p=0.001), undergo cystostomy less often (26.0 vs 54.2%; p=0.002), have less pronounced lower urinary tract symptoms (I-PSS - 18.6 vs 23.8 points; p<0.0001, QoL 4.3 vs 5, 1 point; p<0.0001) and impaired urination parameters (Qmax - 8.1 vs 6.5 ml/s; p=0.09, Qave - 5.5 vs 4.1 ml/s; p=0.015, PVR - 62.4 vs 126.0 ml; p=0.03). The incidence of concomitant diseases (69.9 vs 87.5%; p<0.025) and their number (1.8 vs 3.1; p<0.002) are significantly higher in group II. Among the comorbidities, cardiovascular diseases (31.5 vs 58.3%; p=0.015), diabetes mellitus (5.5 vs 16.7%; p=0.045) and prostatic hyperplasia (8.2 vs 27.1%; p=0.005) predominate. Early surgical complications in group I were detected in 28,8% of patients, in group II - in 2.1% (p<0,0001) of cases. The primary treatment success among patients with permanent urethrostomy is higher than with multistage urethroplasty (85.4 vs 65,8%; p=0,017).

CONCLUSIONS

It is advisable to perform multistage surgery of extended spongy urethral strictures in young and middle-aged men without serious comorbidities in cases of conscious choice and sufficient awareness. Urethrostomy should initially be discussed with the patient as the operation of choice, considering age, cardiovascular comorbidity, diabetes mellitus and prostatic hyperplasia.

[Bradis anti-reflux ureterocysto-anastomosis in children with recurrent obstructive megaureter]

INTRODUCTION

Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research.

PURPOSE

Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradis technique for children with recurrent obstructive megaureter (OM).

MATERIALS AND METHODS

The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradis extravesical reimplantation.

RESULTS

During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the pre-surgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings.

CONCLUSIONS

The simplicity of Bradis extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradis surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.

[The role of angiotensin-converting enzyme and angiotensin ii receptors of the second type in the pathogenesis of proliferative diseases of the prostate]

Angiotensin converting enzyme, angiotensin II, angiotensin II receptors of the first and second types represent the "classical" axis of regulation of the renin-angiotensin system. OBJECTIVE: to analyze the role of the components of the renin-angiotensin system in the pathogenesis of proliferative lesions of the prostate glan MATERIALS AND METHODS: The study included 63 patients who underwent transrectal prostate biopsy. The first group consisted of 19 patients with benign prostatic hyperplasia, the second group consisted of 19 men whose prostate cancer was detected during repeated biopsy, the third group consisted of 25 men with prostate cancer detected during primary prostate biopsy. The expression of angiotensin II type II (AT2-R) receptors in prostate tissue was evaluated using primary polyclonal antibodies Angiotensin II Type 2 Receptor and the EnVision FLEX imaging system (Dako, Denmark) according to a standard technique. The activity of angiotensin converting enzyme (ACE) was determined in the secret of the prostate gland, RESULTS: It was found that the activity of ACE in the secret of the prostate gland in proliferative diseases is significantly higher than in the "healthy" prostate. The highest activity of ACE was noted for benign prostatic hyperplasia, and the minimum - for prostate cancer. The expression of AT2-R in prostate tissues in proliferative diseases of the prostate gland has its own characteristics. The expression of AT2-R in the prostate stroma turned out to be the same, in the nuclei of epithelial cells, the level of expression of AT2-R decreased in the range of BPH-PIN-CP. Thus, an increase in the activity of ACE, the accumulation of angiotensin II in prostate secretions in proliferative prostate diseases against the background of a deficiency of AT2-R is the metabolic basis of malignant transformation of the prostate gland. CONCLUSION: The levels of ACE activity in prostate secretion and the expression of AT2-R in prostate tissue during primary prostate biopsy can be considered as promising prognostic tools for early detection of prostate malignancy.

[Perineal and penile urethrostomy: surgical outcome and risk assessment of complications]

INTRODUCTION

Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients.

PURPOSE OF THE STUDY

To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs).

MATERIALS AND METHODS

85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the 2 test, Fishers test. Multivariate analysis was performed using logistic regression.

RESULTS

Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1; p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications.

CONCLUSION

Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

[Nephron epithelial changes of the obstructive kidney in unilateral ureteral obstruction (experimental study)]

INTRODUCTION

The high prevalence of kidney diseases caused by urinary tract obstruction has led to the need for experimental studies of the dynamics of pathological processes in their lesions. Despite the fact that the general patterns of development of obstructive uropathy are known, the features of renal tissue damage, in particular structural and molecular biological changes in this pathology, remain insufficiently studied.

OBJECTIVE

to study the dynamics of changes in the phenotype of epithelial cells of the nephron of an obstructive kidney with unilateral ureteral obstruction using an experimental model.

MATERIALS AND METHODS

The experimental study was carried out on the basis of the Rostov State Medical University. The model of unilateral ureteral obstruction was reproduced in adult rabbits. The studies were carried out on the 7th, 14th and 21st days of complete obstruction of the left ureter. Immunophenotyping of obstructive kidney tissue samples was performed for markers of epithelial phenotype (cytokeratin 7, E-cadherin) and mesenchymal phenotype (vimentin, - smooth muscle actin).

RESULTS

The sequence of changes in the phenotype of nephron epithelial cells during ureteral obstruction has been established. The first signs of an epithelial-mesenchymal transition (EMT) appear by day 7 in the form of a decrease in visualization of markers of the epithelial phenotype. On the 14th day, the expression of both epithelial and mesenchymal markers is noted. Significant changes in the phenotype of nephron epithelial cells: loss of epithelial markers (cytokeratin 7, E-cadherin) and the acquisition of mesenchymal markers (vimentin, - smooth muscle actin), are noted by the 21st day of the experiment.

CONCLUSION

An experimental model of unilateral ureteral obstruction revealed the transformation of the nephron tubule cell phenotype from epithelial to mesenchymal.

[Theoretical basis of the uropatogens interactions with the host-organism in case of occurrence and development of acute pyelonephritis (review part III)]

The formation and development theories of bacterial inflammation in organs and tissues have been studied in detail and confirmed by experimental and clinical data. However, the development of inflammation in each organ has its characteristics associated with its structures and functions. This fully applies to acute pyelonephritis. The peculiar structure of uropathogens, their virulence, the reaction of the host organism in response to bacterial invasion, namely, factors of innate and acquired immunity, are analyzed in detail in the review. It reflects both the basic mechanisms of development of acute pyelonephritis and proteomic and genetic factors involved during inflammatory lesions.

X-ray micro-computed tomography in the assessment of penile cavernous fibrosis in a rabbit castration model

BACKGROUND

Current assessment methods of penile cavernous fibrosis in animal models have limitations due to the inability to provide complex and volume analysis of fibrotic alterations.

OBJECTIVE

The aim was to evaluate micro-computed tomography (micro-CT) for assessment of cavernous fibrosis and compare it with histological, histochemical, immunohistochemical, and RT-PCR analysis.

MATERIALS AND METHODS

A controlled trial was performed involving 25 New Zealand male rabbits with induced testosterone deficiency by orchidectomy. Penile samples were obtained before and after 7, 14, 21, 84 days from orchidectomy. We consistently performed: a) gray value analysis of corpora cavernosa 3D models reconstructed after micro-CT; b) morphometry of smooth muscles/connective tissue ratio, collagen type I/III ratio, and area of TGF-beta-1 expression in corpora cavernosa; c) RT-PCR of TGF-beta-1 expression.

RESULTS

Micro-CT allowed visualization of penile structures at the resolution comparable to light microscopy. Gray values of corpora cavernosa decreased from 1673 (1512-1773) on the initial day to 1184 (1089-1232) on 21 day (p < 0,005); however, on 84 day, it increased to 1610 (1551-1768). At 21 and 84 days, there were observed a significant decrease in smooth muscle/connective tissue ratio and a significant increase in collagen type I/III ratio (p < 0,05). TGF-beta1 expression increased on 84 day according to immunohistochemistry (p < 0,005). RT-PCR was impossible to conduct due to the absence of RNA in obtained samples after micro-CT.

DISCUSSION AND CONCLUSIONS

Micro-CT provided 3D visualization of entire corpora cavernosa and assessment of radiodensity alterations by gray value analysis in fibrosis progression. We speculate that gray value changes at early and late fibrosis stages could be related to tissue reorganization. RT-PCR is impossible to conduct on tissue samples studied by micro-CT due to RNA destruction. We also suggest that micro-CT could negatively affect the immunohistochemical outcome, as a significant increase of TGF-beta-1 expression occurs later than histological fibrotic signs. This article is protected by copyright. All rights reserved.

[Cystoscopic and morphological features of chronic recurrent papillomavirus cystitis]

INTRODUCTION

Chronic recurrent cystitis (CRC) is a common disease in the female population and a serious medical problem. There are not enough data about etiology of this desiase and effective treatment.

OBJECTIVE

To increase the accuracy of the differential diagnosis of bacterial and papillomavirus chronic recurrent cystitis.

MATERIALS AND METHODS

Analysis of endoscopic and morphological diagnostic methods of 118 patients with CRC, which, depending on the etiological factor, were divided into two groups. Group I (n=65) patients with CRC of HPV etiology and Group II (n=53) - CRC of bacterial etiology (E. coli). All patients were examined according to the EAU and RSU recommendations, and an endoscopic examination of the bladder (cystoscopy) was additionally included, followed by morphological examination of biopsy specimen of the urinary bladder.

RESULTS

The endoscopic picture of bacterial CRC usually is caused by hyperemia of the mucous membrane of the bladder, hyperemia and injection of vessels with the participation of (small-puncture/diapedesic) hemorrhages without signs of proliferative changes. The endoscopic picture in papillomavirus CRC in all patients presented by focal or diffuse, slightly elevated, exophytic, often polypoid formations of a whitish or whitish-gray color, usually localized in the Leto triangle. Morphological analysis of biopsy tissue of the urinary bladder in patients with bacterial cystitis in the mucous and submucous layer showed edema, thickening of the urothelium, capillary abundance, inflammatory infiltration, represented by lymphocytes, plasma cells and leukocytes, among which neutrophilic macrophage leukocytes were predominant. Morphological analysis of the bladder mucosa in all examined patients with signs of HPV-related lesions showed a thickening of the urothelium, squamous metaplasia of the urothelium, chronic inflammation, microcirculatory vascular reaction and edema. An important distinctive pathomorphological sign of HPV within urinary bladder was the presence of koilocytic transformation of urothelium cells due to the cytopathic effect of the virus.

CONCLUSIONS

Papillomavirus CR has characterized by an infectious-inflammatory process in the bladder paries, with lymphocytic-plasmatic infiltration and coylocytic transformation of the urothelium.

[Sources of bacterial penetration into the kidney (review part II)]

Kidney and upper urinary tract infections are a serious general medical problem that is the subject of ongoing experimental and clinical research. However, etiological factors and the pathophysiological mechanisms of acute infectious renal inflammation are poorly understood. This also applies to the problem of sources of bacterial penetration into the kidney. The existing hypotheses on this score have "blank spots". This review comprehensively examines the pathways of invasion of microorganisms into the kidney, causing the development of acute inflammation in it. The proofs in favour of the existing views and their criticism are presented. Also, weaknesses in the inference system are determined.

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

INTRODUCTION

Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented.

MATERIALS AND METHODS

The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width.

RESULTS

No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring.

CONCLUSION

The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.

[Current issues of epidemiology, etiology, risk factors and predisposing conditions of acute pyelonephritis (review part I)]

A growing body of research indicates an upward trend in the incidence of urinary tract infections (UTIs) around the world. Acute pyelonephritis (AP), which is dangerous by the development of complex, life-threatening conditions, is no exception. Today the demographic portrait, as well as the characteristics of the causative agents and predisposing conditions of this disease are a global issue for the entire scientific community. In order to assess the data available in the global literature on the issues of epidemiology, etiology and predisposing factors for the development of AP, the search for publications was performed in the medical literature databases The Cochrane Database, MEDLINE/PubMed Database, eLIBRARY, ClinicalKey. The presented material includes, among others, 43 sources over the past 10 years, of which 31 publications over the past 5 years: the largest and most representative studies reflecting the current situation with AP in the population among patients in certain areas and under various exogenous and endogenous conditions. This study opens a series of three reviews on the problem of AP, involving discussion of key aspects of pathogenesis AP. Analysis of the literature indicates fragmentation and limited data when comparing the incidence of AP in different countries and different periods of time. The complexity of the intranosological structure of the varieties of acute pyelonephritis today dictates the advisability of updating approaches to research in this area, and the disease itself dynamically evolves along with its etiological agents, the nature of social behavior of people and environmental conditions in general.

[Comparison of functional magnetic resonance urography and dynamic renal scintigraphy in the functional assessment of ureteropelvic junction obstruction in children]

PURPOSE

In order to determine the role and significance of functional magnetic resonance urography (fMRU) in the diagnosis of ureteropelvic junction obstruction (UPJO), a comparative analysis of the results of fMRU and dynamic renal scintigraphy (DRS) was carried out.

MATERIALS AND METHODS

From January 2017 to December 2019, fMRU and diuretic DRS were performed in 36 patients (mean age 89+/-63 months). Boys - 26 (72.2%), girls - 10 (27.8%). Left-sided hydronephrosis was detected in 23 (63.9%) children, right-sided in 12 (33.3%) patients, and bilateral lesions in 1 (2.8%) patient (2 renal units (RU)). Antenatal hydronephrosis was detected in 9 (25%) patients, and postnatally in 27 (75%) patients. According to ultrasound data, grade II hydronephrosis occurred in 11 (29.8%) RU, grade III - in 21 RU (56.7%), and grade IV - in 5 RU (13.5%) according to the SFU classification. A diuretic test was performed in 26 patients.

RESULTS

Median and quartiles of differential renal function (DRF) according to fMRU data on the affected side were 37% [29; 43], and according to DRS - 46% [40;49]. When performing fMRU, a positive diuretic test was detected in 20 patients, 5 patients - negative and 1 patient - doubtful, and according to the DRS data, 12 patients had a positive test, 10 patients - negative and 4 patients - doubtful. Differences in DRF between fMRU and DRS varied between 0.7-33%. The average value of differences in DRF on the affected side was 11.3+/-8.5%. When comparing the results of DRF on the affected side, a moderate correlation was found on the Cheddock scale (r=0.59, p<0.05) between fMRU and DRS data. In comparison of the DRF using the Wilcoxon test, statistically significant differences were revealed (p<0,05).

SUMMARY

Our experience demonstrates the high potential of fMRU in terms of replacing the classical methods of diagnosis of UPJO in children, taking into account the high correlation coefficients between the results of fMRU and DRS. Standardization of the fMRU protocol will increase the diagnostic relevance of information and in the future will make fMRU the only necessary study to determine management tactics for patients with UPJO.

[Morphological analysis of the structure of parafistulous tissues in patients with vesicovaginal fistulas by the local interstitial application of platelet-rich plasma]

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF.

PURPOSE OF THE STUDY

to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP.

MATERIALS AND METHODS

Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology.

RESULTS

Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p<0.05). Erosive and ulcerative lesions of the integumentary epithelium were initially detected in 14 patients (64 percent) from Group II. No erosions were detected during control biopsy (p<0.05). The thickness of fibrous tissue in Group II before the therapy was 886.3+/-113.5 M, and 830.1+/-119.9 M (p=0.66) after. Lymphoid infiltration was initially present in 20 patients from Group II, in eight of them (40 percent) it decreased (p<0.05) after the therapy. Cell density decreased after PRP therapy in 11 patients (50 percent), but in four (18 percent) patients it increased from low to moderate (p<0.05). Microvascular density before therapy was 29+/-3,3, and 19.9+/-1.9 after. The difference has statistical validity at the trend level (p=0.078).

CONCLUSION

Taking into account a statistically significant decrease in the activity of the inflammatory process, complete relief of erosive and ulcerative lesions, and decrease in the thickness of fibrosis in the stromal layer in fistula tissues, application of PRP therapy in the surgical treatment of VVF should be considered appropriate and justified.

[Open and laparoscopic Boari distal ureteroplasty technique: a comparative analysis of efficiency and safety]

INTRODUCTION

Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis.

OBJECTIVE

to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches.

MATERIALS AND METHODS

In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months.

RESULTS

Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period.

CONCLUSION

Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.

[Are bacteriological and pathomorphological signs of bacterial prostatitis related between? (An experimental study)]

INTRODUCTION

In some cases, there is a dissociation between the severity of complaints, physical examination data, and levels of contamination of the biomaterial in the differential diagnosis of various categories of prostatitis (NIH-NIDDK, 1995). Patients note the presence of pronounced symptoms when verifying the threshold indicators of microbial load (104-105 CFU / ml) of prostate secretion or post-massage urine in a few observations. However, clinical manifestations and deviations in objective indicators are not so significant in some patients with higher titers of contamination.

PURPOSE OF THE STUDY

To evaluate the relationship between the microbial load indices and the degree of pathomorphological changes in the prostate tissue during infection with the "reference" uropathogen E. coli in various titers under experimental conditions MATERIALS AND METHODS: Animal model was carried out using the FELASA protocols. Experimental individuals: 16 "New Zealand" rabbits, weight: 3580 [3480; 3695] (3300-4410), age: 25 [24; 26] (23-28) weeks. Uropathogen used: E. coli. Titers: 103 CFU / ml, 105 CFU / ml, 107 CFU / ml. Infection pathway: inoculation of the uropathogen was performed through urethra according to the modified technique of J.C. Nickel. Randomization: all lab animals were evenly divided into 4 groups of 4 animals, taking into account the initial titer of the uropathogen and the observation period - experimental groups 1 (103 CFU / ml), 2 (105 CFU / ml), 3 (107 CFU / ml); group 4 was control (Sol.NaCl 0.9%). Observation terms: 1, 3, 7 and 14 days, after which the animals were euthanized and dissected. 4 biopsies (1A-1D) for bacteriological (MacConkey agar - "HiMedia", India) and 2 biopsies (P1-P2) for morphological (Hematoxylin-eosin - "BlikMediklProduction", Russia; magn. 10x, 40x, 100x, 400x) studies were formed from various parts of the prostatic complex (prostate + proprostate + paraprostate). A three-point grading system was used for morphometric assessment of destructive changes in the prostate tissue in different groups. Analytical processing of the results was carried out using the software packages Microsoft 365 ("Microsoft", USA) and Statistica 10.2 ("StatSoft Inc.", USA) by methods of descriptive and nonparametric statistics.

RESULTS

The maximum total absolute / median values of the seeding of biopsy specimens of the prostatic complex were revealed ( titer, 1A-1D) in group 1 and amounted to 76 lg CFU / ml / 5.00 [4.00; 5.25] lgCFU / ml, in group 2 defined as intermediate - 57 lgCFU / ml / 3.50 [3.00; 4.00] lgCFU / ml, and in group 3 were minimal - 48 lgCFU / ml / 3.00 [3.00; 3.25] lg CFU / ml according to the indicators of bacteriological research in the period from 1 to 14 days. Nevertheless, it was found that the cumulative maximum degree of histological changes in the prostate was recorded in group 2 ( p. - 84), in group 1 it was defined as intermediate ( p. - 68), and in group 3, it was the smallest ( p. - 64) according to the data of pathomorphological studies. When comparing daily changes in the seeding values and nominal indicators of inflammatory lesions in the prostate tissue, only in group 1, the trend graphs had a synchronous trend - an increase in microbial load led to the formation of more severe pathomorphological transformations on the day 7; in group 2, destructive changes were significant, and the rates of contamination, on the contrary, were minimal on the day 7; in group 3 a pronounced pathomorphological transformations in the tissues were noted on the day 3 and 7, but the microbial load of the tissues gradually decreased from the day 1. Also, differences in the increase in the "reactivity" of changes in the affected tissues were determined: in groups 1 and 3, a torpid reaction was revealed, accompanied by the development of moderate inflammatory changes on the day 1 and an "abrupt" increase in the intensity of destruction by the day 3; in group 2, in turn, a rapid reaction was determined, that characterized by the formation of a more pronounced destructive process already from the day 1.

CONCLUSION

It was found that the parameters of contamination do not fully reflect the nature and severity of pathological changes in the prostate. Low titers of the uropathogen induce the development of an inflammatory process comparable in the severity of changes with that at higher concentrations. On the contrary, inoculation of obligate pathogenic titers does not always lead to a pronounced increase in microbial load but causes significant inflammatory changes in the prostate.

[Penile cavernous fibrosis: etiology, morphogenesis, erectile dysfunction]

Despite significant advances in andrology, the problem of penile cavernous fibrosis remains not fully understood. Many studies on the epidemiology of erectile dysfunction have been published, but consensus on the place and role of this pathology in the structure of sexual disorders has not yet been reached. The data obtained at different time intervals and in different geographical areas are strikingly different. Also, the role of organic disorders in the penis, including fibroplastic changes, in certain etiological factors has not been determined. In addition, the relationship between etiological factors and morphological changes in penile tissues is disputed due to the small amount of data obtained from the pathohistological study of human penis biopsies. This review is devoted to the systematization of epidemiological data and etiological factors of cavernous fibrosis, the definition of the relationship between them, the analysis of clinical and experimental studies, which study the relationship between the degree of severity of damaging agents and the formation of typical fibrogenic reactions.

[Renomedullary interstitial cell tumor: review of a rare clinical case]

Autopsy study of a 49-year-old patient demonstrates a rare kidney tumor that had a structure of a mesenchymal renomedullary interstitial tumor (RIO), which had specific characteristics. They include a predominance of the cellular component in the tumor, represented by cells with processes elements (fibroblasts, myofibroblasts), which were surrounded by collagen fibers of interstitium. Apparently, these cells can be involved in the regulation of renin and bicarbonates, the exchange of components of connective tissue (collagen fibers, proteoglycans) and hormones (estrogen, progesterone). Since these tumor cells regulate the synthesis and secretion of the substances, numerous clinical manifestations of RIO can be explained. Most likely, these include increased blood pressure, water-electrolyte disorders, hormonal disorders due to the presence of estrogen receptors, progesterone in the tumor tissue and metabolic disorders (diabetes mellitus). However, these assumptions require further clinical, morphological and immunohistochemical studies.

[Prostatic secretion microbiota: a comparative analysis of the hronical prostatitis II and IIIA category]

BACKGROUND

Chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome IIIa (CP/CPPS IIIa) are separate nosologies defined diagnostic verification criteria according to the NIH-NIDDK classification (1995). The identification of enterobacteria in the prostatic secretion (PS) has long been a criterion for the diagnosis of CBP, while PS in patients suffering CP/CPPS IIIa was considered as "sterile". However, the introduction of various methods of PS`s in-depth analysis and UPOINTS classification (2010) development with the allocation of site I (infection) allows us to consider the infectious factor as an etiological predictor of the initiation of inflammation in the prostate with CP/CPPS IIIa. Thus, the determination of the features of the taxonomic composition of microbiota in BP and CP/CPPS IIIa can act as a differentiating factor of these conditions.

AIMS

/Objective: performing a comparative analysis of the PS microbiota in patients suffering from CBP and CP/CPPS IIIa.

MATERIALS AND METHODS

Feature: full-scale, prospective, comparative, uncontrolled study. During the study, a staged PS`s bacteriological study was performed in 101 patients (aged 20-60 years) with prostatitis-like symptoms lasting more than 3 months and identified leukocytosis in PS (> 10x`). Stage I of the PS`s study: a standard nutrient medium and culturing conditions were used. Two comparison groups were formed according to the results of the initial bacteriological study: 49 patients were included in group 1 (CBP), in which E. coli, Klebsiella spp., Proteus spp. were identified in PS (causative uropathogens in CBP), in group 2 (CP/CPPS IIIa) included 52 patients, with no growth of the above microorganisms` taxa in the biomaterial and/or primary negative results of the study. Stage II of the PS`s study: an extended set of selective media and special cultivation conditions were used for accessory verification of bacteria in biomaterial. Biochemical identification of bacteria was carried out using test systems. Statistical processing of seeding rates was carried out using Statistica 10.2 package (StatSoft Inc., USA). In both groups, we used descriptive statistics methods and the Mann-Whitney U test to process the results of bacteriological studies. The significance of differences between the studied parameters was considered at the level of p<0.05 and p<0.01.

RESULTS

Usage of an expanded set of selective media and special cultivation conditions (as compared with the results of the primary bacteriological culture of the exprimate) made it possible to collectively verify in PS to 28 species / genera of microorganisms in both groups (25 in group 1 and 24 in group 2). The taxonomic composition of the PS`s microbiota was almost identical in both groups and presented mainly in the form of multicomponent microbial associations. According to the results of analysis of the bacteria`s identification frequency in PS, it was found that in group 2 (CP/CPPS IIIa) significantly more often than in group 1 (CBP) discovered some representatives of the non-clostridial anaerobic flora (NAB: Peptococcus sp., Propionibacterium spp. and others), coagulase-negative staphylococci (CNS: S.haemolyticus, S.warneri) and certain taxa of gram-positive microorganisms (Corynebacterium spp. and Str. agalacticae). In turn, when analyzing the PS contamination, it was found that integrally in group 1 (CBP) in the samples of the biomaterial a higher titer of microorganisms was determined with a wide range of quantitative values, in relation to group 2 (CP/CPPS IIIa), where the titer indices were somewhat lower and had a smaller variation relative to the average.

CONCLUSION

Identification in patients of both groups in PS of different mixed microbial associations, similar in the taxonomic spectral composition of microbiota, suggests that CP/CPPS IIIa in some cases is unverified CBP, which in turn necessitates a review of diagnostic and therapeutic strategies to achieve positive clinical result.

[Virusuria as a component of the urine microbiota and its significance for assessing the health of the urinary tract: a descriptive clinical study]

AIM

To determine the frequency of occurrence of oportunistic pathogenic bacterial flora and viral pathogens in the urine of healthy people with the establishment of the association between them.

MATERIALS AND METHODS

40 healthy sexually active women and men were examined, which are divided by gender into equivalent groups: Group I - healthy women (n=19), Group II - healthy men (n=21). The age of the subjects ranged from 20 to 25 years, the average age was 22.4+/-1.2 years. In both groups, the average portion of morning urine was taken for a study after a proper hygienic procedure with self-urination of the subjects in a sterile plastic container (Sterile Uricol for urine sample collection "HiMedia"). In addition to the nutrient media regulated by the Clinical Guidelines, additional HiMedia chromogenic media were used to cultivate facultative anaerobic (FAB) and non-clostridial anaerobic bacteria (NAB). Detection of viruses was performed by PCR with detection in "real time". DNA isolation was carried out by the sorption method using the AmpliPrime DNA-Sorb-B ("NextBio") kit from urine samples, with preliminary concentration.

RESULTS

In all 40 cases, normative leukocyturia was detected in the urine. According to the results of bacteriological examination of urine, healthy men and women in all cases found aerobic-anaerobic associations. Coagulase-negative staphylococci (CNS) and Corynebacterium spp. Dominated in the cluster of aerobic taxa of microbiota. (75.0%, 55.0% respectively). The spectrum of CNS was represented by five species: S.epidermidis (30.0%), S.haemolyticus (27.5%), and S.warneri (25.0%), S.saprophyticus and S.lentus (15.0%). Enterococcus spp. were recorded in the urine in 32.5% of cases. Representatives of the Enterobacteriaceae family were represented by 4 taxa: E. coli (10.0%), Klebsiella spp., Proteus spp. (5.0% each), Enterobacter spp., Citrobacter spp. (2.5%). In a cluster of anaerobic bacteria in the urine, Eubacterium spp. (60.0%) and almost half of healthy individuals recorded Lactobacillus spp. and Peptococcus spp. (42.5% each). When analyzing the frequencies of detection of various microbiota taxa, it was found that women significantly more frequently recorded urine Corynebacterium spp., Eubacterium spp. and Lactobacillus spp., as well as Enterococcus spp. and Peptococcus spp. Peptostreptococcus spp. and Veillonella spp. were significantly more often determined (p<0.05) in the urine of men. HHV6 (10.0%), HPV18 and B19 parvovirus (2,5%) were determined in the urine of healthy people. It should be noted that the studied viruses were more often recorded in men, in particular, HPV18 and parvovirus B19 - only in men, and HHV6 more often in men (7.5%), less often in women (2.5%). Significant associations of some genera of microorganisms with the sex of the participants were revealed for E. faecalis and Lactobacillus spp., which were more often found in the urine of healthy women Reliably significant associations were found for three taxa: viruses HPV6, HPV18 and parvoviruses B19 (16.7%) were determined in the presence of Bacteroides spp., Bifidobacterium spp., and Prevotella spp., in urine. Accordingly, in 83.3% of cases, these viruses were detected in the absence of the above-listed taxa of microorganisms in the urine.

CONCLUSIONS

The normal urinary microbiota of healthy women and men has differences: Lactobacillus spp and Candida spp are absent in the urine of men while Streptococcus spp in urine of women. HHV6, HPV18, parvoviruses B19 are found in urine of healthy people and more often in men. Data about the virobiota and microbiota of urine in healthy people can highlight on the pathogenesis of urinary tract infections of various localization and develop targeted approaches in personalized therapy of this group of diseases.

[Experimental evaluation of inflammatory process in the prostate caused by transurethral transmission of uropathogen in low counts]

BACKGROUND

According to the literature, bacterial count of uropathogens isolated from expressed prostate secretion and urine which is sufficient for a diagnosis of bacterial prostatitis I and II categories, remains contradictory. Undoubtedly, the identification of microorganisms from affected organ in high titers indicates the presence of a relevant infectious-inflammatory process. In turn, there is no consensus on the development of bacterial prostatitis at lower titers of uropathogens. Thus, the aim of our study was to identify and compare the potential features of the development and occurrence of an infectious inflammatory process in the prostate during the reproduction of bacterial prostatitis in an animal model using a low titer of causative uropathogens.

MATERIALS AND METHODS

A total of 16 "New Zealand" mature male rabbits aged 24+/-2 weeks old with weight of 3.5+/-0.3 kg were examined. Inoculation was performed via transurethral route, according to the developed experimental technique. E. coli was used as bacterial agent with a count of 1 x 103 CFU/ml, 1 x 105 CFU/ml and 1 x 107 CFU/ml. All animals were randomized into 4 groups of 4 individuals depending on the titer of the inoculated microorganisms (groups 1-3, respectively), group 4 - control (with inoculation by Sol. NaCl 0.9%). Sacrification and vivisection were performed on days 1, 3, 7 and 14 of the control days. Biopsy specimens from the lower urinary tract and internal genital organs of laboratory animals (bladder, urethra, prostatic complex - 6 biopsies #1A-1D, 2A, 2B) were evaluated morphologically and bacteriologically. Analytical evaluation of the experimental data was presented using descriptive statistical methods.

RESULTS

In experimental groups (Groups 1-3), bacteriological examination of prostatic complex biopsies showed growth of microflora in all samples in titers of 101-107 CFU / ml. In group 1, the maximum concentration of uropathogen was observed on day 7, compared to day 1 in both groups 2 and 3. In all observed cases, the highest degree of bacterial contamination was noted in the biopsy specimens from paraprostatic tissues and distal part of the prostate, which was 4.0+/-1.7 lg CFU/ml and 3.5+/-1.9 lg CFU/ml, respectively, and the smallest in proximal prostatic loci (1C) and bladder neck (2B) - 3.0+/-1.2 lg COE / ml and 3.0+/-1.7 lg COE / ml, respectively. According to the morphological study, a relevant progression of the suppurative and destructive inflammation (with foci of colliquation necrosis) was identified in group 1 in the biopsies from the prostate with a maximum degree of changes on day 7 with subsequent formation of loose connective tissue proliferation areas by 14 days. This indicates the conversion of the inflammatory process to the chronic stage. These changes corresponded with the results of histopathological studies in groups 2 and 3 where higher titers of bacterial agent were used. In group 4 (control) the commensal flora was bacteriologically determined in the biopsies, but there were no signs of inflammation, according to the results of the morphological study.

CONCLUSION

In experimental model, we found that E. coli 103 CFU / ml induces the development of a phasic inflammatory process in the structures of the prostatic complex. These processes resulted in the formation of irreversible proliferative changes. As a consequence, it shold be recommended to consider these signs of contamination when evaluating the results of bacteriological examination of expressed prostate secretion/urine samples during planning treatment strategy.

[Paternity rates among men who have not undergone varicocelectomy in childhood or adolescence]

INTRODUCTION

Feasibility of prophylactic varicocelectomy in adolescents is under discussion, which determines the importance of studying the frequency of paternity among men who were actively monitored.

AIM

to evaluate a paternity rate in a group of adult men who have not undergone varicocelectomy in childhood or adolescence.

MATERIALS AND METHODS

The paternity rate was evaluated using a questionnaire-based survey carried out in 2018 among men who were actively monitored for unilateral varicocele with ipsilateral testicular hypotrophy during adolescence in 1999-2004. A total of 202 questionnaires were sent out checking whether the recipients were willing to have children. Median age at the time of the varicocele diagnosis was 15 years [Q1; Q3] (13-17). At the time of diagnosis, varicocele of grade III was found in 114 (93.4%) boys, and in 8 (6.6%) children, varicocele of grade II was seen.

RESULTS

A total of 142 respondents were enrolled. Median age of the participants was 31 (29; 34). 20 men were excluded from the survey, due to prophylactic varicocelectomy (n=8, 5.6%), other reproductive diseases (n=4, 2.8%), previous radiotherapy or chemotherapy (n=2, 1.4%) and reproductive pathologies in the spouses (n=6, 4.2%). 16 (13.1%) participants were not planning to have children. Among the remaining, 9 respondents (6.6%) had no children. Varicocelectomy was carried out in 17 (16.3%) patients due to infertility, and 14 (82.3%) subsequently became fathers. 83 (78.3%) patients had one or more children as a result of spontaneous pregnancy. Paternity frequency in the surveyed group was 91.5%.

CONCLUSION

Our results demonstrate high paternity frequency among men with asymptomatic left-sided varicocele accompanied by ipsilateral testicular hypotrophy during childhood and adolescence who were actively monitored without surgical treatment.

[LUTS/BPH who treats? The results of the epidemiologic study]

INTRODUCTION

In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed.

MATERIALS AND METHODS

a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups.

RESULTS

Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers.

CONCLUSION

the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[The influence of urethral stricture disease and urethroplasty on anxiety and depression in men]

INTRODUCTION

The relationship of surgical treatment of urethral stricture and such mental deviations as anxiety and depression is still poorly understood. Particularly, there is no reliable data on how mental status is associated to surgical treatment of the urethral stricture and its efficacy.

AIM

to study the indicators of anxiety and depression in patients with urethral stricture before and after surgery.

MATERIALS AND METHODS

The prospective study involving 30 men aged 20-74 years with urethral stricture of various etiologies and localizations was conducted. The validated questionnaires, HADS-1 and HADS-2 were used to evaluate anxiety and depression, lower urinary tract symptoms (I-PSS-QoL), erectile dysfunction (IIEF-5) before and 3 and 6 months after surgery.

RESULTS

Almost all patients with urethral stricture before surgery had an increased level of anxiety and depression, which in 70% cases decreased to normal values by 6 months after successful surgery. Clinically, these changes correlated with the improvement of lower urinary tract symptoms. The restoration of erectile function in patients by 6 months was less pronounced, though it had no influence on the resolution of anxiety/depression.

CONCLUSION

The determination of psycho-emotional status in patients with urethral stricture before and after urethroplasty should be as important for the evaluation of the efficiency of surgical treatment, as the resolution of lower urinary tract symptoms and restoration of sexual function.

[Histopathological evaluation of the evolution of oral mucosa grafts used for augmentation urethroplasty]

INTRODUCTION

The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra.

AIM

to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty.

MATERIAL AND METHODS

A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied.

RESULTS

The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium.

CONCLUSION

The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.

[Bacterial prostatitis: epidemiology and etiology]

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

[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.

[Frequency and risk factors for the development of infravesical obstructions caused by surgery of benign prostatic hyperplasia]

Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.

[Long-term monitoring of leukocyturia and bacteriuria after acute obstructive pyelonephritis]

The generally accepted standard of antibiotic therapy aimed at causative agent does not exclude the risk of acute obstructive pyelonephritis (AOP) to become chronic after the end of antibiotic therapy, resulting in a high incidence of relapses. To assess the outcomes of the AOP, we undertook a prospective clinical trial. MATERIALS AND METHODS: The study comprised 51 consistently selected patients (12 men and 39 women) with AOP occurred as a result of unilateral ureteric calculus obstruction. Inclusion criteria for the study were as follows: no history of urological diseases, including urinary stones; the first presentation to the urologist with AOP; the level of the bladder bacteriuria before the drainage of the obstructed kidney more or equal 103 CFU/ml. Bladder urine samples were collected for bacteriological examination by catheterization. At one, 3 and 6 months after completion of the treatment of AOP, the patients underwent a general clinical examination, and midstream specimens of urine were collected from the patients for bacteriological analysis to control leukocyturia and bacteriuria. RESULTS: Eradication of causative uropathogens from urine occurred within 6 months in 96.1% of patients, and at that point, leukocyturia persisted in 23.5% of the patients. The decrease in detecting uropathogens in the urine was accompanied by an increase in the frequency of the presence in the urine of other aerobes and anaerobes, i.e., no sterile urine cultures were obtained from any patient. The rates of eradication of uropathogens were associated with the patients age, the duration of the pre-hospital stage of AOP, and the complicated course of AOP.

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

AIM

To examine the structure of the prostate tissue in patients with III B chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS).

MATERIALS AND METHODS

The study analyzed transrectal fine-needle biopsy specimens of 10 patients with the verified diagnosis of chronic pelvic pain syndrome/category III B chronic prostatitis (CPPS/IIIB CP) according to the National Institutes of Health classification. Tissues were examined using light and electron microscopy, and immunohistochemical study of the expression of CD31, CD34, NSE and S-100 markers.

RESULTS

All biopsy specimens of all patients showed fibroplastic changes of the prostate tissue most markedly pronounced in the stroma and muscle fibers in the form of total fibrosis, myofibril atrophy, and extracellular lipofuscin deposition. The examination revealed a significant reduction in the density of microcirculatory bed vessels and arteriolar luminal stenosis, a reduction in the number of nerve fibers, and compression of their fibrous tissue. No inflammatory changes were found in the prostate.

DISCUSSION

In patients with CPPS/IIIB CP, the changes in the prostate at the microscopic and ultrastructural levels are characteristic of severe chronic tissue hypoxia, which leads to the development of fibrosis resulting in stenosis of microcirculatory bed vessels and degenerative changes in nerve fibers and cells. No signs of an inflammatory reaction in the examined tissue were established.

CONCLUSION

Changes in the prostate tissue in CPPS/IIIB CP suggest the presence of chronic pelvic ischemia and exclude its association with inflammation as the main pathological process.

MicroRNA-Dependent Regulation of IGF1R Gene Expression in Hormone-Sensitive and Hormone-Resistant Prostate Cancer Cells

Using multiple parallel sequencing on Illumina platform, we identified eight microRNAs that showed significant opposite changes of gene expression in cells of the hormone-sensitive LNCaP prostate cancer cell line and in cells of the hormone-resistant DU-145 cell line, in comparison to the microRNA expression in the normal prostate tissue cells. We found that the insulin-like growth factor 1 receptor (IGF1R) gene is a target of five microRNAs whose expression is increased in LNCaP cells and reduced in DU-145 cells.

[The volume of the contralateral testis in unilateral non-palpable cryptorchidism a diagnostic criterion to optimize surgical strategy]

AIM

Given the need to reduce the number of unnecessary laparoscopies, this study aimed to calculate the threshold values of contralateral testicular volume in unilateral non-palpable cryptorchidism to optimize diagnosis and surgical strategy.

MATERIALS AND METHODS

From 2010 to 2016, contralateral testicular volume was prospectively evaluated in 78 patients aged under nine years with unilateral non-palpable cryptorchidism. The volume of healthy testes was calculated by multiplying length * width * height * 0.71. The patients were divided into two groups. Group 1 comprised 41 (52.6%) children with inguinal or intra-abdominal testes, who underwent orchiopexy for undescended testis. The second group consisted of 37 (47.4%) patients with severely hypoplastic testes that needed to be removed, or with testicular aplasia. In both groups, we matched the age (in months) at the time of surgery and the volume of the contralateral testis. Logistic regression was used to develop the diagnostic model. For the model, the ROC-curve (Receiver Operating Characteristic) was constructed, and the threshold of the contralateral testicular volume was selected.

RESULTS

All patients with contralateral testicular volume greater than 2.25 ml had testicular aplasia, or hypoplasia (sensitivity 100.0%, specificity 73.0%). All patients with a contralateral testicular volume less than or equal to 1.04 ml had inguinal or intra-abdominal testes (specificity of 100%, the sensitivity of 34%). The area under the ROC curve calculated to assess the quality of the model was 92.6%, suggesting the high predictive power of the model.

CONCLUSION

Revision scrototomy is indicated in patients with testicular volume exceeding 2.26 ml, while diagnostic laparoscopy is the optimal primary intervention in patients with the contralateral testicular volume of less than or equal to 1.04 ml.

[Evaluation of testosteronemia in men undergoing surgery for urethral strictures]

INTRODUCTION

Testosterone plays an important role in the functioning of various organs and systems of the male body. Its diagnostic and prognostic values are studied both in urological diseases and in the patients undergoing non-urologic surgery.

AIM

To investigate changes in testosterone level in patients with urethral strictures (US) depending on its baseline level, the cause of US, the age of patients and the number of surgeries.

MATERIALS AND METHODS

The study comprised 30 patients aged 19-63 years with traumatic (76.7%) and inflammatory (23.3%) US. Primary and recurrent US were diagnosed in 25 (83.3%) and 5 (16.7%) patients, respectively. Nineteen (63.3%) patients underwent excision and primary anastomosis, while replacement urethroplasty was performed in 11 (36.7%) patients. In addition to the standard diagnostic work-up, all patients were tested for total serum testosterone 24 hours prior to surgery and at 1, 3, 7, 14 days after the operation.

RESULTS

33.3% of men with US had a testosterone deficiency in the absence of any testicular or endocrine injuries and diseases. Surgery was associated with a drop in testosteronemia in 83.3% of patients. The degree of postoperative testosterone level decline and its changes were significantly influenced by the age of patients and the number of operations. Men who had baseline testosterone deficiency and underwent repeat surgeries remained in a hypogonadal state throughout the postoperative period.

CONCLUSION

Investigating the clinical value of testosterone in men with US and the risks of their surgical treatment associated with testosterone deficiency will provide insight into the role of testosterone in the treatment of this condition and the decision-making regarding pharmacological correction of testosterone deficiency in patients undergoing surgery for US.

[Comparative analysis of one- and two-stage augmentation urethroplasty with dorsal INLAY buccal graft for extended stricturesof spongious urethra]

INTRODUCTION

Urethral reconstructive surgery is in constant development. At present, reconstructive urethroplasty with buccal mucosa is increasingly being used. The study aimed to compare the results of a one- and two-stage augmentation urethroplasty with dorsal inlay buccal graft for strictures of the spongious urethra.

MATERIALS AND METHODS

The study comprised 72 patients aged 19-64 with urethral strictures 3-18 cm long. In 34 (47.2%) patients, the stricture was localized in the penile urethra, in 30 patients (41.6%) in the penile-bulbous urethra and in 8 patients (11%) in the bulbous urethra. All patients underwent augmentation urethroplasty with dorsal inlay buccal graft. The results were evaluated separately in 55 (76.4%, group 1) and 17 (23.6%, group 2) patients who underwent one-stage and two-stage surgery, respectively.

RESULTS

The incidence rate of early postoperative complications was higher after one-stage (23.6%) compared two-stage surgery (11.8%) (p<0.05). Hematomas, wound dehiscence and urethrocutaneous fistulas were observed only after single-stage surgery. Primary healing of extensive strictures following augmentation urethroplasty with dorsal inlay buccal graft was achieved in 88.9% of patients; treatment effectiveness in the group 1 was 89.1%, in the group 2 - 88.2% (p>0.05). The final effectiveness of the operation, achieved with the use of additional surgical interventions, is estimated at 98.6%.

CONCLUSION

The results of augmentation urethroplasty with dorsal inlay buccal graft do not depend on the number of stages, but fewer complications accompany two-stage surgery.

[Experience of 157 vesikoscopic operations in children]

AIM

Recent advances in the field of minimally invasive surgical technologies in children and adolescents have led to the development of vesicoscopic (transvesical, pneumoscopic) access (VA). Current limitations in using VA emphasize the need for further studies investigating surgical options for the management of various pathological conditions of the bladder and ureterovesical junction, the features of surgical techniques and the course of the early postoperative period when used in pediatric urological practice.

MATERIALS AND METHODS

From 2013 to 2017, 157 patients (79 girls and 78 boys) aged between 2 months and 18 years (mean age 4.9-8.7 years) underwent surgery using VD. Unilateral and bilateral vesicoscopic ureterocystoneoimplantation was performed in 110 (70%) and 44 (28%) patients, respectively. A total of 198 ureters was implanted. Three (1.9%) children underwent vesicoscopic excision of the bladder diverticulum. Transvesicoscopic Cohen ureteric reimplantation, pneumovesical Glenn-Anderson procedure, and Chumakov ureterocystoneoimplantation were performed in 151 (96.1%), 2 (1.3%) and 1 (0.6%) patients, respectively.

RESULTS

The mean operative time when using VA was 126.8+/-46.7 min. In patients younger than one year, 1-3 years, 4-17 years, it was 136.0+/-43.8 min, 130.1+/-43.5 min and 122.4+/-65.8 min, respectively. The mean length of postoperative hospital stay was 6.2+/-2.3 days. In 3 (1.9%) cases we had to convert to open surgery. Gas migration into the abdominal cavity occurred in 6 (3.8%) patients. Fourteen (9%) patients had early postoperative complications. Transient obstruction of ureterovesical junction occurred in 6 (3.8%) patients. Acute complete obstruction of the distal ureter developed in 3 (1.9%) patients aged three months who did not undergo drainage of the upper urinary tract intraoperatively. A paravesical urine leak occurred in 1 (0.6%) patient. In one (0.6%) of the boys, the distal end of the urinary drainage inserted through the trocar into the ureter migrated in the bladder. The urine leakage from the trocar puncture occurred once (0.6%) and was stopped by indwelling urethral catheterization for seven days. In 2 (1.3%) patients, exacerbation of pyelonephritis required a modification in antibacterial therapy.

DISCUSSION

Despite the accumulated experience, vesicoscopic surgery remains a laborious and complicated surgical intervention, requiring long learning curves even for surgeons who have good manual skills in laparoscopic surgery.

CONCLUSION

In our opinion, vesicoscopic access allows the entire range of surgical interventions on the vesicoureteral junction and bladder in children to be performed. It is effective, significantly less traumatic than traditional open cystotomy access, and associated with an excellent cosmetic result.

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

Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of -blockers in stimulating residual stone clearance after ESWL.

AIM

To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance.

MATERIALS AND METHODS

ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered.

RESULTS

Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy.

CONCLUSION

Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

[Antimicrobial resistance of uropathogens in patients with acute obstructive pyelonephritis]

RELEVANCE

Acute pyelonephritis is known to be the most complicated and severe urinary tract infection occurring in all age groups and accounting for 14% of all kidney diseases. The generally recognized standard antibiotic therapy cannot completely prevent the progression of the disease to its chronic form after relief of its acute manifestations thus leading to a high incidence of relapses. The aim of our study was to investigate the spectrum of uropathogens and their antibiotic sensitivity in acute obstructive pyelonephritis.

MATERIALS AND METHODS

The study comprised 72 patients who underwent semi-rigid ureteroscopy and ultrasonic lithotripsy for ureteral stones. In all patients, bladder urine samples collected by a transurethral catheter were tested bacteriologically using an extended set of culture media within 3 hours after hospital admission. Antibiotics used in antibiotic sensitivity testing for all uropathogens, were grouped into 4 classes (carbapenems, fluoroquinolones, cephalosporins, penicillins). Etiotropic treatment was started upon the availability of the spectrum of microbial patterns, the level of bacteriuria and antibioticogram of uropathogens, 5-6 days after administering initial empirical antibiotic therapy.

RESULTS

The study patients had a high detection rate (83.3%) of canonical uropathogens in the bladder urine identified due to using an extended set of culture media, with a bacteriuria of more or equal 103 CFU/mL. Given the results of local antibiograms, a rational antimicrobial therapy should include carbapenems, namely ertapenem or meropenem as initial empirical antibiotics. Using fluoroquinolones as the first line treatment can lead to an inadequate effect in 15.0 to 67.0% of the cases. The findings of the antibiotic resistance testing of uropathogens to cephalosporins and semisynthetic penicillins showed that they should not be used as initial empirical antibiotic therapy for acute obstructive pyelonephritis in the given department of urology.

[Is bacteriological testing of bladder urine informative in acute obstructive pyelo- nephritis?]

The problem of the etiology and pathogenesis of acute obstructive pyelonephritis (OOP) remains one of the challenging issues of modern urology. Etiological agents of pyelonephritis can be both gram-negative and gram-positive opportunistic bacteria mostly belonging to the normal flora in humans. The generally accepted diagnostic work-up involves a bacteriological testing of not pelvic urine, but of bladder urine collected by a transurethral catheter or midstream specimens of urine collected from the patients. The aim of our study was to compare the microbiota of bladder and pelvic urine in patients with OOP.

MATERIALS AND METHODS

The study comprised 72 sequentially selected patients (12 men and 60 women) with OOP associated with ureteral stones. Mean age of patients was 53.7+/-0.5 years. All patients underwent bacteriological examination of the bladder urine collected by a transurethral catheter and pelvic urine obtained after relieving stone-related ureteral obstruction. Urinary diversion was performed using j-j stent and PCN in 64 and 8 patients, respectively. Preoperative prophylactic antibiotics were administered routinely. Bacteriological testing of urine was carried out using an extended set (9-10) of culture media. Empirical antibiotic therapy was initiated only after the restoration of urine outflow from the kidney and continued for 5-6 days until the availability of bacteriological testing results.

RESULTS

Levels of bacteriuria with Enterobacteria, gram-positive pathogens and NAB in two urine samples did not differ significantly (p>0.05). There was a wide range of bacteriuria from 101 to 106 CFU/ml of most microorganisms except @Proteus spp., S. aureus. In bladder urine, the rates of bacteriuria of more or equal 104 CFU/ml for E. coli, Klebsiella spp. and Proteus spp. were 90.9%, 72.7% and 100.0%, respectively. For the remaining microorganisms, predominant bacteriuria was less or equal 103 CFU/ml. In pelvic urine, the rates of bacteriuria of more or equal 104 CFU/ml for E. coli, Klebsiella spp. and Proteus spp. was 71.8%, 40.0% and 66.7%, respectively. Other uropathogens in the pelvic urine mainly had a bacterial count of less or equal 103 CFU/ml. Only the concentration of Corynebacterium spp. in the pelvic urine significantly (p=0.023) differed from that of the bladder urine. There were no significant differences between microbiota of bladder and pelvic urine depending on duration of OOP except higher rates of Corynebacterium spp. in the bladder urine.

[Role of angiotensin II receptor type 2 in predicting biochemical recurrence in the treatment of prostate cancer]

AIM

To identify markers for predicting aggressive forms of prostate cancer.

MATERIALS AND METHODS

The study retrospectively evaluated expression of angiotensin II type 2 receptors (AT2-R) in prostate needle biopsy tissue from patients with and without biochemical recurrence after combined hormone and radiation therapy.

RESULTS

The study findings showed that low expression of AT2-R in prostate tissue was associated with a high risk of biochemical recurrence. The data on the nature of AT2-R expression in prostate tissue of prostate cancer patients may be considered as a tool for predicting biochemical recurrence after combined hormone and radiation therapy. The test has a sensitivity of 87.5% and specificity of 85.71%.

[Extracorporeal and contact lithotripsy for large ureteral stones]

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

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

INTRODUCTION AND OBJECTIVES

Type 2 diabetes mellitus, as a chronic systemic metabolic disease, is widely spread in the population of middle- aged men. Previously it has been proven the link between the presence of type 2 diabetes and the development of lower urinary tract symptoms in men. At the same time, middle-aged men are characterized by the appearance and progression of benign prostatic hyperplasia.

MATERIAL AND METHODS

We performed a study of middle-aged men with type 2 diabetes to determine the interrelation of micturition disorders with deficiency of serum testosterone, in respect that the pathophysiology of prostatic hyperplasia is regarded as dysmetabolic dyshormonal state. The prospective study examined 112 men with type 2 diabetes randomized by the level of total testosterone. Lower urinary tract symptoms were assessed by I-PSS questionnaire. The study of serum total PSA, uroflowmetry, transrectal prostate ultrasonography were performed.

RESULTS

As a result of the study the association between the severity of type 2 diabetes mellitus and the decrease in total testosterone levels was determined. The relationship of testosterone deficiency and the frequency of the presence and severity of lower urinary tract symptoms were demonstrated. The dependence of the prostate hyperplasia risks progression with the level of serum testosterone was found.

CONCLUSIONS

The association of testosterone deficiency with frequency and severity of lower urinary tract symptoms, partially related with benign prostatic hyperplasia and clinically defined detrusor cistopathy, has been proven. Further clinical studies are needed to determine the pathophysiological and pathomorphological features of type 2 diabetes, which determines the development of detrusor cistopathy and late onset hypigonadism.

[Experimental modeling of acute pyelonephritis]

Acute pyelonephritis (AP) predominates among inflammatory infection kidney affections. In accordance to international classifications, AP is an upper urinary tract infection, subdivided into non-complicated (non-obstructive) and complicated (obstructive) forms. The clinical significance of AP presently is defined by the conditions frequent occurrence and its progression into chronic kidney disease. For a limited number of pathogens the involvement in AP is considered proven: representatives of the Enterobacteriaceae family (E.coli, Klebsiella spp., Proteus spp., etc.), Pseudomonas spp., a number of gram-positive microorganisms (S.aureus, Enterococcus spp.). Beside that, over the last 3 decades there have been rare publications in the world literature describing clinical cases of AP caused by microorganisms not readily cultivated on standard mediums (mostly anaerobic). This was accompanied by an idea that AP might develop in case of kidney invasion not only by aerobic, but also by anaerobic microorganisms, which is practically not taken into account in current clinical practice. In this regard it was deemed feasible to perform an analysis of experimental disease models to refine the discussion points of the disease etiology, to do so an attempt of all-encompassing study in the Russian and English literature databases (linical Key, MEDLINE, PubMed, HighWire Press, The Cochrane Library, BioMed Central, Central scientific medical library of the I.M. Sechenov Moscow medical academy, Russian State Library). A total of 356 literature sources have been studied, of which 41 were selected for the current review.