[Features of the mineral composition of urinary stones depending on the region of residence, gender and age in the Russian Federation, Belarus and Kazakhstan]

INTRODUCTION

Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy.

PURPOSE

in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender.

MATERIALS AND METHODS

the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018-2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction.

RESULTS

The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted.

CONCLUSION

The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.

[Dissolution of uric acid stones in the ureter]

INTRODUCTION

Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures.

MATERIALS AND METHODS

The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses).

RESULTS

In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.

[The role of expression of monocarboxylates of the first and fourth types (MCT1, MCT4) by tumor and stromal cells of prostate cancer in determining the prognosis and the efficiency of definitive treatment]

AIM

A search for new methods for diagnosing clinically significant prostate cancer is of importance due to the insufficient accuracy of modern methods in detecting aggressive tumors. One of the promising opportunities for the early diagnosis of clinically significant prostate cancer is the assessment of the glycolytic profile of the tumor by determining the expression of monocarboxylates (MCT) types 1 and 4 in tumor cells, as well as in adjacent stromal cells.

MATERIALS AND METHODS

An analysis of patients of who underwent radical prostatectomy at the Institute of Urology and Reproductive Health of Sechenov University from 2015 to 2017 was carried out. The patients with histologically confirmed prostate adenocarcinoma were included in the study. Among them, the presence or absence of biochemical recurrence during the first year was studied. An immunohistochemical (IHC) study of postoperative specimen was performed to determine the expression of MCT1 and MCT4 by tumor and stromal cells. The correlation between the intensity of their expression and the risk of biochemical recurrence and the tumor characteristics was evaluated.

RESULTS

High membrane expression of MCT1 directly correlated with high stromal expression of MCT4 (r=0.314, p<0.003). A significant direct correlation was found between the predominance of stromal expression of MCT4 over membrane expression and biochemical recurrence (r=0.403, p<0.001), as well as a high ISUP group (4 and 5) (r=0.294, p=0.005).

CONCLUSIONS

Determination of the level of expression of type 1 and 4 monocarboxylate transporters in adenocarcinoma cells and tumor stromal cells can become an effective tool for risk stratification, and may also predict the biological behaviors of the prostate cancer and the efficiency of definitive treatment.

[Interdisciplinary approach for prevention of recurrent urinary stone disease]

Urolithiasis is a multifactorial metabolic disease caused by the interaction of genetic, environmental factors and is directly related to lifestyle. Multiple factors influencing the initiation of stone formation and the growth of urinary crystals are presented in the article. Based on the available data, an involvement of various specialists, including urologists, geneticists, physician office laboratory, radiation diagnostics specialists, nutritionists, endocrinologists, immunologists, physiotherapy and balneotherapy specialists, general practitioner, is necessary for effective treatment of patients with kidney stones.

[Adjustment of urine PH as effective tool for successful metaphylaxis of urinary stone disease. phytotherapy]

Urinary stone disease constitutes significant burden for healthcare system worldwide. Metaphylaxis after removal or spontaneous passage of urinary stone may be an effective measure for the prevention of recurrent stone episodes. An adjustment of urine pH, based on the type of urinary stone plays a key role in the metaphylaxis of urolithiasis. The use of combined preparations based on herbal plants, which has antioxidant, anti-inflammatory, antimicrobial activity and diuretic effect, and also affects pH level of urine without impairment of the body microbiome, is very promising for the metaphylaxis of urinary stone disease.

[Results of analysis of the structural and functional state of the kidneys by the method of mathematical processing of contrast-enhancing MD-CT data in patients with urolithiasis]

INTRODUCTION

and Objectives: to date there have been several hypotheses on the causes of kidney stone formation. Compromised intrarenal blood flow might play one of major roles in stone formation. Advances in software and 3D technologies have unveiled the nature of contrast medium flow in the intrarenal structures. Mathematical analysis and 3D rendering of computed tomography (CT) scans was utilized for inrarenal contrast medium flow assessment in patients with stone kidney disease. This study aimed at assessing split glomerular filtration rate (sGFR) in patients at the initial stage of stone kidney disease (SKD). sGFR was measured by means of mathematical analysis of 3D rendering abdominal contrast enhanced CT scans. As well as that, possible correlations between irregular inrarenal contrast medium flow and causes of stone formation were considered.

MATERIALS AND METHODS

23 patients of both sexes with stone kidney disease (SKD) were recruited. They underwent US/Dopler investigation of the kidneys and the bladder, plain X-ray, histopathological evaluation of the tissues (those patients who were operated on), spectroscopic analysis of the stone(s). Mathematical analysis of 3D rendering of CT scans was utilized for sGFR assessment (sGFR reference value: 0,55% of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size less than 1,5-2,0 cm 3) stones that do not block urine flow 4) non-operated young patients; 5) patients free of comorbidities. Inclusion criteria were set to mitigate the effects of other factors that might influence on intrarenal blood flow and conduct the study per se.

RESULTS

Mathematical analysis of 3D rendering of CT scans allowed to elucidate changes in sGFR in 22 (95,6%) patients out of 23. HypErfiltration (hyperF) was detected in 10 (43,5%) patients, hypOfiltration (hypoF) was detected in 11(47,8%) patients. sGFR values were statistically significantly different in these groups both on the left (p=0,000142) and on the right (p=0,00068). No significant gender differences were observed (hypoF group aged 25-67 years with the mean age of 43,5 years; hyperF group aged 17-57 years with the mean age of 39 years (p=0,563). Ultrasound Doppler renal resistive index in renal arteries was within the normal range in both groups with no statistically significant difference between the groups. However, 1 patient demonstrated no sGFR changes. Another patient had hyporfiltration on the left (0,48%) and hyperfiltration on the right (0,62%) Conclusions: sGFR alterations (hypo- or hyperfiltration) were detected in the majority of the patients with SKD (95,6%). This in turn might be suggestive of compromised intrarenal blood flow. Further studies are needed to elucidate the optimal management of these patients.

[Urinary stone disease. Part V. Drugs used for metaphylaxis of urinary stone disease]

The stages of postoperative metaphylaxis, drugs used for correction of metabolic disturbances are reviewed. In addition, the basic principles of drug metaphylaxis in various types of stone formation are described.

[Urinary stone disease. Part IV. Recurrence prevention for urinary stone disease]

The place and indications for recurrence prevention of urinary stone disease, general principles of recurrence prevention, role of mineral water and changes of dietary habits during recurrence prevention are reviewed in the article.

[Role of drinking and dietary factors in effective dissolution therapy and recurrence prevention of uric acid kidney stones]

The use of alkaline mineral waters leads to alkalization of urine and an increase in level of urinary citrate, which represent important factor inhibiting the formation of urinary stones. Combination of alkaline mineral waters with citrates facilitates the achievement of target urine pH level not only during dissolution therapy, but also during recurrence prevention. Alkalization of urine and reducing of the influence of alimentary factor dont preclude drug therapy. Patients should be counselled about complex strategies aimed to modifiable risk factors for urinary stone disease.

[Methanaphylaxis of urolithiasis. Part 3. The factors associated with increase in incidence of urinary stone disease. Current views on the mechanisms of stone formation]

All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

[Vitamin D and urinary stone disease: the current state of problem]

Disturbances of vitamin D metabolism is one of the factors leading to the impairment of phosphate and calcium homeostasis which plays leading role in the development of urinary stone disease. Vitamin D is necessary for wide spectrum of physiologic processes and good health condition. Until now, in many guidelines on urolithiasis there is an advice to limit vitamin D intake due to concerns of an increase in the stone formation. In vivo studies have shown that 1,25()2D3 can both increase and decrease and not to influence on calcium excretion. The results of the studies assessing the relationship between vitamin D blood/plasma level and urinary stone disease are often inconsistent and even controversial. In patients with urinary stone disease the vitamin D deficiency is often found and currently there is still a lack of studies dedicated to problem of vitamin D deficiency in patients with urinary stone disease and the need for its correction.

[Recurrence prevention for urinary stone disease. Part II.The factors associated with increase in incidence of urinary stone disease. Current views on the mechanisms of stone formation (continuation)]

Urinary stone disease is one of the most actively progressing diseases, which are associated with metabolic disturbances and are influenced by the genetic, environmental factors and lifestyle \. In the article the current views on initiation factors of stone formation and theories of stone formation are reviewed. The factors that play an important role in the activation and inhibition of nucleation and aggregation of stone-forming substances are discussed. All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

[Urate urolithiasis: pathogenesis and possibilities of conservative therapy]

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

[Methanaphylaxis of urolithiasis. Part 1. Factors for increasing incidence of urolithiasis. Current theories of renal stone formation]

Urolithiasis is one of the most actively progressing diseases, a metabolic disorder that is strongly associated with a combination of genetic, lifestyle, and environmental factors. The first part presents current views on the factors triggering the formation of stones and the theory of stone formation. More specifically, the article discusses factors that contribute to the activation and inhibition of nucleation and aggregation of stone-forming substances.

Comparative Monte-Carlo simulations of charge carrier transport in amorphous molecular solids as given by three most common models of disorder: The dipolar glass, the Gaussian disorder, and their mix

We have performed Monte-Carlo simulations of the charge carrier transport in a model molecularly doped polymer using three most popular hopping theories (the dipolar glass model, the Gaussian disorder model, and an intermediate between them) in a wide range of applied electric fields and temperatures. Time of flight transients have been computed and analyzed in logarithmic coordinates to study the Poole-Frenkel field dependence, the non-Arrhenius mobility temperature dependence, and the nondispersive versus dispersive current shapes. We also have made an attempt to estimate the total disorder energy directly from simulation data at the lowest electric field thus checking the consistency of the model fitting. Computational results have been compared with the analytical and experimental information available in the literature.

[Troyakov. Experience in using hytolysin in the integrated management of urinary tract infections and methapylactics of nephrolithiasis]

RELEVANCE

Urinary tract infection (UTI) are a risk factor for diseases leading to impairment of renal function and kidney stone disease (KSD). Growing resistance of uropathogens to antibacterial agents is a challenging issue in most countries of the world. Urolithiasis is the second most prevalent urologic condition following urinary tract infections and has a pronounced tendency to recur. Rational stone metaphylaxis leads to a significant reduction in the incidence of recurrent stones. In recent decades, there has been a markedly increasing interest in plant-based therapies in managing urologic diseases.

AIM

To evaluate the effectiveness of phytotherapeutic medication Phytolysin in the integrated management of UTI and metaphylaxis of urolithiasis.

MATERIALS AND METHODS

Comprehensive evaluation of the effectiveness of Phytolysin was conducted at the Department of Urology, I.M. Sechenov First MSMU and Department of Urology, Andrology and Sexology, Voino-Yasenetsky Krasnoyarsk SMU in 40 women with episodes of exacerbation of chronic cystitis and 30 patients of both sexes during the postoperative metaphylaxis of the KSD. The age of the patients ranged from 20 to 68 years (mean age 40+/-2,8 years).

RESULTS

Adding Phytolysin to the integrated management results in the improvement in general clinical signs and laboratory parameters of blood and urine, leads to a decrease in the level of leukocyturia, bacteriuria and an increase in diuresis and urinary alkalinization, reduces the number relapses of UTI and stone formation.

CONCLUSION

Phytolysin is an effective and safe medication.

[The place of mineral water in the metaphylaxis of urolithiasis]

Urinary stone disease is a metabolic disorder tending to recur and having a growing proportion of younger patients. Current methods of surgical treatment do not guarantee the disease non-recurrence without effective subsequent metaphylaxis. At present, the principles of general and special (medical) metaphylaxis of urolithiasis have been developed and widely applied according to underlying metabolic disorders, the type of stone formation and risk factors for recurrence. Oversaturation of the urine with stone forming substances is a major factor in stone formation. Recommendations for using mineral water should not be given without a clear understanding of the expected effect of particular water. Its selection for treating urolithiasis depends on the chemical composition of the stones, underlying metabolic disorders, urine pH, the functional state of the gastrointestinal tract, concomitant diseases, etc.

[THE ROLE OF 3D-COMPUTER SIMULATION IN IMPROVING THE STAGHORN NEPHROLITHIASIS TREATMENT RESULTS]

This article presents the experience of applying 3D-computer simulation for treatment planning in patients with coral kidney stones. The impact of the kidney internal structure and the nephrolithiasis stage on the treatment results of the patients with staghorn stones are analyzed on the basis of authors' own experience. They note the usefulness of computer modeling in preoperative planning for improving the treatment results and preventing intraoperative complications.

[The use of vitaprost in the treatment of patients with prostate diseases]

Inflammatory diseases of the prostate are common among men. These diseases are frequently characterized by long-term course and relapses. Prostatitis-associated symptoms significantly reduce the quality of life of patients. Due to the lack of generally accepted criteria for the diagnosis of prostatitis, the frequency of inflammatory diseases of the prostate is difficult to establish. Inflammatory diseases of the prostate should be differentiated from chronic pelvic pain syndrome. The mainstay of treatment of infectious and inflammatory processes in the prostate are antibacterial drugs (generations III and IV fluoroquinolones). The recommended course of treatment includes 4-6 weeks. Prostate peptides from bovine (cytomedines) have proven efficacy in the treatment of patients with prostatitis; cytomedines influence the differentiation and proliferation of prostate cells, have anti-inflammatory and immunomodulatory properties. In clinical trials, high efficiency of cytomedines in prostatitis and prostate adenoma, as well as long-term remission of the diseases is demonstrated.

[Herbal preparation Canephron N in the treatment of patients with urolithiasis]

Under current conditions, high-technology herbal preparations take an important place in the complex treatment of patients with urolithiasis. Canephron N (Bionorica, Germany) is one of these herbal drugs widely used in urology. The article presents the results of comprehensive evaluation of the effectiveness of the canephron N in patients with urolithiasis, who undergone extracorporeal shockwave lithotripsy, in the postoperative period and in the period of early (up to 3 months) metaphylaxis. It is shown that the use of the drug in complex treatment of patients with urolithiasis contributes to more rapid discharge of fragments of stones and effective improvement of renal function after removal of stones. The use of canephron N has great potential in the complex metaphylaxis of urolithiasis.

[Sympathic hyperactivity and reservoir function of the bladder in men]

Effects of the sympathetic nervous system (SNS) on detrusor function in the collection phase were studied in 57 men over 50 years of age. Heart rate (HR) was a clinical marker of SNS activity, effective volume of the bladder marked detrusor activity in 34 patients of group 1. The value HR/volume were registered in all voidings for 1-3 days. It was found that enhancement of SNS activity was accompanied by a decline of the reservoir function of the bladder. In HR < 80 and > 100 b/min the differences were significant and reached 56%. Group 2 patients (n = 23) with prostatic adenoma have undergone uroflowmetric monitoring before and after treatment with doxasozine (640 uroflowgrams). The reservoir function of the bladder increased from 111.0 to 151.4 ml (by 36.3%) in response to block of alphal-adrenoreceptors. Thus, SNS plays an essential role in management of detrusor function in the collection phase. Its hyperactivity leads to this phase decifiency. It may be a humoral process mediated by vasoconstriction and disorder of vesical blood flow. The proportion HR/volume shows "sympathetic background" in patients before administration of alpha1-adrenoblockers.