[The use of prostate extract preparations in patients after transurethral resection of prostate for its benign hyperplasia]

The purpose of the study is to study the efficacy and safety of the prostate extract (GEROFARM LLC, Russia) in the postoperative period in patients after transurethral bipolar resection of the prostate.

MATERIALS AND METHODS

The clinical study included 127 men aged 50 to 78 years with grade II benign prostatic hyperplasia (adenoma) who underwent a typical bipolar transurethral resection of the prostate. Patients of the main (n=60) group received tamsulosin 0.4 mg/day for 30 days in the postoperative period in combination with prostate extract 10 mg rectally for 21 days. In the control group (n=67) - tamsulosin 0.4 mg/day for 30 days as monotherapy. To assess the results of treatment, the questionnaire of the international system of total assessment of symptoms in prostate diseases (IPSS) with the definition of quality of life (QoL), the international index of erectile function (IIEF-5) and uroflowmetry were used. The control was carried out in terms of 1 and 3 months after the operation.

RESULTS

In the main group, in the observation period of 1 and 3 months after the operation, a decrease in the average IPSS score by 40.2% and 52.9% was revealed, and an improvement in the quality of life by 45% and 64.7%, respectively, was noted. In the control group, at the same time of observation, a decrease in the average IPSS score by 34% and 44.7%, respectively, was revealed, and the quality of life improved by 25.5% and 37.3%, respectively. The increase in the average rate of urination in the main group by the end of 1 and 3 months of treatment was 59.2% and 85.7%, respectively, and in the control group, these figures were 40.5% and 50%. The positive effect of the proposed combination therapy on erectile function in the main group by the end of 1 and 3 months of treatment was 5.2% and 9.2%, respectively, and in the control group, these figures were 2.9% and 5.2%.

DISCUSSION

There is a significant decrease in the symptoms of the lower urinary tract in the group of patients who received the drug Prostateks (GEROFARM LLC, Russia).

CONCLUSIONS

The efficacy results of Prostatex (GEROFARM LLC, Russia) (reduced symptom severity on IPSS (11.7 1.2 ) and QoL (2.3 0.3)) scales are comparable to those of Vitprost Plus which allows you to evaluate the effectiveness of two drugs equally.

[Investigation of the role of polymorphic loci RS2299941, RS1903858, RS10490920, RS2735343 of the PTEN gene in patients with prostate cancer]

Prostate cancer is a clinically heterogeneous disease, and accurate risk stratification of patients is becoming a key clinical task. This is the most common malignant neoplasm and the leading cause of cancer death in men worldwide. Genomic markers include tools and technologies that can predict the probability of an initial positive biopsy, reduce the number of unnecessary repeated biopsies, identify tumors with low, medium and high risk, classify the degree of disease, as well as predict and monitor the clinical response to intervention. Variants of the PTEN gene are of great interest as genetic markers of the risk of developing prostate malignancies.

Early Changes in Clinical and Laboratory Parameters in Patients Died of COVID-19

261,435,768 COVID-19 infections were detected worldwide, of them 5,207,634 deaths were registered. Identifying markers of the patient severity early in the course of the disease can facilitate the assessment of the risk of adverse outcome.

The objective: To compare values of laboratory parameters and their changes during treatment of patients with a complicated course of COVID-19 infection.

Subjects and Methods. 56 patients were included in the study, all of them were hospitalized to COVID Hospital of the Clinic of Bashkir State Medical University, Russian Ministry of Health, from September 30, 2021 to November 15, 2021, and their complicated course of the disease necessitated transfer to the intensive care unit (ICU). The laboratory evaluation included the following: a general blood and urine counts, blood chemistry including urea and creatinine, liver transaminases, and blood coagulogram (prothrombin time (PTT), prothrombin index (PTI), thrombin time, fibrinogen, and blood clotting time).

Results. In the group of patients with a fatal outcome on the day of transfer to ICU, lymphocytopenia, eosinopenia, elevated values of creatinine, total bilirubin, transaminases, C-reactive protein, D-dimer, and ferritin were noted. Also on this day, microscopic hematuria, proteinuria and cylindruria were detected in the urine tests of most patients in this group during treatment.

Conclusion. Critical deviations in the results of hematological and biochemical tests were revealed. Particular attention should be paid to such parameters as the level of erythrocytes, lymphocytes, eosinophils, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, C-reactive protein, D-dimer, and ferritin.

Significance of tumor-associated macrophages in bladder cancer development

Bladder cancer is the 2nd most common urological oncological disease in the worlds. Tumors can be muscle invasive and non-muscle invasive. Recently, tumor microenvironment (TME) became a focus of investigation in malignant tumors of the bladder. According to the currently available data, TME is a specific environment crating optimal conditions for carcinogenesis in the neoplastic lesion. The main parts of TME are extracellular matrix and stroma including vasculature, stromal, and immune cells. Additionally, TME includes cytokines, chemokines, and other compounds activating signal pathways necessary for tumor cells. Tumor-associated macrophages (TAMs) are being extensively studied as representatives of TME in solid tumors of varying locations. These macrophages can be classified into 2 phenotypes: M1 (pro-inflammatory and antitumor) and M2 (anti-inflammatory and protumor). The phenotypes perform different roles, and M2 macrophages regulate the most important processes of oncogenesis (invasion, proliferation, neoangiogenesis, etc.). In the context of bladder cancer, M2 macrophages are the most significant as they are the most numerous TAMs in TME.

Aim. To study the role of tumor-associated macrophages in development of bladder tumors, as well as prognostic value of these macrophages.

Digital medicine: expectations and prospects

The purpose of the research is to systematize the problems of the branch, formulate goals and objectives, search for methods and software and organizational solutions for digital medicine. Applied systems analysis, software engineering and artificial intelligence methods are used as research methods. The result of the research is the digital platform “Health History”, an organizational and technical system, which is a working prototype of a system solution for the reorganization of processes. The conclusion is postulated about the need for fundamental organizational changes in medicine based on information technologies, which is the essence of the digital transformation of healthcare.

Mobile medical teams during the Covid‑19 pandemic: legal aspects and implementation experience

During the pandemic of the new coronavirus infection Covid 19, the healthcare system faced serious challenges, one of which is a shortage of qualified personnel. One of the methods for solving this problem was the creation of mobile multidisciplinary mobile teams on the basis of federal medical institutions. In this article, the authors analyze the legal aspects of the functioning of mobile teams, and also give the experience of the employees of the Federal State Budgetary Educational Institution of Higher Education Bashkir State Medical University in the regions of Russia and abroad.

[A place of robot-assisted cystectomy in treatment of muscle-invasive bladder cancer]

Bladder cancer occupies one of the leading positions in morbidity in the world and constitutes a serious problem for healthcare system. The muscle-invasive bladder cancer is the most aggressive and more difficult to treat with drug therapy. Radical cystectomy is the standard treatment for muscle-invasive bladder cancer, with the most commonly used open approach. Currently, there is an active introduction of minimally invasive procedures, which is due to their advantages in perioperative care. Laparoscopic procedures have been broadly adopted for the oncourological practice, but the real breakthrough in the field of minimally invasive surgery has occurred after implementing of robotic-assisted interventions. It should be noted that the extensive radical procedures are associated with significant intra- and postoperative complications, which directly affects the patients condition and quality of life postoperatively. In this regard, robotic-assisted radical cystectomy appears to be a promising treatment method for muscle-invasive bladder cancer. The aim of this review is to collect and analyze current information on the results of robotic-assisted radical cystectomy, with particular attention to the comparison with open and laparoscopic techniques for different surgical and oncological outcomes.

[Acute kidney injury in the pathogenesis of coronavirus infection]

COVID-19 is an acute respiratory viral disease that primarily affects the lungs, but can also affect other organs, including the kidneys. Damage to the kidneys can be caused by direct effects arising from the invasion of the virus into kidney cells, or it occurs secondarily due to immunological, hemocoagulation and ischemic disorders. Given the importance of preserving kidney function during illness and after recovery, this review aims to investigate the impact of novel coronavirus infection on the kidney and its role in the development of acute kidney injury.

[The potential role of mirnas in the pathogenesis of hemorrhagic fever with renal syndrome]

Hemorrhagic fever with renal syndrome (HFRS) is an acute natural focal viral disease caused by viruses of the genus hantavirus, characterized by damage to small blood vessels, kidneys, lungs and other organs of a person. MicroRNAs (miRNAs) are 18-22 nucleotide endogenously expressed RNA molecules that inhibit gene expression at the post-transcriptional level by binding to the 3-untranslated region of the target mRNA. It has been proven that miRNAs play a significant role in various biological processes, including the cell cycle, apoptosis, cell proliferation and differentiation. It has been proven that miRNAs may be involved in the pathogenesis of infectious diseases, including HFRS. Hantavirus infection predominantly affects endothelial cells and causes dysfunction of the endothelium of capillaries and small vessels. It is known that the immune response induced by Hantavirus infection plays an important role in disrupting the endothelial barrier. In a few studies, both in vitro and in vivo, it has been shown that endothelial dysfunction and the immune response after infection with Hantavirus can be partially regulated by miRNAs by acting on certain genes. Most of the miRNAs is expressed within the cells themselves. However, in some biological fluids of the human body, for example, plasma or blood serum, numerous miRNAs, called circulating miRNAs, have been found. Circulating miRNAs can be secreted by cells into human biological fluids as part of extracellular vesicles as exosomes or be part of an RNA-bound protein complex as miRNA-Argonaute 2 (Ago2). These miRNAs are resistant to nucleases, which makes them attractive as potential biomarkers in various human diseases. There is no specific antiviral therapy for HFRS, and the determination of laboratory parameters that are used to diagnose, assess the severity, and predict the course of the disease remains a challenge due to the peculiarities of the pathophysiology and clinical course of the disease. Studying the role of miRNAs in HFRS seems to be expedient for the development of specific and effective therapy, as well as for use as diagnostic and prognostic biomarkers (in relation to circulating miRNAs).

[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.

[Specific immunization for the prevention of recurrent nephrolithiasis after percutaneous nephrolithotomy]

AIM

To study the effect of prophylactic immunization with combined Staphylococcus-Proteus-Pseudomonas vaccine in combination with the probiotic Bacillus subtilis on the development of recurrent nephrolithiasis in patients after percutaneous nephrolithotomy (PCNL).

MATERIALS AND METHODS

A total of 76 patients with a high infectious risk of stone formation in the early postoperative period after PCNL were included in the study. All patients received antibiotic therapy in accordance with the current guidelines as indicated. The patients were divided into 3 groups. In the comparison group (n=30), patients continued to receive antibiotics on the outpatient basis. In the group A (n=20), in addition to antibiotics, two-stage immunization with Staphylococcus-Proteus-Pseudomonas vaccine was performed. In the group B (n=26), additionally, patients received probiotic preparation "Bactisporin dry", which is a lyophilized spore-forming bacteria Bacillus subtilis strain 3N. All participants had urine culture and stone analysis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. A study of specific antibodies level and factors of cellular and humoral immunity was carried out at specific time points. The duration of follow-up was 36 months.

RESULTS

The study revealed a difference in the pathogens isolated from urine and infection stones in the same patient. This convincingly suggests that pathogens form biofilms in the stones and are not detected during routine urine culture. The main pathogens isolated from the stones were Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus epidermidis and Klebsiella pneumonia. Microbial associations were found in 25.7% of cases. The Staphylococcus-Proteus-Pseudomonas vaccine demonstrated good immunogenicity, its antigenic components provided protective properties against autologous and opportunistic bacteria. In addition to the ability to induce a specific response to antigens, the vaccine stimulated the phagocytic activity of neutrophils. Immunization with the combined Staphylococcus-Proteus-Pseudomonas vaccine in combination with probiotic results in uncomplicated postoperative course in 84% of patients. Hospital-acquired infectious and inflammatory complications were seen in 16.2% of cases. The recurrence of stone formation in this group of patients within 36 months was 8.2%. In patients receiving only combined Staphylococcus-Proteus-Pseudomonas vaccine after PCNL, the postoperative period was uneventful in 65% of cases. The rate of upper urinary tract infection was 35%, while the inflammatory process was accompanied by mild clinical manifestations and quickly resolved. Recurrence of stone formation during the follow-up was seen in 18% of patients. In the control group, the proportion of uncomplicated cases in patients with nephrostomy tube was 40%, the development of pyelonephritis was noted in 60% of cases, and recurrent stones within 36 months were diagnosed in 46.7% of cases.

CONCLUSION

Our results emphasize that the role of an infectious factor in the development of recurrent nephrolithiasis after PCNL is often underestimated. The use of a specific vaccination and the Bacillus subtilis preparation in patients with a high infectious risk of recurrent stone formation allows to achieve a significant reduction in the recurrence rate (more than 5 times) compared to the control group during 36 months of postoperative follow-up.

Exosomal Long NonCoding Rnas as Cancer Biomarkers and Therapeutic Targets

Extensive study of extracellular vesicles began about ten years ago. Exosomes are extracellular membrane vesicles 30–100 nm in diameter secreted by various types of cells and present in most biological fluids. For a long time they were considered non-functional cellular components. However, it has been proven that they serve as a means of intercellular exchange of information. They can move bioactive molecules such as proteins, lipids, RNA, and DNA. Several studies have shown that their contents, including proteins and non-coding nucleic acids, may be of particular interest as biomarkers of diseases. The most promising of all these molecules are non-coding RNAs (ncRNAs), including microRNAs and long non-coding RNAs (lncRNAs). LncRNAs are a large group of non-coding RNAs (ncRNAs) longer than 200 nucleotides. As regulatory factors lncRNAs play an important role in complex cellular processes, such as apoptosis, growth, differentiation, proliferation, etc. Despite many advances in diagnosis and treatment (surgery, radiation therapy, chemotherapy), cancer remains one of the most important public healthcare problems worldwide. Every day brings a better understanding of the role of exosomes in the development of cancer and metastases. Liquid biopsy has been developed as a method for the detection of cancer at an early stage. This is a series of minimally invasive tests of bodily fluids offering the advantage of real-time tracking of the tumour development. In fact, circulating exosomal lncRNAs have been found to be closely linked to processes of oncogenesis, metastasis and treatment. In this paper we review current studies into the functional role of exosomal lncRNAs in cancer and discuss their potential clinical use as diagnostic biomarkers and therapeutic targets for cancer.

[Analysis of the results of ERAS protocol in real-life clinical practice AFTER radical cystectomy (the first prospective multicenter study in Russia)]

AIM

to carry out a multicenter prospective analysis of the results of the ERAS protocol in patients undergoing radical cystectomy in real-life clinical practice. The aims of the study were to assess the complication and mortality rate after radical cystectomy using the ERAS protocol and to assess how often ERAS protocol was imple- mented.

MATERIALS AND METHODS

a multicenter study was carried out in 4 clinics in Russia. A total of 134 patients who underwent radical cystectomy in 2017 were prospectively analyzed. Open and laparoscopic radical cystectomy was performed in 35 (26.1%) and 99 (73.9%) patients, respectively. Bricker procedure prevailed as a method for urine derivation (91.7%). Complication and mortality rate, and each principle of ERAS protocol was analyzed both in the general sample of patients and separately for open and laparoscopic radical cystectomy.

RESULTS

length of hospitalization before the radical cystectomy was 1 (1-2) day. The median duration of surgery was 260 (205-300) minutes, median blood loss was 300 (200-400) ml. The median of the patients time in ICU was 1 (0-2) day. A total of 95 (70%) complications were recorded in the 90-day period after the surgery, including Clavien I-II category in 52 (38.8%) cases and Clavien III-IV in 43 (32%) cases. Of these, gastrointestinal tract complications were predominated. Gastroparesis requiring a nasogastric tube was observed in 16 (11.9%) patients. Ileus developed in 43 (32.1%) cases, and 22 patients (16.4 %) were managed conservatively; however, 21 patients (15.7%) undergone to reoperation. A 90-days mortality reached 5.2% and the main causes included multiple organ failure as a complication of peritonitis, acute heart failure after myocardial infarction and massive bleeding. Re-hospitalization rate was 9.7% (n=13). Length of stay was 12 (9-16) days. According to univariate and multivariate analysis, an absence of antibacterial prophylaxis, a history of coronary heart disease and the patients age more than 75 years were predictors of an increased complication rate. A 30-days mortality rate is 5.2%, and re-hospitalization was required in 9.7% (n=13) cases. An average length of stay was 12 (9-16) days. Frequency of implementation of ERAS protocol in each of the participating clinic varied. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay.

CONCLUSION

1. Despite the use of the ERAS protocol, radical cystectomy has a high frequency of complications (up to 70%); most of them are Clavien I-II. A 30-days mortality rate is 5.2%, and re-hospitalization is required in 9.7% cases. 2. Univariate and multivariate analysis showed that an absence of antibacterial prophylaxis, a coronary heart disease and the patients age more than 75 years are predictors of an increased complication rate. 3. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. 4. To obtain more convincing data on the ERAS protocol after radical cystectomy, long-term studies are required.

[Experimental morphological rationale for the use of cultures of multipotent mesenchymal stem cells in combination with biomaterials in the reconstruction of the pelvic floor]

To date, descension of the pelvic floor is a fairly common gynecological pathology that requires surgical treatment. The development of cellular technologies suggests that the use of multipotent mesenchymal stem cells (MMSC) in the treatment of this pathology can stimulate the regeneration of damaged tissue and contribute to the reconstruction of the structures of the pelvic floor.

OBJECTIVE

to evaluate the effectiveness of using MMSC in combination with biological and synthetic materials in vitro and in vivo with descension of the pelvic floor.

MATERIALS AND METHODS

Sprague Dawley rats 10 weeks old weighing 200 grams were used in the experiment. Under sterile conditions, mechanical damage to the posterior wall of the vagina was carried out, with the restoration of which vicryl 3-0 was used. On the 2nd and 4th day, the wound was cut off in a volume of 1.5 ml with xenograft, allograft and multipotent mesenchymal stem cells (MMSC) (5 thousand cells) obtained from the adipose tissue of rats. In the control group was not used biological material. At the second stage of the experiment, the compatibility of the mesh prosthesis with MMSC and allograft in vitro was evaluated.

RESULTS AND DISCUSSION

xenograft does not lead to full tissue regeneration, but contributes to rapid epithelialization and reduces the degree of inflammatory reaction in the wound during the regeneration of connective tissue. The use of allograft leads to quick and complete epithelialization of the wound and the formation of a structurally complete connective tissue lamina of the vaginal mucosa. The introduction of MMSC resulted in complete epithelialization of the wound and the formation of a structurally complete connective tissue plate of the mucosa and submucosa, but with a slightly smaller number of blood vessels in them than with the use of a biomaterial. At the second stage of the experiment, weak cell adhesion to the polypropylene substrate of the tablet was observed during cell culture in the presence of only a fragment of the mesh prosthesis. After MMSC cultivation in the presence of a mesh prosthesis fragment and an allograft, a relatively uniform distribution of cells around the mesh prosthesis loops was observed.

CONCLUSIONS

it was determined that the use of MMSC and allograft has a positive effect on the process of vaginal tissue regeneration in rats. When combining these materials with mesh prostheses, it was found that MMSCs are not fixed directly to the synthetic material, but when the allograft is added, they concentrate and presumably have the maximum anti-inflammatory effect and promote tissue regeneration at the site of the mesh prosthesis. Thus, the use of autologous MMSC cells in combination with allograft and mesh polymeric materials for pelvic floor reconstruction can significantly improve the results of reconstructive operations.

[Safety of tadalafil in patients with cardiovascular comorbidities]

Tadalafil is a drug from the phosphodiesterase-5 inhibitors (PDE-5) group, which is used to treat erectile dysfunction (ED), lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and ED with LUTS in patients with BPH. The efficacy and safety of tadalafil were reviewed. The focus was on cardiovascular safety of tadalafil due to frequent cardiovascular comorbidities in patients with ED. We concluded that tadalafil is well tolerated and safe in patients with cardiovascular comorbidities and, in addition, has a beneficial effect on the cardiovascular system.

[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.

Identification of alterations in the nucleotide sequence of the chromatin remodeling gene PBRM1 in clear cell renal cell carcinoma patients

Kidney cancer is a heterogeneous group of malignant tumors, the vast majority of which are renal cell carcinomas (RCC) of various morphological types, of which the most common is the clear cell renal cell carcinoma (ccRCC). Particular attention in the carcinogenesis of the ccRCC is given to a number of tumor suppressor genes located on the short arm of the third chromosome. One of these genes, which are inactivated in the case of ccRCC is the PBRM1 gene encoding the PBAF SWI/SNF subunit of the chromatin remodeling complex, BAF180. The PBRM1 gene is located on the short arm of the third chromosome in the 3p21 region near the von Hippel-Lindau gene (VHL), the mutation in which is the main event in the occurrence of ccRCC. The aim of our investigation is identification of changes in the nucleotide sequence of the PBRM1 tumor suppressor gene in patients with ccRCC. 210 pairs of DNA samples isolated from ccRCC tissue were studied. Analysis of changes in the nucleotide sequence of DNA was carried out by HRM analysis and direct sequencing. In the PBRM1 gene, two somatic mutations were found (c.233G>A (p.D45N) in exon 2, c.1675-1676delTC in exon 15) which were not described previously, and one known polymorphic variant rs17264436 (in exon 23). The frequency of detected mutations was 0.95 % of cases. Analysis of the allelic association for the polymorphic locus rs17264436 showed a statistically significant increase in the risk of developing advanced kidney cancer in carriers of allele rs17264436*A, which can be used in the development of prognostic marker panels. Perhaps the low frequency of mutations in the samples we studied is due to the fact that the inactivation of the PBRM1 gene takes place in other ways, and may also be due to the ethno-specificity of the studied group of patients.

PRELIMINARY EXPERIENCE OF THE AORTO-FEMORAL SHUNTING USING THE DA VINCI SURGICAL SYSTEM

Introduction. Robot surgery is one of the most high-demand and dynamic developing realms of medicine. It is widely used in urology, proctology, thoracic, cardiovascular surgery and gynecology. In February 2018 a robot surgery centre opened in Volga Federal District of the Russian Federation based on the clinic of the Bashkir State Medical University (city of Ufa).

Materials and methods. The present paper demonstrates the first successful robot-assisted vascular operations within a master-class called "Aorto-Femoral Shunting with the use of robot-assisted surgical system Da Vinci".

Results. Exemplified with three operations: two linear aorto-femoral shunting and lumbar sympathectomy demonstrate technical peculiarities and advantages of robot-assisted vascular surgery. The findings show positive short-term results of the performed surgical interference that combine minimal injury and blood loss which help to reduce hospital stay in an intensive therapy department and intestinal distention duration. These clinical effects enabled to provide early activization of patients and possibility to adequately correct nutritional status with enteral feeding. The above-mentioned advantages eventually resulted in reduction of post-operation stay of patients in in-patient department and of cost of treatment.

Conclusion. Robot-assisted surgical system Da Vinci being the most cutting-edge in the realm of endoscopic surgery, enables to carry out operational interference with minimal blood loss and injury of tissues which helps to reduce postoperation and recovery periods. 

[Biomarkers of renal injury in contact ureteral lithotripsy]

AIM

To optimize the transurethral endoscopic management of patients with ureterolithiasis by measuring biomarkers of renal parenchymal damage.

MATERIALS AND METHODS

One hundred fifty-one patients with solitary ureteral stones were tested for levels of cystatin C, neutrophil gelatinase-associated lipocalin, 2-microglobulin and interleukin 18.

RESULTS

An increase in the levels of markers of renal injury was observed both in the preoperative period and after CULT. Differences in the values of these indices depended on the timing of the CULT, the size and location of the stone and the type of lithotripter.

CONCLUSIONS

All patients were found to have damage to the renal tubular system. The established critical values of the markers of renal injury in ureterolithiasis may be used as diagnostic criteria for renal injury.

[Structural-morphological changes of the connective tissue of the vaginal mucosa and perineal skin in women with stress urinary incontinence]

AIM

To investigate the morphological and structural changes in the connective tissue of the vaginal mucosa and perineal skin in women with stress urinary incontinence.

MATERIALS AND METHODS

From 2010 to 2013, 71 patients of reproductive age with stress incontinence were observed. The control group comprised 80 women, who also underwent biopsy of the vaginal mucosa and perineal skin. The sections of specimens were stained by Van Gieson, Mallory and Weigert. In immunohistochemical studies, rabbit antibodies specific for collagen types I, III, and IV were placed on each section.

RESULTS

Morphological picture of the perineal skin the study group patients completely confirms the clinical manifestations and results of immunohistochemical test, broadens the notion of structural changes in tissues. According to immunohistochemical and histological examination of the vaginal mucosa, some fibrous elements in the lamina were weakly stained. Due to the decrease in the number of vessels and the destruction of their basal membranes and the basal membrane of the epithelial layer, the amount of type IV collagen was markedly reduced.

DISCUSSION

Elastic fibers in the vaginal mucosa and skin of the perineum together with the collagen fibers are the supporting framework of the skin, and together with the interstitial substance of the above authorities lend elasticity in tension. Studies have shown that stress urinary incontinence may be the result of dysregulation of processes. For this pathology in the lamina propria of the vaginal mucosa and dermal lamina of the skin of the perineum destroyed elastic fibers and changes the ratio of collagen of various types. That is, the predominant type III collagen is type I collagen, as well as in the basal membranes, reduced the number of specific collagen type IV.

CONCLUSION

Mucous membrane of the vagina and perineal skin in women with a stress urinary incontinence is found to exhibit marked pathomorphological changes due to inflammatory, destructive and compensatory-adaptive processes leading to scarring of the connective tissue and alteration in the ratio of collagen content in various tissues.

[The role of urinary tract infection in the development of recurrent nephrolithiasis]

This is a literature review on the role of microbial flora in the development of recurrent urolithiasis. The authors outline pathogenetic aspects of recurrent stone formation associated bacterial flora. A number of studies reported that standard urine culture has limited sensitivity in detecting urinary tract infection.

[Experience with radical surgery for muscle-invasive bladder cancer in patients with end-stage chronic kidney disease]

The article outlines the experience with radical surgical treatment of muscle-invasive bladder cancer in two patients with dialysis-dependent end-stage chronic kidney disease. The authors describe diagnosis and surgical technique in this category of patients.

[Mutational landscape of prostate tumors revealed by whole-exome sequencing]

The results of the whole-exome DNA sequencing of eight prostate adenocarcinoma patients are presented. DNA was isolated from the peripheral blood as well as healthy and tumor prostate tissue from each patient. Bioinformatics analysis was conducted and the most significant mutations in prostate cancer patients were revealed. The obtained data could be important for understanding of the molecular mechanisms of prostate cancer pathogenesis and facilitate development of new approaches for treatment of the disease.

[Extracorporeal shock wave lithotripsy: benefits, limitationsand prospects]

The article provides an overview of current approaches to the treatment of urolithiasis using extracorporeal shock wave lithotripsy (ESWL). The clinical aspects of use of ESWL in patients with urolithiasis are reported; the main technical specifications of lithotripters are described; the limitations and contraindications for lithotripsy are discussed. Based on the analysis of the main barriers to successful ESWL, data on current trends in the development of this method and increase of its efficacy are presented.

[MicroRNAs as potential noninvasive markers in the diagnosis of urological malignancies]

Small non-coding RNAs (microRNAs) are involved in almost all biological mechanisms of carcinogenesis. Due to their stability in biological fluids microRNAs may serve a perspective biomarker for diagnosis and prognosis of oncological diseases. The review is dedicated to the analysis of microRNAs, as potential diagnostic markers of urological malignancies. Recent advances in the knowledge of miRNAs origin in body fluids, their stability and application as a potentially new class of biomarkers in medicine are summarized and discussed in the article.

[MARKERS OF KIDNEY DAMAGE AND NEPHROPROTECTIVE THERAPY IN RADICAL CYSTECTOMY]

The comparative analysis of changes of the functional (osmolar clearance and fractional excretion of urea) and structural (NGAL, β2-microglobulin in the blood plasma, and NGAL, β2-microglobulin, microalbumin in the urine) biomarkers of kidney damage before and at various stages after radical cystectomy was performed. The study included patients with T2N0M0 stage bladder cancer. The main group consisted of 37 patients receiving nephroprotective treatment (N-acetylcysteine), the comparison group--31 patients receiving background therapy. It was revealed that severity of kidney dysfunction and the incidence of chronic kidney disease in the long-term period after surgery decreased in the main group.

[The Role of MiRNAs in the Development of Prostate Cancer]

MicroRNAs (MiRNAs) act as key post-transcriptional regulators of gene expression. This review examines current advances in the study of the role of miRNAs in cancer, including prostate cancer. Issues devoted to the nomenclature, biogenesis, the role of miRNAs as oncogenes and tumor suppressors, and their role in the diagnosis, treatment, and prognosis of prostate cancer are discussed. Assessment ofthe role of miRNAs in the development of prostate cancer will promote early diagnosis and will be important for the development of new approaches to the disease treatment.

[PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP]

Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.

111Cd Time Differential Perturbed Angular Correlation Studies of High Specific Activity 111In-Aqueous Solutions

Time-differential PAC measurements have been made using the high specific activity of 111In, both in aqueous solutions of the ClO- 4 , NO- 3 and Cl- at pH values between 1.0 and 9 and temperatures between 186 and 293 K.

[Determinants of risk of the development of erectile dysfunction in the Russian Federation: analysis of epidemiological studies]

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

[DNA repair XRCC1, XPD genes polymorphism as associated with the development of bladder cancer and renal cell carcinoma]

We examined the correlations between the polymorphic alleles of the DNA repair genes XRCC1 (c.839G> A, rs25489; and c.1196A> G, rs25487), XPA (c.-4A> G, rs1800975), and XPD (c.2251A> C, rs13181) and the progression and severity of neoplasias in the bladder and kidney in patients of three distinct ethnic groups, Bashkir, Russians, and Tatar, residing in the Republic of Bashkorostan. The study enrolled 468 cancer patients and 351 healthy individuals. Genotyping for polymorphic alleles was carried out using the PCR-RFLP method. We identified a correlation between allele A of the c.839 G>A locus of the XRCC1 gene and the incidence of the bladder cancer (BC) and kidney cancer (KC) in the Tatar study group, using the additive genetic effects model (Odds Ratio (OR) = 5.23 and OR = 3.90). In turn, the heterozygous G/A genotype was present at a significantly higher frequency in the KC patients of Bashkir ethnic origin, compared with the control group (p = 0.0061, OR= 4.72). Additional analysis with consideration of participants' smoking status showed that the G/A genotype is significantly more frequent in smokers with BC (OR = 1.96, p = 0.05) then in healthy smokers. We also determined, using the recessive genetic model, that the genotype A/A of the c. 1196A>G locus of the XRCC1 gene was correlated with a higher risk of BC in the Russian cohort (OR = 2.29, p = 0.0082) and an increased incidence of KC in the Bashkir group (OR = 4.06, p = 0.05). A similar correlation was obtained for smokers. In contrast, the allele c.2251 A>C in the XPD gene correlated with a lower risk for BC and KC in the Tatars (p = 0.0003, OR = 0.48 and p < 0.0001, OR = 0.37) in the additive model and in the Bashkirs (p = 0.0083, OR = 0.12) and Russians (p = 0.0001, OR = 0.14) in the recessive model. Further, we uncovered that polymorphism c.839 G>A in the XRCC1 gene contributes to the progression of noninvasive and invasive BC and promotes KC at early and advanced stages of the disease. Thus, we identified similar correlations between DNA repair gene polymorphism and the incidence and progression of BC and KC. We propose that this result points to the involvement of common pathogenetic mechanisms in the initiation and progression of the urinary neoplasias.

[Results of open multicenter study of the safety of doxazosin in combination with indigal in men with stages I-II prostatic adenoma]

The article presents a method of conservative treatment of men with I-II stage prostatic adenoma using a combination of doxazosin and indigal, which has antioxidant, antiproliferative and anti-inflammatory properties, that allowed improving urodynamic parameters and reducing the progression prostate adenoma, minimizing the adverse effects of treatment.

[Cryodestruction in neurosurgery]

The study aimed to work out the method of cryodestruction of brain tumors. 10 patients with neuroepithelial brain tumors were prospectively operated on with the use of cryodestruction. MRI was performed before and after the operation. The operation strated from tumor biopsy under the ultrasound control with further injection of cryoprobe with further destruction. The study demonstrated that ultrasound navigation is an effective means of the cryodestruction control on all stages. The cryodestruction itself is a miniinvasive, easily controlled and effective method, applicable for tumors, located in functionally important regions of the brain, where major surgery could be mutilating.

[Analysis of the results of epidemiological study on prevalence of erectile dysfunction in the Russian Federation]

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

[Water and electrolyte metabolism disturbances in patients with metabolic syndrome]

Taking into account the high prevalence of renal disease in metabolic syndrome (MS), relationship between the reduction of the renal function and severity of disorders of lipid metabolism and increased risk of cardiovascular complications, evaluation of electrolyte and nitrogen metabolism was performed for 112 patients with MS. In addition, serum levels ofaldosterone, adrenocorticotropic hormone, neutrophil gelatinase-associated lipocalin, cortisol, beta2-microglobulin, vasopressin, and level of microalbumin in urine were assessed. MS patients showed a reduction of the daily expression of the main osmotically active substance - urea, potassium, sodium and chloride. The increased production of antidiuretic hormone and related water retention, increased microalbumin excretion, indicating the development of systemic endothelial dysfunction and glomerular hyperfiltration, were detected. Reported violations are developing by type of "vicious circle": fluid retention leads to hyperfiltration, renal dysfunction exacerbates water-electrolyte disorders.

[Brain cryodestruction in mammals in vivo]

26 animals (13 pigs and 13 rabbits) were involved in the study. Liquid nitrogen cryodestruction experimental  machine was used. The following measurements and investigation were performed: invasive temperature measurement, intraoperative ultrasound, magnetic resonance imaging and pathomorphologic assessment. An ice sphere was hypoechogenic with hyperechogenic  contour by ultrasound.  Postoperative MRI showed signs of local ischemic oedema in cryodestruction zone, no signs of bleeding were detected. Morphologically zones of total necrosis, oedema and minor dystrophic changes were recognized. Cryodestruction proved to be a reliable technique of cold brain necrosis.

Clinical study of the efficiency and safety of afala in patients with benign prostatic hyperplasia

The use of afala in patients with benign prostatic hyperplasia and moderate urination disturbances reduced the symptoms of the disease, improved urodynamic parameters, and increased quality of life. Clinical efficiency of afala was comparable with the efficiency of Serenoa repens extract (reference preparation).

[Effects of indol-3-carbinol and epigallocatexin-3-gallate on alteration and reparation in affected urethra of experimental animals]

The effects of indol-3-carbinol and epigallocatexin-3-gallate on alteration and reparation in the urethra were studied in 30 male Shinshilla rabbits. From the observation day 2 the rabbits were fed with indol-3-carbinol and epigallocatexin-3-gallate in addition to standard diet. Microcirculation was assessed with a laser analyzer of capillary circulation LAKK-01 which detected earlier recovery of microcirculation in the group of the animals fed with indol-3-carbinol and epigallocatexin-3-gallate. Thus, antioxidant and antiproliferative properties of indol-3-carbinol and epigallocatexin-3-gallate improve alteration and reparation in affected urethra due to development of soft elastic connective tissue with better capillary circulation.

[Electrometric study of hard dental tissues of the patients with chronic inflammatory kidney diseases]

The electrometric study of the hard dental tissues of patients with chronic inflammatory kidney diseases was carried out. The significant changes in the properties of the hard dental tissues were detected in the patients. The electrometric indicators exceeded the norm in all teeth. The most differences were determined in the fourth teeth (first premolars).