A review of the European Association of Urology Guidelines on management of urological cases during the COVID-19pandemic

The COVID-19 pandemic had an unprecedented effect on health systems around the world. The current situation has left its mark on all medical organisations. The principles of management of patients with various diseases have changed, and patients of urological clinics have not become an exclusion. On the whole, specialist recommend to postpone any interventions as late as possible, except for life-threatening situations that require urgent medical care In all other cases, remote consultation and treatment of patients are proposed. We prepared a review of the recommendations of the European Association of Urology (EAU) on treatment, diagnosis and follow-up of such patients during the COVID-19 pandemic.

The efficacy and safety of EN BLOC resection in non-muscle-invasive bladder cancer

In surgical treatment of non-muscle-invasive bladder cancer (BC) the en bloc resection technique – removal of tumour in a single piece with the subjacent muscle (detrusor) – is becoming more widely used. The objective of this review was to assess the oncological efficacy (relapse incidence) and safety (of peri- and post-operative complications) of this technique for various tumour sizes. This systematic review was written in accordance with the PRISMA criteria. The relevant literature published over the past 20 years was chosen in two databases (Medline and Scopus) with the use of the search query “en bloc” and “bladder cancer”. We selected publications that assessed the efficacy and safety of en bloc resection of the bladder wall with non-muscle-invasive tumour, and also publications comparing the efficacy of en bloc резекции resection with that of transurethral resection (TUR) of the bladder. Based on analysis of 18 studies (1592 patients after en bloc resection), the following conclusions were made: the incidence of BC relapses after en bloc resection of the bladder wall (with non-muscle-invasive tumour) is significantly lower than after conventional TUR of the bladder; a practically 100-percent presence of muscle fibers is found in the histological tumour specimen; the frequency of peri- and post-operative complications in en bloc resection is significantly lower as compared with classical TUR; the choice of a power source does not influence the oncological outcomes, but laser en bloc resection is safer than electrical; extraction of tumours with sizes up to 2-3 cm is possible in one piece; tumours of larger diameters should be preliminary fragmented in the bladder cavity; comparison of tumours of various diameters did not reveal any statistical differences between the oncological outcomes of patients. The technique of en bloc resection of the bladder wall with non-muscle-invasive tumour is effective and safe for removal of smaller tumours (~ to 2 cm); as some authors point out, it is also effective in larger tumours but there are no literature evidence sufficient for such an. Key words: systematic review, en bloc resection, non-muscle-invasive bladder cancer

mpMRI/TRUS fusion, saturation, standard and cognitive transrectal prostate biopsy: what? whom? when?

The aim of this literature review was to demonstrate the pluses and minuses of each kind of biopsy, which can be helpful for preparing an algorithm and determining the indications and contraindications for each prostate biopsy (PB). Prostate biopsy is the main method of diagnosing prostate cancer (PC), and it remains relevant even in spite of the appearance of a number of new diagnostic tests and methods. Transrectal 12-core biopsy without pre-biopsy mpMRI remains a routine sampling of prostate material. But with the appearance of a great variety of PB and their introduction into practice, there arises the need to compare these methods with each other. At present, all available studies dealing with the informativity of some biopsy method or another, were conducted in different time periods and cannot reliably reflect their informativity for making a comparison. In our opinion, further research into this problem is required and research works should study the informativity of various kinds of biopsy depending on visualization of a pathological site for suspected prostate cancer, in TRUS and its location coincidence in mpMRI, in Pi-RADSv2.1 classification. Key words: prostate biopsy, prostate cancer, transrectal ultrasound

Androgen deficiency in patients with prostatic diseases

Negative effects of androgen deficiency in males can be avoided by regular androgen screening in patients over 50 years of age. We measured testosterone levels in 521 men aged between 18 and 93 years (mean age 60.94 years). A total of 235 patients (45.2%) were found to have age-related hypogonadism. We have developed a diagnostic algorithm for androgen deficiency at outpatient facilities. We also assessed the prevalence of prostatic diseases and a number of somatic disorders in patients with age-related hypogonadism. We have proposed a variant of medical correction of androgen deficiency. Key words: age-related hypogonadism, testosterone, prostate, screening, androgen replacement therapy

First outcomes of simultaneous videosurgery in bilateral kidney tumours

Objective. To improve the outcomes of treatment of patients with bilateral kidney tumours. Patients and methods. 30 patients with synchronous bilateral kidney tumours received laparoscopic and retroperitoneoscopic treatment in the Institute of Urology and Reproductive Health, I.M.Sechenov First Moscow State Medical University (Sechenov University) from March 2012 to August 2018. 22 patients underwent staged operative treatment, 8 patients had one-stage surgery. The patients’ stage of disease was classified as Т1аN0M0 to Т3аN0M0. In most cases, the histological type had a malignant character. Results. 22 patients underwent 3D modelling of pathological process at the stage of preoperative preparation. The classical triad of renal cancer symptoms was not found. 7 operations were performed by the retroperitoneoscopic access, the others laparoscopically. The number of operations with retro- and retro-approach was 1, retro- and laparo-approach was 3, with laparolaparo-approach was 4. Performance of bilateral laparoscopic resection takes more time as compared with the combination of retro- and laparoscopic approaches. Two resections performed from the retro- and laparoscopic accesses make possible an operation without the surgeons going to the opposite side and changing the position of the endosurgical equipment, which shortens preparation to the second step of surgery and the duration of anaesthesia. Apparently, division of the surgical approach to the kidneys into the abdominal cavity and the retroperitoneal space is preferable, since it allows an adequate evaluation of the course of the early postoperative period and a differential control over the development of complications, first of all, bleeding. Conclusion. First evaluation of the outcomes of treating 8 patients, who underwent one-stage surgery, showed that this approach is safe, since it is not associated with an increase of intraoperative blood loss or other complications as compared with two-stage operations. Also, the duration of anaesthesia is shorter in one-stage surgery than in staged treatment. Enhancement of the volume of operative treatment does not reduce the length of hospitalization but rules out the need for repeated hospitalisation. We have obtained positive results that encourage further enrolment of patients and assessment of long-term outcomes of treatment. Key words: bilateral kidney cancer, synchronous cancer, organ-preserving surgery, nephrectomy, simultaneous and staged surgery, laparoscopic and retroperitoneoscopic surgery

Optimization of the parameters of a superpulse thulium fiber laser with wavelength 1.94 μm for minipercutaneous lithotripsy

At present, minipercutaneous nephrolithotripsy is a highly effective and safe method for fragmentation of stones with sizes up to 3 cm. The use for lithotripsy of a holmium: yttrium aluminum garnet laser with wavelength 2.1 μm (Ho:YAG) is a common practice today. Of late, however, more attention is paid to a new superpulse thulium fiber laser with wavelength 1.94 μm and maximum output power 40 W. The use of a thulium laser with pulse energy 0.025–6 J and a high repetition rate (to 1600 Hz) permits to obtain (compared with a holmium laser) better results of stone dusting. Objective. Selection of the optimal modes of stone fragmentation in minipercutaneous nephrolithotripsy with the use of a superpulse thulium fiber laser with wavelength 1.94 μm and maximum output power 40 W in patients with nephrolithiasis. Patients and methods. The study included patients (n = 171), who underwent minipercutaneous nephrolithotripsy using a superpulse thulium fiber laser during the period from February 2018 to July 2019. The following parameters of laser radiation were used: pulse energy 0.1-6 J, power 6-40 W, pulse rate 30-300 Hz. The impact of modes on endoscopic visualization and retropulsion was assessed intraoperatively. Results. Statistical analysis of the specificities of the most often used modes was conducted: No 1 – «0.15 J, 200 Hz, 30 W», No 2 – «0.5 J, 30 Hz, 15 W», No 3 – «0.8 J, 31.25 Hz, 25 W», No 4 – «0.8 J, 37.5 Hz, 30 W», No 5 – «1.5 J, 15 Hz, 30 W», No 6 – «1.5 J, 26.6 Hz, 40 W», No 7 – «2 J, 15 Hz, 30 W», No 8 – «2 J, 20 Hz, 40 W», No 9 – «4 J, 10 Hz, 40 W»; their effects on retropulsion and on endoscopic visualization were studies. The stone free rate was assessed on the first post-operative day according to the findings of low-dose CT. Conclusion. Study of the modes of thulium fiber lithotripsy, assessment of retropulsion and endoscopic visualization depending on the choice of emitted radiation parameters of a thulium fiber laser make it possible to improve the outcomes of operative treatment in patients with nephrolithiasis. Key words: minipercutaneous, nephrolithotripsy, nephrolithiasis, MPNL, thulium fiber lithotripsy, retropulsion, visibility, superpulse thulium fiber laser, wavelength 1.94 μm, stone free rate

Imaging diagnostic methods in assessment of renal function in patients with kidney tumours

The article offers a review of modern methods of assessing renal function in patients with kidney tumours. At present, there are many methods of assessment of renal function, beginning with laboratory diagnostic tests and up to radionuclide diagnostic methods. Examination of glomerular filtration rate and the Rehberg-Tareev test are widespread and accessible methods, but they are not precise indicators and do not allow determination of the split renal function. Scintigraphy is a “gold standard” permitting to obtain comprehensive information about split renal, but it is a costly procedure. Contrast computered tomography might be a promising a method for assessing renal function during both the preoperative and postoperative periods. Key words: computered tomography, assessment of renal function, partial nephrectomy, scintigraphy

Staged buccal mucosa graft Bracka urethroplasty in children with proximal hypospadias

For management of proximal hypospadias in children both one-stage (Hodgson, Ducket), and two-stage (Bracka) technieuqa are used. The staged Bracka repair is preferable because of fewer complications. The objective of the study was to assess and improve the outcomes of treating children with proximal hypospadias by improving the staged buccal mucosa graft Bracka repair. Patients and methods. In the department of uroandrology of the National Children’s Clinical Hospital in the period from 2013 to 2019 126 boys with proximal hypospadias received operative treatment according to the methos of buccal mucosa graft Bracka repair. Depending on whether it was primary surgery or an operation after failed repair, all patients were divided into 2 groups. Results. Both functional and cosmetic outcomes of treatment were assessed in the near and long-term post-operative periods. The assessment of the functional outcomes was based on the following criteria: recovery of free passage of urine with a wide stream (average urinary flow rate) and absence of penile curvature. Cosmetic outcomes were analysed by the HOPE score. Conclusion. Staged buccal mucosa graft urethroplasty permits to obtain positive functional and cosmetic outcomes of treatment in 60% (51% good and 9% satisfactory) of patients in the near and long-term periods. The percentage of complications is 41% and they are mainly presented by urethral fistulae. In patients with a history of failed surgery the risk for developing complications is practically the same as in primary patients. Key words: hypospadias, curvature correction

Management of dorsal and lateral curvature of the penis in children with hypospadias

Lateral and dorsal curvature of the penis in hypospadias in children are very rare conditions. Articles dealing with correction of these rare forms of curvature in children are not easy to find. The objective of this work was to improve the outcomes of treating children with hypospadias and rare (dorsal/lateral) forms of penile curvature. Patients and methods. The study included 49 patients with coronary and penile hypospadias, chordee with hypospadias, and also with rare forms of curvature – dorsal and lateral at 30-45 degrees. Depending on the form of penile curvature the patients were divided into 2 groups. Group 1 – 36 patients with dorsal curvature, who underwent ventral plication of the corpora cavernosa; group 2 – 13 patients with lateral curvature and lateral plication of the contralateral corpus cavernosum (9 patients had a curve to the left and 4 – to the right). Results. No penile curvature in the early post-operative period and a year afterwards was not noted in patients of both groups. Dorsal penile curvature occurs in 5% of cases, and lateral in 1.7% of cases. Conclusion. The use of the method of plication of the corpora cavernosa opposite the curvature makes it possible to obtain good functional and cosmetic outcomes of management of hypospadias. Key words: lateral curvature, dorsal curvature, hypospadias, curvature correction