Clinical features of spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age<18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.

MRI-TRUS fusion biopsy in diagnostics of prostate cancer

Introduction. Significant improvement in the quality of visualization of the prostate using magnetic resonance imaging (MRI), as well as the development of technologies for virtual combination of MRI and ultrasound images opens new horizons in the diagnosis of prostate cancer. The introduction of the PI-RADS system has allowed the standardization of MRI findings, and the development of fusion biopsy systems seeks to make diagnostics more accurate and less operator-dependent. Materials and methods. In this literature review, we evaluate the effectiveness of various biopsy approaches and discuss the prospects for targeted biopsies. The search for publications was carried out in the databases PubMed, e-library, Web of Scince et al. For citation, 55 literature sources were selected that met the search criteria for the keywords, «prostate cancer», «biopsy», «MRI», «TRUS», «fusion». Results. Diagnosis of prostate cancer using MRI. Modern technologies for radiological diagnosis of prostate cancer using magnetic resonance imaging (MRI) are based on the standardized PI-RADS protocol, using different modes (T2, diffusion-weighted images and contrast enhancement), which provides the best visualization of tumor-suspicious nodes in the prostate gland, allowing determination of lesion localization and size for subsequent targeted biopsy. Options for performing a prostate biopsy to diagnose prostate cancer. A description of the methods and effectiveness of transrectal and transperineal biopsy under ultrasound guidance is carried out - due to the fact that ultrasound diagnostics of prostate cancer has a rather low sensitivity due to small differences in the ultrasound structure of normal and tumor tissue of the prostate, an extended template biopsy technique was proposed, which involves puncture of the prostate through a special lattice. It also describes the technology of fusion biopsy and also provides literature data comparing the diagnostic accuracy of standard TRUS and fusion prostate biopsy, as well as the importance of transrectal / transperineal access. Questions for further study. Given the desire to reduce the number of biopsies while maintaining or even increasing the accuracy of diagnosing prostate cancer, data from studies investigating the feasibility of combining polyfocal (non-targeted) and targeted (targeted) biopsies are presented. Conclusion. The existing methods of non-targeted biopsy (polyfocal, saturation, template) and targeted (fusion biopsy) have their advantages and disadvantages, which currently do not allow making certain recommendations for their use, but a significant number of authors prefer MRI-as sisted, fusion -biopsy.

Foreign bodies of the urinary tract in children: Multicenter study

Introduction. Urinary obstructions caused by foreign bodies (FB) represent quite a rare clinical case in practicе of pediatric urologists. However, some recent publications note a tendency towards higher occurrence of FB in urinary tracts in children. Most publications on FB urinary obstructions in children are devoted to the descriptions of individual medical cases. Considering the lack of multicenter research works on the problem, a study based on generalized clinical experience of several hospitals appears relevant. Materials and methods. The study is based on retrospective analysis of treatment results of 44 pediatric cases from 10 clinics of Russia and Belarus during the period from 2000 through 2020. The study population comprised 28 (63.3%) boys and 16 (36.4%) girls. Mean age of the patients was 10.9±3.7 years. The children were subdivided into two groups: group I included 28 (63.3%) cases where FB had been introduced in the urethra or bladder by the child; group II included 16 (36.4%) cases where foreign bodies ended up in urinary tracts as a result of instrumental or surgical procedures. Results. Clinical manifestation of FB was typical among the patients in the group I while in group II the condition more often occurred inapparently. Children often concealed FB introduction in the urinary tracts, and so contacts with a healthcare institution were ordinarily triggered by changes in urine analysis findings. Concealment of FB introduction in the urinary tracts determined help seeking start later than 7 days following the incident in 64.2% cases of group I. More than a half of the FB in children of group I were revealed within the first month after the incident. In group II, FB were revealed accidentally during follow-up examinations in 75% of the children. Transurethral FB extraction succeeded in 50% of the patients in group I. In group II, transurethral FB extraction was performed in 5 (31.3%) children. In 2 cases (12.5%), FB were extracted using flexible ureteroscopy. Percutaneous nephroscopy was used in 2 (12.5%) patients. 5 (31.3%) cases required pyelotomy with laparoscopic access, and in 2 (12.5%) patients a lumbotomy had to be carried out. Discussion. The rarity of FB of the urinary tract in the practice of a pediatric urologist is the reason for the combination ofthe existing experience in providing medical care to children from 11 centers. Delayed demand for medical care was noted if FB were introduced by the child independently. The generalized material shows that in childhood, the same approaches to FB extraction are applicable as in adult patients; endoscopic FB removal is optimal. Conclusions. In most cases of children suffering from foreign bodies in urinary tracts, the FB can be extracted using endoscopy without complications and with favourable outcome.

Bladder neck sclerosis: alternative methods of treatment and prospects for their development

Introduction. Bladder neck sclerosis (BNS) is a widespread complication of the surgical treatment of prostate diseases. Nevertheless, the etiology and pathogenesis of BNC development are not well understood, the frequency and degree of iatrogenic BNS varies depending on what treatment took place before its appearance. Treatment options for BNS can vary from simple dilatation to complex surgical interventions. Clinical variants of BNS, as well as their treatment options, vary in complexity, from simple short annular contractures to obliterating stenosis, which requires a significant expansion of surgical treatment volume. The purpose of this study – is to assess the effectiveness of modern and alternative methods of prevention and treatment of BNS based on the analysis of published studies. Materials and methods. The search and analysis of publications in the databases PubMed, Scopus, Cochrane Library, elibrary, according to the keywords, «bladder neck sclerosis», «benign prostatic hyperplasia», «bladder neck contracture», «bladder neck stenosis», «balloon dilatation», «treatment». As a result, 46 publications were selected and included in this review. Results and discussion. In this review, we highlighted the routine and alternative methods of BNS treatment. Currently, there are quite modern methods for treating prostate diseases (using robotic techniques, electrosurgical resections, and enucleations, laser enucleations, etc.), which are often complicated by secondary BNS. Nowadays, there are a lot of routine and alternative methods of treatment of secondary BNS in the urologist’s armamentarium. Routine methods include TUR and incision of the bladder neck using electric and laser energy, alternative methods include balloon dilatation, installation of a urethral stent, instillation (or intraoperative injection) of the bladder with cytostatics, hormonal drugs, derivatives of hyaluronic acid, and biomedical cell products. Conclusions. According to the literature from the listed alternative treatment methods for BNS, balloon dilatation is the most promising one. Based on the results of the literature analysis, we concluded that the use of balloon dilatation as a method of primary (least invasive) treatment and prevention of the occurrence of BNS is advisable.

Actual possibilities of pathogenetic treatment of patients with with purine dismetabolism

Introduction. Purine dysmetabolism is occured by increased production of uric acid, which leads to hyperuricemia and hyperuricuria. The most common forms of purine metabolism disorders are the uratenephropathy, gout, and asymptomatic hyperuricemia. Purpose. To evaluate the data published from 1992 to 2021 on the prevalence, forms of purine metabolism disorders, diagnostics and methods of their treatment. Two hundred and seventy original publications were identified, of which 37 were selected and analyzed. Materials and methods. The search results in the scientific database PubMed, Web of Sciеnce, Sciеnce Direct were analyzed for the queries «urates», «gout», «uric acid», «purine metabolism», «hyperuricosuria», «treatment of urate nephrolithiasis», «luteolin; quercetin», «Smilax riparia». Results. Urates are formed as a result of the metabolism of purine bases, two-thirds of which are excreted with urine. The most common form of purine dysmetabolism is urate nephrolithiasis, which accounts for up to 10% of all forms of kidney stone disease. The main risk factors include low urinary pH, decreased urine output and hyperuricosuria. Treatment options for such stones depend on the size, chemical composition, location, and concomitant diseases. The main methods of treatment are conservative therapy and surgical interventions. Conclusions. Since the available conservative therapy may not be suitable for all patients, and surgical intervention carries certain risks, a unique herbal complex «Uralix®» was created to treat patients with urate stones in the kidneys and urinary tract. Its components luteolin, quercetin and sarsaparilla extract reduce uric acid levels and improve renal function in urate nephropathy.

Experimental evaluation of the influence of isobornylphenols on the development of BPH and the redox potential of prostate cells

Introduction. Benign prostatic hyperplasia (BPH) is a common urological disorder in older men. It is characterized by the development of glandularstromal hyperplasia of the prostate with the formation of new glandular structures and subsequent symptoms from the lower urinary tract. It has now been established that the pathogenesis of this disease is multifactorial and one of the possible mechanisms for the development of BPH is oxidative stress. Purpose. Study of the effect of phenols with a bulky isobornyl substituent (2,6-diisobornyl-4-methylphenol and 4-hydroxymethyl-2,6-diisobornylphenol)on the growth of experimental BPH and the antioxidant balance of prostate cells in comparison with Prostamol Uno. Materials and мethods. Experiments were carried out on 50 male Wistar rats. BPH was caused by daily administration of sulpiride (60 days) to male rats of late reproductive age. After 2 months, the animals were weighed and sacrificed in a CO2 chamber. The mass, mass coefficient, volume of the lateral lobe of the pancreas were determined, morphological analysis was performed. Investigated prooxidant and antioxidant activity. The results were processed by the method of variation statistics using the Mann-Whitney nonparametric U test. Results. The efficacy of the investigated drugs in BPH decreased in the following sequence: sulpiride + substance 4-hydroxymethyl-2,6-diisobornylphenol (HDB) → sulpiride + substance Dibornol (DB) → sulpiride + Prostamol Uno (PU). When comparing the results of evaluating the anti-prooxidant status with the therapeutic effect of the studied drugs, it was found that isobornylphenols, which are highly effective as prostatotropic drugs, did not show a more significant effect, compared to PU, on the redox potential of prostatic tissue cells. Conclusions. Drugs DB, HDB, PU have a normalizing effect on the level of severity of redox reactions in the sulpiride model of BPH.

Clinical significance of sperm morphology in male infertility treatment

Introduction. Sperm morphology is one of the most common tests in fertility practice. The interlaboratory variability is the main drawback of the method. The clinical significance of sperm morphology in assisted reproductive technologies is controversial. The aim of the review is to address this question. Materials and methods. The search of relevant publications was carried out in PubMed and e-Library databases using the keywords «male infertility», «sperm morphology», «teratozoospermia», «IUI», «IVF», «ICSI». Conference abstracts and dissertations were excluded from analysis and 56 publications were included in this literature review. Results. The small numbers of studies were evaluated to the effect of teratozoospermia on the likelihood of natural pregnancy. The pregnancy rate was higher in the group of couples with normozoospermia. In the couples with severe teratozoospermia pregnancies rate was also detected. The most studies did not reveal a statistically significant effect of tertozoospermia on the frequency of pregnancy during intrauterine insemination. The data about the influence of sperm morphology on in vitro fertilization are contradictory. Early studies showed a positive correlation between normal sperm morphology and frequency of conception, but these results were not confirmed in further studies. The most studies have not been revealed the correlation between normal sperm morphology male fertility status, clinical and live birth rate. Discussion. To date the spermatozoa mofophology studying remains the «starting point» ofa man's examination for infertility. However, the data available do not confirm its role in choosing the method ofassisted reproductive technologies or predicting their results. Conclusions. To date the role of sperm morphology on conceive and pregnancy frequencies in ART use is controversal. The data available does not confirm the value of this test as a proxy of higher pregnancy and birth of healthy child probability. The further studies are required to address this question.

Options for antibacterial prophylaxis of infectious complications of prostate biopsy

Introduction. Amount of prostate biopsy procedures rises every year and up to 95% of cases of prostate biopsy is performed via transrectal approach. The incidence of infectious complications of transrectal prostate biopsy reaches up to 17%, while incidence of such complications of transperineal biopsy is about 1%. The majority of international clinical guidelines recommends for obligatory antibiotic prophylaxis prior to prostate biopsy of any approach, but the choice of antibiotic is still debatable. The aim of this review is to sum up the approaches of international urological guidelines to the antibiotic prophylaxis prior to prostate biopsy. Materials and methods. We analyzed the search results in the scientific databases PubMed, Google Scolar, elibrary.ru for the queries «prostate biopsy», «antibacterial prophylaxis» and «guidelines». Results. According to the recommendations of most professional communities, antibacterial prophylaxis of infectious complications of prostate biopsy can be carried out in various ways - once or for a long time, one- or two-component, empirically or on the basis of urine culture on microflora. Conclusion. Despite the differences in the levels of sensitivity and resistance of coliform flora around the world, the clinical guidelines in most countries are uniform in terms of the choice of drugs to reduce the risk of developing infectious complications after prostate biopsy. Approaches to antibacterial prophylaxis after prostate biopsy differ only depending on the type of biopsy access.

3D printing in urology as a trend in personalized medicine

Introduction. 3D printing technology is being actively introduced into the urological practice. Apart from improving of patients counselling, this technology allows for improved planning end performance of surgery. Aim of study. To determine the current state of three-dimensional printing in the urological practice. Materials and methods. Embase, Medline, Google Scholar, Scopus databases were searched to find related publications until September 2020. Inclusion criteria were: the availability of the full article, the use of 3D models for teaching patients or residents, and their use in planning and performing surgery on patients over 18 years of age. Results. One hundred and ninety seven publications were included, of which 40 were selected for a further analysis. 11 articles were related to the study of the usefulness of printed models in counseling patients with urolithiasis, planning and training of retrograde lithotripsy and percutaneous nephrolithotripsy. In 20 articles, the printed model was used to counsel patients with renal neoplasms, planning and intraoperative navigation. In 9 papers, the results of the use of printed models in communication with patients with prostate tumor, in improving the determination of its localization and planning of the upcoming surgery were published. Conclusion. The creation of three-dimensional printed models is promising in urology. Despite the current limitations this field is becoming more accessible for both patients and doctors.

Penile rehabilitation in patients after radical prostatectomy

Introduction. Prostate cancer (PCa) is one of the most common cancers in men. Radical prostatectomy (RP) is one of the main treatment modalities for localized PCa. Erectile dysfunction (ED), being a consequence of surgical treatment, can have detrimental effects on both physical health and psychosocial status and significantly impair the quality of life of patients and their partners. The risk of ED in the postoperative period in patients undergoing RP, according to the modern literature, is about 60–70%. Materials and methods. The paper describes in detail the pathogenesis of ED after RP. The main components of penile rehabilitation (PR) and their mechanism of action are described, literature data confirming their effectiveness is presented. Results. Currently, after nerve-sparing radical prostatectomy, the following penile rehabilitation methods are used - the use of inhibitors of PDE-5 type, shock wave therapy, vacuum erection therapy (VED), intracavernous injections, penile prosthetics and a combination of these methods. Combined rehabilitation programs promote EF recovery after RP with better results compared to monotherapy. Conclusion. We see a perspective in the development of combined approach strategies for the rehabilitation of erectile funktion (EF) after RP. Further improvement of the surgical technique of nerve-sparing RP, as well as a deeper understanding of the implementation of the postoperative process is crucial to develop an algorithm for the EF restoration program.