No 4 (2024)

Introduction. Today it is urgent to introduce into clinical practice more advanced methods of kidney stone treatment with high indicators of their effectiveness and safety while minimizing the risk of repeated interventions. The goal of effective treatment of kidney stones is to completely rid the patient of stones and complaints, to eliminate organ dysfunction, using minimally invasive treatment methods that reduce the patient’s hospital stay and the risk of complications. However, there are only few studies comparing the clinical efficacy and safety of modern methods of surgical treatment of kidney stones 2 to 3 cm in size. Remote shockwave lithotripsy or retrograde intrarenal surgery is the treatment of choice for kidney stones up to 2 cm, and percutaneous nephrolithotomy is the treatment of choice for stones larger than 2 cm. Flexible ureterorenoscopy is not recommended as first-line treatment in patients with kidney stones >2 cm due to the high risk of reintervention, according to the RTC clinical guidelines. However, it can be performed successfully in centers with extensive experience with this technique. The advantages of retrograde intrarenal surgery are low trauma, low risk of complications such as bleeding and damage to adjacent organs, and shorter hospital stay. The efficacy of flexible ureterorenoscopy is significantly lower for stones larger than 3 cm, and for stones between 2 and 3 cm there are only a few studies, which do not allow a reliable judgment on the efficacy and safety of this technique.

Purpose of the study. To evaluate the efficacy and safety of flexible ureterorenoscopy in comparison with mini-percutaneous nephrolithotomy for kidney stones from 2 to 3 cm.

Materials and methods. A prospective randomized study to determine the efficacy of methods of surgical treatment of kidney stones from 2 to 3 cm in size using flexible ureterorenoscopy and mini-PCNL was conducted at the Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University (Sechenov University) in Moscow. The study analyzed the results of the performed surgical interventions in patients with urolithiasis using flexible URS and mini-PCNL as an example from the point of view of their effectiveness and safety for kidney stones from 2 to 3 cm.

The study utilized the results of 133 patients (including 64 patients after flexible URS and 69 patients after mini-PCNL). The mean size and mean density and location of the nodule between the groups were comparable and had no statistically significant differences.

The effectiveness of the intervention in the form of complete absence of concretions, length of stay in the clinic, operative time, development of postoperative complications (bleeding, urinary tract infection) and Clavien’s surgical complication score were evaluated.

Results of the study. The duration of surgery was longer in the flexible URS group where it amounted to 69.9±9.3 minutes, in the mini-PCNL group the duration of surgery averaged 48.3±5.8 minutes (p=0.0001).

The incidence of early postoperative complications in the flexible URS group was 6,2%, in the mini-PCNL group – 12,6%, which had statistically significant differences between the study groups at the level of p=0.001.

The length of stay in the clinic was shorter in the flexible URS group, which averaged 2±1 days, while in the mini-PCNL group the length of stay was 5±2 days (p=0.0003).

The frequency of concrement removal 3 months after the surgical intervention detected by computed tomography in the group of flexible URS was lower and amounted to 90,6%, in the group of mini-PCNL this index was at the level of 92,7% (p=0,06).

Conclusion. The results of this study demonstrate that flexible URS and mini-PCNL have a comparable success rate in removing concretions. Flexible URS reduces hospitalization time, causes fewer complications and can be used as an alternative in the treatment of kidney stones from 2 to 3 cm. Meanwhile, mini-PCNL has shown a higher percentage of effectiveness in getting rid of concretions 3 months after surgical intervention.

Purpose of the study. Comparison of the pharmacokinetic characteristics of the drug Vildegra^® registered in the Russian Federation with literature data for the original drug Viagra^®.

Materials and methods. Study design: prospective, open-label in healthy volunteers with a single oral dose on an empty stomach. The study included 48 male volunteers aged 18 to 45 years with a verified diagnosis of “healthy.” All subjects of the clinical study took 1 tablet of Vildegra^® once on an empty stomach. Blood samples to determine the concentrations of active substances were taken before taking the study drug and then after 0.25; 0.5; 0.75; 1; 1.5; 2; 2.5; 3; 3.5; 4; 4.5; 5; 5.5; 6; 7; 8; 10; 12; 16; 24; 30; 36; 48 and 72 hours after taking the drug. Dynamic monitoring was carried out throughout the study, including clinical examination, measurement of vital signs, monitoring of laboratory parameters and monitoring of adverse events (AE). The concentrations of sildenafil and its active metabolite N-desmethylsildenafil in the blood plasma of volunteers were determined by high-performance liquid chromatography with tandem mass spectrometric detection. Pharmacokinetic parameters were calculated using a model-free method using the specialized program PK Solution2.0.

Results. The AUC0-t, AUC0-∞ and Cmax values for sildenafil and its active metabolite when taking the drug Vildegra are in good agreement with the literature data for the original drug Viagra. The values of tmax and t1/2 of the drug Vildegra^® are slightly higher than those of the original drug, which is apparently explained by the extended-release dosage form in the case of Vildegra^®. In 10 of 48 volunteers (21%), 20 AE were recorded, which resulted in complete recovery. No serious or unexpected AE were noted.

Conclusion. The results obtained allow us to conclude that the pharmacokinetics, good tolerability and satisfactory safety profile of the drug Vildegra^® are comparable with the published data for the original drug Viagra^®.

Introduction. Urinary incontinence is a socially significant disease affecting millions of women around the world. High efficiency of modern treatment methods and short hospital stay contribute to lower psychological discomfort of patients.

Aim. To assess the psychological state of patients suffering from stress urinary incontinence before and after surgical treatment in a day patient department and while staying in the hospital for 3-4 days.

Materials and methods. A total of 133 patients aged from 34 to 69 years were included, who underwent surgical treatment in the City Clinical Hospital named after. S.I. Spasokukotsky from 2021 to 2022 in a day patient department and a standard hospital.

Results. In homogeneous groups, there was a decrease in the level of anxiety and depression, as well as an increase quality of life after surgery, which was more pronounced in those treated in a day patient department.

Introduction. Chronic recurrent cystitis is a common and difficult problem of modern urology. Traditional use of antimicrobial drugs often cannot lead to the long-term remission.

Aim. To evaluate the efficacy and safety of using different dosages and routes of the drug Superlymph^® in rectal and vaginal suppositories 10 U and 25 U in patients with chronic recurrent cystitis.

Materials and methods. A randomized comparative clinical study in parallel groups included 60 patients aged from 18 to 80 years with a diagnosis of chronic recurrent bacterial uncomplicated cystitis. All study participants were randomized into three groups. In Group 1 (n=25), Superlymph^® suppositories 25 U were prescribed rectally once a day for 20 days. In group 2 (n=25), Superlymph^® suppositories 10 U were administered vaginally 2 times a day, for 20 days.

In accordance with the prescription information, Superlymph^® 10 U/25 U can be used vaginally or rectally depending on the gender. In addition, it is possible to change the route of administration, for example, Superlymph^® 25 U one suppository once a day or Superlymph^® 10 U, one suppository 2 times a day in the morning and in the evening. The duration of the course is from 10 to 20 days. The main aim of the study was to compare an influence of various route of administration of Superlymph^® in women with frequent relapses of cystitis on the urothelium according to biopsy results, as well as on the symptoms of recurrent cystitis. The reparative effect of Superlymph^® was evaluated as well. In the control group (n=10), standard therapy was administered (fosfomycin trometamol 3.0 g once, and then, on the next day from the start of therapy, nitrofurantoin 100 mg three times a day for 5 days).

The study consisted of screening, therapy and follow-up stages. The duration of therapy was 20 days. All groups did not differ significantly in the main baseline characteristics.

Results. The drug Superlymph^® demonstrated efficacy as monotherapy of uncomplicated lower urinary tract infection in women compared with standard treatment. Rectal administration of the drug was more effective than vaginal. This was primarily manifested by a decrease in the level of urothelial metaplasia by the end of the study by 41% in the group of rectal suppositories and by 9% for the vaginal suppositories. In the control group, no changes in the level of metaplasia were found. A symptom scale showed an improvement of 36% in the group of rectal suppositories, 25% in the group of vaginal suppositories, and 19% in the control group. Improvements in the quality-of-life score were 50.8%, 33.9%, and 31.1%, respectively. The mean pelvic pain symptom scale score improved by 30%, 23%, and 13%, while a decrease in the mean leukocytes level in urine was most significant in the group of vaginal suppositories, by 39%. The respective indicators in the group of rectal suppositories and the control group were 27% and 21%, respectively. Innate immune factors were also assessed. The evaluation of gene expression levels in the bladder mucosa after using Superlymph^® was also performed. A significant decrease in TLR4 gene expression by 3 times, TNF gene expression by 4.2 times, and HBD1 expression by 2.7 times was found, which indicates a significant decrease in the level of inflammation in the bladder mucosa.

Conclusion. The immunomodulator Superlymph^®, representing a complex of natural antimicrobial peptides and cytokines, has demonstrated efficacy as monotherapy of chronic recurrent cystitis in women compared to standard treatment. Rectal route of administration was more effective than vaginal. This was primarily manifested by a decrease in the level of urothelial metaplasia by the end of the study. Therefore, the rectal suppositories should be used in older patients with a long history of the cystitis as intermittent therapy.

Aim. To study the dynamics of cystatin C in patients after procedures on retroperitoneal viscera using laparoscopic and retroperitoneal access.

Materials and methods. A prospective study of serum and urine cystostatin C levels in 162 patients with renal cysts using laparoscopic (n=83) and retroperitoneal access (n=79) was carried out. Patients were divided into four groups depending on the duration of the procedure and the gas level. For determination of cystatin C level in serum and urine, flow cytometry was performed using Human Kidney Function Panel 2 Mix and Match Subpanel (for Serum/Plasma Samples).

Results. A significant increase in the serum and urine level of cystatin C in groups 3 and 4 was seen on the 1st day after laparoscopic procedures in case of pneumoperitoneum pressure above 12 mm Hg., regardless of its duration. For retroperitoneoscopic procedures, similar changes were found only in group 4 with a gas pressure above 12 mm Hg and duration of the intervention of more than 30 minutes. By day 3, cystatin C levels returned to baseline values in all groups.

Conclusion. The most significant risk factor for acute kidney injury after laparoscopic and retroperitoneoscopic procedures is the gas pressure. The second most important factor is the duration of the intervention. Pneumoperitoneum has a greater effect on cystatin C levels compared to retropneumoperitoneum.

In addition to tumor imaging, advanced high-tech PET/CT imaging is increasingly used to elucidate the underlying causes of fever of unknown origin caused by various inflammatory processes, including pyelonephritis. Two clinical cases of whole-body PET/CT with 18F-FDG glucose, which allowed to visualize the molecular and cellular features of acute pyelonephritis as the cause of fever of unknown origin, are presented in the article. The scientifically based mechanisms of this process and the reliability of the results are discussed.

Objective: To compare the tolerability and feasibility of transrectal (TR) versus transperineal (TP) routes for prostate biopsy under local anaesthesia (LA). To assess the functional outcome and the complication of both procedures.

Methods. A prospective cohort observational study was performed on patients who underwent prostate biopsy under LA. Visual Analogue Scale (VAS) was used during the procedure. International Prostate Symptoms Score (IPSS) and International Index of Erectile dysfunction (IIEF) were assessed before the procedure and in 14 days after the procedure. Complication for each procedure was recorded.

Result. A total of 128 patients with 64 patients for each group underwent prostate biopsy by TP and TR under LA. TP targeted biopsy group had comparable pain scores to those who underwent the procedure using the TR routes. The median pain score for the TP group was 2 and TR was 3, (IQR=2, range 0–10 for both groups) with no significant pain difference between both groups (P=0.48). Furthermore, there was no significant difference in urinary function(p=0.68) and sexual function (p=0.19) between the two groups post-procedure. Both groups have similar rates of complications, with no significant difference observed. Urinary tract infection incidents that did occur were rare and did not significantly differ between the groups (p=0.21). None of the patients experienced sepsis postoperatively. AUR was reported in both groups, slightly higher with 9.4%(N=6) in the TP group and 6.3%(N=4) in the TR group however no significant difference(p=0.112) was noted. Haematuria is common in both groups with TP (66%) and TR (59%) but self-limiting with Clavien-Dindo grade I without significant difference (p=0.589).

Conclusion. Our results showed that both Transperineal and transrectal approaches have similar tolerability with no significant difference in functional outcome or complications. Further studies are mandatory to verify our results.

In the era of antibiotic resistance, strict control of foci of infection (for example, a long-term stent) and adherence to the timing of drainage removal are necessary.

The spread of pan-resistant pathogens requires the development of effective alternative antimicrobial measures, in particular, bacteriophage therapy.

A clinical case of a 42-year-old patient with a closed spinal cord injury, lower paraplegia, pelvic organs dysfunction, post-traumatic right ureteral stricture, and right kidney stones is presented in the article.

The patient developed stent-associated urosepsis due to pan-resistant Klebsiella pneumonia after endoscopic removal of a long-term right ureteral stent (over 3 months) with endotoxic shock, disseminated intravascular coagulation syndrome and wound sepsis, which was treated using personalized local bacteriophage therapy.

The available literature data on the prevention of infectious and inflammatory complications after minimally invasive urological procedures based on current knowledge about urobiome as the main point of application of preventive measures are summarized in the article. The main risk factors for the occurrence of inflammatory complications at all stages of the perioperative process are analyzed. The role of antibacterial prophylaxis is emphasized, and its features and the importance of finding ways to overcome one of the main problems of modern medicine, which is antibiotic resistance, are discussed.

Acute iliopsoas tendinitis (inflammation of the iliopsoas muscle) it is a rare and poorly studied disease. The author, who has his own experience in treating 29 patients with iliopsoas tendinitis (the largest material in Europe) with a mortality rate of 3.4%, analyzed the literature for the last 50 years and presented a review based on 60 literature sources (the experience of surgeons and urologists from Europe, America, Asia, Africa). We have investigated the clinical manifestations, diagnostics and treatment of acute iliopsoitis and determined the main distinct features in comparison to purulent paranephritis. The most typical symptoms of the iliopsoas tendinitis are pain in ilio-inguinal area, lameness, continuous fever, tenderness and palpable infiltrate in the area of the iliac-psoas muscles and psoas-symptom. The most accurate methods in the differential diagnosis with paranephritis are ultrasound, CT and MRI. This study is of importance for practical healthcare, since the differences between the clinical manifestations, diagnosis and treatment of iliopsoas tendinitis and paranephritis are discussed.

Data on the possibilities of using the bioregulatory peptide Prostatex is presented in the literature review, based on results of various studies for different prostate diseases.