Urology reports (St. - Petersburg)

BACKGROUND: Robot-assisted radical prostatectomy (RARP) offers advantages over open and laparoscopic approaches, including superior visualization and enhanced surgeon ergonomics. This study analyzed the short-term outcomes of the first RARP performed at the N.N. Petrov National Medical Research Center of Oncology, comparing them with laparoscopic radical prostatectomy (LRP).

AIM: To compare the outcomes of RARP and LRP in patients with clinically localized prostate cancer of low and favorable intermediate risk.

MATERIALS AND METHODS: The study included patients who underwent radical prostatectomy (RP) for localized prostate cancer of low and favorable intermediate risk (according to the NCCN classification) between 2022 and 2023. The final cohort consisted of 49 patients who underwent LRP and 58 patients who underwent RARP.

RESULTS: There were no significant differences between the groups in the incidence of early postoperative complications. However, positive surgical margins were significantly more frequent in the RARP group (51.7%) than in the LRP group (20.4%). Urethral catheter removal occurred earlier in the LRP group (median: 4 days) than in the RARP group (median: 6 days). At six months postoperatively, erectile function, including with conservative therapy, was preserved in 36.4% of patients after RARP and in 21.4% after LRP (χ² = 0.202). Severe urinary incontinence was observed in 3.5% of patients in the LRP group and 12.5% in the RARP group (χ² = 0.249).

CONCLUSIONS: The study demonstrated a significantly lower rate of positive surgical margins following LRP compared to RARP. However, it should be noted that the RARP group included patients operated on at the N.N. Petrov National Medical Research Center of Oncology during the initial implementation of this technique, which may have influenced the outcomes. Further studies are required.

BACKGROUND: Recurrent and extensive strictures of the ureteropelvic junction and proximal ureter pose a significant challenge in modern reconstructive urology, as standard surgical procedures are not always effective or technically feasible. Such cases require complex upper urinary tract surgeries, such as renal descensus with ureteral resection and end-to-end anastomosis, or substitution of the stenotic segment with a buccal mucosa graft.

AIM: To conduct a comparative analysis of the outcomes of laparoscopic buccal ureteroplasty and renal descensus with ureteral resection and end-to-end anastomosis.

MATERIALS AND METHODS: Surgical reconstruction of extensive recurrent strictures of the ureteropelvic junction and the upper and middle thirds of the ureter was performed in 72 patients: 35 men (48.6%) and 37 women (51.4%), aged 19 to 77 years. The patients were divided into two groups: group 1 included 30 patients (41.6%) who underwent buccal mucosa ureteroplasty, and group 2 included 42 patients (58.4%) who underwent renal descensus with resection of the stenotic ureteral segment and end-to-end anastomosis. The causes of stenosis included previous pyeloplasty (n = 54), contact ureterolithotripsy in the proximal ureter (n = 12), impacted stones (n = 4), ureteropelvic junction injury during laparoscopic excision of a parapelvic cyst of the left kidney (n = 1), and retroperitoneal fibrosis due to acute cholecystopancreatitis (n = 1). Laparoscopic access was used in 69 patients, and robot-assisted access was used in 3 cases.

RESULTS: A major intraoperative complication occurred in one patient from group 2, who developed bleeding from a lower pole vessel, requiring conversion. Group 1 demonstrated significantly shorter operative time (197.1 ± 52.9 vs. 227.6 ± 30.6 min, p = 0.003), lower blood loss (93.0 ± 21.0 vs. 176.6 ± 44.6 mL, p < 0.001), fewer postoperative complications (23.3% vs. 47.5%, p = 0.039), and a lower reoperation rate (6.6% vs. 30.8%, p = 0.043). The surgical success rate was 93.4% in group 1 and 71.5% in group 2 (p = 0.0009).

CONCLUSIONS: Compared with renal descensus, ureteral resection, and end-to-end anastomosis, buccal ureteroplasty is a highly effective procedure with a lower incidence of postoperative complications.

BACKGROUND: Chronic prostatitis is the most prevalent condition among male reproductive system disorders. The treatment of chronic prostatitis has not only medical but also significant social implications.

AIM: To evaluate the efficacy of a biogenic complex containing Tambukan mud in patients with chronic abacterial prostatitis.

MATERIALS AND METHODS: The study included 67 patients aged 28 to 57 years diagnosed with chronic abacterial prostatitis. All patients received a biogenic complex containing Tambukan mud in the form of suppositories, administered twice daily for 15 days. The total follow-up period was 1 month, with clinical evaluations conducted during the initial visit, on Day 15 (second visit), and on Day 30 (third visit).

RESULTS: Analysis of patient-reported outcomes using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) revealed that the total score decreased from 25.9 ± 3.8 to 3.9 ± 0.11 during treatment. Palpation of the prostate gland showed improvement: in all 67 patients (100%), the prostate became elastic, and in 63 patients (94%), it became non-tender. Transrectal ultrasound findings at the second visit demonstrated an average prostate volume reduction of 1.3 times, which further decreased to 1.5 times by the third visit. At the third visit, there was a statistically significant increase in both peak systolic and diastolic blood flow velocities in the central and peripheral zones of the prostate compared to baseline (p < 0.001).

CONCLUSIONS: The findings indicate that a biogenic complex containing Tambukan mud has a beneficial effect on the key clinical manifestations of chronic abacterial prostatitis. It significantly reduces pain and urinary symptoms, decreases prostate volume, restores prostatic hemodynamics, and may be recommended for this patient population.

This article presents modern approaches to the treatment of comorbid anxiety and depressive disorders in patients with primary painful bladder syndrome. The pharmacotherapy options and various non-pharmacological methods (psychotherapy, cognitive-behavioral therapy, hypnotherapy) for managing these conditions are detailed. It is noted that treatment targeting only the physical component of chronic pelvic pain is often ineffective. To achieve the desired outcome in some patients, it is also necessary to address cognitive, emotional, and behavioral factors associated with pain syndrome.

Bladder exstrophy is a severe multisystem congenital anomaly, and its surgical treatment remains a challenging task even for the most experienced surgeons. This article presents contemporary data on the epidemiology, anatomical aspects, and variations of bladder exstrophy, as well as modern surgical treatment strategies. The advantages and disadvantages of various surgical approaches are outlined. Advances in pediatric urology, including prenatal diagnosis, the implementation of numerous surgical techniques, and the use of osteotomy with pelvic and lower limb immobilization, have contributed to improving the quality of life for children with this condition.

Condylomata acuminata of the penis are a type of anogenital venereal warts characterized by exophytic growths on the skin of the external genitalia and the mucosa of the urethra. They are caused by human papillomavirus (HPV) types 6, 11, 16, 18, 31, 33, and 35, with types 6 and 11 being the most pathogenic. The virus is primarily transmitted sexually, entering the bloodstream through mucosal or skin defects during unprotected intercourse. The presented clinical case highlights the necessity of combining surgical treatment with local and systemic pharmacotherapy in a young patient with multiple recurrent condylomata acuminata of the glans and foreskin that were resistant to conservative treatment. A combination of prolonged antiviral therapy and topical application of podophyllotoxin proved insufficient, leading to widespread penile involvement. Persistent disease progression was attributed to infection with HPV type 6. The surgical intervention included circumcision, frenuloplasty, excision of residual warts on the glans, and electrocauterization of affected skin areas, followed by antiviral therapy with interferon, which resulted in complete clinical recovery. No recurrence was observed within six months.