ISSN (print): 2225-9074, ISSN (online): 2687-1416 Founder: Eco-Vector LLC Editor-in-Chief: Tkachuk Vladimir Nikolaevich, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Subscription Included in: Higher Attestation Commission List, RISC
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Clinical Course of Recurrent Urolithiasis: A Pilot Study
BACKGROUND: Urolithiasis is one of the most common urological disorders, characterized by a chronic recurrent course. Various predictive models have been proposed to assess the risk of stone recurrence. However, their effectiveness remains limited, which necessitates further investigation into the clinical features of the disease, including its recurrent nature. AIM: To evaluate the features of the clinical course of recurrent urolithiasis. METHODS: This study included 471 patients admitted to a urology department between 2019 and 2021 with a diagnosis of urolithiasis (ICD-10 codes N20, N23). Statistical analysis of data was performed using RStudio (version 4.3.3). RESULTS: Compared to patients with first-onset urolithiasis, those with recurrent disease had a higher body mass index (28.0 and 27.4 kg/m2, respectively; p = 0.043), a higher prevalence of overweight (76.6% and 67.5%, respectively; p = 0.002), and a greater number of stones in each kidney and overall in both kidneys. The total stone volume was also significantly higher in recurrent urolithiasis: median 855 mm3 and 433 mm3, respectively (p < 0.001). A history of spontaneous stone passage was reported in 42% of patients, whereas 58% had previously undergone surgical intervention for urolithiasis. Patients with a history of surgical interventions for urolithiasis had a higher body mass index, a more frequent presence of obesity compared to patients with spontaneous stone passage (39.2% and 23.8%, respectively; p = 0.011), as well as a greater number of urinary stones in both kidneys. CONCLUSION: Recurrent urolithiasis is more common among patients with excess body weight and is associated with more intensive stone formation than in patients with first-onset of urolithiasis. In recurrent urolithiasis, obesity is linked to an increased need for surgical intervention and a lower probability of spontaneous stone passage. In this context, body weight normalization appears to be the most appropriate strategy for reducing the risk of urolithiasis recurrence.
版权所有 © Eco-Vector, 2025 https://creativecommons.org/licenses/by-nc-nd/4.0/
Photodynamic Inactivation of Uropathogenic Biofilm-Forming Microorganisms: A Pilot Study
BACKGROUND: Methods for microbial inactivation, including physical approaches aimed at the destruction of biofilms formed by uropathogenic microorganisms for the prevention of infectious and inflammatory diseases in urology, remain insufficiently studied. The development of new strategies in this field remains relevant. AIM: To evaluate the feasibility of photodynamic inactivation of biofilms formed by typical representatives of uropathogenic microorganisms using an antiseptic agent with a bacteriostatic effect—methylene blue—possessing photochemical properties. METHODS: Cultures of Staphylococcus aureus and Escherichia coli isolated from renal calculi of patients from a urology department were used. In vitro experiments on photodynamic inactivation of microorganisms were conducted on mature preformed biofilms. Irradiation was performed using a diode laser emitting at a wavelength of 662 nm through a sterile 0.1% methylene blue solution in continuous mode across five setups (three control, two experimental). After irradiation, biofilms on the cover glasses were fixed on microscope slides using colorless varnish. The prepared specimens were stained with acridine orange solution, dried in the dark, examined under a fluorescence microscope at ×100 magnification using an immersion system, and photographed with a digital camera. Images were digitally processed using 3D modeling technologies with ImageJ software version 1.52a. RESULTS: The impact of the photoactive agent and laser irradiation was assessed at two power settings—450 mW and 1100 mW. In the first case, partial destruction of the biofilms was noted (41.9% of the original biofilm structure for S. aureus and 82.4% for E. coli), whereas in the second case, exposure at 1100 mW resulted in complete degradation of the mature multilayer biofilm into single cells without extracellular matrix, corresponding to 97.7% destruction of the original biofilm structure for S. aureus and 96.5% for E. coli. CONCLUSION: This study is the first to demonstrate the feasibility of photodynamic inactivation of uropathogenic biofilm-forming microorganisms using a photochemically active agent—methylene blue. The promising results suggest that combined laser irradiation and methylene blue application may serve as an alternative or adjunct to systemic antibiotic therapy in urological practice.
Predictive Factors for Successful Penile Augmentation via Suspensory Ligament Release
BACKGROUND: Modifying the shape and size of the genitalia has been a relevant concern since ancient times. Surgical penile augmentation may improve quality of life in appropriately selected patients. Identifying predictors of success in penile augmentation surgery is an important and practically relevant task in surgical andrology. AIM: To identify predictive factors for successful penile augmentation to support the selection and optimization of surgical approach. METHODS: We analyzed anatomical and topographic data from 66 patients who underwent penile augmentation at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov between 2022 and 2025. The procedure involved suspensory ligament release with V–Y skin plasty, Heineke–Mikulicz plasty, and lipectomy. RESULTS: Based on the obtained data, it was determined that the effectiveness of penile augmentation surgery was significantly influenced by the thickness of the subcutaneous fat in the pubic area and the length of the penile suspensory ligament. CONCLUSION: Preoperative assessment of anatomical structures may support the selection of the optimal surgical technique and help form adequate and realistic expectations in patients regarding surgical outcomes.
Efficacy of Instillation of a Combination of Botulinum Toxin Type A and Titanium Glycerosolvate in Patients With Overactive Bladder: A Pilot Study
BACKGROUND: Overactive bladder is a common syndrome with symptoms that significantly reduce patients’ quality of life. Conventional treatment methods are not always satisfactory, prompting ongoing research into novel and effective therapeutic options. Intravesical instillations of botulinum toxin A represent one of the promising minimally invasive treatment modalities. AIM: To evaluate the efficacy of intravesical administration of a combination of titanium glycerosolvate and botulinum toxin A in patients with overactive bladder. METHODS: This clinical study included 10 patients (9 females and 1 male, mean age 63.2 ± 7.78 years) with idiopathic overactive bladder. All patients underwent a single intravesical instillation of a combination consisting of 25 mL of 40% titanium glycerosolvate solution and 500 IU of abobotulinumtoxinA diluted in 4 mL of 0.9% NaCl solution. The mean exposure time of the mixture in the bladder was 2 hours. Treatment efficacy was assessed based on voiding diaries and the Overactive Bladder Symptom Score (OABSS), completed by patients before treatment and at 1, 3, and 6 months thereafter. RESULTS: At 1 month after intravesical instillation of the experimental mixture, the mean OABSS score decreased from 10.0 ± 3.1 to 7.67 ± 3.35 (−23% compared to baseline), the frequency of urgency episodes decreased from 3.4 ± 2.78 to 1.82 ± 1.6 per day (−46.5%), the frequency of micturition decreased from 13.69 ± 3.67 to 10.4 ± 3.12 times per day (−24%), and the mean voided volume increased from 90.4 ± 74.4 to 105.6 ± 69.2 mL (+16.8%). At 3 months of follow-up, a return of overactive bladder symptom severity to baseline levels was observed in treated patients. This was evidenced by an increase in total OABSS scores, a rise in the frequency of urgency episodes and micturitions, and a decrease in mean voided volume. CONCLUSION: The results of this pilot study demonstrate the efficacy of intravesical instillation of a combination of titanium glycerosolvate and botulinum toxin A in patients with overactive bladder, with therapeutic effects persisting for up to 3 months. The observed positive clinical changes suggest that further research in this direction is warranted.
版权所有 © Eco-Vector, 2025 https://eco-vector.com/for_authors.php#07
Specific Features of Treatment of Intraoperative Ureteral Injuries Complicated by Peritonitis
BACKGROUND: Ureteral injury is a rare condition, accounting for less than 3% of all urinary tract injuries. The majority of ureteral injuries are iatrogenic. Intraoperative ureteral injuries are identified late in 75% of cases, which leads to the development of post-traumatic complications. The timing of peritonitis manifestation after ureteral transection or thermal damage varies, affecting treatment strategy. AIM: To determine the optimal treatment strategy for intraoperative ureteral injury complicated by urinary peritonitis. METHODS: This retrospective study included 26 patients treated at the I.I. Dzhanelidze Research Institute of Emergency Medicine between 1998 and 2022 for intraoperative ureteral injury complicated by urinary peritonitis. RESULTS: The median patient age was 51 years [Q1 41; Q3 66]. Among the surgical interventions leading to intraoperative ureteral injury, gynecological operations were the most common. The time to detection of urinary peritonitis ranged from 11 to 103 hours after the initial surgery. Urinary peritonitis was detected in the reactive phase in 8 patients, in the toxic phase in 6, and in the terminal phase in 12. Surgical treatment was performed in all cases of urinary peritonitis. Primary reconstructive surgery was performed in 13 (50%) patients. In 10 cases (38.5%), staged procedures were required before reconstructive ureteral surgery could be performed. In 3 patients (11.5%), reconstructive surgery was not carried out; instead, permanent drainage of the upper urinary tract using a nephrostomy was performed. CONCLUSION: If intraoperative ureteral injury is identified during the reactive or toxic phase of urinary peritonitis, reconstructive surgery may be performed. In the terminal phase of peritonitis, only staged procedures aimed at draining the upper urinary tract should be performed.
Evaluation of the Effectiveness of a Novel Technique for Laparoscopic Radical Prostatectomy
BACKGROUND: Radical prostatectomy remains the primary surgical treatment for patients with localized prostate cancer. Regardless of the surgical approaches, the risk of complications persists. Therefore, improving the technique of radical prostatectomy remains a pressing issue in uro-oncology. AIM: To evaluate the effectiveness of a novel technique for laparoscopic radical prostatectomy in patients with localized prostate cancer. METHODS: An analysis of surgical treatment was performed in 137 patients with localized prostate cancer. Laparoscopic radical prostatectomy was performed in all patients: 80 patients (group 1) underwent the procedure using a modified technique with preservation of the pelvic supportive ligamentous structures, and 57 patients (group 2) — using the standard technique. RESULTS: Patients in group 1 demonstrated shorter total operative time, reduced intraoperative blood loss, and a decreased duration of urinary bladder drainage via urethral catheter. Earlier recovery of spontaneous urination was associated with a shorter postoperative hospital stay. On average, patients in group 1 had a 1.4-fold shorter hospitalization compared to those in group 2. CONCLUSION: A new technique for extraperitoneal laparoscopic radical prostatectomy with preservation of the pelvic supportive ligamentous structures has been developed, implemented, and clinically tested in patients with localized prostate cancer. Further research is warranted to assess long-term surgical outcomes.
Hypersensory Bladder Disease: Concept and Pathogenetic Basis
This review article is devoted to current concepts of hypersensory bladder. It provides a detailed description of the epidemiological, clinical, and pathophysiological features of overactive bladder and bladder pain syndrome / interstitial cystitis, emphasizing the similarity of their clinical manifestations. The molecular mechanisms of the mechanosensory function of the urothelium under normal conditions and in the presence of hypersensory disorders are thoroughly described. The data presented allow these conditions to be regarded as manifestations of a common pathological process based on increased bladder sensitivity. It is noted that the mechanism of hypersensitivity in overactive bladder and bladder pain syndrome / interstitial cystitis is similar and involves the pathological amplification of afferent signal transmission from the bladder to the central nervous system. This process may be associated with multiple factors, but inflammation is regarded as the main cause of increased afferent activity in the bladder. The role of central sensitization in the development of hypersensory bladder disorders is also highlighted. Given the commonality in symptoms, clinical course, and pathogenesis, the concept of “hypersensory bladder disease” is proposed, uniting the hypersensory phenotypes of overactive bladder and bladder pain syndrome / interstitial cystitis. It is stated that this concept is justified from a pathogenetic standpoint, although many aspects require further investigation and discussion.
Treatment of Urethral Strictures in Women
The limited coverage of female infravesical obstruction has led to the absence of a clear algorithm for the diagnosis and treatment of urethral strictures in women. Currently, various treatment methods are used—from urethral dilation to urethroplasty—with their effectiveness and indications remaining the subject of ongoing discussion. The article discusses the issues of etiology, diagnosis, and treatment of urethral strictures in women and examines the effectiveness of various invasive methods for managing narrowing of the female urethra. The required information was searched in PubMed, Web of Science, CyberLeninka, eLibrary, and Scopus databases for the period 1999–2022 using the following keywords: стеноз меатуса (meatal stenosis), стриктура уретры у женщин (female urethral stricture), стриктурная болезнь уретры (urethral stricture disease), вентральная уретропластика слизистой половой губы и влагалища (ventral urethroplasty using labial and vaginal mucosa), дорсальная буккальная уретропластика (dorsal buccal urethroplasty), пластика уретры лоскутом стенки влагалища (urethral reconstruction using vaginal wall flap), бужирование (urethral dilation), обструктивное мочеиспускание у женщин (female obstructive voiding), and инфравезикальная обструкция у женщин (female infravesical obstruction). It was noted that urethral dilation and internal optical urethrotomy are often used as initial treatments and demonstrate satisfactory results, though they are associated with a relatively high recurrence rate. In patients with partial urethral obliteration and recurrent stricture after previous interventions, subsequent surgical options may include urethral reconstruction using flaps of the anterior or lateral vaginal wall, vestibular flaps, or free grafts (in dorsal or ventral position). The choice of surgical technique may be influenced by several factors—location and length of the stricture, presence of trophic changes in the mucosa, mechanism of development, as well as the surgeon’s experience and preferences. Urethrotomy and dilation may be used as initial treatment methods in some cases; however, in the presence of recurrence, marked fibrotic changes, and significant stenosis, urethroplasty is considered more appropriate. Flap-based urethroplasty techniques have demonstrated effectiveness and safety and may therefore represent a preferred treatment method for female urethral strictures.
Prostatic Hyperplasia and Urethral Stricture as Comorbid Factors of Infravesical Obstruction
Prostatic hyperplasia and urethral strictures are the most common causes of infravesical obstruction. These disorders are typically studied in isolation, without consideration of their potential coexistence in a single patient, which leads to insufficient awareness of the combined condition of the urethra, prostate, and bladder. This review analyzes the scientific data published between 2020 and 2024 that addresses infravesical obstruction caused by the combination of prostatic hyperplasia and urethral stricture. Scientific sources were searched in both Russian (eLibrary) and international (PubMed, Embase, Cochrane Library, Web of Science, Scopus) databases. The following keywords were used: стриктура уретры (urethral stricture), доброкачественная гиперплазия предстательной железы (benign prostatic hyperplasia), инфравезикальная обструкция (infravesical obstruction), симптомы нижних мочевых путей (lower urinary tract symptoms), хроническая задержка мочи (chronic urinary retention), хирургическое лечение (surgical treatment), and послеоперационные осложнения (postoperative complications). Only a limited number of publications were found that discuss clinical scenarios where infravesical obstruction is simultaneously caused by both prostatic hyperplasia and urethral stricture. Treatment strategies for such patients should be based on a functional and anatomical assessment of the lower urinary tract, which may vary significantly in each case. An individualized approach is required when managing patients with this comorbidity. The lack of large-scale studies limits the ability to obtain meaningful data necessary for developing treatment guidelines for the concurrent management of both conditions.
Current State of Integration of ERAS Principles into Radical Prostatectomy Practice for Prostate Cancer
The Enhanced Recovery After Surgery (ERAS) concept is a comprehensive multidisciplinary approach based on scientific principles, aimed at optimizing patient management during the perioperative period. Despite the proven efficacy of ERAS across various oncological surgeries, the impact of this approach on perioperative outcomes in the treatment of prostate cancer remains underexplored. This review analyzes current scientific data on the application of ERAS principles in the preoperative, intraoperative, and postoperative stages of prostate cancer treatment. A literature search was conducted in the electronic databases PubMed and Google Scholar using the following keywords in Russian and English: концепция ускоренного восстановления после операции / enhanced recovery after surgery, радикальная простатэктомия / radical prostatectomy, роботическая радикальная простатэктомия / robotic radical prostatectomy, рак предстательной железы / prostate cancer, and eras. The search was performed in accordance with PRISMA guidelines. A total of 100 studies were included in the review. ERAS encompasses the entire perioperative period, from patient preparation to postoperative recovery. This enables effective implementation of radical prostatectomy and ensures high-quality rehabilitation. Currently, the combination of ERAS with robotic radical prostatectomy demonstrates advantages related to minimal invasiveness and high procedural reliability, which contribute to shorter operative times, reduced postoperative complications, accelerated patient’s recovery, and improved healthcare staff satisfaction. To fully assess the benefits of ERAS, it is essential to systematize existing concepts and recommendations in the field of surgical treatment of prostate cancer and to conduct high-quality multicenter studies aimed at exploring rehabilitation, complication prevention, and patient-reported outcomes. This will help expand the potential of ERAS and enhance its impact on treatment outcomes.
Surgical Treatment of Platinum-Resistant Recurrent Urothelial Carcinoma: A Case Report and Review
Patients with upper urinary tract urothelial carcinoma often develop aggressive recurrences even after radical surgery, with reported recurrence rates ranging from 6.2% to 33%. This article presents a review on the topic and a clinical case of surgical treatment of platinum-resistant recurrent urothelial carcinoma. A 52-year-old male patient underwent right laparoscopic nephroureterectomy with resection of the right ureteral orifice due to a 1.5 cm tumor of the lower third of the right ureter complicated by hydronephrosis. Histological examination revealed a non-invasive papillary urothelial carcinoma of the ureteral mucosa, G2, pTa, with negative resection margins. No malignant cells were detected in the removed lymph nodes. Seven months later, the patient was diagnosed with a large recurrent tumor in the right posterolateral pelvis with signs of invasion into the bladder wall and sigmoid colon, which was resistant to platinum-based chemotherapy and lacked PD-L expression. Repeat surgery was performed, including radical cystoprostatevesiculectomy with Bricker ileal conduit, obstructive anterior resection of the rectum, and sigmoidostomy. Histological analysis revealed recurrent urothelial carcinoma of the right ureter with invasion into the prostate, bladder, and large intestine. Tumor regression was minimal. Resection margins of the intestine and ureter were free of tumor. Given the extent of the recurrent tumor and lack of response to standard chemotherapy, the patient was prescribed immunotherapy with pembrolizumab, which resulted in no further disease progression. A rare clinical case of treatment of advanced platinum-resistant recurrent urothelial carcinoma with long-term remission following surgical intervention is presented. This case describes the aggressive course of non-invasive urothelial carcinoma despite high-grade tumor differentiation.