ORIGINAL ARTICLES
Introduction. Despite the improvement of endoscopic equipment and methods of percutaneous and transurethral interventions on urolithiasis, acute pyelonephritis remains one of the most frequent postoperative complications.
Purpose of the study. Objective assessment of frequency, causes and severity of postoperative pyelonephritis in endoscopic surgery for urolithiasis, as well as additional interventions needed to manage this complication.
Materials and methods. The results of 1027 endoscopic operations (percutaneous and transurethral) performed in Republican Specialized Center of Urology (RSCU, Tashkent, Uzbekistan) for kidney and upper urinary tract stones were analyzed. «Simple» stones were in 446 (43.4%) patients, «complex» – in 581 (56.6%) ones. The severity of postoperative pyelonephritis were assessed using Clavien-Dindo grading system according to the necessity of additional interventions.
Results. Postoperative pyelonephritis developed in 115 (11.2%) patients. According to the systematization of postoperative complications patients with pyelonephritis were distributed as follows: I-0, II-95, IIIa-8, IIIb10, IVa-2, IVb-0, V-0.
Conclusions. Patients with initial urinary tract infection (UTI) and complications arising during endoscopic interventions and in postoperative period should be considered as «patients with absolute risk of postoperative infectious and inflammatory complications development». Complicated pyelonephritis was eradicated conservatively in 82.6% of patients, additional invasive interventions and intensive therapy were required in 17.4% of patients.
Introduction. Oncological diseases is a serious medico-social problem of modern society. The article presents the analysis of prostate cancer morbidity with consideration of regional health level differences.
Objective. To conduct spatial-temporal analysis of prostate cancer incidence in Rostov region; to identify areas with a statistically significant increase in the incidence of prostate cancer; to identify regional differences (environmental determinism) in the development of cancer in the southern Federal district.
Materials and methods. We’ve analysed incidence of prostate cancer in the Rostov region for the period of 2001-2016. The analysis has been performed using tools spatio-temporal statistics on software ArcGis 10 *.
Results. Areas and cities of Rostov region with a statistically significant increase in prostate cancer incidence were identified. It has been shown that in the regions and cities of the Rostov region with a low level of medical-ecological safety had a statistically significant increase in prostate cancer incidence
Conclusions. The results can serve as a basis for the directional analysis of factors causing increased risk of cancer and development on this basis strategies for monitoring and prevention of cancer diseases in the Rostov region.
Background. Nowadays dissolution of uric acid kidney stones is the first line treatment according to existing clinical guidelines. Besides dual-energy CT, which is costly, there is no non-invasive tool to predict uric acid stone composition.
Aim. To develop a new tool for uric acid stones prediction which will improve patient selection for oral stone dissolution therapy.
Materials and methods. We retrospectively analyzed treatment results of 189 patients which were distributed to two groups: with pure uric acid stones - 59 patients and with other composition - 130 patients. Demographic data, results of 24 hour urine analysis and CT scans were analyzed.
Results. Among above mentioned parameters the following had the highest significance: body mass, body mass index, urine pH and stone density in Hounsfield Units (p<0.01). Product of multiplication of urine pH and CT-stone density called «Urate index» yielded highest AUC (0.96) which permitted with high accuracy diagnose uric acid stones.
Conclusion. «Urate-index» is simple to obtain and has high predictive value which might help choosing target population for kidney stone dissolution.
Introduction. The Duplex kidney is one of the most common anomalies of urinary system. Approaches to the surgical management of these conditions significantly differ. Taking into account the preferences of surgeons, heminephroureterectomy is offered to perform openly or laparoscopically, uretero-cysto-anastomosis of ectopic ureter or two ureters en bloc. Some publications about the possibility of ureteroureteral anastomosis have lately begun to appear. We present the experience of ureteroureteral anastomosis performed openly and laparoscopically in 9 clinics of Russia and Belarus.
Objective. Improvement of treatment results of ureterohydronephrosis in children with complete ureteral duplication.
Material and methods. We retrospectively reviewed medical records of 38 children who underwent ureteroureteral anastomosis surgery from 2007 to 2016. There were 10 boys (26.3%) and 28 girls (73.7%). The mean age of patients was 40.2 months. Right duplex kidney was confirmed in 15 (39.5%) children, the left one was diagnosed in 23 (60.5%) children. All the patients were divided into two groups according to the surgical technique used. Fourteen children 14 (36.8%) were included in the first group, in whom the ureteroureteral anastomosis has been performed openly, the second group comprised 24 (63.2%) patients with laparoscopically made anastomosis.
Results. There weren’t any cases of conversion in this cohort. One patient in each group suffered from acute pyelonephritis. In the early postoperative period, urine leakage along the drainage occurred in 3 (12.5%) patients after laparoscopically performed ureteroureteral anastomosis, one (4.2%) child had residual ureteral stump. Thus, five (13.2%) children had complications, one (2.6%) patient required redo surgery.
Conclusion. There are few clinics where ureteroureteral anastomosis is performed via open or laparoscopic approach. This operation is at the stage of development and accumulation of experience. It is a safe technique which allows to minimize the risk of loss of duplex kidney function.
Introduction. Prostate cancer is one of the common oncological diseases in men. Standard prostate biopsy with subsequent histological verification is now an integral part of the diagnosis of prostate cancer; however, the number of false-negative results and cases of underestimation of the degree of tumor aggressiveness remain excessively high. Advances in multiparametric magnetic resonance imaging have lead to improved detection of prostate tumors.
Objective. Disclosure of the main advantages of prostate biopsy under the magnetic resonance imaging control, consideration of technical aspects of its implementation.
Materials and methods. The fusion of magnetic resonance imaging data with transrectal ultrasound enables the targeted biopsy of suspicious areas. 136 consecutively selected patients were examined, mean age of 62 years, mean prostate volume was 53 cm3, the average prostate-specific antigen 11.3 ng/ml. All the patients underwent at least 1 transrectal prostate biopsy. We assigned patients into 3 groups: group 1 (n=43) underwent repeated standard transrectal biopsy of the prostate; in group 2 (n=39) patients had transperineal biopsy of the prostate; in group 3 there were patients (n=39) in whom a targeted fusion biopsy with magnetic resonance imaging and transrectal ultrasound - navigation has been performed. An average number of biopsy cores in each group was 12, 26.6 and 25.3, respectively.
Results. Prostate cancer was diagnosed in 30.2%, 53.7 % and 56.4 % respectively. Better prostate cancer detectability during fusion biopsy generally occurred due to the localized forms of the disease (93.3 %).
Conclusion. Fusion biopsy using magnetic resonance imaging and transrectal ultrasound and perineal biopsy allows precise determination of prostate cancer pathological stage, Gleason grade of a tumor and its exact localization. Most tumors detectable by saturation perineal biopsy and fusion biopsy using magnetic resonance imaging and transrectal ultrasound were clinically significant, which makes it possible to recommend these methods of biopsy to patients with a high level of suspicion for prostate cancer.
Rationale. Implementation of vesicoscopic (transvesical, pneumovesicoscopic) approach (VA) in the treatment of abnormalities and diseases of vesico-ureteral junction and a urinary bladder as alternative to the open surgery makes it relevant to study efficacy of such approach in the treatment of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO).
Aim. To study efficacy of vesicoscopic reimplantation in vesicoureteral reflux and ureterovesical junction obstruction.
Materials and methods. From April, 2013 to July 2017 we carried out vesicoscopic surgery in 134 patients with VUR (177 ureters) and 24 patients with UVJO (25 ureters), 158 children at the age of 2 months-18 years in total. To determine indications to the surgery USI, excretory urography, retrograde voiding cystourethrography were used.
Results. Average duration of the surgery with use of VA in all patients was 128.6±50.0 min, in patients with VUR - 121.6±44.1 min, that slightly less than in children with UVJO – 168.9±62.4 min. Duration of postoperative period was 6.3±2.4 days, in the VUR group – 5.9±2.1 days, in the UVJO group – 8.1±3.1days. In patients with VUR reflux was repaired in 131 patients (97.7 %), in the UVJO group obstruction was eliminated in 23 patients (95.8%). Postoperative complications developed in 25 cases (15.8%) and assessed according to Clavien-Dindo classification. Relapses developed in 3 patients from the VUR group and in 1 patient from the UVJO group. We had to use conversion in 3 (1.8%) cases: once in the UVJO group (4.1%) and twice - in the VUR group (1.5%).
Conclusions. In the VUR group the percent of complications was significantly lower than in the UVJO group, that may be due to older age of the patients with reflux and as a result due to large bladder volume and space for surgeon manipulation. Total efficacy of the procedure is comparable to the results of the open surgery in both groups. But the percent of complications remains enough high, especially in the group with obstruction in the area of UVJ, that may be due to younger age of the patients in such category and, as a result, due to lesser bladder volume.
Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.
Aim. To evaluate the results of complicated stress urinary incontinence (SUI) surgical treatment using a transobturator adjustable sling Urosling (Lintex).
Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS).
Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89) patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89) patients. In 3.4% (3/89) women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89) patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO). Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84) of the patients were «very» or «very» satisfied.
Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the risk of postoperative BOO development.
