IMPACT OF THE SARS-COV-2 VIRUS ON THE URINARY BLADDER

Introduction. There are publications about the impact of a new coronavirus infection (COVID) on the lower urinary tract, including the development of overactive bladder (OAB) or COVID-associated cystitis. The cause of dysuria in patients with COVID is not fully understood. Material and methods. A total of 14 consecutive patients after COVID with complaints of frequent urination with urgency were included in the study. The main inclusion criterion was the development or worsening of OAB symptoms after resolution of COVID, confirmed by the eradication of SARS-CoV-2 by a polymerase chain reaction. The severity of OAB was assessed using the International Scale of Symptoms (Overactive Bladder Symptom Score, OABSS). Results. Three (21.4%) out of fourteen patients had OAB symptoms prior to COVID, while in 11 (78.6%) patients OAB symptoms developed in post-COVID period. In 4 patients (28.6% of the entire cohort and 36.4% of patients in de novo group) urge urinary incontinence and urgency developed. The average score on the OABSS scale in patients with baseline OAB was 6.7±0.8, which corresponded to the moderate severity. In this group, one patient developed urge urinary incontinence and urgency, which were not present prior to COVID. In a retrospective evaluation of symptoms before the COVID, their average score on the OABSS scale was 5.2 ± 0.7, i.e., past COVID led to an increase in OAB symptoms by 1.5 points. In patients with OAB de novo, the symptoms were less pronounced, with a score of 5.1±0.6 points, that is between mild and moderate OAB. At the same time, urinalysis in 9 patients did not have signs of inflammation: in 5 cases, 5–7 white blood cells per field of view was seen only once. A follow-up urine test was normal, suggesting contamination. None of the cases revealed bacteriuria over 102 CFU/ml. All patients were prescribed trospium chloride at a dose of 30 mg per day. The choice of the drug was due to the absence of a negative effect on the central nervous system, which is very important both during COVID and in post-COVID period, since the neurotoxicity of SARS-CoV-2 has been proven. Conclusion. A past history of COVID led to an increase in OAB symptoms by 1.5 points in patients who had OAB prior to infection. In 11 patients, after the treatment of COVID, the moderate symptoms of OAB developed de novo. Our small study showed the importance of focusing the attention of internists and infectious disease doctors on urination disorders in patients with COVID and timely referral to a urologist. For the treatment of post-COVID OAB, trospium chloride is the drug of choice, as it does not aggravate the potential neurotoxicity of SARS-CoV-2. © 2023, Bionika Media Ltd.. All rights reserved.

[Dynamics of the structure of renal tuberculosis over 20 years].

BACKGROUND: Tuberculosis is a serious medical and social problem that does not lose its importance, despite all the advances in pharmacology and surgery. Diagnosis of urogenital tuberculosis (UGTB), as a rule, is delayed due to low index of suspicion to tuberculosis and the absence of pathognomonic symptoms. AIM: Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999-2004 (1155 patients), second period 2005-2014 (2657 patients), and the third period 2015-2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated. RESULTS: Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients - 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole. CONCLUSION: Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.

Tuberculosis of the testis and its appendages

Tuberculosis of the genitourinary system has not lost its relevance. During the years of the pandemic of a new coronavirus infection, the number of newly diagnosed cases of tuberculosis of all localizations has decreased, but their structure has become more severe and mortality has increased. There is a wide variation in the statistics of urogenital tuberculosis (UGT) in the literature. The true incidence of scrotal tuberculosis is not known;at the end of the last century, it was believed that it was 7% of all cases of tuberculosis. It is believed that the share of isolated tuberculosis of the genital organs of men accounts for no more than 30% of all localizations of UGT, and most often tuberculosis develops in the epididymis. The spread of M. tuberculosis to the organs of the scrotum, as a rule, occurs by the hematogenous route from the primary focus in the lungs or kidney. However, the infection can also spread retrogradely from the prostate and seminal vesicles to the epididymis and testicles. Tuberculosis of the testis and its epididymis is often complicated by infertility and the formation of fistulas. This disease has no pathognomonic symptoms. Differential diagnosis is carried out between tuberculous epididymo-orchitis, testicular tumor, testicular torsion, bacterial epididymo-orchitis. Ultrasound examination is of great diagnostic value in tuberculosis of the scrotal organs. The ultrasound picture in tuberculosis of the testis and its epididymis is divided into 4 types: diffuse enlargement, heterogeneous hypoechogenicity;diffuse increase, uniform hypoechogenicity;nodular enlargement, heterogeneous hypoechogenicity;miliary dissemination. The world literature does not describe an example of tuberculosis of the scrotal organs, when the disease would be diagnosed during the patient’s initial visit to the doctor. As a result of late diagnosis or low suspicion for TB, up to 70% of patients undergo unnecessary surgery, although TB orchiepididymitis can be treated medically. The lecture also analyzed a number of clinical observations. © 2022, Remedium Group Ltd. All rights reserved.

[Practice of urological departments during the COVID-19 pandemic]

INTRODUCTION: The pandemic of novel coronavirus infection has had a strong impact on the whole medical system, including urological departments. MATERIAL AND METHODS: We assessed the impact of restrictions due to the pandemic on the work of urological departments of private (Medical Center "Avicenna", Novosibirsk) and community (KGBUZ "City Clinical Hospital No. 11, Barnaul") hospitals;GBUZ of the Novosibirsk region "City Clinical Emergency Hospital" (GBUZ CCEH) No. 2, Novosibirsk) clinics, as well as the urogenital department of the TB Research Institute of Ministry of Health of Russia during the period from 2019 to 2020. The changes in the spectrum of surgical procedures, as well as the structure of patients' visits to a urologist were evaluated. RESULTS: In March 2020, the urogenital department of the TB Research Institute of Ministry of Health of Russia was redesigned into an observational one. Community departments worked with small restrictions or without any limitations. In KGBUZ "City Clinical Hospital No. 11, Barnaul", an increase in the number patients with bladder cancer, ureteral stones, concomitant kidney and ureteral stones by 3-27% was noted (p<0.05), as well as those with acute epididymo-orchitis, including testicular abscess. At the same time, a significant decrease in the number of patients with varicocele, pyelonephritis, chronic cystitis, chronic prostatitis, and phimosis was found. A surgical department of GBUZ CCEH from October to December 2020 was restructured to an infectious hospital;this led to a decrease in the volume of urological care and the number of procedures. The Avicenna Medical Center also established anti-epidemic measures, which made it possible not only not to reduce, but in a number of procedures to increase the volume of surgical care. CONCLUSION: Owing to anti-epidemic measures, including the patient flow distribution, an introduction of mandatory testing, an early detection of patients and carriers among employees, mask regime, the opening of an observational department, single rooms, the lack of contact between patients, short length of stay, it was possible to prevent an outbreak of coronavirus infection among patients and personnel. Both in the municipal and private urological clinics, well-organized work precluded the negative impact of the pandemic.