A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?

PURPOSE: To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. METHODS: Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. RESULTS: 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91 cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). CONCLUSIONS: VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.

[Robot-assisted prostatectomy for PT3. Oncological and functional outcomes].

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

[Use of tamsulosin for a prevention of acute urinary retention in the perioperative period in patients undergoing to surgical procedures].

The perioperative management of patients involves multiple aspects. Acute urinary retention (AUR) is one of the possible postoperative complications. Alpha-adrenoblockers are commonly used for treatment and prevention of AUR. Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups. The aim of our study was to evaluate the efficiency of perioperative use of tamsulosin for the prevention of postoperative AUR. A literature review from January 2013 to June 2023 in Scopus and PubMed databases was carried out. According to the results, tamsulosin results in a significant reduction in the risk of postoperative AUR. A personalized approach allows to overcome difficulties in the perioperative management of patients and significantly improve their quality of life/satisfaction from treatment.

[HIFU therapy of localized prostate cancer using image-guided robotic HIFU Focal One].

INTRODUCTION: Prostate cancer (PCa) is the second most commonly diagnosed malignant tumor in men after lung cancer and is the fifth leading cause of death worldwide. In November 2019, the spectrum of alternative treatment for PCa was added by a novel minimally invasive method, namely high-intensity focused ultrasound (HIFU) using the latest Focal One machine (with the possibility of combining intraoperative ultrasound and preoperative MRI data). MATERIALS AND METHODS: During the period from November 2019 to November 2021, HIFU using Focal One device (manufactured by EDAP, France) was performed in 75 patients with PCa. Total ablation was done in 45 cases, while 30 patients undergone to focal prostate ablation. The average age of the patients was 62.7 (51-80) years, the total PSA level was 9.3 (3.2-15.5) ng/ml and the prostate volume was 32.0 (11-35) cc. The maximum urinary rate was 13.3 (6.3-36) ml/s, IPSS score was 7 (3-25) points, IIEF-5 score was 18 (4-25). Clinical stage c1N0M0 was diagnosed in 60 patients, 1bN0M0 in 4 patients, 2N0M0 in 11 patients. In 21 cases, transurethral resection of the prostate was performed within 4-6 weeks prior to total ablation. Before surgery, all patients underwent magnetic resonance imaging (MRI) of the pelvis with intravenous contrast and PIRADS V2 assessment. MRI data were used intraoperatively for precision planning of the procedure. RESULTS: In all patients, the procedure was performed under endotracheal anesthesia in accordance with the technical recommendations of the manufacturer. Prior to surgery, a silicone urethral catheter of 16 or 18 Ch was placed. The average duration of the intervention was 101 (56-147) minutes. The postoperative period was uneventful in all cases.Patients received antibiotic therapy via parenteral route for 4 days, followed by oral administration for another 10 days, as well as alpha-blockers (at least 1 month after procedure). After removal of urethral catheter on the 4th day, all patients started to void. In 9 cases there was acute urinary retention in the evening and in 4 patients in the next morning, requiring temporary bladder catheterization. A year after the procedure, 53 patients were fully examined: the average total PSA level in patients who underwent total ablation (n=53) was 0.96+/-0.11 ng/ml, the IPSS score was 6.9+/-0,6 points (no difference compared to baseline). Follow-up biopsy revealed PCa in 6 patients; in other cases, prostate fibrosis was determined. CONCLUSIONS: HIFU in patients with localized PCa using image-guided robotic HIFU (Focal One) is promising and feasible. This method has shown good oncological results with a short follow-up period. It is advisable to carry out further prospective analysis.

[Biofilm control in urological practice].

Urinary tract infections (UTIs) have long been among the most common diseases. In the structure of the general infectious morbidity, UTIs rank second after acute respiratory viral infection. Every year, researchers note an increasing number of mutations in the genomes of bacteria that cause infectious diseases, which leads to the formation of more and more aggressive forms of pathogens. Patients with infectious diseases of the urinary system have the highest risk of biofilm formation, the frequency of which is directly proportional to the length of time the urethral catheter is located and accounts for more than half of all nosocomial infections. The presence of resistant strains of pathogenic bacteria and the development of bacterial biofilms are major problems in the treatment of urinary tract infections. The increasing number of nosocomial bacterial strains in the hospital increases the postoperative bed-day, the frequency of readmission and the number of antibacterial drugs used. In light of increasing antibacterial resistance, the use of medical resources is dramatically increasing, which ultimately leads to an increase in the cost of treatment. Along with this, the selection of resistant strains brings to the fore both the rational use of antibacterial drugs and the search for alternative methods of therapy. This review of publications on the problem of bacterial biofilm formation in urological practice demonstrates updated information on the role of enzymes, probiotics, and bacteriophages in preventing biofilm formation on various medical biomaterials, such as urethral catheters.

[Alpha1-adrenergic blockers therapy and sexual function].

An increase in life expectancy and the number of older and elderly men, an improvement in the quality of medical care and socio-economic factors in most countries contributed to an increase in the number of patients with benign prostatic hyperplasia (BPH). Currently, improvement of the quality of life is the mainstay of strategy for managing patients with BPH, as well as prevention of complications and the need for surgery. In this regard, the pharmacotherapy with 1-adrenergic blockers (1-AB) is widely used as an effective method for improving lower urinary tract symptoms and reducing the risk of BPH progression. Given that the quality of life is becoming increasingly important in evaluating the efficiency of BPH treatment, including therapy in elderly patients, it is necessary to take into account its effect on sexual function, when choosing a particular drug. The use of 1-AB can be accompanied by side effects manifested by various sexual disorders. Alfuzosin does not adversely affect sexual function in men with BPH, may improve erectile and ejaculatory function and should be considered as the drug of choice, especially in sexually active men and patients who already suffer from worsening ejaculatory function while using another 1-AB.

[Evaluation of the clinical efficacy of urethroplasty after failed hypospadias repair].

BACKGROUND: Evaluation of surgical treatment of hypospadias is one of the most controversial problem in urology, considering a lack of continuity in the management of these patients between pediatric andrologists and general urologists. Patients who undergone to multiple hypospadias repairs remain one of the most difficult categories for reconstructive urethral surgery and urology in general. MATERIALS AND METHODS: The treatment results of 112 adult patients who had complications of previously performed hypospadias repairs were evaluated. The results of repeated procedures were compared in patients, in whom modified balloon urethral catheter (group 1; n=50) or standard Foley catheter (group 2; n=62) was used, respectively. RESULTS: Most patients after surgery assessed the appearance of the penis as "good" (92% in group 1, 77.4% in group 2). In group 1, satisfactory results was seen in 8% of cases and there were no unsatisfactory results, while in group 2, where standard Foley catheter was used, these values were 19.4% and 3.2%, respectively. In group 1, complication rate was lower than in group 2 (10% versus 41.9%; p<0.05). In group 1, there was a significantly higher proportion of patients with a Qmax score of more or equal 18 ml/s (90% versus 74.2%; p<0.05). CONCLUSIONS: Repeated procedures in adult men with late complications of surgical treatment of hypospadias are quite effective, although they are accompanied by a rather high complications rate. The use of a new model of the urethral catheter with dilating cuff and an irrigation canal allows to improve treatment results in this category of patients.

[Moscow program of early detection and treatment of prostate cancer].

The aim of this study is to improve the results of detection and treatment of patients with prostate cancer (PCa) in the Moscow. For this purpose, we performed our own clinical diagnostic, epidemiological, autopsy, experimental and comparative studies that emphasize the relevance of the stated subject in the study of the diagnosis and treatment of patients with PCa. Urology Department of A. I. Evdokimov Moscow State University of Medicine and Dentistry was at the forefront of the Men's Health program in Moscow and in early 2003 it was the first to have an office for early diagnosis of prostate diseases, as part of the Program. Over 20,000 patients were screened for PCa. For the first time in Russia, methods for the early detection of PCa were investigated on a cohort of Russian men using PCA3 and the Prostate Health Index. The role and significance of prostate saturation biopsy was examined. The investigation of aspects of the morphological assessment of prostate diseases formed the basis for the development of an electronic atlas of PCa images. A series of studies on various prostate visualization methods, including Histoscanning system and MRI, have been performed. A new minimally invasive method for the treatment of prostate cancer has been introduced - a robot-assisted radical prostatectomy and cryoablation. The concept of surgical treatment of localized forms of PCa has been developed and the factors predicting the success of treatment have been determined. This study is reflected in numerous publications both in Russia and abroad, in monographs and dissertations.

[Fusion biopsy of the prostate].

AIM: to compare the prostate cancer (PCa) detection rate, accuracy and safety of prostate image-guided fusion biopsy methods (cognitive fusion, software-fusion and HistoScanning-guided biopsy) on the basis of published studies in patients from 48 to 75 years with suspected prostate cancer during primary or repeat biopsy. To identify the limitations of these methods and improve the efficiency of fusion biopsy of the prostate in a further clinical trial. MATERIALS AND METHODS: search was carried out in the PubMed, Medline, Web of Science and eLibrary databases using following requests: (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy); (prostate cancer OR prostate adenocarcinoma) AND (PHS OR Histoscanning) AND (targeted biopsy) and (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy) AND (cognitive registration), targeted prostate biopsy, prostate histoscanning, histoscanning, cognitive prostate biopsy. RESULTS: a total of 672 publications were found, of which 25 original scientific papers were included in the analysis (n=4634). According to the results, PCa detection rate in patients with an average age of 62.5 years. (48-75) and an average PSA of 6.3 ng/ml (4.1-10.8), who underwent cognitive fusion biopsy under MRI control (MR-fusion) was 32.5%, compared to 30% and 35% for histoscanning in combination with a systematic biopsy and combination of methods (MR-fusion biopsy and histoscanning-guided biopsy), respectively. The accuracy of cognitive MR-fusion biopsy was 49.8% (20.8%-82%), the accuracy of the software MR-fusion biopsy was 52.5% (26.5%-69.7%), the accuracy of histoscanning-guided targeted biopsy was 46.8% (26%-75.8%). The highest values were observed in the patients undergoing primary biopsy (75.8%). DISCUSSION: Currently, imaging methods allow us to change the approach to the diagnosis of PCa by improving the efficiency of prostate biopsy, the only formal method for verifying PCa. A common method for PCa diagnosis in 2018 is a systematic prostate biopsy. However, due to the its drawbacks, fusion biopsy under control of MRI or ultrasound has being introduced into clinical practice with superior results. So far, there is a lack of sufficient scientific data to select a specific technique of the fusion biopsy of the prostate. According to the analysis, it was concluded that the incidence of complications didnt increase when performing targeted biopsy in addition to the systematic protocol. CONCLUSION: The efficiency of cognitive MR-fusion biopsy is comparable to software MR-fusion biopsy. Histoscanning-guided biopsy has lower diagnostic value than MR-guided target biopsy using software. The lack of solid conclusions in favor of a particular prostate fusion biopsy technique stresses on the relevance of further research on this topic.

Data on somatic mutations obtained by whole exome sequencing of FFPE tissue samples from Russian patients with prostate cancer.

Prostate cancer (PCa) is the most frequently diagnosed among men malignant disease that remains poorly characterized at the molecular level. Advanced PCa is not curable, and the current treatment methods can only increase the life expectancy by several months. Identification of the genetic aberrations in tumor cells provides clues to understanding the mechanisms of PCa pathogenesis and the basis for developing new therapeutic approaches. Here we present data on somatic mutations, namely single nucleotide variations (SNVs), small insertions and deletions, detected in prostate tumor tissue obtained from Russian patients with PCa. Moreover, we provide a raw dataset on the whole exome and targeted DNA sequencing of tumor and non-tumor prostate tissue obtained from Russian patients with PCa and benign prostatic hyperplasia (BPH). This data is available at NCBI Sequence Read Archive under Accession No. PRJNA506922.

[One-stage cryoablation of two renal tumors]. / Odnomomentnaia krioablatsiia dvukh opukholei u patsienta s pochechno-kletochnym rakom.

The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.

[Evaluation bacteriological analysis of urine in patients with long-term bladder drainage].

INTRODUCTION: The experience of comparative evaluation of the effectiveness of various types of urethral catheters in prevention of catheter-associated infection is described in this article. MATERIALS AND METHODS: The study included 69 patients treated at the CCH n.a. S.I. Spasokukotsky in the period from December 2017 to March 2018. The average age of patients was 67.5 years. In all patients, the bladder was drained by a two-way Foley catheter No. 16-18 Ch (100% silicone). In the 1st group (n=18), the bladder was drained with a standard urethral uncoated catheter, in the 2nd (n=16) - with a silver impregnated urethral catheter, in the 3rd (n=15) - with an urethral catheter coated with nitrofuran, in the 4th (n=20) urethral catheter with the possibility of controlled irrigation of the bladder and urethra with antiseptic solutions and (a new model of the urethral catheter developed during cooperative work of the Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov Urology Department and National Medical Research Center of Obstetrics, Gynecology and Perinatology n.a. V.I. Kulakov). RESULTS: The bladder was drained by Foley urethral catheter for more or equal 15 days. A microbiological study of urine (on the example of clinical isolates of conditionally pathogenic microorganisms) with preparation of an inoculum, inoculation of nutrient media, counting cultures of pathogenic bacteria and determining the sensitivity of pathogenic bacteria to antibiotics was carried out. The study showed the effectiveness of the new urethral catheter model in patients with long-term bladder drainage. CONCLUSIONS: Conducting multicenter studies evaluating the effectiveness of the proposed urethral catheter model with the inclusion of a larger number of patients will reduce the economic costs, associated with treating patients with prolonged bladder drainage in the long term by reducing the number of nosocomial infection cases and reducing postoperative day.

[Efficacy of tamsulosin for treating lower urinary tract symptoms in patients with advanced prostate cancer].

RELEVANCE: From the moment of their first use to the present day, -adrenoblockers remain the most popular medication in urology. Indications for their clinical use for various pathological conditions are constantly expanding. AIM: To compare the efficacy of androgen deprivation therapy (ADT) alone and ADT with concomitant use of tamsulosin in treating lower urinary tract symptoms (LUTS), and to estimate the efficacy and safety of tamsulosin in relieving voiding dysfunction symptoms in patients with advanced PCa treated for 6 months. MATERIALS AND METHODS: This paper presents data from a randomized, open, single-center trial that evaluated the efficacy and safety of tamsulosin co-administered with ADT for LUTS in patients with advanced prostate cancer. The study comprised 50 people aged below 75 years. In the first group of patients (n=25), ADT was used as a monotherapy, in the second group (n=25) ADT with concurrent administration of the -adrenoblocker. The duration of treatment was 6 months. RESULTS: Both groups showed an improvement in the severity of LUTS, decrease in the total I-PSS score and residual urine volume and increase in the urinary flow rate. At the same time, co-administration of ADT and -adrenoblocker resulted in greater and faster relief of LUTS than using ADT alone. There were no significant side effects in any of the groups. CONCLUSIONS: Co-administration of ADT and the -blocker is an effective and safe treatment for advanced prostate cancer in patients with LUTS.

[Conservative management of benign prostatic hyperplasia: are urologists satisfied?]

The author presents his point of view on the conservative management of benign prostatic hyperplasia and the role of combination therapy (co-administration of -blockers and 5-reductase inhibitors) in the treatment of voiding symptoms. The latest evidence for combination therapy of prostatic hyperplasia published in 2017 is also presented.

[Results of urethral reconstruction in adults after multiple hypospadias repairs].

AIM: To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. MATERIALS AND METHODS: Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. RESULTS: The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively. CONCLUSION: The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

Datasets for next-generation sequencing of DNA and RNA from urine and plasma of patients with prostate cancer.

Current prostate cancer (PCa) diagnostic tests suffer from insufficient sensitivity and specificity. Novel biomarkers that can be detected by minimally invasive methods are of a particular value. Here we provide two datasets. The first one is on the whole transcriptome profiling by RNA-seq of urine and plasma obtained from patients with PCa and benign prostatic hyperplasia (BPH). The second one represents targeted sequencing of DNA from urine and plasma of patients with PCa and BPH. Both datasets are available at NCBI Sequence Read Archive under Accession No. SRP093707 and No. SRP093842 respectively.

[The role of the uretral catheter in the development of catheter- related urinary tract infection].

The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

[Current methods of early diagnosis of prostate cancer].

Prostate cancer is the most common cancer among men, except for lung cancer. Therefore, it is imperative to identify diagnostic methods for early detection of prostate cancer to determine patients from healthy populations, which helps guide a timely treatment at an initial stage of the disease. The article provides an in-depth review of the most current diagnostic biomarkers of prostate cancer, their role in clinical practice as a means of the early detection and screening for prostate cancer.