[Extravesical reimplantation of heavily-dilated ureters according to Bradi technique].

INTRODUCTION: Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented. MATERIALS AND METHODS: The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width. RESULTS: No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring. CONCLUSION: The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.

[Histopathological evaluation of the evolution of oral mucosa grafts used for augmentation urethroplasty].

INTRODUCTION: The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra. AIM: to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty. MATERIAL AND METHODS: A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied. RESULTS: The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium. CONCLUSION: The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.

[The influence of urethral stricture disease and urethroplasty on anxiety and depression in men].

INTRODUCTION: The relationship of surgical treatment of urethral stricture and such mental deviations as anxiety and depression is still poorly understood. Particularly, there is no reliable data on how mental status is associated to surgical treatment of the urethral stricture and its efficacy. AIM: to study the indicators of anxiety and depression in patients with urethral stricture before and after surgery. MATERIALS AND METHODS: The prospective study involving 30 men aged 20-74 years with urethral stricture of various etiologies and localizations was conducted. The validated questionnaires, HADS-1 and HADS-2 were used to evaluate anxiety and depression, lower urinary tract symptoms (I-PSS-QoL), erectile dysfunction (IIEF-5) before and 3 and 6 months after surgery. RESULTS: Almost all patients with urethral stricture before surgery had an increased level of anxiety and depression, which in 70% cases decreased to normal values by 6 months after successful surgery. Clinically, these changes correlated with the improvement of lower urinary tract symptoms. The restoration of erectile function in patients by 6 months was less pronounced, though it had no influence on the resolution of anxiety/depression. CONCLUSION: The determination of psycho-emotional status in patients with urethral stricture before and after urethroplasty should be as important for the evaluation of the efficiency of surgical treatment, as the resolution of lower urinary tract symptoms and restoration of sexual function.

[Comparative analysis of one- and two-stage augmentation urethroplasty with dorsal INLAY buccal graft for extended stricturesof spongious urethra].

INTRODUCTION: Urethral reconstructive surgery is in constant development. At present, reconstructive urethroplasty with buccal mucosa is increasingly being used. The study aimed to compare the results of a one- and two-stage augmentation urethroplasty with dorsal inlay buccal graft for strictures of the spongious urethra. MATERIALS AND METHODS: The study comprised 72 patients aged 19-64 with urethral strictures 3-18 cm long. In 34 (47.2%) patients, the stricture was localized in the penile urethra, in 30 patients (41.6%) in the penile-bulbous urethra and in 8 patients (11%) in the bulbous urethra. All patients underwent augmentation urethroplasty with dorsal inlay buccal graft. The results were evaluated separately in 55 (76.4%, group 1) and 17 (23.6%, group 2) patients who underwent one-stage and two-stage surgery, respectively. RESULTS: The incidence rate of early postoperative complications was higher after one-stage (23.6%) compared two-stage surgery (11.8%) (p<0.05). Hematomas, wound dehiscence and urethrocutaneous fistulas were observed only after single-stage surgery. Primary healing of extensive strictures following augmentation urethroplasty with dorsal inlay buccal graft was achieved in 88.9% of patients; treatment effectiveness in the group 1 was 89.1%, in the group 2 - 88.2% (p>0.05). The final effectiveness of the operation, achieved with the use of additional surgical interventions, is estimated at 98.6%. CONCLUSION: The results of augmentation urethroplasty with dorsal inlay buccal graft do not depend on the number of stages, but fewer complications accompany two-stage surgery.

[Evaluation of testosteronemia in men undergoing surgery for urethral strictures].

INTRODUCTION: Testosterone plays an important role in the functioning of various organs and systems of the male body. Its diagnostic and prognostic values are studied both in urological diseases and in the patients undergoing non-urologic surgery. AIM: To investigate changes in testosterone level in patients with urethral strictures (US) depending on its baseline level, the cause of US, the age of patients and the number of surgeries. MATERIALS AND METHODS: The study comprised 30 patients aged 19-63 years with traumatic (76.7%) and inflammatory (23.3%) US. Primary and recurrent US were diagnosed in 25 (83.3%) and 5 (16.7%) patients, respectively. Nineteen (63.3%) patients underwent excision and primary anastomosis, while replacement urethroplasty was performed in 11 (36.7%) patients. In addition to the standard diagnostic work-up, all patients were tested for total serum testosterone 24 hours prior to surgery and at 1, 3, 7, 14 days after the operation. RESULTS: 33.3% of men with US had a testosterone deficiency in the absence of any testicular or endocrine injuries and diseases. Surgery was associated with a drop in testosteronemia in 83.3% of patients. The degree of postoperative testosterone level decline and its changes were significantly influenced by the age of patients and the number of operations. Men who had baseline testosterone deficiency and underwent repeat surgeries remained in a hypogonadal state throughout the postoperative period. CONCLUSION: Investigating the clinical value of testosterone in men with US and the risks of their surgical treatment associated with testosterone deficiency will provide insight into the role of testosterone in the treatment of this condition and the decision-making regarding pharmacological correction of testosterone deficiency in patients undergoing surgery for US.

[SURGICAL TREATMENT OF STRICTURES OR OBLITERATIONS OF URETHRA].

The article introduces the clinical and statistical analysis of 113 patients treated for urethral strictures (US) in the urological clinic of the Rostov State Medical University in 2011. 58% of patients experienced a recurrent course of the disease. Radical curative surgery was possible in 93 (82.3%) patients. In other cases, non-invasive strategy was indicated (13.3%) or surgery for urethral stricture was impossible due to comorbidities (4.4%). Resection with urethral end-to-end anastomosis, which is the most effective approach to the treatment of patients with US, was possible in only half of the patients (51.8%). In the rest of the patients, one-, two- or more stage urethroplasty substitution was carried out. By the end of 2013, treatment of 84 (90.3%) patients was completed with a total of 110 operations. 9 (9.7%) patients were scheduled for operation in 2014.

[Internal optic urethrotomy in urethral strictures complicates subsequent reconstructive surgery].

The results of open reconstructive operations performed in 86 patients with traumatic urethral stricture show that the efficacy of these operations and frequency of complications are lower in using urethroplasty as a primary treatment while primary internal optic urethrotomy significantly reduces possibility of effective surgery without complications.

[A new approach in the surgery of prostatic sclerosis]. / Novyi podkhod v khirurgii skleroza predstatel'noi zhelezy.

The authors propose a new technique of prostatic sclerosis surgery which makes use of a transperineal approach and is based on the principles underlying surgical management of posterior urethra high strictures with establishment of a cystourethral shunt. Good results obtained in 17 patients with prostatic sclerosis allow the authors to consider the above procedure as an alternative to transvesicular prostatectomy according to V. S. Karpenko.

[The validation of applying a longitudinal suture to the bladder neck in bladder-urethra anastomosis]. / Obosnovanie nalozheniia prodol'nogo shva na sheiku mochevogo puzyria pri tsistouretroanastomoze.

The author gives theoretical validation for placing a longitudinal suture instead of a cross suture on the bladder cervix in cystourethral shunting. Cross sutures preclude deviations in the shunt region thus reducing probability of urethral stricture recurrences. For conduction of the suturing a special device "needle bougie" has been developed. Surgical treatment of 11 patients with recurrent strictures of the prostatic urethra with the use of the above unit secured positive results in all those treated.

[A method for joining the ends of the resected urethra]. / Sposob soedineniia kontsov rezetsirovannoi uretry.

In spite of the fact that the operations after B. N. Khol'tsov, P. D. Solovov, and V. I. Rusakov have found a wide recognition and use, the rate of complications and poor results remains still high, reaching 3-29%. The authors consider that one of the reasons for poor outcomes in such operations is evolving urethral ischemia at the site of anastomosis, which is caused by compression of tissues with suturing material with the routine suturing of urethral ends through all its layers. The experiment with the male dogs and human cadavers provided evidence for this assumption. The mathematical calculation indicated that with the sutures applied, over 12-16% of the urethral tissue volume became ischemic at the site of anastomosis. A new technique was proposed to attach the ends of the resected urethra, which eliminates the suture of the urethral ends through all the layers. The essence of the technique is that after resection, the ends of the urethra are opposed and fixed with the outer layers without suturing the urethra via all the layers with 6 stitches. Twenty nine patients were operated on in this fashion. Twenty eight patients were discharged with recovered micturition. A relapse occurred in one patient with inflammatory urethral stricture. For 3 months to 3 years, 22 subjects were examined, another patient had a relapse 3 months following surgery. The two patients were reoperated, with a good effect. The remaining patients reported normal micturition and presented no complaints.

[Rational extent of therapeutic measures in the early period after urethral trauma]. / Ratsiona'lnyi o''bem lechebnykh meropriiatii v rannii period posle travmy uretry.

The character and volume of medical measures performed at the early period after traumatic injuries of the ureter are analyzed. Based on positive results of treatment of 61 patients with trauma of the ureter and 379 patients with its consequences the authors recommend a number of curative measures depending on the kind of isolated and associated injuries of the ureter. Special attention is given to the character of the material used for preparing the draining ureteral catheters and to their diameter which are thought to be responsible for possible development of ureter strictures.

[Surgical treatment method for nephroptosis]. / K metodike khirurgicheskogo lecheniia nefroptoza.

A new method of nephropexy with an autograft by the upper pole to the diaphragm from intercostal lumbotomy is described. The method induces little injury, is technically simple and can be employed in those patients who do not need a revision or surgery on the renal pelvis, ureter or vascular pedicle. The method was used in operations on 45 patients. Good immediate and remote results were obtained.