[Challenges in the clinical diagnosis and treatment of encrusted cystitis].

Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.

[Ureteral obstruction and segmental ureteral stents].

Currently, various types of stents are widely used in urological practice. One of the indications is the presence of upper urinary tract strictures. The factors leading to the development of strictures can be endogenous and exogenous, iatrogenic and non-iatrogenic, benign and malignant. After open, laparoscopic and X-ray-endoscopic procedures a double-J stent is usually placed or, less often, nephrostomy tube. It should be noted that both methods have certain side effects and may affect the patient's quality of life. To reduce the stent-related symptoms and increase their tolerability, various modifications of ureteral stents have been developed. In this article, we analyze the publications devoted to the most commonly used segmental stents without renal and bladder coils, such as Memokath, Uventa, Allium, Memotherm and nitinol stents manufactured by MIT LLC.

[Complications after PCNL: diagnosis and management].

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

[Design and materials for ureteral stents: past, present and future].

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

[A comparison between enucleation of the prostate using holmium and thulium laser in volume over 80 cc: retrospective clinical study with 12-months follow-up].

AIM: The aim of our study was to evaluate efficiency of thulium laser enucleation of the prostate (ThuLEP) for the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A retrospective analysis of 112 patients with BPH who underwent ThuLEP (n=60) or holmium laser enucleation of the prostate (HoLEP) (n=52) at our institution from January 2017 to June 2017 was carried out. The perioperative data and complication rate were assessed. Severity of lower urinary tract symptom (LUTS) was evaluated after 1, 6 and 12 months using International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]. To shorten learning curve, we modified the technique and simplified the intervention. To reduce noise during surgery, we performed ThuLEP using Vela XL. RESULTS: There were significant differences in pre- and perioperative parameters, including operative time (113.15+/-12.14 vs. 118.08+/-15.76 min, p=0.46), decrease in serum sodium concentration (3.49+/-0.83 vs. 3.48+/-0.84 mmol/L, P=0.97), hemoglobin drop (1.37+/-0.18 vs. 1.43+/-0.38 g/dL, p=0.65), catheterization time (2.15+/-0.38 vs. 2.27+/-0.39 days, p=0.52) and hospital stay (6.95+/-0.82 vs 7.56+/-1.36 days, p=0.25) between the two groups (ThuLEP and HoLEP). Compared with the HoLEP group, intraoperative noise was lower in ThuLEP group (47.22+/-10.31 vs. 59.45+/-9.65 db, p<0.05). At 1-, 6- and 12 months follow-up, the LUTS severity (I-PSS, QoL score and Qmax) were significantly improved in both groups in comparison with the baseline values. Furthermore, there was no difference in LUTS severity between two groups (p>0.05). CONCLUSION: ThuLEP is comparable to the holmium laser in terms of efficiency, safety and indications and represent minimally invasive treatment option for patients with LUTS secondary to BPH.

[Comparative analysis of results in laparoscopic radical cystectomy with extracorporeal and intracorporeal neobladder formation].

INTRODUCTION: The aim of the study is to compare the results and complications of muscle- invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation. MATERIALS AND METHODS: Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden). RESULTS: In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases - Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis. CONCLUSION: Due to medical technologies development and endovideo-surgical equipment improving, it became possible to perform high-technological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.

[Conservative management of rectourethral fistula: modern treatment].

INTRODUCTION: & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. MATERIALS & METHODS: From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. RESULTS: During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). CONCLUSIONS: Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.

[Metaphylaxis of urolithiasis: new look, modern approach, implementation in a mobile application].

AIM: To analyze the sub-segment of mHealth devoted to assessing of the risk of recurrent stone formation and metaphylaxis of stone formation. To design a smartphone application (app.) in Russian language for urolithiasis patients. MATERIALS AND METHODS: Three working groups of urologists from three St. Petersburg clinics searched for downloadable medical applications relevant to the above requirements. After searching and analyzing existing medical applications, the most acceptable design and structure of our own application were identified. RESULTS: The developed "Urolithiasis" application is available for free download in Russian language versions in App Store (Apple, Inc.) and Google Play (Android market, Google, Inc.). It features the following sections: 1) "Take the test" (personalized calculation of the risk of kidney stone recurrence and providing relevant recommendations using ROKS nomogram), 2) "Water" (with reminders to drink water and automatic logging of the water intake), 3) "Food" (Nutrition facts on the content of calcium, oxalate, purine, protein, citrate and calories in common foods), 4) "My doctor" (in the future this option will allow for on-line communication with a patients physician), 5) "Feedback" (if the patient does not find the desired product or has a question - this section is for him/her). CONCLUSIONS: The smartphone application "Urolithiasis" in Russian may be recommended to patients with urolithiasis for improving the effectiveness of metaphylaxis.