[Validation of the Russian version of the ureteral stent symptoms questionnaire (USSQ) for the evaluation of quality of life and stent-related symptoms].

INTRODUCTION: Ureteral stents are frequently used in urology practice and have a significant impact on health-related quality of life (QoL). In 2003 . Joshi et al. developed the specific questionnaire for evaluation of QoL and stent-related symptoms, namely Ureteral Stent Symptoms Questionnaire (USSQ). USSQ consists of 40 questions and 2 visual analog scales (VAS), divided into 6 domains. Over the past decade, this questionnaire has been translated into 9 languages. A Russian version of the questionnaire has not been developed yet. AIM: To perform linguistic validation of the Russian version of the USSQ. MATERIAL AND METHODS: Linguistic validation of the original USSQ was performed through a standard process including translation, back translation and pilot study. A total of 103 patients undergone ureteral stent placement and successfully filled in the Russian USSQ at weeks 1 and 4 after stenting, and at week 4 after stent removal. In addition, 30 healthy people filled in the same questionnaires twice at 3-week intervals, as a control group. To evaluate reliability, validity and sensitivity to change of the Russian USSQ, statistical analysis was performed. External criteria included validated questionnaires (EQ-5D, IPSS and pain VAS). RESULTS: Content validity was approved by experts and proved during patients interviewing. Reliability test-retest was satisfactory for urinary symptoms, body pain, general health, and work performance domains (p<0,001 between test and retest evaluation). USSQ domains showed good correlations between each other (correlation coefficient was 0,80-0,94). Cronbach's alpha coefficient of internal reliability was 0.73-0.95. Correlation between other instruments and corresponding USSQ domains was good (p<0,001), proving criterial validity. Sensitivity to changes after stenting and stent removal was also good for most domains (p less or equal 0,001). CONCLUSION: Russian version of USSQ is a valid, reliable and sensitive instrument for the assessment of QoL and stent-related symptoms and is ready for application in the routine clinical practice.

[IPSS-QOL questionnaire in assessing symptoms and quality of life in patients with anterior urethral stricture].

RELEVANCE: The IPSS-QOL questionnaire is frequently used to assess symptoms and quality of life of men with urethral strictures. However, the psychometric properties of the questionnaire in assessing these patients have not been evaluated. AIM: To test the psychometric properties of the IPSS-QoL questionnaire in assessing patients with anterior urethral strictures. MATERIAL AND METHODS: Thirty five men with anterior urethral strictures self-completed the IPSS-QoL questionnaire. The reliability of the questionnaire was estimated by computing Cronbachs coefficient and the "point-scale" correlation coefficients. Validity was assessed by the "external criteria" - the correlations between the questionnaire scores and objective indicators - maximum urinary flow rate (Qmax) and residual urine volume (Ures), between QoL scores and index values and EQ-5D scores using a VAS rating scale. RESULTS: The content validity of the IPSS-QoL was assessed by experts and patients: the storage symptoms were found insignificant for patients with anterior urethral stricture, while the symptoms of primary importance (post-micturition dribbling) were not covered. Cronbachs coefficient of reliability was 0.65 (0.55-0.69 with one of the questions removed), i.e. it was below the generally accepted threshold of 0.7. The "point-scale" correlation coefficients ranged from 0.146 to 0.585; for 2 of the 7 questions they were lower, than the conventional threshold of 0.2, showing the internal inconsistencies of the questionnaire. The construct validity assessment showed no correlation between the questionnaire scores and objective indicators Qmax (R=0.178, p=0.306), Ures (R=-0.074, p=0.673). Correlations between QoL scores and index values and EQ-5D scores on the VAS were weak and statistically insignificant: R=-0.26, p=0.18 and R=-0.21, p=0.27, respectively. CONCLUSION: IPSS-QoL questionnaire in assessing men with anterior urethral stricture does not have sufficient reliability and validity. Its design does not allow for adequate assessment of all the symptoms, reliability indices are unsatisfactory, the questionnaire scores do not correlate with objective indicators. This questionnaire cannot be recommended for evaluating health status and quality of life of this category of patients.

[Quality of life as an effectiveness criterion of surgical treatment for anterior urethral strictures].

RELEVANCE: Recent trends in the contemporary medicine have shown a growing request for the personalized choice of treatment and evaluation of its results. PROM-USS questionnaire has been designed for patients undergoing surgical correction of anterior urethral strictures to measure the treatment success using patient reported outcomes in numerical terms. AIM: To test the effectiveness of different surgical modalities for anterior urethral strictures using patient reported outcomes. MATERIAL AND METHODS: Ninety men self-completed the PROM-USS questionnaire after surgical treatment of anterior urethral strictures. Mean and median follow-up was 6-132 months and 72 months, respectively. Measures included lower urinary tract symptom score, overall quality of life (QOL) and overall health, and patient satisfaction with treatment. RESULTS: At the median follow-up of 72 months after surgery for anterior urethral stricture, the survey findings showed LUTS total score 7.4+/-1.2 and urination score on VAS scale 2.3+/-1.1. Sixty-five (72%) of the men believed that residual LUTS did not significantly affect their quality of life. Fifteen (17%) and 10 (11%) patients reported a slight and moderate/strong negative impact of urinary symptoms on their quality of life, respectively. The EQ-5D score of overall health state on VAS was 73+/-4.2 out of 100, the EQ-5D score of the overall quality of life was 0.79+/-0.2. Seventy-eight (86.7%) of 90 men were satisfied (32.2% very satisfied and 54.5% satisfied) with the surgery results, and 12 (13.3%) were dissatisfied. Reasons for dissatisfaction were the emergence of new problems (post-micturition dribbling) with an overall improvement of urinary symptoms (5) and the lack of improvement in urinary symptoms (7). Among patients treated with OIU, 79% were satisfied, which was significantly less than in groups of men who underwent anastomotic urethroplasty - 89% (p<0.05) and substitution urethroplasty using a buccal mucosal grafting - 95% (p<0.05). CONCLUSION: The patient-reported outcomes showed that surgery for anterior urethral stricture is highly effective and characterized by a long term patient satisfaction and quality of life.

[VALIDATION OF THE RUSSIAN VERSION OF THE QUESTIONNAIRE TO ASSESS THE EFFECTIVENESS OF SURGICAL TREATMENT OF PATIENTS WITH ANTERIOR URETHRAL STRICTURE (PATIENT-REPORTED OUTCOME MEASURE FOR URETHRAL STRICTURE SURGERY (PROM-USS): A PILOT STUDY].

Currently, the patient-reported outcome measures are widely used for the analysis of the effectiveness of treatment. In 2011, the questionnaire to assess the effectiveness of treatment of men with anterior urethral stricture (PROM-USS) was proposed. Study objective: during validation to perform pilot testing of the Russian version of the PROM-USS questionnaire for determining its psychometric properties (reliability, validity and sensitivity). The study involved 35 men with anterior urethral stricture, who completed PROM-USS questionnaires before and 6 months after surgery. The questionnaire consists of 14 questions and 2 visual analogue scales (VAS), combined in 2 domains: 1--evaluation of lower urinary tract symptoms (LUTS), 2--assessment of the quality of life; questionnaire also includes questions about treatment satisfaction. The reliability, validity and sensitivity of the PROM-USS questionnaire were assessed. High intraclass correlation (ICC) coefficients (0.7-0.96) and Cronbach's α = 0.76, indicated reliability of the questionnaire. The correlation coefficient between LUTS scoring and an index of maximum urine flow rate (Qmax)--R = -0.81 (p < 0.05) confirmed the criterion validity. After the surgery, the total LUTS scoring decreased from 14.0 ± 0.72 to 5.66 ± 0.58 (P < 0.05); VAS EQ-5D index increased from 51.43 ± 5.3 to 71.42 ± 7.64 (P = 0.01) with an increase of Qmax from 3.4 ± 0.3 to 17.9 ± 0.9 ml/s (P < 0.001), indicating the sensitivity of questionnaire to changes. Ninety-four percent of men were satisfied and very satisfied with the result of the surgery; 88% had residual LUTS not affecting the quality of life or affecting slightly. For the final conclusions about the feasibility of this tool, further studies involving a larger number of patients are required.

[Replacement plastic reconstruction of extended ureteral stricture using buccal mucosa autograft].

The potentials for the use of free buccal mucosa graft in reconstruction plastic surgery of extended uretral stricture are evaluated. From 2007 to 2013, 9 operations in 8 patients (mean age 54,5+/-7,2 years) were performed. The average length of cicatricial uretral stricture was 5,1+/-0,7 cm. 1 patient has lesion in the upper third of the ureter, 4 patients - in the middle portion, and 4 patients - at the bottom portion. The causes of extended uretral stricture were following: long standing calculi (n=3), ureteral injury after ureterolithotripsy (n=2) and after bringing down the calcuus using loop (n=1), radiotherapy (n=3, one patient had bilateral injury). All patients underwent plastic reconstruction of ureter using buccal mucosa graft by "on-lay" type. During the follow-up (median, 42 months, from 3 to 72 months), in 7 (88,9 %) of 8 patients (8 operations) ureteral strictures relapses were not observed. They all had satisfactory renal excretory function without the pronounced violations of passage of urine along the ureter. The excretory urography showed moderate expansion of the ureter at the site of operation in 6 of them. Due to the progression of secondary renal scarring, one patient underwent nephrectomy 1.5 year after reconstruction plastic surgery. In this patient, pronounced anatomical and functional changes in the kidney occurred before the operation. Application of the buccal mucosa graft in reconstruction plastic surgery in extended uretral stricture is high effective due to the relatively low level of early and late postoperative complications and low recurrence rate.

[The level of neopterin in blood serum in premature newborn in the process of their adaptation to postnatal life].

The study had a purpose to evaluate the level of serum neopterin in the process of adaptation of healthy newborns to postnatal life. The dynamic clinical monitoring and comparative analysis was applied to determine the level of neopterin in serum of umbilical blood in 46 children and in peripheral blood of their mothers. The immune-enzyme analysis was implemented. It is established that in healthy newborn the content of neopteril reliably exceeds common normative indicator of adults i.e. less than 10 nmol/l. The increased level of neopterin in blood of newborns and their mothers reflects the total reaction of immune response to delivery process. The dependence is established between the level of neopterin and pathologic course of gestation period (acute respiratory viral disease, fetoplacental insufficiency) and morphologic functional maturity of child

[Kidney transplantation in recipients with renal carcinoma].

Transplantation of the kidney in patients with renal carcinoma is disputable. The article presents the results of kidney transplantation in different cancer lesions of the patient's kidneys. Seven case histories of patients with primary renal tumors are retrospectively analysed. A clinical case of development of the tumor of own kidney in a patient after transplantation is reported. A time factor of kidney transplantation after tumor removal in a recipient is discussed.

[Vascular endothelial growth factor in patients with prostate cancer and benign prostatic hyperplasia].

The authors examined 25 patients with prostate cancer (PC) and 36 patients with benign prostatic hyperplasia (BPH). In the group of patients with morphologically verified PC mean serum level of vascular endothelial growth factor (VEGF) was significantly higher than in patients with BPH (p < 0.05). The study demonstrated strong negative association between VEGF and prostate specific antigen (PSA) levels (r = 0.72, p < 0.05) in PC patients. There was no association between VEGF serum level and the stage or malignancy of PC (Gleason score). In benign prostatic glands moderate VEGF expression was observed only in basal cells, whereas in cases of PC all tumor cells displayed active VEGF expression; the difference was significant (p < 0.05). High serum VEGF levels and its active expression in patients with PC suggest an important role of angiogenic factors in the pathogenesis of this disease. The negative association between VEGF and PSA serum levels in PC indirectly confirms antiangiogenic activity of PSA, shown before.

[Effect of antiorthostatic pre-training on transcapillary turnover of fluids in extra- and intracranial vessels of rats in antiorthostatic hypokinesia]. / Vliianie predvaritel'noi trenirovki k antiortostazu na transkapilliarnyi obmen zhidkosti vo vne- i vnutricherepnykh sosudakh u krys v protsesse antiortostaticheskoi gipokinezii.

Dynamics of the transcapillary turnover of liquids in the brain and soft tissues of the head was studied in pre-trained small laboratory animals (rats) during antiorthostasis, and their controls. Training for antiorthostasis consisted of tail-suspension for 2 hours in the period of two weeks. The transcapillary turnover of liquids was determined based on the arteriovenous difference in blood density (AVBD). Blood density was measured with the equipment of Anton Paar K.G. (Austria). Rats in the horizontal position did not exhibit any apparent trend in the dynamics of blood transcapillary turnover. Blood drain from the interstitial space at the time of return of the antiorthostatic rats into the horizontal position was dependent on the length of antiorthostatis. Beginning from the fifth hour of tail suspension, changed AVBD sign was an indication of edema of the muzzle soft tissue. This phenomenon was not observed in the pre-trained rats. Similar results were obtained in the investigation of cerebral vessels AVBD. Hence, changes in the transcapillary turnover of liquids in cranium during antiorthostatic hypokinesia point to the dominance of liquid filtration into the extravascular space. Antiorthostatic pre-training precludes liquid deposition in the interstitial space of the brain and the cerebral soft tissue.