[The use of a urethral catheter with an ultrasound-induced biopolymer drug coating for the prevention of recurrent bladder neck sclerosis in patients after endoscopic treatment of benign prostate hyperplasia].

Recurrent bladder neck sclerosis is one of the common complications of endoscopic treatment of benign prostate hyperplasia, which often leads to multiple re-operations, including complex open and laparoscopic reconstructive procedures. One of the most promising minimally invasive methods for preventing recurrence of bladder neck sclerosis is balloon dilatation under transrectal ultrasound guidance. To improve the results of using this technique, a urethral catheter with a biopolymer coating, capable of depositing a drug and eluting it under the influence of diagnostic ultrasound, was proposed.

[Mini-PCNL, micro-PCNL or RIRS: comparative efficacy and safety in renal stones up to 2 cm].

INTRODUCTION: One of the main trends in the evolution of endoscopic treatment of urolithiasis is the miniaturization of instruments. This is obvious in the development of minimally invasive percutaneous nephro-lithotomy (PCNL) and retrograde intrarenal surgery (RIRS). However, there are few studies comparing the efficiency and safety of these methods. AIM: To evaluate and compare the efficiency and safety of mini-PCNL, micro-PCNL and RIRS in the treatment of kidney stones up to 2 cm in size. MATERIALS AND METHODS: Between October 2020 and December 2022, a total 72 patients underwent minimally invasive endoscopic procedures in two centers, including RIRS (n=30), mini-PCNL (n=26) and micro-PCNL (n=16) using thulium fiber laser FiberLase U2. The efficiency of procedure (stone free rate [SFR]) was assessed using non-contrast-enhanced CT. SFR was considered as the absence of residual fragments > 4 mm. Complications (safety) were evaluated based on the Clavien-Dindo classification. RESULTS: The mean age of all patients was 47.7 (22-84) years. There were no significant differences between three groups in stone characteristics according to CT (maximum diameter, density, volume and number of stones, the presence of pelvicalyceal dilation). SFR was significantly different between the groups (p=0.034). The overall SFR was 81.9% (n=59). After RIRS, mini-PCNL, and micro-PCNL the SFR was 93.3%, 80.8%, and 62.5%, respectively. A significant difference was found between the RIRS and micro-PNL groups, with 2 out of 30 and 6 out of 16 patients requiring repeat procedure, respectively (p=0.026). The overall rate of complication of grades I-II, IIIa and IIIb according to Clavien-Dindo was 6.9%, 9.7% and 6.9%, respectively. A significant difference was found between the RIRS and micro-PCNL (p=0.021) for grade I-II complications. A rate of grade III complications was not differed between the groups. The operation time was higher for mini-PNL (79.8 (30-145) min), and it was shorter for RIRS (55.7 (30-155) min). The length of stay was lower in RIRS group (4.5 (1-12) days). CONCLUSION: The highest SFR was achieved in the RIRS group. In terms of the number of complications of I-II grades according to Clavien-Dindo, the duration of the procedure and the length of stay, RIRS also showed the advantage. There were no significant differences in efficiency and safety between the micro-PNL and mini-PNL. There are not enough studies comparing minimally invasive methods for treating kidney stones. It is necessary to continue research in this area in order to develop an optimal algorithm for choosing the method of endoscopic treatment.

[Interpretation of biopsy material after transuretral and laser en bloc resection of non-muscle-invasive bladder cancer]. / Interpretatsiya biopsiinogo materiala posle transuretral'noi i lazernoi rezektsii edinym blokom nemyshechno-invazivnogo raka mochevogo puzyrya.

Bladder cancer is one of the most common onco-urological diseases, ranked second in frequency among all tumors of the urinary system after prostate cancer. At the time of detection of the primary tumor, approximately 75% of patients have no invasion into the muscularis layer (non-muscle-invasive carcinoma), with tumor growth limited to the basal membrane (stage Ta) or submucosal base (stage T1). Removal of the tumor in a «unified block¼ (laser en-bloc resection or L-ERBT), unlike routine transurethral resection, allows to obtain qualitative biopsy material for precise pathomorphological staging of the tumor process. In order to accurately stratify a patient into one or another risk group, verification of the following morphological parameters is required: degree of tumor differentiation and its malignancy, depth of invasion, foci of carcinoma in situ at resection margins, presence or absence of lymphovascular invasion. Identification of tumor variant histology is also recommended. Information on presence or absence of detrusor elements in the specimen is necessary in the morphological report, as this parameter is considered as a criterion of radically performed tumor removal. According to ICCR recommendations (International Collaboration on cancer reporting), it is recommended to use subclassification of T1 stage using all possible criteria: volume and/or depth of invasion (assessed in mm), and/or width of invasion «spot¼ (assessed in mm), and/or involvement of anatomical structure - muscularis mucosae. Full morphological examination of the material obtained during the primary resection of the tumor is an important step in the diagnosis and treatment of bladder cancer, as it allows to stratify the patient into one or another risk group and, accordingly, allows to develop a personalized postoperative management.

[Normative parameters for monitoring of nocturnal penile tumescences: a systematic review and algorithm development].

OBJECTIVE: a systematic review of the available literature sources about criteria for nocturnal penile tumescences (NPT) registration, as well as the development our own criteria for evaluating erectograms obtained from Androscan "MIT" software complex. MATERIALS AND METHODS: a systematic search about NPT criteria was conducted in the Medline database. A PRISMA flowchart was used to visually represent the design of the study. The necessary calculations were carried out using the STATISTICA 12 software. RESULTS: Normal erectile function is characterized by a relative increase in penis diameter (RIn) of 30% or more with the duration of such NPTs of more than 60 minutes. For a mild ED in the case of a good RIn (30% or more) with a duration of NPT with such RIn less than 10 minutes (the time of 1 effective erection), it is advisable to determine the duration of the NPT with a RIn of 20% or more. If RIn is less than 30% it is advisable to use the duration of sufficient erections (with a relative increase in diameter of 20% or more) and the border value in this case is 60 minutes or more. Severe ED is characterized by RIn less than 20% or duration of NPT of less than 10 minutes with any RIn. CONCLUSION: at the moment there are no uniform criteria for the diagnosis of ED using the Androscan "MIT" software complex. As part of the unification of ED diagnostics we first introduced the terms of "effective erection", "sufficient erection", "relative increase" and also developed regulatory criteria and an algorithm for evaluating erectograms which will ensure continuity as well as the possibility of comparison of the results from different research groups.

[Predictors of bladder neck contracture after transurethral procedure on the prostate].

The development and widespread implementation of modern endourological procedures for the treatment of benign prostatic hyperplasia (BPH) has led to a significant reduction in postoperative complications, but these interventions are associated to an increase of bladder neck contracture (BNC) rate. Various data on the frequency, pathogenesis, and risk factors for the development of BNC after endourological interventions are presented in the literature review. The prevalence of BNC after transurethral procedures depending on the type of energy used reaches up to 10%. Risk factors of BNC included the presence of chronic prostatitis and urinary tract infections, as well as small volume BPH. The age, cardiovascular diseases, type 2 diabetes, obesity, and a long-term smoking are considered as additional risk factors. A detailed study of the risk factors for BNC will further minimize BNC rate after transurethral procedures, thus improving the quality of life of patients.

[Varicocele and reproductive function: pathozoospermia treatment (a prospective comparative study)].

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. OBJECTIVE: to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia. STUDY DESIGN: a multicenter case-control study with stratified randomization. MATERIALS AND METHODS: data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel. RESULTS: After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million; B - +1.9 million; C - +17.1 million (p<0.05); D - +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p>0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.

[Shear wave elastography guided targeted biopsy in the diagnosis of prostate cancer].

OBJECTIVE: to compare the effectiveness of targeted biopsy guided by the shear wave elastography (SWE) and systematic biopsy in the diagnosis of prostate cancer (PCa). MATERIAL AND METHODS: A total of 164 patients with suspected PCa were examined. Multiparametric TRUS, including SWE, was performed to all patients with the use of the Aixplorer ultrasound system (Supersonic Imagine, France), followed by TRUS guided 12-samples systematic prostate biopsy in combination with targeted biopsy from hypoechoic and/or stiff areas according to SWE data. Comparison of the results of histological examination and tissue stiffness measurements were carried out according to the specimens and patients. A total of 2 171 biopsy samples were analyzed (1 968 systematic and 203 targeted). After morphological evaluation all specimens were divided into groups of PCa+ (n=441) and PCa- (n=1 730), and patients to the group of PCa (n=74) and the control group (n=90). RESULTS: PCa was found in 17.3% of systematic biopsy specimens and in 76.9% of SWE targeted biopsy specimens (P<0.0001). The significant moderate positive correlations of Youngs modulus and Gleason scores (rS=0.51, P<0.0001), Youngs modulus and% specimen involvement (rS=0.59, P<0.0001) were founded in the group of PCa+ biopsy specimens. The percentage of PCa+ specimens was significantly higher with any types of targeted biopsy, than with systematic biopsy. With SWE targeted biopsy the percentage of PCa+ specimens was significantly higher than with B-mode guided targeted biopsy. Similar regularities were observed when comparing these types of targeted biopsy according to morphological prognostic ISUP groups and perineural invasion. Performing of targeted biopsy increased the morphological prognostic group in 5.4% of patients, additionally revealed perineural invasion in 2.7% of patients with PCa, and transferred additional 9.5% of patients from the group of clinically insignificant to the group of clinically significant PCa. CONCLUSION: SWE-guided targeted biopsy shows the significantly higher positive biopsy rate than conventional systematic biopsy. The use of SWE-guided targeted biopsy in addition to systematic biopsy can increase clinically significant PCa detection rate and improve the detection of perineural invasion.

[Novel approaches for transurethral en-bloc resection of large bladder tumors].

OBJECTIVE: to develop optimal techniques of en-bloc resection of large non-muscle invasive bladder tumors, determine the proper method of specimen extraction and assess the quality of specimens obtained by different techniques. MATERIALS AND METHODS: A total of 12 patients with primary cT1 bladder cancer underwent transurethral en-bloc resection between January 2018 and March 2019 were enrolled into the study. Tumor size ranged from 3.5 cm to 6.2 cm. For removal and extraction of large bladder tumors using thulium fiber en-bloc laser three different techniques were developed: "swiss cheese technique", "crown and root technique" and "three steps technique" technique". The main pathologic criteria used for assessment of removal technique were tumor grade (G), depth of invasion (T), presence of carcinoma in situ (CIS), variant histology (VH), lymphovascular invasion (LVI), presence of detrusor muscle. Additional criteria were horizontal and vertical resection margin, subclassification of T1-stage and presence of focal necrosis in tumor. RESULTS: Among the techniques developed and tested, the best quality of specimens for morphological evaluation was obtained using the combined "crown and root technique". First step is electroresection of the exophytic part of the tumor into pieces, and the next step is en-bloc laser resection (using thulium fiber or holmium laser) of the tumor base. Overall, the quality of all specimens obtained using three techniques met the current requirements of pathologic study. SUMMARY: En-bloc resection techniques of large bladder tumors allow obtaining specimen suitable for proper morphological evaluation and correct tumor staging. Further studies are required to evaluate the impact of these techniques on long-term results of treatment options.

[Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?]

INTRODUCTION: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS: In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION: According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.

[Experimental verification of thulium lithotripsy].

AIM: Experimental evaluation of the efficacy and safety of lithotripsy using a new pulsed thulium fiber laser operating at a wavelength of 1.94 microns, peak power of 500 watts (maximum average power of 50 watts) by comparing it with a holmium laser operating at a wavelength of 2.1 microns (average maximum power 100 W and 120 W). RELEVANCE: The proportion of minimally invasive surgery in the management of urolithiasis, including retrograde intrarenal surgery, is steadily growing. The most appropriate tool for stone destruction is a laser. To date, the gold standard of minimally invasive surgical treatment of nephrolithiasis is holmium laser lithotripsy, which uses a laser on yttrium-aluminum-garnet activated by holmium ions (Ho: YAG) operating at a wavelength of 2.1 m. However, in recent years, lasers on a Tm-activated fiber with a wavelength of 1.94 m have become increasingly popular since the water absorption coefficient for the Tm radiation of a fiber laser is 5.5 times higher than for a Ho: YAG laser and in 2.2 times higher than for the Tm: YAG laser. This difference may translate into greater effectiveness and speed of stone crushing, which in turn leads to shorter operating time. MATERIALS AND METHODS: This article describes physical foundations of holmium and thulium laser radiation, the mechanisms of stone fragmentation, data from a series of experiments comparing the efficiency and safety of ex-vivo lithotripsy using a holmium solid-state laser with a wavelength of 2.1 m and a thulium fiber laser with a wavelength of 1.94 m. RESULTS: The study findings suggest that the STA IRE-Polyus thulium fiber laser operating at a wavelength of 1.94 microns and a maximum power of 500 watts has several advantages over the holmium laser in the stone fragmentation in urological practice. CONCLUSION: The results of the experimental work allow us to conclude that the use of a thulium fiber laser operating at a wavelength of 1.94 m and a maximum peak power of 500 W enables highly effective and safe lithotripsy.