[Comparative study of the efficacy and safety of a new generation of thulium fiber lasers for ureteroscopy and lithotripsy].

INTRODUCTION: The development and implementation in clinical practice of a 3rd generation thulium fiber laser with the possibility of computer control (modulation) of the shape, amplitude and pulse repetition rate opens up new possibilities for thulium fiber laser lithotripsy. AIM: To carry out a comparative study of the efficacy and safety of thulium fiber laser lithotripsy using a of the 2nd (FiberLase U3) and 3rd generation devices (FiberLase U-MAX). MATERIALS AND METHODS: A total of 218 patients with solitary ureteral stones, who underwent to ureteroscopy with lithotripsy using 2nd and 3rd generation thulium fiber lasers (IRE-Polus, Russia) from January 2020 to May 2022 with the same peak power (500 W), laser settings of 1 joule, 10 Hz and with a laser fiber diameter of 365 m, were included in the prospective study. For lithotripsy using FiberLase U-MAX laser a new original modulated pulse, which was found and optimized in a preclinical study, was used. Depending on the laser, the patients were divided into 2 groups. In 111 patients, stone fragmentation was performed on FiberLase U3 (2nd generation), while 107 patients were undergone to lithotripsy on a new laser device FiberLase U-MAX (3rd generation). Stone size ranged from 6 mm to 28 mm (11+/-4 mm). The duration of procedure and lithotripsy, the quality of the endoscopic picture during fragmentation (from 0 to 3 points, 0-bad, 3-excellent), the frequency of retrograde migration of stones, as well as damage to ureteral mucosa (of 1-3 degrees) were evaluated. RESULTS: The time of lithotripsy was significantly lower in the group 2 than in the group 1 (12.3+/-4.6 vs. 24.7+/-6.2 min; p<0.05). The average quality of the endoscopic picture was significantly better in the group 2 (2.5+/-0.4 vs. 1.8+/-0.2 points; p<0.05). Clinically significant retrograde migration of stone or its fragments (the need for additional ESWL, flexible ureteroscopy) was noted in 16% vs. 8% of patients in group 1 and 2, respectively (p<0.05). Damage to ureteral mucosa of the 1st and 2nd degree due to laser exposure in the group 1 was noted in 24 (22%) and 8 (7%) cases, compared to 21 (20%) and 7 (7%) cases in group 2, respectively. Stone-free state was 84% in group 1 and 92% in group 2. CONCLUSION: Modulation of the laser pulse shape allowed to improve endoscopic visibility, increase the speed of lithotripsy, reduce the frequency of retrograde stone migration without increasing the trauma to ureteral mucosa.

[Endoscopic marsupialization of parapelvic renal cysts].

INTRODUCTION: Parapelvic renal cysts are very common. Indications for surgical treatment are upper urine tract obstruction, pain and recurrent gross hematuria. AIM: To analyze the efficiency and safety of endoscopic transurethral and percutaneous laser marsupialization of parapelvic renal cysts. MATERIALS AND METHODS: A total of 9 patients were undergone to transurethral intrarenal marsupialization of parapelvic renal cysts from March 2016 to February 2021 (4 men, 5 women, aged 42-78 years). Another 2 patients (2 men, aged 46 and 52 years) were treated by percutaneous approach. The average size of the cyst according to contrast-enhanced multi-slice computed tomography (MSCT) was 3.1+/-1.8 cm. In two cases, papillary tumor of the pelvis was suspected. The anteroposterior diameter of the pelvis was 2.6+/-1.3 cm; 9 patients had pain in the loin area, while in 7 patients recurrent gross hematuria was also an indication for surgical treatment. For marsupialization, a holmium (Ho:YAG) laser Auriga XL (Boston Scientific, USA) was used in 4 patients, and in other cases (n=7) a procedure was performed using a thulium fiber laser (Tm Fiber) Fiberlase U1 (IRE-Polus, Russia). In 3 patients, to clarify the site of incision of the cyst, intraoperative ultrasound was used. In all cases, after draining the cyst, an internal stent was placed inside the cyst for a period of 4-6 weeks. RESULTS: The duration of transurethral surgery was 26+/-11 minutes, while percutaneous marsupialization of the cyst, which was performed in combination with percutaneous nephrolithotomy, took 10 and 18 minutes, respectively. The average catheterization time was 12+/-8 hours. Nephrostomy tube was removed on the 2nd day. The length of stay was 4+/-2 days. Febrile fever was noted in 1 patient (9%), which required a change in antibiotic therapy. During ultrasound control at discharge, the dilatation of the collecting system was not detected in any cases, while the residual cavity was found in 2 patients (18%). Follow-up contrast-enhanced MSCT and ultrasound within 3-30 months in all patients (n=11) showed no dilatation of the collecting system. In 1 (9%) patient, the residual cavity was preserved with a decrease in size to 1.2 cm without signs of upper urinary tract obstruction; the initial diameter of the cyst in this patient was 4.9 cm. There was no recurrence of gross hematuria. CONCLUSIONS: In our opinion, transurethral and percutaneous laser marsupialization of parapelvic renal cysts is an effective and safe method that allows definitive treatment for cysts up to 4 cm in size. If the cyst is larger than 4 cm, endoscopic removal should be balanced with the possibility of preserving the residual cavity. The most common complication of endoscopic treatment of intrarenal cysts is acute pyelonephritis with a rate of 9%.

[New approaches to combined therapy of irritative symptoms in patients with benign prostatic hyperplasia].

INTRODUCTION: Daytime and nighttime urinary frequency is a common complaint in patients with benign prostatic hyperplasia (BPH). The most common reason for seeking elective surgery is an ineffective treatment with alpha-blockers. The aim of the study was to evaluate the efficacy and safety of combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg in patients with BPH and predominant irritative symptoms. MATERIALS AND METHODS: from January 2018 to December 2019 in the outpatient department of the city clinical hospital named after D.D. Pletnev, a total of 64 patients with BPH with complains of frequent nighttime and daytime frequency and a desire to undergo surgery were followed. The patients underwent a comprehensive clinical and laboratory examination, according to which 10 patients had indications for surgery, and they were excluded from the study. In 6 patients, the prevalence of nocturnal over daytime diuresis was revealed and they were also excluded. Combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg a day was prescribed to 48 patients. The average duration of therapy was 15.4 +/- 3.1 months. Patients underwent a follow-up examination to evaluate the efficiency and safety after 3, 6 and 12 months of therapy. Adverse events, possibly treatment-related, were recorded. RESULTS: there was an additional decrease in irritative complaints according to the I-PSS, namely 2 points after 3 months and 4 points after 6 and 12 months. In addition, a decrease in the number of nocturnal urinations by one, a decrease in daytime urination by one after 3 months and by two after 6 and 12 months, as well as an increase in the average voided volume from 150 +/- 33 to 240 +/- 40 ml after 12 months of therapy was seen. The change in other parameters was not significant. Two patients stopped taking the drug due to non-medical reasons. In other 2 patients, the development of sinus tachycardia and a transient increase in blood pressure were noted, which did not require discontinuation of the drug. CONCLUSIONS: Combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg reduces the frequency of daytime and night urination with the maximum effect after 6-12 months, improves the quality of life and has a good safety profile.

[Paradigm shift in combination therapy during the COVID-19 pandemic].

INTRODUCTION: Insufficient efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors with subsequent proceeding to surgical treatment in the absence of absolute indications is a prerequisite for poor postoperative results. AIM: to evaluate the efficiency of changing standard combination therapy to -adrenergic blockers + m-cholinoblockers instead of proceeding to surgical treatment. MATERIALS AND METHODS: From January 2019 to December 2019, a total of 137 patients with lower urinary treatment were referred to the Pletnev City Clinical Hospital due to limited efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors in order to undergone laser enucleation/vaporization of the prostate. After evaluation, 41 patients with absolute indications for surgical treatment or with suspected prostate cancer were excluded. After a comprehensive examination, 96 patients were prescribed tamsulosin 0.4 mg daily in combination with solifenacin 10 mg daily. All patients were followed up for 12 months. RESULTS: As a result of using solifenacin, better control over storage symptoms was achieved according to the I-PSS scale (-4 points), which also led to a significant decrease in the total I-PSS score after 12 months of therapy. There was an increase in the mean voided volume (by 53%) after 6 months. Neither Qmax, nor residual urine volume did not change significantly. According to the MIEF-5 scale, an improvement in erectile function was revealed. There was a slight decrease in the average prostate volume and an increase in the PSA level from 3.1 to 4.1 ng/ml. There was no acute urinary retention. However, 6 patients discontinued taking of m-cholinoblockers due to dry mouth. CONCLUSIONS: If there are no absolute indications for surgical treatment, changing the combination of -adrenergic blockers + 5-Reductase inhibitors to a combination of -adrenergic blockers + m-cholinoblockers results in a pronounced symptomatic improvement due to alleviation of storage symptoms.

[The use of alfuzosin in the treatment of patients with acute urinary retention].

AIM: To study the efficiency of using alfuzosin 10 mg (Alfuprost MR, SUN Pharma) in routine clinical practice in order to predict its feasibility for treating acute urinary retention. MATERIALS AND METHODS: A total of 47 patients, aged from 54 to 88 years old (mean 68.5+/-5.6) with acute urinary retention due to benign prostatic hyperplasia were treated at the urology department of City clinical hospital named after D.D. Pletnev from September to December 2019. 14 patients were excluded from the study since they had chronic urinary retention. In all cases, urethral catheter was put and left in place for 24-72 hours (mean 44+/-12). All 33 patients were prescribed alfuzosin 10 mg. After removal of the urethral catheter, spontaneous voiding was restored in 19 patients. Transurethral resection of the prostate was consequently performed in three patients. In one patient, the urethral catheter was changed to cystostomy tube due to the urethritis. Recurrent urinary retention occurred in 10 men, and 8 patients underwent cystostomy. In other two cases, spontaneous voiding was restored after repeated removal of the urethral catheter. RESULTS: the efficiency of conservative therapy was 63.6% (21/33). According to our results, history of severe lower urinary tract symptoms, the prostate volume more than 50 cc and intravesical protrusion of more than 1 cm have a significant influence on the outcome of conservative therapy in patients with acute urinary retention. CONCLUSIONS: Based on a prospective study, a high efficiency and safety of the Alfuprost MP 10 mg/day in patients with acute urinary retention was established.

[Long-term results of combined treatment of patient with multiple primary cancers, including locally-advanced renal cell cancer, bladder cancer and transitional-cell cancer of the contralateral kidney].

A clinical case of the successful surgical treatment of patient with multiple primary cancers, including locally-advanced right renal cell cancer, transitional-cell cancer bladder cancer and metachronous transitional-cell cancer of the left kidney with one of the longest follow-up and survival time described in the literature.

[Transurethral endopyelotomy using thulium fiber laser].

INTRODUCTION: Transurethral endopyelotomy is an alternative treatment method for short stricture of ureteropelvic junction (UPJ). AIM: to evaluate the efficiency of transurethral thulium laser endopyelotomy. MATERIALS AND METHODS: A total of 94 patients with UPJ obstruction during the period from December 2016 to December 2018 were prospectively enrolled in the study. Pelvic size did not exceed 3 cm in 31 patients, and it was in the range from 3 to 4 cm and more than 4 cm in 35 and 28 cases, respectively. Depending on the treatment, all patients were divided into 2 groups. The main group included 48 patients who underwent retrograde thulium fiber laser endopyelotomy. In the control group (n = 46), patients underwent Anderson-Hynes laparoscopic pyeloplasty. In the main group, there were significantly more patients with more preserved ipsilateral kidney function, with short (less than 1 cm) and recurrent UPJ strictures and less severe hydronephrosis compared to the control group. In addition, there were no patients with crossing vessel in the main group. Postoperatively, an internal stent of 6-8 Fr was put in all patients for a period of 6-8 weeks. After stent removal, all patients underwent a follow-up examination, including an ultrasound examination and, if pelvic size was more than 3 cm, contrast-enhanced CT-urography was performed. RESULTS: In all patients, after stent removal, a decrease in the pelvic size was noted. The operation time in the main and control group was 24+/-14 minutes and 82+/-26 minutes, respectively. In all cases, ureteropyeloscopy was performed prior to laparoscopy to determine the exact length of stricture and to exclude narrowing of other parts of the ureter. After follow-up of 24 months, an examination in 36 patients of the main group and 29 patients of the control group was performed. There was 1 recurrence after laparoscopic pyeloplasty and 1 recurrence after endopyelotomy. In other patients of both groups, there were neither stricture, nor impaired renal function. CONCLUSION: The first experience of using a thulium fiber laser for transurethral endoscopic treatment of UPJ obstruction is presented in the article. Indications for the transurethral thulium endopyelotomy are the presence of primary or secondary UPJ obstruction (with a decrease in kidney function by no more than 40%), length of up to 1 cm, absence of an additional vessel and pelvic dilatation of no more than 4 cm.

[Bipolar and laser endoscopic enucleation for large benign prostatic hyperplasia].

BACKGROUND: endoscopic enucleation is a conventional minimally invasive method of surgical treatment for large prostates. AIM: The aim of the study was to analyze preoperative, intraoperative, immediate postoperative outcomes and 12-month functional results of endoscopic enucleation of the prostate. MATERIALS AND METHODS: a total of 120 endoscopic enucleations were performed in the Department of Urology, City Clinical Hospital named after D.D. Pletnev in 2016-2017. Bipolar electroenucleation was performed in 63 cases, while laser enucleation was done in 57 patients (28 holmium and 29 thulium). Three-lobe, two-lobe and en-block electroenucleation was performed in 23, 24 and 16 patients, respectively. The technical advantages of laser enucleation included lesser need for mechanical traction during enucleation of the adenoma from the prostatic capsule and the predominant use of two-lobe technique (33 cases). En-block laser enucleation was done in 7 patients, while three-lobe technique was used in 17 patients. Both groups were comparable in terms of I-PSS, QoL, prostate volume, maximum urination rate, and residual urine volume. RESULTS: weight of the removed adenoma after electroenucleation was 105+/-24 g and 98+/-18 g after laser enucleation; the operation time was 118+/-10 and 132+/-25 min, duration of the catheterization 48+/-16 and 51+/-10 h, length of stay 3.6+/-1.2 and 3.8+/-1.3 days, respectively. Closed prostate perforation more often occurred after electrosurgical enucleation (6 vs. 1). There were no significant differences in the outcomes in both groups one year after the surgery. After removal of the urethral catheter, incontinence developed in 9% (6/63 and 5/57, respectively) of cases. During the period from 6 to 12 months, urinary incontinence persisted only in one patient, who subsequently was underwent to injection therapy with a partially positive effect. All 22 patients with urinary disturbances that occurred after enucleation had a short distance from the top of the verumontanum to the external sphincter (less than 1.5 cm; risk ratio (RR) = 3.5) and intravesical protrusion of more than 1 cm (RR=2.1). CONCLUSION: endoscopic bipolar and laser enucleation is an effective and safe treatment method for large BPH. It should be noted that postoperatively there was an increased frequency of irritative symptoms, which disappeared by 6 months.

[Lower urinary tract symptoms after transurethral resection of the prostate].

An analysis of the frequency of residual lower urinary tract symptoms after surgical treatment is presented in this literature review. A special attention is paid to prognostic criteria for persistence of irritative symptoms after the surgery. The analysis of modern approaches to the treatment of urinary disturbances has been performed. The possibility of the combined use of various classes of drugs to improve the efficiency of the treatment is highlighted.

[Use of cytomedins in case of prostatic involvement in chronic prostatitis according to UPOINT classification].

BACKGROUND: chronic prostatitis is a common disease that significantly influence on the quality of life. AIM: Our aim was to assess the prevalence of particular domains of UPOINT classification and determine the efficiency of prostate-selective cytomedins in complex therapy of chronic prostatitis with the predominance of organic component. MATERIALS AND METHODS: a total of 96 patients aged from 24 to 48 years were treated in City clinical hospital named after D.D. Pletnev in 2017-2018 yy. with a previously diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The mean duration of the disease was 18.0+/-6.2 months. The total NIH-CPSI score was 24+/-7.3 (pain score 9+/-4.9, urinary score 7+/-2,7, quality of life 8+/-2.3), Qmax was 16+/-4.2 ml/s, prostate volume - 34+/-12 cc. Leukocyturia in post-massage urine was found in 52 patients (54%). Positive urine culture after prostate massage or positive bacterial semen study were found in 22 patients (23%). Prostate-specific therapy consisted of 20 days of rectal suppositories Vitaprost-forte followed by oral therapy by Vitaprost tablet of the same duration. RESULTS: Follow-up examination of 72 patients (75%) was performed after 3 months of therapy. The total NIH-CSPI score decreased to 15.6+/-5.1 (pain score 6.3+/-3.8, urinary score 4.6+/-2.2, quality of life 4.7+/-2), Qmax was 16+/-3.8 ml/s and mean prostate volume was 24+/-6 cc. The normalization of laboratory parameters was achieved in all cases. CONCLUSION: using the UPOINT classification allows to optimize the treatment of patients with chronic prostatitis. Use of prostate-specific cytomedins (Vitaprost) is highly effective in case of prostatic involvement according to the UPOINT classification.

[Current prospects for improving the quality of life of patients with internal stents].

Internal drainage of the upper urinary tract by stenting is a common urological procedure. The use of stenting in modern urological practice is on the rise due to widespread adoption of modern endourological, laparoscopic, percutaneous and high-tech robotic interventions. The presence of a stent in the patients body may cause stent-related symptoms and negatively affect the quality of life, resulting in additional outpatient visits and hospitalizations. The review provides an analysis of the causes, diagnostic evaluation, prevention and treatment of stent-related symptoms. The authors describe the management options including -blockers, anticholinergics, and their combinations.

[Combination therapy in the management of urinary disorders after transurethral resection of the prostate].

INTRODUCTION: Surgery in patients with large prostates due to benign prostatic hyperplasia (BPH) results in severe dysuria manifesting as frequent or urgent need to urinate and urinary incontinence. Traditionally, these conditions are treated with alpha blockers. Recently, alpha-blockers and the anticholinergic combination have been used showing additional advantages. This study aimed to investigate the comparative effectiveness of monotherapy versus combination therapy in the treatment of postoperative dysuria in BPH patients with large prostates undergoing transurethral surgery. MATERIALS AND METHODS: From September 2016 to March 2017, 94 BPH patients with prostates greater than 100 cc underwent transurethral surgery at the Department of Urology of D.D. Pletnev Clinical Hospital; 22 patients had exclusion criteria. In the postoperative period, 36 patients received 0.4 mg of modified release tamsulosin (Omnik) for a month, and 36 patients were administered controlled release tablets tamsulosin 0.4 mg + solifenacin 6 mg (Vezomni) as fixed-dose combination therapy. At one month postoperatively, patients were asked to rate their symptoms on a visual analogue scale and fill out I-PSS and QoL questionnaires. Preoperative parameters of the groups were: visual analogue scale scores were 5.1 and 5.2, I-PSS scores were 24 and 24.2, QoL scores were 4.5 in both groups. Prostate volumes were 114 and 118 cc; maximum urinary flow rates were 7.7 vs. 7.5 ml/sec, residual urine volumes were 110 vs. 105 ml, respectively. RESULTS: Visual analogue scale scores were 6.5 versus 9.2 points, I-PSS scores were 16.3 versus 12.1. The patients of the second group had greater mean micturition volume (150 versus 240 ml); other variables did not differ statistically significantly between the groups. Adverse reactions were mild, and drugs were not discontinued in any case. CONCLUSION: In BPH patients with dysuria after transurethral resection of large prostates, Vezomni administration results in a better quality of life due to an improvement in urgency and nocturia.

[Initial experience in clinical application of thulium laser contact lithotripsy for transurethral treatment of urolithiasis].

INTRODUCTION: The choice of an effective and safe method of disintegration of stones in upper and lower urinary tract is very important in the context of continuous scientific and technological progress. In current clinical urological practice, various lithotriptors with rigid and flexible probes are used for contact disintegration of stones, having both advantages and disadvantages. This study aimed to analyze the first results of the clinical application of the native Tm: fiber Urolaz laser (STA IRE-Polyus, Russia) for contact transurethral lithotripsy. MATERIALS AND METHODS: The study comprised 56 patients who underwent transurethral contact thulium laser lithotripsy for 68 stones of the upper and lower urinary tracts between April and September 2017. Forty-four patients had kidney and ureteral stones, and twelve patients had urinary bladder stones. Twenty-four kidney stones were removed by retrograde intrarenal surgery using ureteral casing, flexible ureteropyeloscope and thulium laser, 32 stones in various ureteral segments - by rigid contact thulium laser ureterolithotripsy and 12 bladder stones - by thulium laser cystolithotripsy. The size of the upper urinary tract stones varied from 0.6 to 1.8 cm, bladder stones measured from 1.1 to 3.5 cm. Also, experimental studies were carried out to investigate the effects of the fiber thulium and holmium laser on the stone displacement and temperature environment during lithotripsy. RESULTS: Full stone fragmentation was achieved in 100% of patients. 47.7% of patients required additional lithoextraction of fragments; there was no retrograde migration of large stones. The mean duration of stone disintegration was 19 minutes. Postoperatively, 15.9% of patients had an exacerbation of pyelonephritis, which was successfully managed by conservative measures. The mean postoperative hospital stay was 2.4+/-1.1 days. At follow-up examination 4-6 weeks after surgery, one patient was found to have a residual symptomatic ureteral stone, which required extracorporeal short-wave lithotripsy. The experimental study showed that fiber thulium laser lithotripsy produced much less propulsion of artificial stone than Holmium laser lithotripsy. With the use of therapeutic power, neither of the lasers resulted in "dangerous" rises of the washing fluid temperature during stone disintegration. CONCLUSION: Using the universal thulium laser system "Urolaz" provides a significant improvement in the effectiveness of endourologic upper urinary tract interventions and significantly reduces the likelihood of intraoperative trauma and postoperative complications, which contributes to improving the quality of specialized urological care.

[Rehabilitation of patients after modern endourological procedures for urolithiasis].

INTRODUCTION: Numerous publications on the successful use of NefraDoz (Stada, Germany) in the metaphylaxis of urolithiasis after extracorporeal lithotripsy, and the prevention and treatment of infectious inflammatory diseases of the lower and upper urinary tracts, served as the rationale for a study aimed to evaluate the effectiveness and safety of long-term use of NefraDoz in patients after transurethral and percutaneous interventions performed for urological diseases. PATIENTS AND METHODS: The study analyzed results of 116 transurethral and percutaneous endoscopic operations for urolithiasis performed in 62 men and 54 women aged 21 to 84 years from November to December 2017 at the D.D. Pletnev City Clinical Hospital. Depending on the localization of the stones, all patients were divided into three groups: kidney stones (n=68), ureteral stones (n=28), and bladder stones (n=21). In each group, patients were assigned either to receive (study group, n=50) or not to receive (control group, n=66) postoperative NefraDoz, which was administered at a dose of 1 capsule three times daily for one month. Patients in the control group (n=66) received standard antibacterial therapy for one month. The analysis included leukocyturia, 24-hour diuresis, the severity of the symptoms of the disease and the patients quality of life. RESULTS: The use of NefraDoz after transurethral lower urinary tract procedures, reduced the severity of irritative symptoms, improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis. The use of NefraDoz after upper urinary tract procedures improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis, and improved the clearance of residual fragments. There were no adverse events associated with NefraDoz. CONCLUSIONS: We have proved the advantage of using the NefraDoz complex in the rehabilitation of patients after endourologic procedures.

[Lower urinary tract symptoms secondary to benign prostatic hyperplasia in 2017: update from the 32nd annual congress of European association of urology].

This review article summarizes new data on mono- and combination therapy for male urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). A special attention is paid to the reports made at the 32nd Annual EAU Congress and published in the congress proceedings. The article outlines new data on the epidemiology of LUTS secondary to BPH, recent changes in the pathogenesis of LUTS, provides a critical analysis of the latest publications on -blockers, 5-reductase inhibitors, antimuscarinics and phosphodiesterase type 5 inhibitors in pharmacological management of LUTS. The authors analyze recent data on the effectiveness of surgical methods for treating BPH.

[Solitary stones of the lower renal calyx: how to treat?]

INTRODUCTION: The choice of treatment for the stones of the lower renal calyx is one of the challenging issues of modern urology. The aim of this retrospective and prospective study was to investigate the clinical effectiveness and safety of 3 modern minimally invasive techniques for treating renal stones: percutaneous (PNL) and transurethral (TNL) nephrolithotripsy and extracorporeal shock wave lithotripsy (ESWL) in patients with solitary lower calyx stones sized from 10 to 15 mm. MATERIALS AND METHODS: The study included 136 patients with symptomatic stones of the lower calyces, who underwent ESWL, PNL and TNL from November 2010 to the present day. The criteria for inclusion in the study were: the presence of a solitary stone of the lower calyx, the stone size of 10 mm to 15 mm, the performance of the classical (standard) PNL in the prone position (puncture access 28-30 Fr) and the follow-up examination at 3 months after the operation. Forty-six patients underwent ESWL, 49 - PNL, and 41 - TNL. Postoperative follow-up was done at 3 months and included a plain radiography, ultrasound and non-contrast-enhanced computed tomography. The stone free rate (SFR) was used as a criterion for the effectiveness of the intervention, where the stone size of 3 mm was taken as the upper limit for the possible presence of fragments. Besides, the rate of repeat interventions, complications and subjective assessment of patients treatment satisfaction (0 to 10) by using visual analogue scale (VAS) were investigated. RESULTS: The effectiveness analysis of the three methods for treating the lower calyx stones sized 10-15 mm showed that PNL was no more effective than TNL (SFR 95.9% and 85.4%, respectively), but both methods were significantly more effective than ESWL (SFR 69.5%). 29.3% of patients who underwent TNL required repeat interventions (TNL or ESWL), while among those treated with ESWL, 45.6% required repeat ESWL sessions. PNL resulted in stone clearance in one stage. Postoperative inflammatory complications were most prevalent among patients who underwent TNL (26.8%). Bleeding requiring hemotransfusion was observed only after PNL (14.3%). Obstructive complications were observed in all study groups. For them, internal stenting was most often performed after ESWL (10.9%), puncture nephrostomy - after TNL (7.3%). Statistically significantly higher VAS measured quality of life was found after ESWL (7.9) and PNL (7.0) compared with THL (4.8). CONCLUSION: All three methods (PNL, TNL and ESWL) for treating lower calyceal stones sized from 10 to 15 mm are quite effective. Using them separately or in combination allows most patients to safely achieve a stone-free state.

[Internal drainage in cancer patients: optimizing treatment of stent-related symptoms].

INTRODUCTION: The so-called stent-related symptoms caused mainly by detrusor overactivity due to distal ("cystic") curl of the internal stent are common among patients with this type of drainage. The need for long-term stenting makes the quality of life of cancer patients one of the challenging problems of modern urology. The aim of this study was to optimize treatment of stent-related symptoms in cancer patients with internal long-term stents by complementing the treatment regimen with m-anticholinergic solifenacin. MATERIALS AND METHODS: From November 2013 to November 2015 68 cancer patients (26 males, 42 females, age 36-79 years) underwent elective internal ureteral stenting for drainage of the upper urinary tract (UUT) with special long-term stents coated with the hydrogel. The urinary tract obstruction was caused by urological (24), gynecological (26) and colorectal (18) cancers. Before deciding on urinary tract drainage, all patients were treated with radiation or chemotherapy, 28 (41.2%) patients underwent surgery, but on admission all of them had contraindications to radical surgery for different reasons. In 52 (76.5%) patients UUT stenting was performed using transurethral access, in 12 (17.6%) by percutaneous access and in another 4 (5.9%) by the combined access with patients in the supine position. Percutaneous and combined access was used in cases of impracticability (failure) of transurethral stenting. Patients in group 1 (n=32) after stent placement received standard therapy co-administered with solifenacin 5 mg daily, group 2 (n=36) - only standard therapy. The data analyzed were the technical features of the internal drainage, optimal access and registered solifenacin-related adverse events. Control examinations were scheduled once in 3 months after stent placement according to the following algorithm: ultrasound scanning, laboratory test monitoring and, if indicated, plain urography. To objectify the severity of stent-related symptoms, a survey of patients using a special questionnaire was conducted. Visual analog scale was used to measure subjectively the patients condition. RESULTS: After 12 months only 48 patients (26 from group 1 and 22 from group 2) completed the study. Follow-up examinations revealed that the patients in group 1 had significantly lower score of stent-related symptom severity and better ratings in visual analog scale. The greatest difference (1-2 points) was found in urgency and urinary frequency scores. The safety profile of solifenacin 5 mg corresponded to the findings of previous studies, there was no serious adverse events requiring discontinuation of the drug. CONCLUSIONS: Installing internal stents in UUT in cancer patients requires relevant experience in Roentgen-endoscopic operations using transurethral and percutaneous approaches and special equipment. In most cases, for preventing and eliminating supravesical obstruction in cancer patients, special internal stents for the long term placement are required. The add-on solifenacin therapy 5 mg/day resulted in almost 20% reduction in the severity of stent-related irritative symptoms and improved the quality of life in this extremely challenging category of patients.

[Age-related androgen deficiency and benign prostatic hyperplasia: how to improve the rehabilitation of patients after transurethral surgery?]

RELEVANCE: Age-related androgen deficiency often coexists with benign prostatic hyperplasia (BPH), which requires surgical treatment. At the same time, severe lower urinary tract symptoms secondary to BPH are considered a relative contraindication to testosterone replacement therapy. The aim of this study was to evaluate the importance of correcting age-related androgen deficiency in patients with benign prostatic hyperplasia after transurethral operations. MATERIALS AND METHODS: The study comprised 60 patients with androgen deficiency (plasma testosterone levels below12.1 nmol/L) detected during preoperative workup for BPH surgery. All patients were operated on within 30 days after the study enrollment. During that time prior to surgery, all patients received tamsulosin 0.4 mg once daily to prevent acute urinary retention. In all cases, bipolar transurethral resection (TUR) of the prostate was performed. The patients were divided into two groups of 30 men. The patients of the study group received 50 mg of testosterone as a 1% topical gel Androgel from the time of diagnosis and for 12 weeks postoperatively. In the control group, the patients were managed without testosterone replacement therapy. The primary endpoint of the study was the libido scores measured by the AMS and IIEF-5 scales. Secondary endpoints were total testosterone level by the end of treatment, the incidence of hemorrhagic and infectious complications after surgery, I-PSS and QoL scores, prostate volume and urinary flow rate. RESULTS: In the study group, AMS score, IIEF-5 score and testosterone level were 48, 15 and 4.2 nmol/L preoperatively, and 21, 22 and 18 nmol/L after treatment completion, respectively. In the control group post-treatment values did not differ from baseline. The incidence of bleeding complications was 3% in the study group and 10% in the control group; the incidence of postoperative prostatitis was 6 and 13%, respectively. There were no differences in the prostate volume and urinary flow rate. I-PSS scores and quality of life indices were not statistically significantly better in the study group. No adverse events associated with the use of Androgel were observed. CONCLUSION: Detection of age-related androgen deficiency should be included in the preoperative evaluation of patients with BPH. Correcting androgen deficiency results in greater effectiveness and safety of the surgery and leads to a more favorable postoperative course. Testosterone replacement therapy after transurethral resection of the prostate enables achieving sexual and social rehabilitation of patients.

[Use of Vitaprost (tablets and rectal suppositories) for patients rehabilitation after invasive diagnostic urological interventions].

The successful experience with the drug Vitaprost in the treatment of chronic prostatitis, and the emerging research evidence on the use of the drug in the treatment of urinary disorders served as a prerequisite to conduct a prospective study comparing the effectiveness of the combined application of rectal suppositories Vitaprost forte and Vitaprost tablets (production of JSC Nizhpharm, STADA CIS) in the rehabilitation of patients who had undergone invasive urologic procedures. 90 patients who underwent prostate biopsy (63) and urethrocystoscopy with bladder biopsy (27) were followed from January to July 2015. All patients were randomized to the control group (n=50) and the intervention group (n=40). Patients assigned to the control group were treated with standard anti-inflammatory therapy, and intervention group besides standard therapy received rectal suppositories Vitaprost forte for 10 days with the transition to Vitaprost pills also for 10 days. Treatment efficacy was evaluated by comparing the subjective and objective measures before and after biopsy in both groups, and rates of complications and adverse events. The both formulations of Vitaprost were well tolerated. Objective parameters (Qmax, prostate volume) in groups at 1 month did not differ significantly. However, there was a statistically significant greater reduction in subjective indicators (I-PSS, QoL) in the study group (12,4+/-1,1 and 2,1+/-0,4 points, respectively) compared with the control group (15,8+/-1,9 and 3,2+/-0,6 points, respectively). Also, patients treated with Vitaprost, had significantly higher scores in IIEF and Well-Being Index on a visual analog scale. Vitaprost use resulted in reduced risk of acute urinary retention and frequency of hematospermia. To conclude, the combined use of Vitaprost forte and Vitaprost in the rehabilitation of patients after invasive urologic interventions is beneficial in terms of improvement of patients subjective and objective indicators.

[THE MODERN VIEW OF CONSERVATIVE THERAPY OF LOWER URINARY TRACT SYMPTOMS IN MEN].

This literature review summarizes recent evidence on monotherapy and combined treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Particular attention is given to the latest publications on this topic presented at the 30th Congress of the European Association of Urology. α-blockers, 5α-reductase inhibitors, anticholinergics and phosphodiesterase type 5 inhibitors are the main classes of medications for monotherapy. Combination therapy of the above medications is the most promising part of this trend in urology allowing increase the effectiveness of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. A personalized approach to therapy involves a thorough examination of the patient and the administration of treatment according to his individual needs.