[The use of neural algorithms when choosing a method of surgical treatment of urolithiasis].

AIM: to assess the possibility of using neural network algorithms in choosing a method for surgical treatment of urolithiasis. MATERIALS AND METHODS: treatment results of 625 patients with kidney stones were analyzed in the study. Information about each patient was presented in the form of a multidimensional vector characterized by following preoperative investigations: questionnaires, clinical examination, instrumental and laboratory studies. A register was created where information on more than 50 parameters for each patient was added. Each example has an output parameter representing a predefined treatment strategy (extracorporeal shock-wave lithotripsy [ESWL] - 1, percutaneous nephrolithotomy [PCNL] - 2, pyelolithotomy or nephrolithotomy - 3). The initial database served as the basis for training the neural network estimation technique. RESULTS: A prospective trial was conducted to assess the clinical efficiency of the recommendations of neural network. A cohort of 150 patients admitted to the urology department was divided into two groups of 75 people. In the group 1, patients received treatment according to the standard recommendations. In group 2, treatment strategy was chosen based on the results of neural network analysis. In the group 1, ESWL was performed in 40 (53.3%) patients. The average number of sessions was 1.8. At the discharge, residual fragments were diagnosed in 12 (30%) cases. In 4 patients, acute pyelonephritis developed, which required performing ureteral catheterization and subsequent treatment. In group 1, the efficiency of ESWL was 75%. In the group 2, where the neural network assessment technique was used, the average number of sessions was 1.4. At the discharge, 7 (15.6%) patients had residual fragments: 4 in the kidney, in 3 in the lower ureter ("steinstrasse"). In 4 cases, a conversion for PCNL was performed. ESWL efficiency was 91.1%. Stone-free rate for ESWL in the second group was significantly higher due to the greater number of stone fragmentation. In addition, number of shock waves was lower (the average number of sessions was 0.4 less). Improvement of treatment tactics through the use of neural network algorithms led to a decrease in hospitalization times, as well as to an improvement in the quality of treatment. The low efficiency of ESWL, as the first-line method, led to a change in treatment tactics in 25% of patients in group 1 and only in 8.9% of patients in group 2. Using these algorithms, it was possible to reduce hospitalization time, need for changing treatment strategy, number of auxiliary procedures, readmission rates, the incidence of inflammatory complications, and the number of residual fragments after ESWL. CONCLUSIONS: The possibility of using the neural network prediction technique at the preoperative stage in patients with kidney stones has been shown. This technique allows practicing urologist to make a decision on the choice of the optimal treatment method on an individual basis, thereby minimizing the risk of early postoperative complications.

[Specific features of the immune status and blebbing of the plasmatic membrane of lymphocytes patients with urolithiasis complicated by the pyelonephritis].

INTRODUCTION: According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role. AIM: To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis. MATERIALS AND METHODS: A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes plasmatic membrane was evaluated by phase contrast microscopy. RESULTS: It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.

[Acute uncomplicated cysititis: do we follow the guidelines?]

INTRODUCTION: Lower urinary tract infection are a common urologic disease, but a therapy is not always optimal. AIM: to evaluate the compliance of prescriptions made by urologists in treatment of patients with lower urinary tract infection, in particular with acute uncomplicated cystitis. MATERIALS AND METHODS: A specially designed questionnaire was filled out by 161 urologists from Novosibirsk, Barnaul and Krasnoyarsk, as well as participants of VII Congress of urologists of Siberia. RESULTS: The survey showed that 34.8%, 27.9%, 22.4% and 14.9% of urologists had 6-10, 11-20, 1-5 and more than 20 patients with acute uncomplicated cystitis a month, respectively. According to results, 91.9% of urologists are familiar to National guidelines on treatment of lower urinary tract infections and 91.2% of doctors consider them to be reasonable. Among those surveyed, 29.2% of urologists believe that National Guidelines differ from European Guidelines; 95.7% of participants adhere to recommendations, but only 47.4% respect it almost always, 16.9% do it in half of cases and the remaining 35.7% comply with them in less than 40% cases. Moreover, 86.4% of urologists started a treatment of acute cystitis with antimicrobial therapy and preferred fosfomycin in 41.0%, nitrofurans in 20.9%, fluoroquinolones in 21.6% and cephalosporins in 16.5% cases, respectively. Almost all respondents (93.8%) are convinced that antibiotic therapy should be accompanied by phytotherapy, and 71.5% of urologists administer Canephron. CONCLUSION: In the urologic community there are controversies in the treatment of patients with acute uncomplicated cystitis. The choice of therapy is not always optimal.

[Troyakov. Experience in using hytolysin in the integrated management of urinary tract infections and methapylactics of nephrolithiasis].

RELEVANCE: Urinary tract infection (UTI) are a risk factor for diseases leading to impairment of renal function and kidney stone disease (KSD). Growing resistance of uropathogens to antibacterial agents is a challenging issue in most countries of the world. Urolithiasis is the second most prevalent urologic condition following urinary tract infections and has a pronounced tendency to recur. Rational stone metaphylaxis leads to a significant reduction in the incidence of recurrent stones. In recent decades, there has been a markedly increasing interest in plant-based therapies in managing urologic diseases. AIM: To evaluate the effectiveness of phytotherapeutic medication Phytolysin in the integrated management of UTI and metaphylaxis of urolithiasis. MATERIALS AND METHODS: Comprehensive evaluation of the effectiveness of Phytolysin was conducted at the Department of Urology, I.M. Sechenov First MSMU and Department of Urology, Andrology and Sexology, Voino-Yasenetsky Krasnoyarsk SMU in 40 women with episodes of exacerbation of chronic cystitis and 30 patients of both sexes during the postoperative metaphylaxis of the KSD. The age of the patients ranged from 20 to 68 years (mean age 40+/-2,8 years). RESULTS: Adding Phytolysin to the integrated management results in the improvement in general clinical signs and laboratory parameters of blood and urine, leads to a decrease in the level of leukocyturia, bacteriuria and an increase in diuresis and urinary alkalinization, reduces the number relapses of UTI and stone formation. CONCLUSION: Phytolysin is an effective and safe medication.

[The study of effectiveness of polyhydroxyalkanoates based biodegradable stents in ureteropelvic segment pyeloplasty].

INTRODUCTION: Among urologic diseases, ureteropelvic segment stenosis with hydronephrosis is a common indication for instrumental or surgical correction. The restriction of urine flow with dilatation proximal to obstruction develops in 6.5-37% of cases at different times after the ureteral reconstruction. All this urges to develop and improve stents and search for effective ways to place stents and control their function. AIM: To investigate the effectiveness of polyhydroxyalkanoates based biodegradable stent compared with a commercial analogue in upper urinary tract drainage after ureteropelvic segment pyeloplasty. MATERIALS AND METHODS: Morphological and functional changes in the stented ureter were investigated in 45 male rabbits of "Soviet chinchilla" breed weighing 4550-5200 g that underwent stenting of ureteropelvic segment (UPS). The study used polymeric stents based on poly-3-hydroxybutyrate, poly-4-gidroksibutirotom P (3GB/4GB) and a mixture of poly-3-hydroxybutyrate with polycaprolactone II (3GB)/PCL with the inclusion of PCL 75%; the control material was polyurethane stents. Morphologic evaluation was conducted on ureteral fragments and UPSs in the area of the stent placement at 7, 14 and 28 days after operation. RESULTS: Throughout the experiment, excretory urography and spiral tomography in experimental groups showed no changes in the pelvicalyceal system after placing polymeric stents. The morphologic examination in the experimental group at day 28 after surgery revealed preserved longitudinal folding of ureteral mucosa and absence of muscle hypertrophy. Transitional epithelium had no signs of atrophy and desquamation, its mean thickness was 112.4+/-8.5 mm, whereas in the control group a productive inflammation resulting in sclerosis was found to develop. CONCLUSIONS: We conducted a comparative study of morphologic and functional changes in rabbit ureters after stenting using polyurethane stents (control group) and polymeric stents made of poly-3-hydroxybutyrate, poly-4-hydroxybutyrate II (3GB /4GB) and a mixture of poly-3-hydroxybutyrate with polycaprolactone II (3Gb)/PCL (experimental group). Despite the difference in physical and mechanical properties of biodegradable PGA-based stents, the tissue response to both types of stent was comparable. Ureteral wall preserved longitudinal folds, there was no muscle layer hypertrophy, and mucous membrane had smooth contours with a uniform thickness of the transitional epithelium, whereas in the control group a productive inflammation resulting in sclerosis was found to develop.

[RATIONAL THERAPY FOR RECURRENT INFECTIONS OF THE LOWER URINARY TRACT. THE RESULTS OF A PROSPECTIVE OBSERVATIONAL PROGRAM TO ASSESS THE EFFECTIVENESS AND SAFETY OF CEFORAL®, SOLUTAB®* AND URO-VAKSOM® IN PATIENTS WITH RECURRENT UNCOMPLICATED LOWER URINARY TRACT INFECTIONS (FLORA)].

Remaining generally unchanged, urinary tract infection (UTI) treatment protocols require continuing monitoring due to growing antibiotic resistance and lowered immune status of the majority of patients. The article presents the results of a prospective observational program carried out the Russian Federation in to assess the effectiveness and safety of Ceforal®, Solutab® and Uro-Vaksom® in patients with recurrent uncomplicated lower urinary tract infections (FLORA). The results of the program suggest that Ceforal® Solutab® and Uro-Vaksom® administered as a part of routine clinical practice contribute to a significant reduction in the number of UTI recurrences and have a good safety profile. These findings support recommendation to use this treatment protocol in patients with recurrent UTI, taking into account individual and epidemiological features.

[Nephrolithiasis: choice of optimal treatment].

As shown by the results of 113 percutaneous operations for nephrolithiasis, percutaneous nephrolithotomy with lithoextraction is effective in dense, large, multiple, and in some cases, in stag-horn concrements. This operation is a method of choice. Mean duration of the operation is 38.3 +/- 3.8 min, hospital stay is 9.4 +/- 1.6 days.

[Modified percutaneous nephrolithotripsy as monotherapy in stag-horn nephrolithiasis with complex stereometric configuration].

Percutaneous nephrolithotripsy (PN) was used as monotherapy in modification with one additional nephroscopic approach in surgical treatment of 57 patients suffering from stag-horn nephroliths with complicated stereometric configuration. According to classification of stag-horn concrements, C3 and C4 groups comprised 36 (63.1%) and 21 (36.9%) patients, respectively. The greater part of the stone was removed through a standard percutaneous approach regarding the angle of a rigid nephroscope, the other part of the concrement was evacuated through an additional transcutaneous approach for a small-diameter nephroscope. A mean duration of the operation was 60-150 min. The internal stent-catheter was not installed. Residual concrements were detected in 2 (5.6%) and 4 (19%) cases, in C3 and C4, respectively. The presence of residual fragments is explained by complicated stereometric configuration, high density of the concrements, technical difficulties in surgical intervention. As in such cases residual fragments were clinically significant, they were destroyed ub fragments and eliminated according to the "second look" technique in early postoperative period (day 3-4) through nephrostomic fistulas. All the patients were discharged from the hospital in satisfactory condition on postoperative day 5-9. This modification has advantages: one-stage removal of the stone, low invasiveness and traumatism.

[Urolithiasis morbidity in Tadzhikistan regions: some biogeochemical and environmental factors].

The aim of the study was to investigate urolithiasis prevalence in the main administrative regions of Tadzhikistan, to ascertain effects of drinking water quality, water pollutants and other environmental factors on urolithiasis morbidity in endemic regions of Tadzhikistan. It was found that high urolithiasis incidence rate in some regions was associated with high water pollution (class III and IV), its high natural mineralization and hardness, high content of chlorides, sulphates and other components of salt composition, organic and non-organic pollutants. Chemical and microbiological tests showed that sanitary standards were not strictly observed in the regions with high urolithiasis morbidity. These regions are also characterized by high incidence of acute intestinal infections, thyphoid, nephropathies, high environmental pollution, high density of population.

[Potentialities of current methods for laboratory analysis in the evaluation of the severity and prevalence of nephrolithiasis in Tajikistan].

The investigation was undertaken to study a relationship between some biogeochemical and environmental factors and nephrolithiasis morbidity rates in the regions of Tajikistan. The paper presents the data of an integrated examination involving biochemical, chromatographic, and mass-spectrometric studies of 1180 patients aged 14 to 76 years who have been treated at the Dushanbe Urology Medical Center. The investigation established a relationship of an increase in ICD morbidity in poor environmental regions of the Republic of Tajikistan to the high organic and non-organic pollution, the high natural mineralization and hardness of water, and the elevated levels of chlorides, sulfates, and other salt components, which in turn influences the severity of a pathological process.