[A comparative analysis of the effectiveness of serenoa repens and serenoa repens in combination with urtica dioiccus for lower urinary symptoms suggestive of benign prostatic hyperplasia associated with chronic inflammation in prostate tissue].

INTRODUCTION: Benign prostatic hyperplasia (BPH) is the most common proliferative disease of the prostate gland in the elderly. MATERIALS AND METHODS: The results of an open, randomized comparative study of the effectiveness of Serenoa repens in the combination with Urtica dioiccus (Prostagut-forte) are presented in the article. All patients were divided into two groups, depending on the therapy. In group I (n=51) Serenoa repens in combination with Urtica dioiccus 160/120 mg twice daily for 3 months was given, while in Group II (n=51) patients were prescribed to Serenoa repens 320 mg once a day, for 3 months. RESULTS: According to the results, herbal preparations, like Serenoa repens, are effective for the medical treatment of BPH, which is confirmed by a decrease in LUTS severity, an increase in Qmax, a decrease in postvoid residual urine volume and an intensity of the inflammatory process in the prostatic tissue. However, in patients with BPH associated with chronic inflammation, it is preferable to use Serenoa repens in combination with Urtica dioiccus.

[Histopathological evaluation of the evolution of oral mucosa grafts used for augmentation urethroplasty].

INTRODUCTION: The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra. AIM: to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty. MATERIAL AND METHODS: A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied. RESULTS: The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium. CONCLUSION: The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.

[The influence of urethral stricture disease and urethroplasty on anxiety and depression in men].

INTRODUCTION: The relationship of surgical treatment of urethral stricture and such mental deviations as anxiety and depression is still poorly understood. Particularly, there is no reliable data on how mental status is associated to surgical treatment of the urethral stricture and its efficacy. AIM: to study the indicators of anxiety and depression in patients with urethral stricture before and after surgery. MATERIALS AND METHODS: The prospective study involving 30 men aged 20-74 years with urethral stricture of various etiologies and localizations was conducted. The validated questionnaires, HADS-1 and HADS-2 were used to evaluate anxiety and depression, lower urinary tract symptoms (I-PSS-QoL), erectile dysfunction (IIEF-5) before and 3 and 6 months after surgery. RESULTS: Almost all patients with urethral stricture before surgery had an increased level of anxiety and depression, which in 70% cases decreased to normal values by 6 months after successful surgery. Clinically, these changes correlated with the improvement of lower urinary tract symptoms. The restoration of erectile function in patients by 6 months was less pronounced, though it had no influence on the resolution of anxiety/depression. CONCLUSION: The determination of psycho-emotional status in patients with urethral stricture before and after urethroplasty should be as important for the evaluation of the efficiency of surgical treatment, as the resolution of lower urinary tract symptoms and restoration of sexual function.

[Frequency and risk factors for the development of infravesical obstructions caused by surgery of benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.

[Comparative analysis of one- and two-stage augmentation urethroplasty with dorsal INLAY buccal graft for extended stricturesof spongious urethra].

INTRODUCTION: Urethral reconstructive surgery is in constant development. At present, reconstructive urethroplasty with buccal mucosa is increasingly being used. The study aimed to compare the results of a one- and two-stage augmentation urethroplasty with dorsal inlay buccal graft for strictures of the spongious urethra. MATERIALS AND METHODS: The study comprised 72 patients aged 19-64 with urethral strictures 3-18 cm long. In 34 (47.2%) patients, the stricture was localized in the penile urethra, in 30 patients (41.6%) in the penile-bulbous urethra and in 8 patients (11%) in the bulbous urethra. All patients underwent augmentation urethroplasty with dorsal inlay buccal graft. The results were evaluated separately in 55 (76.4%, group 1) and 17 (23.6%, group 2) patients who underwent one-stage and two-stage surgery, respectively. RESULTS: The incidence rate of early postoperative complications was higher after one-stage (23.6%) compared two-stage surgery (11.8%) (p<0.05). Hematomas, wound dehiscence and urethrocutaneous fistulas were observed only after single-stage surgery. Primary healing of extensive strictures following augmentation urethroplasty with dorsal inlay buccal graft was achieved in 88.9% of patients; treatment effectiveness in the group 1 was 89.1%, in the group 2 - 88.2% (p>0.05). The final effectiveness of the operation, achieved with the use of additional surgical interventions, is estimated at 98.6%. CONCLUSION: The results of augmentation urethroplasty with dorsal inlay buccal graft do not depend on the number of stages, but fewer complications accompany two-stage surgery.

[Evaluation of testosteronemia in men undergoing surgery for urethral strictures].

INTRODUCTION: Testosterone plays an important role in the functioning of various organs and systems of the male body. Its diagnostic and prognostic values are studied both in urological diseases and in the patients undergoing non-urologic surgery. AIM: To investigate changes in testosterone level in patients with urethral strictures (US) depending on its baseline level, the cause of US, the age of patients and the number of surgeries. MATERIALS AND METHODS: The study comprised 30 patients aged 19-63 years with traumatic (76.7%) and inflammatory (23.3%) US. Primary and recurrent US were diagnosed in 25 (83.3%) and 5 (16.7%) patients, respectively. Nineteen (63.3%) patients underwent excision and primary anastomosis, while replacement urethroplasty was performed in 11 (36.7%) patients. In addition to the standard diagnostic work-up, all patients were tested for total serum testosterone 24 hours prior to surgery and at 1, 3, 7, 14 days after the operation. RESULTS: 33.3% of men with US had a testosterone deficiency in the absence of any testicular or endocrine injuries and diseases. Surgery was associated with a drop in testosteronemia in 83.3% of patients. The degree of postoperative testosterone level decline and its changes were significantly influenced by the age of patients and the number of operations. Men who had baseline testosterone deficiency and underwent repeat surgeries remained in a hypogonadal state throughout the postoperative period. CONCLUSION: Investigating the clinical value of testosterone in men with US and the risks of their surgical treatment associated with testosterone deficiency will provide insight into the role of testosterone in the treatment of this condition and the decision-making regarding pharmacological correction of testosterone deficiency in patients undergoing surgery for US.

[SURGICAL TREATMENT OF STRICTURES OR OBLITERATIONS OF URETHRA].

The article introduces the clinical and statistical analysis of 113 patients treated for urethral strictures (US) in the urological clinic of the Rostov State Medical University in 2011. 58% of patients experienced a recurrent course of the disease. Radical curative surgery was possible in 93 (82.3%) patients. In other cases, non-invasive strategy was indicated (13.3%) or surgery for urethral stricture was impossible due to comorbidities (4.4%). Resection with urethral end-to-end anastomosis, which is the most effective approach to the treatment of patients with US, was possible in only half of the patients (51.8%). In the rest of the patients, one-, two- or more stage urethroplasty substitution was carried out. By the end of 2013, treatment of 84 (90.3%) patients was completed with a total of 110 operations. 9 (9.7%) patients were scheduled for operation in 2014.

[THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF STRICTURE DISEASE OF THE MALE URETHRA].

The article presents a comprehensive study of 121 patients with stricture disease of the male urethra. Diagnosis and staging of the disease were made on the basis of medical imaging, namely retrograde urethrography, voiding cystourethrography and magnetic resonance imaging with complex pulse sequences developed by the authors. The results were compared with surgical findings and morphological study of surgical specimens. Detailed semiotics of magnetic resonance imaging of stricture disease, differences in the visualization of traumatic and inflammatory strictures of various locations, as well as features of primary and recurrent lesions are described. Detailed analysis of the data shows significant advantages of MRI in identifying stricture disease of the male urethra over traditional methods of endoscopic visualization. It makes possible to increase the diagnostic accuracy for detection of the disease and better surgical planning strategy.

[Dynamic magnetic resonance imaging in the diagnosis of male urethral diseases (a complex of pulse sequences)].

OBJECTIVE: To estimate the capabilities of a developed complex of pulse sequences (PSs) for magnetic resonance imaging (MRI) to diagnose male urethral diseases. MATERIAL AND METHODS: The results of MRI, X-ray contrast retrograde urethrography (RUG), and voiding cystourethrography (VCUG) were analyzed in 46 patients of different ages who were treated for suspected urethral pathology at the Urology Unit, Rostov State Medical University Clinic. RESULTS: An algorithm is proposed for tomographic examination of the male lower urinary tract, which involves patient preparation and positioning, a list of PSs and the order of their use, and their parameters. The MRI semiotics of urethral stricture disease is described. There is information on the clinical application of MRI in urologic practice, which is compared with the results of other medical imaging and the data of surgical intervention and histological examination of the material obtained. CONCLUSION: Along with the known advantages of MRI over other radiation techniques, the complex of PSs proposed to study the male urethra surpasses conventional X-ray contrast RUG and VCUG in diagnostic informative value. This MRI technology can reliably identify and accurately locate stricture or obliteration of the urethra in its all portions and determine the extent and degree of abnormal urethral narrowing, as well as provides a way of estimating the extent of fibrous changes in the spongy body.

[Internal optic urethrotomy in urethral strictures complicates subsequent reconstructive surgery].

The results of open reconstructive operations performed in 86 patients with traumatic urethral stricture show that the efficacy of these operations and frequency of complications are lower in using urethroplasty as a primary treatment while primary internal optic urethrotomy significantly reduces possibility of effective surgery without complications.

[Magnetic resonance imaging of the penis. Its normal anatomy].

OBJECTIVE: To estimate the capabilities of magnetic resonance imaging (MRI) to identify penile anatomic structures and their topographic relationships. MATERIAL AND METHODS: Penile MRI results were analyzed in 52 men of different ages who had no history, clinical, laboratory, and radiological data in favor of diseases of this organ. RESULTS: Penile imaging technology and its algorithm, including patient preparation and posi-tioning and a list of impulse sequences and their parameters, are proposed. Penile MRI and anatomy are described in detail; magnetic resonance signal characteristics of the main structural elements of the organ and its adjacent tissues on T1- and T2-weighted images are specified. The MRI morphometry results of the cavernous and spongy bodies, urethra, and penis as a whole, which agree well with the similar known literature data, are given. CONCLUSION: The investigation has provided evidence for the high informative value of the technique in recognizing the relatively small anatomic structures of the penis, which is comparable with that of the morphological study of a gross specimen of this organ, which in turn predetermines a further investigation of the capabilities of MRI to diagnose penile diseases and to estimate the quality of their treatment.

[Microbial contamination of penile tissues as a risk factor for complications in the treatment of hypospadia].

Biopsy of the skin, fascia and urethra was performed in 29 cases of urethroplasty for hypospadia in children and adults. The patients were divided into two groups: group 1 (n=14) with primary plastic urethra and group 2 (n=15) with secondary urethroplasty of hypospadia with complication. Tissue samples were examined microbiologically and morphologically. Focal infection of penile skin was found after iodopiron sterilization as well as contamination of the skin, fascia and urethra in all the patients of group 2. Nonclostridial anaerobes dominated among the bacteria. Microbiological investigations in groups 1 and 2 proved a great role of Bacteriodes fragilic in the development of penile tissue inflammation.

[Classification of urethroplasty complications in hypospadias].

The article presents the data on surgical treatment of 126 patients with hypospadias (a total of 343 operations). This experience gave rise to classification of complicated forms of hypospadias proposed by the authors.

[Cystourethroanastomosis in extended obliterations and strictures of the posterior urethra in men].

The authors review short- and long-term clinical results of surgical treatment of extended urethral strictures and obliterations. A new vesicourethral anastomosis was created by novel technique with longitudinal suturing of the neck of the urinary bladder. A scheme of the operation is presented. Causes necessitating this plastic intervention are analysed. Variants of possible urine incontinence after operation depending on etiological cause of the stricture or obliteration of the posterior urethra in males are considered.

[Extracorporeal shock-wave therapy in Peyronie's disease]. / Udarno-volnovaia terapiia pri bolezni Peironi.

The aim of the study was to validate clinical methodology on application of shock-wave impact on plaques in Peyronie's disease (PD). We studied short- and long-term results of extracorporeal shock-wave therapy (ESWT) in 54 patients 3, 6 and 12 months after the exposure. We performed ESWT sessions on different lithotriptors using different mechanisms of shock wave mechanism (hydromechanical and piezoelectric). Choice of the ESWT technique was based on the thickness and density of the plaque. The proposed ESWT method provides an effective treatment of the disease basing on the initial angle of penis deformation in erection.

[Endoscopic nephropexy]. / Endoskopicheskaia nefropeksiia.

In line with new prospects, introduction of laparoscopic technique in nephropexy gave rise to some problems. One of them--postoperative rotation of the kidney (RK). Upper-pole endovideosurgical nephropexy (EVSN) with prolen net performed in the diagnostic center "Zdoroviye" in 90 patients has demonstrated that late after surgery 9 (10%) patients had pains provoked by RK and abnormal renal circulation confirmed by Dopplerography. In 1998 specialists of the diagnostic center "Zdoroviye" developed a novel method of EVSN providing elimination of the ptosis and RK. A total of 88 patients have been operated since. 67 patients with nephroptosis and RK have undergone nephropexy with a splitted flap of the prolen net, 21 patients without RK--standard nephropexy. Long-term postoperative follow-up showed that only 3 of 88 patients failed to retain normal velocity of the major renal blood flow, though they improved this velocity noticeably. Thus, a differentiated approach to EVSN based on dopplerographic examination of the major renal blood flow brings about improved treatment results in nephroptosis.

[State of the gastric mucosa in patients with benign prostatic hyperplasia in the early postoperative period at initial stages of chronic renal failure]. / Sostoianie slizistoi obolochki zheludka u bol'nykh s dobrokachestvennoi giperplaziei v rannem posleoperatsionnom periode pri nachal'nykh stadiiakh khronicheskoi pochechnoi nedostatochnosti.

Biochemical, endoscopic and morphological tests were made to study changes in gastric mucosa and activity of antioxidant defense enzymes of the blood in patients with benign prostatic hyperplasia and initial chronic renal failure early after transvesical adenomectomy. Acute erosive-ulcerative lesions of gastric mucosa and acute gastric hemorrhages arose most frequently in patients with latent stage of chronic renal failure operated on without preoperative preparation. Preoperative medication lowers probability of the complications.

[A new approach in the surgery of prostatic sclerosis]. / Novyi podkhod v khirurgii skleroza predstatel'noi zhelezy.

The authors propose a new technique of prostatic sclerosis surgery which makes use of a transperineal approach and is based on the principles underlying surgical management of posterior urethra high strictures with establishment of a cystourethral shunt. Good results obtained in 17 patients with prostatic sclerosis allow the authors to consider the above procedure as an alternative to transvesicular prostatectomy according to V. S. Karpenko.

[The validation of applying a longitudinal suture to the bladder neck in bladder-urethra anastomosis]. / Obosnovanie nalozheniia prodol'nogo shva na sheiku mochevogo puzyria pri tsistouretroanastomoze.

The author gives theoretical validation for placing a longitudinal suture instead of a cross suture on the bladder cervix in cystourethral shunting. Cross sutures preclude deviations in the shunt region thus reducing probability of urethral stricture recurrences. For conduction of the suturing a special device "needle bougie" has been developed. Surgical treatment of 11 patients with recurrent strictures of the prostatic urethra with the use of the above unit secured positive results in all those treated.