[Assessment of sexual function and quality of life in women with postcoital cystitis].

INTRODUCTION: According to the literature, 20-50% of women will experience urinary tract infection (UTI) in their lifetime, and in 10-30% of cases, cystitis will recur. Despite the high prevalence of recurrent UTI, there are lack of studies dedicated to its impact on the quality of life, and the influence of postcoital cystitis on the quality of life and sexual function has not been previously evaluated. AIM: To assess the quality of life and sexual function in patients with recurrent postcoital cystitis before and after transposition of the urethra. MATERIAL AND METHODS: Women suffering from recurrent postcoital cystitis, who underwent urethral transposition from 2019 to 2021 were included the study. The SF-12v2 questionnaire was used to assess quality of life, while sexual function was evaluated using Female Sexual Function Index [FSFI]. Questionnaires were filled out by 70 patients, before and after surgery. RESULTS: All domains of the quality of life were significantly different in the pre- and postoperative period. More pronounced changes were found in the mental health-related quality of life. In addition, there were significant differences in each domain of FSFI and the overall score postoperatively compared to baseline. CONCLUSION: Our study reports a high prevalence of sexual dysfunction among women with recurrent postcoital cystitis as well as a reduced quality of life. This work shows the social significance of the problem, as well as the high rehabilitation potential of urethral transposition.

[Pathogenesis and treatment of postcoital cystitis: are our approaches correct?]

AIM: To study the pathogenetic factors in the development of postcoital cystitis and the efficiency of extravaginal transposition of the urethra. MATERIALS AND METHODS: Literature data and our point of view on the causes of postcoital cystitis are described. Case histories of 438 patients aged 18 to 61 (mean 24+/-1.3) were analyzed. The efficiency of extravaginal transposition of the urethra for the prevention of recurrence of postcoital cystitis was evaluated. RESULTS: The long-term results of operations in 315 patients were studied. A positive effect was noted in 297 (94.3%), which means the complete recovery or reduction in the frequency of cystitis to 2 or less times a year, while complete recovery occurred in 214 patients. In 18 (5.7%), the surgical procedure was ineffective, which required repeated interventions. DISCUSSION: According to our observations, the external opening of the urethra is located in patients with postcoital cystitis and in healthy women at the same level - before the introitus. During sexual intercourse, everyone experiences vestibulo-vaginal frictional dislocation of the urethra, however, exacerbations of the inflammatory process in the bladder occur only in some females, which is associated with the multifactorial nature of the disease. CONCLUSION: Postcoital cystitis develops as a result of a complex of factors, the most significant ofwhich are the state of the vaginal microflora, the virulence of uropathogenic bacteria, the anatomical features of the urethra and vagina, its narrowness with a mismatch with the penile size, the intensity and duration of sexual intercourse, severe, complicated childbirth and surgical procedures in this area. Performing extravaginal transposition of the urethra according to Komyakov demonstrated high efficiency in the prevention of recurrence of postcoital cystitis.

[Lower urinary tract urodynamics after reconstruction of the pelvic part of the ureter].

INTRODUCTION: The problem of impaired urodynamics of the lower urinary tract after reconstructive surgery of the pelvic ureter remains almost unexplored in modern literature. There are only a few publications about the effect of operations in the area of the ureterovesical segment on bladder function. AIM: To study the function of bladder after replacing the pelvic ureter with bladder flap, small intestine or appendix. MATERIALS AND METHODS: We performed a retrospective analysis of reconstructive operations of the distal ureter, which were performed in 273 patients. Boari flap or its modifications were used in 142 (52%) cases; ureteroappendicocystanastomosis - 23 (8.4%) patients, and replacement of the pelvic ureter with small intestine in 105 (38.5%) cases. A follow-up urodynamics was carried out on the 10-14th day of the postoperative period, after 3 months, then after 6 and 12 months. We evaluated: uroflowmetry, cystometry, and pressureflow study. RESULTS: In 75 (53%) of 142 patients who underwent Boari flap or its modifications, varying degrees of disturbance of bladder urodynamics were observed. After isoperistaltic intestinal ureteroplasty in 2 (2.5%) of 79 patients, detrusor hyperactivity was observed, which was regressed following conservative therapy. Urodynamics of bladder did not suffer after appendicoplasty. CONCLUSION: Deformation, denervation and devascularization of detrusor are the main causes of bladder dysfunction after flap operations. Ileal ureter substitution with isoperistaltic position of the graft provides physiological passage urine from the kidney to the bladder, following good bladder function. The inclusion of antiperistaltic ileal loop in the urinary tract negatively affects the urodynamics.

[Technical features of intestinal ureteroplasty. Part 7: forming ureterointestinal anastomoses].

AIM: To present the results and technical features of forming the ureterointestinal anastomoses in intestinal ureteral substitution. MATERIAL AND METHODS: From 1998 to December 2016, 168 patients (mean age 51 +/- 8.7 years) underwent ureteral substitution using intestinal segments at the Urology Clinic of the I.I. Mechnikov NWSMU. Of them, 76 (45.2%) were males. In 119 (70.8%) patients, intestinal segments were used to replace various parts of the ureters (iliac in 92, colonic in 4, appendix in 23), and in 49 (29.2%) patients ureteroplasty was combined with orthotopic ileocystoplasty. 96 patients underwent isolated ureteral substitution with segments of the small and large bowel. RESULTS: Among the 96 patients, early postoperative complications occurred in 8 (8.3%) patients, whereof 5 (5.2%) required reoperations. Among them, 2 (2.1%) had a proximal anastomotic failure. Late postoperative complications occurred in 7 (7.3%) patients whereof 4 (4.2%) required surgical treatment. These patients developed strictures of the proximal ureter-intestinal anastomoses over 3 or more months after the operation. The urinary flow was restored by antegrade dilation. Vesicoureteral reflux occurred in 2 (2.1%) patients. However, it was not clinically evident and was not accompanied by hydroureteronephrosis and recurrent urinary tract infection. CONCLUSION: A perfect ureterointestinal anastomoses should be easy to create and have a low risk of stenosis and reflux. These requirements are met by direct anastomosis, which is associated with a minimal risk of stricture, and with isoperistaltic positioning and sufficient length (not less than 15 cm) of the graft provides antireflux protection. It should be noted that proximal (ureterointestinal) anastomoses are vulnerable in these operations and prone to the stricture formation. Unlike proximal, the distal anastomosis of the graft with the bladder is always wider, and therefore the risk of its narrowing is minimal. Isoperistaltic positioning of the graft prevents reflux formation.

[Technical features of intestinal ureteroplasty. art 6: simultaneous ureteral and bladder substitution].

AIM: To present the results and technical features of different methods of simultaneous ileal ureteral and bladder substitution. MATERIALS AND METHODS: From 2001 to 2016, 154 patients (mean age 52+/-9.2 years) underwent ileal and appendicular ureteroplasty. Of them, 70 (45.4%) were men and 84 (54.6%) women. Among them, 49 (31.8%) patients underwent ureteroplasty concurrently with orthotopic ileocystoplasty. The Studers ileal-ureter cystoplasty and Y-shaped bladder and ureteral reconstruction were performed in 38 (77.5%) and 11 (24.5%) cases, respectively. RESULTS: Early postoperative complications occurred in 8 (16.3%) patients: 4 of them suffered recurrent bouts of pyelonephritis, 3 experienced an acute adhesive intestinal obstruction, and another one had a failure the right-sided pouch-ureteral anastomosis. Late postoperative complications occurred in 7 (14.3%) patients. Of them, 3 suffered recurrent bouts of chronic pyelonephritis, 2 developed a pouch-ureteral-pelvic reflux, and 2 had strictures of ileoureteral anastomosis, requiring antegrade dilation with ureteral stenting. CONCLUSION: Simultaneous ureteral and bladder substitution is one of the most challenging and traumatic surgical interventions. Sometimes, due to severe comorbidities, disorders of upper tract urodynamics and decreased renal function, two-stage surgery may be necessary. At the first stage, cystectomy with cutaneous ureterostomy should be performed, and then, after the patients stabilization ileal substitution of the bladder and pelvic parts of ureters may be done.

[Technical features of intestinal ureteroplasty. Part 2: right-sided ileoureteroplasty].

AIM: To present the results of intestinal ureteroplasty and technical features of right-sided ileoureteroplasty. MATERIAL AND METHODS: From 2001 to 2015, 78 patients underwent isolated reconstruction of the ureter using a segment of the ileum, of whom 57 (73%) and 21 (27%) patients had unilateral and bilateral operation, respectively. In total, isolated segments of the ileum were used to substitute 101 ureters including 45 (44.6%) right ureters. RESULTS: The follow-up period ranged from 3 months to 14 years (mean 8.3 +/- 0.8 years). Early postoperative complications occurred in 8 (10.2%) patients and 5 (6.4%) of them required reoperation. Long-term postoperative complications occurred in 7 (8.9%) patients and 4 required surgical treatment. All patients had good results of conservative treatment and reoperations. There were no deaths. All patients achieved restoration of urodynamics and normalization of kidney function. CONCLUSION: Right-sided, especially total, ileoureteroplasty is the most technically challenging among other possible options to substitute the ureter with a small bowel segment. To avoid mesenteric torsion when performing isoperistaltic ureteroplasty, the graft should be placed above and in front of the intestinal anastomosis.

[Technical features of uretral intestinoplasty. Part 3: laparoscopic ileo- and appendiceal ureteroplasty].

PURPOSE: Presentation of the results and the technical features of the laparoscopic intestinal and appendicular ureteroplasty. MATERIALS AND METHODS: From 2001 to 2015, intestinal and appendicular ureteroplasty was performed in 103 patients. ileum was used for the replacement of ureteral defects in 78 (75.7%) patients, appendix - in 21 (20.4%), and colon - in 4 (3.9%). In 10 (9.7%) cases, the surgery was performed laparoscopically. Among them, 7 patients underwent ileoureteroplasty (6 - laparoscopic ileoureterocystoanastomosis, 1 - right-sided laparoscopic ileoureterocystoanastomosis by Yang-Monti) and 3 patients underwent appendiceal ureteroplasty. In one case, ileoureteroplasy was performed in patient with complete ureter duplication. RESULTS: The period of follow-up varied from 2 to 14 years, and the average follow-up period was 8+/-5.8 years. Complications occurred in 8 (8.1%) patients who underwent open ileo- and appendiceal ureteroplasty. Among the 10 patients who underwent laparoscopic surgery complications were not observed. The length of postoperative hospital stay was significantly shorter in patients who underwent laparoscopic surgery (median, 6 days) than in patients who underwent open surgery (median, 12 days). The results of treatment in all patients were successful. There were no fatal outcomes. CONCLUSION: The use of endovideosurgery for intestinal and appendicular ureteroplasty reduces surgical injury and reduces the length of hospital stay. However, there are not enough publications on this issue available in modern literature. To date, there are few number of operations performed, and it is not allow to consider the findings and conclusions as statistically significant.

[Technical features of intestinal ureteroplasty. Part 4: YANG-MONTI ureteric reconstruction with reconfigured ileal segment].

AIM: To present the results of ureteroplasty and technical features of ureteric replacement using the Yang-Monti procedure. MATERIAL AND METHODS: From 2001 to 2016, 105 patients underwent intestinal appendiceal ureteroplasty. In 5 (4.8%) cases, ureteric replacement using the Yang-Monti procedure was performed. Among them, 2 and 3 patients had left and right ureter replacement, respectively. RESULTS: Postoperative complications occurred in 2 of the 5 operated patients, and one of them required re-surgery. Repeat operations were successful; there were no deaths. CONCLUSIONS: The advantages of ureteric replacement using the Yang-Monti procedure include the ability to replace any ureteral defects 5-6 cm in length by using one ileal segment. However, this may result in an ileal segment with insufficient blood supply and partially lost contractility included in the urinary tract. For this reason, for more than a decade, this operation has not been widely adopted, and Yang-Monti procedure needs to be further assessed in larger comparative studies with longer follow-up.

[Technical features of intestinal ureteroplasty. part 5: bilateral ureteroplasty].

AIM: To present the results and the technical features of the various methods of bilateral ileal ureteroplasty. MATERIALS AND METHODS: From 2001 to 2016, 154 patients (mean age 52+/-9.2 years) underwent ileal and appendicular substitution of the ureter and urinary bladder. Study participants comprised 70 (45.4%) men and 84 (54.6%) women. All patients underwent comprehensive examination, including ultrasound, X-ray, radioisotope and endoscopic tests. Bilateral isolated ileal ureteroplasty was performed in 20 patients (40 substituted ureters) whereof in 14, 5 and 1 cases U-shaped, 7-shaped and two separate grafts were used, respectively. RESULTS: Postoperative complications occurred in 2 (10%) of 20 patients who underwent bilateral intestinal ureteroplasty. Acute small bowel obstruction occurred in a patient after a U-shaped substitution of extended defects of both ureters. He underwent relaparotomy, bypass ileotransverse side-to-side anastomosis. Another patient developed right-sided ureteral-intestinal anastomotic leak following bilateral 7-shaped ureteroplasty. After relaparotomy and right ureter ligation, the breakdown site of the graft was closed with suturing. Repeat operations were successful; there were no deaths. CONCLUSION: Bilateral ileal ureteroplasty is much more complicated surgery than a unilateral operation. For proper collection and preparation of ileal graft in isoperistaltic position without mesenteric torsion, one should know how to place it in relation to intestinal anastomosis. Depending on this, several types of bilateral ileal ureteroplasty may be used: U-shaped, bilateral 7-, J- or L-shaped or separate isoperistaltic ileoureteroplasty.

[Intestinoplasty of ureters].

The review provides a comparative evaluation of reconstructive surgery in patients with extensive restrictions of ureter using intestinal transplants. The questions relating to the main stages of intestinal reconstruction of ureters, forming intestinal transplant, technique of creating of anastomoses are discussed; a comparative analysis of long-term results and complications of intestinoplasty of ureters is performed.

[The results of intestinoplasty of ureters].

The article presents the immediate and long-term results of intestinoplasty of extensive uretral obstructions. From 2001 to 2012, 47 patients underwent intestinoplasty, and 3 patients--sigmoureteroplasty. 33 patients (66%) had unilateral lesions, and 17 (34%)--bilateral lesions. Postoperative complications occurred in 14% of cases. Early complications occurred in 6 (12%), late complications--in 1 (2%) patient. Complications requiring surgery occurred in 3 (6%) patients. The results of re-operations were successful. Deaths were not recorded. The observation period ranged from 3 months to 11 years. All patients achieved the restoration of urodynamics and normalization of kidney function. Intestinoplasty in extensive uretral obstruction is the operation of choice, as it allows to restore the flow of urine from the kidney, improves its function, arrests the chronic pyelonephritis and rescues patients from permanent renal and ureteral fistulas.

[Long-term results of appendicouretheroplasty].

The article presents the long-term results of 15 operations for replacement of urethral strictures of various locations by appendix. One patient undergone plastics of top third of the right ureter, other undergone replacement of it pelvic part, and replacement of left ureter was performed in 3 cases of replacement of pelvic part. Surgical technique was modified in 12 cases by using a cut area from head of blind colon for better appendicocystanastomosis. The follow-up period ranged from 3 months to 14 years, on an average 6.1 +/- 3.2 years. Postoperative complications requiring surgical correction occurred in 2 (13.3%) patients. Urinary tract patency was restored in all cases. Thus, good short-term results are obtained for the 2 (86.7%) patients, and good long-term results--for all patients. Fatal cases were not registered. Results of our clinical observations suggest the possible success of replacement of the any part of right ureter and left pelvic ureter by appendix.

[Ureteral obstruction as a complication of reconstructive surgery on the aorta and ileal arteries].

The results of surgical interventions in patients with ureteral obstruction after reconstruction of the abdominal part of the aorta and aortofemoral bifurcation bypass are analysed. Of 168 patients of the retrospective group ureteral obstruction after angiosurgery arose in 7 (4.2%) patients. Ureterolysis of the lumbar part of the ureter followed by peritonisation was made in 5 of them, ureterolysis and ureteral resection with ureteroureteroanastomosis end-to-end--in the rest patients. Two patients had relapse of the obstruction after ureterolysis. This was managed with ureteral endoprosthesis with nitilon stent. Treatment outcomes were good. No lethality was registered. Among patients of the prospective group moderate unilateral hydronephrosis was detected in 5 (4.8%) patients. They had no urinary complaints, hydroureteronephrosis was diagnosed in them at ultrasound examination. Surgical policy in early diagnosis of ureteral obstruction seems optimal as it restores urodynamics of the urinary tract and preserves function of the kidney.