[Effect of a simple kidney cyst on renal function].

INTRODUCTION: Renal cysts are a common disease that occurs at a rate of 7-10%. Currently there are no clinical recommendations for the treatment of patients with simple renal cysts. In the current literature there is some evidence that a simple renal cyst has negative effects on renal function. Decreased renal function occurs due to partial atrophy and loss of the renal parenchyma (in the "crater" area at the base of the cyst) caused by compression. Therefore, the efforts to analyze the effect of simple kidney cysts on kidney function and identify the characteristics of the cyst that affect renal function to determine the indications for surgical treatment remains a substantial task. The aim of the study was to analyze the effect of simple renal cysts on renal function, to investigate the relationship between cyst size, atrophied parenchyma volume, and renal function, and to determine indications for surgical treatment of simple renal cysts. MATERIALS AND METHODS: We conducted a prospective cohort study. The study included 109 patients with simple renal cysts. Patients with a solitary cyst of the right or left renal kidney, grade I-II according to Bosniak classification, were included in the study. The estimated glomerular filtration rate (eGFR) of the patients was calculated using various formulas. A contrast CT scan of the urinary tract was also performed to determine the maximum size of the cyst, calculate the volume of the renal parenchyma, and the volume of the lost (atrophied) parenchyma. Patients underwent renal scintigraphy with calculation of total GFR and split renal function. We analyzed the symmetry of the function of both kidneys by comparing the GFR of the affected and healthy kidneys, analyzed the relationship between the presence of a kidney cyst and a decrease in GFR, between the maximum size of a renal cyst and a decrease in its function compared with that of a healthy kidney. We also analyzed the correspondence of total GFR values obtained in renal scintigraphy and GFR values calculated according to the formulas. RESULTS: Data from 109 patients were available for analysis; the mean blood creatinine was 87.4 mol/L. The median maximum cyst size was 80 mm. The median baseline volume of the affected kidney parenchyma was 174 ml, the median volume of the lost parenchyma was 49 ml, and the median proportion of the lost parenchyma was 28%. The median total GFR was 77.07 ml/min. The median GFR of the healthy kidney was 45.49 mL/min, and the median GFR of the kidney affected by the cyst was 34.46 mL/min. The median difference in GFR of the healthy and affected kidney units was 11 mL/min and was statistically significant. Comparison of the eGFR values obtained by the formulas with the reference values of GFR obtained by scintigraphy showed that the Cockcroft-Gault formula with standardization on the body surface area calculated closest eGFR values to the reference ones. Correlation analysis revealed a statistically significant association between the proportion of lost parenchyma volume and the maximum cyst size: =0.37 with 95% CI [0.20; 0.52] (p-value = 0). A multivariate logistic regression model revealed that a statistically significant factor influencing the probability of a significant decrease in GFR was the percent of lost renal parenchyma volume (OR=1,13; =0). CONCLUSIONS: Our study showed that growth of renal cysts associated with renal parenchyma atrophy and decrease of GFR of the affected kidney. An increase in the volume of atrophied parenchyma leads to the decrease in GFR of the affected kidney. The obtained data suggest that performing dynamic renal scintigraphy to assess the decrease in affected renal function and determine the indications for surgical treatment of renal cysts is a reasonable recommendation. According to the results of the study, the loss of 20% of the renal parenchyma can be considered an indication for renal scintigraphy. The Cockcroft-Gault formula with standardization on the body surface area allows to calculate closest GFR values to those obtained by scintigraphy and, therefore, can be recommended as the optimal formula for calculating eGFR in daily clinical practice.

[Laparoscopic partial nephrectomy using a technology of augmented reality: new vector of the development of operative urology?]

AIM: to evaluate the efficiency and usefulness of augmented reality (AR) technology using HoloLens glasses for laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: From July to December 2019, a total of 5 patients with localized kidney cancer (cT1aN0M0) underwent AR-assisted LRP. The mean RENAL score was 6 points (5-8). Preoperatively, all patients underwent contrast-enhanced multispiral computed tomography (MSCT). The three-dimensional reconstructions of the kidney, tumor, part of the abdominal aorta with the renal artery and its branches, part of the inferior vena cava with the renal vein were segmented with color coding and connected into a single virtual 3D model, which was loaded into the program in order to display image in AR glasses. The duration of surgery and thermal ischemia, type and frequency of intraoperative complications, as well as the time spent on preparing the 3D model and the Microsoft HoloLens device were evaluated. To assess the feasibility of using AR technology intraoperatively, a Likert scale was filled out by the surgeon. RESULTS: It took 10 (9-11) hours to prepare the model, including time to optimize the model and to set up its display and interactions. The setup of HoloLens required an average of 7.8 (5- 12) min. The total duration of the operation and the period of warm ischemia was 108 (90-120) and 20 (15-25) min, respectively, while intraoperative blood loss was 160 (110-250) ml. In all cases, a negative surgical margin was found. The surgeon who performed all the operations assessed the use of AR technology with the HoloLens device as highly beneficial in all clinical cases. CONCLUSION: The use of AR technology with a HoloLens holographic device during LPN can lead to improved treatment outcomes.

[Stage-by-stage treatment of vesicovaginal fistula followed by orthotopic plastic surgery of the bladder and vagina with a small intestine]. / Etapnoe lechenie puzyrno-vlagalishchnogo svishcha s posleduyushchei ortotopicheskoi plastikoi mochevogo puzyrya i vlagalishcha tonkoi kishkoi.

High incidence of iatrogenic lesions of genitourinary system (during gynecological and oncogynecological operations) followed by urogenital fistulae and great percentage of recurrences after reconstructive surgery justify the need to improve surgical reconstruction of genitourinary organs and urine discharge in these patients. Stage-by-stage surgical treatment of a patient with extensive vesicovaginal fistula is reported in the article. A defect was associated with loss of 2/3 of the volume of tissues of adjacent organs. Multiple operations in various clinics were failed to eliminate the fistula and resulted decrease of bladder capacity up to microcystis.

[Complications of percutaneous nephrolithotomy and their management].

To date, percutaneous nephrolithotomy (PNL) is the standard treatment modality for large-volume renal stones and staghorn stones in patients with urolithiasis. Despite low invasiveness, this method is not without complications. This review discusses the most common complications and suggests methods for their prevention and appropriate management. To unify the study of complications they were categorized based on the modified Clavien classification. According to the available data, about 80% of the PNL complications belong to grade I-II complications and does not require any additional treatment. The most serious complications include sepsis, bleeding, and injury to nearby organs.

[Experience in ureteroscopy for managing urolithiasis in one clinic. when does quantity transform into quality?]

INTRODUCTION: In recent years, there has been an increasing role of ureteroscopy in managing urinary tract calculi of various locations. Several studies have reported the relationship between the efficacy and safety of ureteroscopic interventions and surgeons skills and hospital caseload volume. The aim of our study was to assess the effectiveness of urethroscopic stone removal, the changes in treatment effectiveness, frequency and types of complications along with gaining experience in these interventions. MATERIALS AND METHODS: We analyzed 4031 urolithiasis patients who were admitted to our urological department and underwent ureteroscopy from 2001 to 2013. To determine the effectiveness and safety of the method, as the experience gained, the time of observation was divided into three periods: from 2000 to 2004, from 2004 to 2009, from 2009 to 2013. The parameters were evaluated for the entire observation time and for each period. RESULTS: Complete fragmentation of the stones was observed in 3628 (90%) patients, partial - in 219 (5.4%). No treatment effect was observed in 138 (3.4%) patients. The greatest effectiveness (96.94%) was seen in stones in the lower third of the ureter. The proportion of unsuccessful ureteroscopies was 5.7%, 4.5% and 3.5% for the periods 2000 -2004, 2005-2009 and 2009-2013, respectively (p=0.027). The incidence of acute postoperative pyelonephritis in the corresponding periods was 15.4%, 3.3% and 2.9% (p<0.001). CONCLUSION: Ureteroscopy is an effective and safe treatment modality for managing upper urinary tract calculi. It is most effective in treating distal ureteral stones. The increase in the treatment effectiveness and the reduction in the incidence of complications along with gaining experience, suggests that these interventions should be practiced mainly in urology centers specializing in the care of patients with urolithiasis.

[Analysis of factors affecting the compliance with medical therapy for benign prostatic hyperplasia].

AIM: To investigate factors affecting the compliance of patients with the combination therapy for benign prostatic hyperplasia. MATERIALS AND METHODS: Four hundred BPH outpatients treated with combination therapy were surveyed. RESULTS: The absolute majority of patients (76.16%) expected a quick positive result. 10.47% viewed their disease as too advanced, did not believe in the effectiveness of medical therapy and believed the surgery to be the only treatment option. 24.42% of patients changed the medication dosage on their own, and 11% were ready to discontinue the treatment without consulting their doctors. 76.16% of patients considered the recommended treatment to be effective, 77.33% fully trusted the doctor. In the opinion of 8.7% of patients, the doctor did not sufficiently inform them about the prescribed drug. 22.67% of patients had doubts about a physicians competence, and 5.23% believed the doctor complicated their medical treatment and changed prescriptions too often. CONCLUSIONS: The patients had a high level of trust in doctors and showed psychological adherence to therapy. However, about a quarter of patients changed the treatment regimen on their own. Many patients had exaggerated expectations of the treatment. 8% of patients reported insufficient awareness regarding the nature and appropriateness of drug therapy, and one in five patients had difficulties in perceiving, remembering and following the treatment regimen. CONCLUSION: streamlining therapeutic regimens, prescribing non-titratable or combined drugs will help improve patients therapy compliance.