Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture

A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.

Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest

Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods.

Extravesical reimplantation of an extravesical-ectopic ureter from the upper pole of a duplicated kidney

Extravesical ureter ectopia is a rare cause of urinary incontinence. We are reporting a case of a 3-year-old girl with urinary incontinence. The girl was observed and treated for recurrent urinary tract infection (UTI) against the background of left-side duplication of the upper urinary tract and vesicoureteral reflux (VUR). Two-time endoscopic treatment using a dextranomer/hyaluronic acid allowed to eliminate VUR on both sides and achieve stable clinical and laboratory remission of UTI. After potty training, the child had a constant drip of urine along with normal urination. The examination revealed extravesical ureter ectopia of the left duplicated kidney upper pole and a bladder space-occupying mass with hyperdensive inclusions in the projection of the vesical trigone on the left, which we regarded as a result of the migration of the implant and the appearance of histopathological changes in it. The presence of a bladder space-occupying mass determined the choice of the surgical technique in favor of the formation of a ureterocystoanastomosis with a duplicated ectopic ureter and the removal of a bladder space-occupying mass. When managing patients after endoscopic treatment of VUR, it should be considered the possibility of morphological changes in the bulking agent due to the accumulation of calcium and uric acid salts.

Surgical treatment of extended spongy urethral strictures in men: minimizing the risks of narrowing in the anastomotic zones between the buccal graft and the native urethra using the dorsal inlay technique

Introduction. Currently, the most common method of treating extended urethral strictures is augmentation urethroplasty using oral mucosa grafts. Analysis of the long-term outcomes of this surgery type shows a high incidence of relapses and complications.Purpose of the study. To improve the outcomes of augmentation urethroplasty, in particular the dorsal inlay (Asopa) technique, in patients with extended spongy urethral strictures by minimizing the risk of recurrent strictures.Materials and methods. The study is based on an analysis of the surgery in 90 patients (aged 18-72 years) with extended spongy urethral strictures. Seventy patients (group I) underwent dorsal inlay augmentation urethroplasty according to the Asopa technique, and 20 patients (group II) — according to the author's modified technique. Statistical data analysis was carried out using the SPSS ver.26 software (SPSS Inc. Chicago, IL, USA).Results. A comparative analysis of the course of the early postoperative period showed a lower number of complications in group II patients compared to group I — 20.0% versus 34.3%, respectively. The recurrent strictures were registered for groups I and II in 18.8% and 5.6% of cases 6 months after surgery, respectively. The recurrent urethral narrowing was most often localized in the area of distal anastomosis between the buccal graft and the native urethra in patients from both groups.Conclusion. The modified dorsal inlay augmentation urethroplasty technique developed and implemented in clinical practice by increasing the internal urethral lumen in the areas of proximal and distal anastomosis between the buccal graft and the native spongy urethral body allows minimizing the risks of recurrent urethral narrowing after augmentation urethroplasty.

Extensive penile skin necrosis after surgery for Peyronie's disease

The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface.

Possibilities of peripheral magnetic neuromodulation in the treatment of lower urinary tract symptoms in men

Introduction. Lower urinary tract symptoms (LUTS) are common in men and are associated with a significant decrease in quality of life. To date, there is no universal approach to the treatment of LUTS, which determines the need to search for new methods for influencing the lower urinary tract.Purpose of the study. To test the hypothesis that the use of peripheral magnetic neuromodulation (PMN) in male patients with LUTS will reduce the severity of LUTS.Materials and methods. Sixty-eight men with LUTS were enrolled in a prospective, randomized study. Patients were randomized in a 1:1 ratio for PMN or drug therapy with an alpha-1-blocker (tamsulosin). The primary endpoint was a reduction the LUTS severity such as urinary frequency during the day, nocturia and urgency as assessed using the IPSS questionnaire and urination diary. Improvements in urodynamic parameters such as maximum urine flow rate (Q max), mean urine flow rate (Q ave), and residual urine volume (PVR) were the secondary endpoint of the study. The results were evaluated on equal terms (10 days and 1 month) in both groups.Results. Sixty-seven (98.5%) subjects were included in the final base. Ten days after the start of therapy in the magnetic stimulation group, symptom relief was noted by 21 people (61.7%), the mean IPSS score showed a decrease from 18.1 ± 2.1 to 16.9 ± 3.2 points (p = 0.037). The number of urinations per day decreased from 14 (6 - 20) to 10 (6 - 14) times (p < 0.001). Objective indicators of urodynamics did not change in both groups. At a period of 1 month, PMN occurred in 22 (64.7%) patients, the IPSS score was 16.6 ± 3.7 points (p = 0.032), the number of urinations 9 (6 - 14) times (p < 0.001). Objective indicators have not changed. In the tamsulosin group, IPSS score changed from 19.27 ± 5.08 to 15.4 ± 4.85 (p < 0.001), Q max 14.36 ± 2.82 ml/s increased to 15.94 ± 2.71 ml/s (p = 0.032), while the Q ave did not change (p = 0.17). The number of urinations decreased from 13 (6 - 19) times to 10 (6 - 14) times (p <0.001).Conclusion. The study demonstrated the promise of PMN in men with LUTS in terms of improving the quality of life. The proposed method may be preferable for patients dissatisfied with drug therapy. Further placebo-controlled studies are required to help determine the role of PMN in the management of patients with LUTS.

Iodine-125 brachytherapy and robotic stereotactic radiotherapy — treatment options for patients with localized prostate cancer

Introduction. Modern radiological treatment options for patients with localized prostate cancer (PCa) have several advantages and allow achieving high rates of biochemical control.Purpose of the study. To compare immediate, proximate, and long-term results of low-dose Iodine-125 brachytherapy (I-125 BT) and robotic stereotactic radiotherapy (SBRT) in patients with localized low- and intermediate-risk PCa.Materials and methods. The study included 296 patients with localized low- and intermediate-risk PCa. I-125 BT and SBRT were performed in 208 and 88 patients, respectively. All patients with an intermediate-risk PCa were prescribed neoadjuvant androgen-deprivation therapy (NADT) with luteinizing hormone-releasing hormone analogues (LHRH) for 4-6 months. Only radiation treatment was used for low-risk PCa. As a result, two groups and four subgroups of patients were formed depending on the treatment method. The immediate, proximate, and long-term results of radiation treatment methods were studied in groups and subgroups.Results. No complications were recorded during brachytherapy I-125. Radiation cystitis grade 1 and radiation rectitis grade 1 were diagnosed after SBRT in 16.6% and 4.0% of cases, respectively. In the only I-125 BT subgroup, the PSA level during the year decreased from 8.3 to 1.1 ng/ml, in the SBRT subgroup — from 7.5 to 0.8 ng/ml. In the case of combined treatment, PSA decreased from 1.2 to 0.93 ng/ml and from 4.5 to 0.5 ng/ml, respectively. Changes in prostate volume, residual volume, and urinary quality (I-PSS) were comparable in all subgroups. Five-year cancer-specific survival and overall survival in the group of patients after SBRT was 100%, after I-125 BT — more than 90%.Conclusion. Radiation treatment options for patients with localized PCa are safe. Conducting NADT does not significantly reduce the prostate volume and does not affect the indicators of urodynamics. High rates of cancer-specific five-year survival rate testify to the effectiveness of the evaluated treatment options.

Dislocation of the penis: a rare case of genital trauma

Traumatic dislocation of the penis is one of the rarest types of genital trauma. This type of injury is accompanied by a violation of the integrity of the skin and the penile ligamentous apparatus, with the dislocation of the penis into the scrotum under the skin of the thigh, or the area of the pubic joint. The low occurrence frequency of such injuries and the small number of observations described in the literature entails the absence of generally accepted treatment tactics for this category of patients. The article describes a clinical case of successfully treated traumatic dislocation of the penis with penile transposition into the pubic joint area and the formation of subcutaneous urinary leakage after late treatment of the patient for medical care.

Impact of dietary supplements based on L-carnitine on free-radical processes in model systems

Introduction. According to the results of numerous studies and meta-analyses, the effectiveness of male infertility therapy with micronutrients-antioxidants in various variants remains low, especially concerning the increase in live-birth rates and the incidence of clinical pregnancy. This may be due to both the empirical nature of such therapy with an imbalance of ejaculate redox systems, and an overdose of individual ingredients of antioxidant complexes.Purpose of the study. To evaluate the antioxidant activity of complex preparation based on L-carnitine for the treatment of male infertility in an experimental model system.Materials and methods. The dietary supplements «AndroDoz®» («Nizhfarm» JSC, Russian Federation) and «Proxeed® plus» (Sigma-Tau Pharmaceuticals Inc., Italy) were tested. The antioxidant properties of the preparations were determined in vitro by recording chemiluminescence in model systems generating reactive oxygen species using the «LKB-Wallac 1256 chemiluminometer» (Wallac Oy/PerkinElmer®, Finland). Chemiluminescence was evaluated by the light sum and the maximum amplitude of the glow, the antioxidant activity in the biological environment was studied when adding drugs to chicken yolk lipids similar to blood lipoprotein complexes.Results. The introduction of «AndroDoz®» and «Proxeed® plus» into the incubation medium in an amount comparable to the physiological level of L-carnitine in seminal plasma, inhibited the luminescence of the model system. At the same time, if «Proxeed® plus» almost completely inhibited the formation of radicals, then an equivalent dose of «AndroDoz®» reduced the intensity of chemiluminescence by 60%. Approximately in the same proportions, the preparations suppressed the intensity of lipid peroxidation processes in a model system with lipoprotein complexes similar to blood lipids, that is, the antioxidant activity was preserved in the biological environment. A decrease in the value of the chemiluminescence light sum was also found against the background of the use of these dietary supplements, which may indicate their protective effect on biological membranes, including subcellular structures of spermatozoa.Conclusion. The combined dietary supplements used in the study have a high antioxidant potential. The preparation «Proxeed® plus» can completely suppress the processes of lipoperoxidation with the possible development of a deficiency of free radicals that provide vital processes. The preparation «AndroDoz®» has a milder effect on free-radical phenomena probably due to a lower content of active ingredients and a balanced composition, which reduces the risk of complications in the form of an «antioxidant paradox» or reductive stress.

Percutaneous cystolithotripsy for patients with benign prostatic hyperplasia

Introduction. According to the literature, 5.0% of patients with urolithiasis are characterized by the presence of stones in the bladder. The issue of bladder stones for patients with benign prostatic hyperplasia remains relevant and requires further improvement of approaches to surgical treatment.Purpose of the study. To evaluate the safety and efficacy of energy-diverse percutaneous cystolithotripsy (and placement of a cystostomy catheter) in comparison with transurethral cystolithotripsy.Materials and methods. A retrospective analysis of 56 cases in patients (aged 54-82 years) with bladder stones was carried out. All patients were treated in the Urology Clinic of the Mechnikov North-Western State Medical University from 2019 to 2021. Two groups were formed: group I — 26 (46.4%) patients who underwent percutaneous cystolithotripsy, group II — 30 (53.6%) patients underwent transurethral cystolithotripsy. The duration of surgery, intraoperative and postoperative complications were assessed.Results. On average, the duration of surgery for the percutaneous approach was shorter than for transurethral access (35 vs 44 min). The stone-free rate in the case of the percutaneous approach was 100.0%, while in transurethral cystolithotripsy the stone-free rate was 90.0%. In the early postoperative period, in groups I and II, gross hematuria was observed for 2 (7.6%) and 4 (13.3%) patients, respectively. In the late postoperative period, 2 patients from group II had a urethral stricture.Conclusions. Percutaneous cystolithotripsy is a minimally invasive method of stone fragmentation, characterized by a minimal risk of intra- and postoperative complications.