Treatment of patients with anterior urethral strictures: the role of perineal urethrostomy

The article reviews the 2000-2020 literature on the use of perineal urethrostomy in the treatment of patients with anterior urethral strictures. Historical issues of the development of urethrostomy techniques are considered. The algorithms to choose the method of treatment of urethral strictures in favor of perineal urethrostomy are highlighted, according to the guidelines of the world's professional urological associations. The performance indicators of perineal urethrostomy were studied considering the age characteristics of the patients, the etiological genesis of the strictures, their length and location, as well as depending on the surgical technique and the follow-up period. Considerable attention is paid to studies devoted to the analysis of the functional results of urethrostomy, as well as the quality of life of patients associated with urination and sexual activity. Data are presented on the incidence of early and late surgical complications, including urethrostomy stenosis, as one of the most common. An analysis of studies evaluating factors that negatively affect the outcome of surgery was carried out. The main reasons for the growing demand for the technique in surgery for complex anterior urethral strictures and the importance of the technique among other treatment methods are discussed

Multi-stage urethroplasy for anterior urethral strictures: objective parameters of long-term efficacy and patient-reported outcomes

Introduction. Multi-stage urethral surgery is used in cases of the most complex urethral strictures. The evaluation of surgical treatment results given by patients is a significant criterion for the efficacy of urethroplasty along with the assessment of urethral patency through instrumental examinations.Objective. To evaluate the long-term efficacy of multistage urethroplasty for complex anterior urethral strictures considering the patients' quality of life and satisfaction with the surgical outcomes.Materials and methods. The study included 73 patients aged 18 – 84 years with anterior urethral strictures who underwent multi-stage urethroplasty in 2010 – 2019. Surgical and functional outcomes of urethroplasty were assessed through general blood and urine tests, physical examination, uroflowmetry, and retrograde urethrography and urethroscopy in case of urinary disorders.  Subjective parameters of treatment efficacy were studied using questionnaires: International Prostate Symptom Score (IPSS); Quality of life (QoL); Patient-reported Outcome Measure for Urethral Stricture Surgery (USS-PROM); Patient Global Impression of Improvement (PGI-I).Results. Recurrent urethral stricture was detected in 19 (26,0%) patients with the average follow-up period being 65 months. Independent urination was restored in 71 (97.3%) cases, including repeated interventions. After surgery, there was a significant increase in urinary flow rate parameters (Q max: 8.1 vs 19.1 ml/s, p < 0.0001; Q ave: 5.5 vs 10.7 ml/s; p = 0.0004), decrease in residual urine volume (62.4 vs 18.6 ml, p < 0.0001), decrease in total IPSS score (18.7 vs 5.7 points; p < 0.0001) and QoL index (4.3 vs 1 .8 points, p < 0.0001). A comparative analysis of preoperative and postoperative USS-PROM questionnaire results demonstrated an improvement in indicators assessing LUTS (12.9 vs 3.4 points; p < 0.0001; 3.6 vs 1.7 points; p < 0.0001), and urination-associated quality of life (2.6 vs 0.6 points; p < 0.0001) and overall health (EQ-5D index: 0.73 vs 0.91 points; p = 0.025; EQ-VAS: 68.0 vs 88.1 points, p = 0.004). Fifty-seven (81.4%) men were “very satisfied” or “satisfied” with the treatment outcomes, while nine (12.9%) respondents noted a moderate effect of residual urinary disorders on the quality of life. Significantly higher satisfaction was observed among cystostomy patients and in cases where repeated interventions were unnecessary.Conclusion. Multi-stage urethroplasty for complex anterior urethral strictures achieves efficacy in 97.3% of cases and is accompanied by high levels of quality of life and patient’s satisfaction during long-term follow-up

Treatment of post-COVID-19 patients with chronic recurrent prostatitis: efficacy of recombinant interferon α-2b medications

Introduction. The tactics of managing and treating patients with chronic recurrent bacterial prostatitis (CRBP) in some cases is a difficult-to-treat condition for a practicing urologist. This circumstance occurs because the disease has several predisposing factors, a complex and multifaceted pathogenesis, and certain difficulties in diagnosis and treatment.Objective. To study the effectiveness of recombinant interferon α-2b medications in post-COVID-19 patients with chronic recurrent prostatitis against the background of antibiotic multi-drug resistance of microorganisms verified in prostate secretion.Materials and methods. The treatment of 52 post-COVID-19 patients with CRBP was analyzed, divided into three therapy-dependent groups. Group 1 patients (n = 18) received antibiotic therapy (ABT): Levofloxacin 500 mg q.d. PO for 28 days. Group 2 patients (n = 18) underwent combined therapy: ABT supplemented with recombinant interferon α-2b with an antioxidant complex of vitamins E and C (“Viferon®” rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. Group 3 patients (n = 16) received monotherapy with recombinant interferon α-2b with an antioxidant complex of vitamins E and C (“Viferon®”rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. The follow-up period was 6 months with monitoring of clinical and laboratory parameters assessed before treatment, after 1, 3 and 6 months from the start of therapy.Results. Based on the monitoring of the clinical picture and laboratory parameters, after 1 follow-up month, there was a significant decrease in the symptoms of the disease in all study groups. However, after 3 and 6 follow-up months, this trend was observed only in patients of groups 2 and 3 receiving recombinant interferon alfa-2b with an antioxidant complex (vitamins E and C).Conclusions. Strengthening the standard CRBP-therapy with recombinant interferon α-2b with an antioxidant complex of vitamins E and C makes it possible to normalize both clinical and laboratory parameters in most patients

СРАВНИТЕЛЬНЫЙ АНАЛИЗ БАКТЕРИАЛЬНОЙ ПОПУЛЯЦИИ ПРОСТАТЫ ПРИ РАКЕ И ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИИ ПРОСТАТЫ

A bacteriological study of prostate biopsy specimens was conducted in patients with prostate benign hyperplasia (PBH) and in those with prostate cancer (PC). It revealed a wide range of aerobic (Corynebacterium sp., Enterococcus sp., E. coli, S. haemolyticus, S. hominis) and nonclostridial anaerobic (Bacteroides sp., Bifidobacterium sp., Eubacterium sp., Propionibacterium sp., Рeptococcus niger, Peptostreptococcus sp., Prevotella sp., Veilonella sp., Fusobacterium sp., Capnocytophaga ochracea, Streptococcus parvulus) bacteria. Differences were seen in the detection rate of these microorganisms and in the level of tissue infectivity in PBH and PC. The average seeding of the prostate biopsy specimens and the detection rate of different types of bacteria in PBH were greater than those in PC; moreover, some bacteria were undetectable in PC at all.Проведено бактериологическое исследование биоптатов предстательной железы (ПЖ) у пациентов, имеющих доброкачественную гиперплазию предстательной железы (ДГПЖ) и рак предстательной железы (РПЖ). Выявлен широкий спектр аэробных (Corynebacteriumsp., Enterococcussp., E. coli, S. haemolyticus, S. hominis) и неклостридиально-анаэробных (Bacteroidessp., Bifidobacteriumsp., Eubacteriumsp., Propionibacteriumsp., Рeptococcusniger, Peptostreptococcussp., Prevotellasp., Veilonellasp., Fusobacteriumsp., Capnocytophagaochracea, Streptococcusparvulus) бактерий. Определены различия в частоте обнаружения данных микроорганизмов и уровне инфицированности ткани при ДГПЖ и РПЖ.Средний уровень обсемененности биоптатов простаты и частота выделения различных видов бактерий при ДГПЖ превышают таковые при РПЖ, причем некоторые бактерии при РПЖ не обнаруживаются вовсе

A MICROBIAL CONTAMINATION OF PROSTATIC TISSUE IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER

Bacteriological results of prostatic tissue in benign prostatic hyperplasia and prostate cancer are shown in this article. A use of extended amount of media for bacterial isolation allows a wide spectrum of nonclostridial anaerobic (Bacteroides sp., Bifidobacterium sp., Eubacterium sp., Propionibacterium sp., Рeptococcus sp., Peptostreptococcus sp., Prevotella sp., Veilonella sp., Fusobacterium sp., Streptococcus sp., Capnocytophaga ochracea) and aerobic bacteria (Corynebacterium sp., Enterococcus sp., E. coli, S. haemolyticus, S. hominis). It is revealed that nonclostridial anaerobes are predominant flora in qualitative and quantitative terms in prostate cancer as well as benign prostatic hyperplasia. Both a mean level of bacterial contamination of prostate bioptates and incidence rate of most bacteria was higher in patients with benign prostatic hyperplasia

EFFECTIVENESS AND SAFETY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UNCOMPLICATED PELVIC CONCREMENTS

Introduction. Extracorporeal shockwave lithotripsy (ESWL) allowed to improve the treatment results for patients suffering from the kidney stone disease (KSD), decrease the number of complications, optimize the nearest and distant therapy results; however, its success depends on the initial size and shape of the stone. Purpose of the study. Тo examine the clinical effectiveness and safety of electromagnetic ESWL used on simple renal calculi taking their sizes into account. Materials and methods. The survey included 110 patients with simple renal calculi who passed electromagnetic ESWL procedures. The first group consisted of 75 patients with calculi ≤ 15 mm in diameter, the second group included 35 patients with stones > 15 mm. Results. Complete disintegration of stones ≤ 15 mm was accomplished in 74,7% of cases in 1-2 lithotripsy sessions, and after 3 months residual fragments were found in 4% of cases only. Elimination of stones > 15 mm from the renal collecting system takes considerably longer, all patients require more than 1 lithotripsy session. In 3 months following the ESWL residual stones were found in 17,2% of analysed cases. Stone sizes had no bearing on the pain syndrome frequency and severity as well as activation of urinary infection. Macrohematuria, renal haematomas, and an increase of blood creatinine level compared with the original value were more frequent in patients with stones > 15 mm. Conclusions. Electromagnetic ESWL is an efficient and safe method for monotherapy of patients with uncomplicated pelvic concrements. Clinical ESWL effectiveness for stones ≤15 mm by the 3rd month of monitoring reaches 96,0%, for stones > 15 mm it is 82,8% (р<0,05). The level and severity of complications is higher in case of pelvic stones >15 mm compared with the stones < 15 mm in diameter (р<0,05)

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\u3c0.05). 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\u3e0.05). 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

MICROBIOTA URINE AND ANTIBIOTIC PROPHYLAXIS FOR LITHOTRIPSY SIMPLE JUNCTION STONES

Extracorporeal shock wave lithotripsy (ESWL) may be associated with infectious and inflammatory complications. The dynamics of the microbial spectrum of urine and the need for antibiotic prophylaxis are still poorly understood. The study included 40 patients with simple pelvic stones, which one session was held ESWL. Bacteriological examination were taken midstream urine to ESWL, when the first urination after ESWL, 1, 3, 7 days. Patients were divided into 2 groups. Group I consisted of patients (60%) with antibiotic prophylaxis. Patients of group II (40%) of antibiotic prophylaxis was not performed. The pattern of isolated microorganisms were as follows: NAB - 92.5%, Gram-positive microorganisms - 70.0%, urease-producing microorganisms - 60,0%, E.coli - 12,5%. Dynamic study of the microbial spectrum of urine Group found that the prophylactic use of antibiotics after ESWL simple junction stones accompanied by increased frequency of occurrence and levels of contamination of urine urease-producing bacteria, Candida, Gram-positive microorganisms and increases the risk of infectious and inflammatory complications in connection with the question of the need for antibiotic prophylaxis to be decided individually