Aminjon Yusufovich Odilov

Objective: To conduct a comparative assessment of nephrectomy indicators taking into account kidney volume, duration of surgery and patient body mass index. Materials and Methods: The study analyzed data from 803 patients who underwent nephrectomy. The evaluation was conducted taking into account the following parameters: the volume of the removed kidney, the duration of the surgery, and the patients' body mass index. Results: The most significant differences were found in patients with kidney volume of 100 cm3 or more compared to patients with volume less than 100 cm3. In patients whose surgery lasted more than 2 hours, a significant increase in blood loss was observed, averaging 63.1 ml (1.8 times more).

Objective: To analyze the comparative results of nephrectomy indicators in cases of severe and mild paranephritis, without pyonephrosis and nephroureterectomy, depending on the nosology and type of kidney damage (benign diseases, space-occupying lesions, donor kidneys). Materials and Methods: An analysis of 803 case histories of patients who underwent nephrectomy using various methods was conducted. The effectiveness of these methods was also assessed depending on the clinical situation. Results: Surgical success rates in patients with severe paranephritis were worse than in patients with mild paranephritis. In the group of patients who underwent nephrectomy without regard to pyonephrosis or nephroureterectomy, we found no significant differences in outcomes across all groups. Nephrectomy outcomes for donor nephrectomy were statistically more favorable than those for nephrectomy for benign kidney disease and neoplasms (except for surgical duration). Nephrectomy for renal neoplasms, compared with nephrectomy for benign diseases, had advantages in the following indicators: the length of the incision for kidney removal (on average by 3.6 cm, p<0.0001), the volume of blood loss (on average by 46.8 ml, p<0.0001), stay in intensive care (p<0.0001), the consumption of narcotic analgesics (p<0.0001), complications after surgery (p<0.0006) and the number of hospital days after surgery (p<0.0001). In the retroperitoneoscopic donor nephrectomy group, age (by an average of 6.8 years; p=0.0053), weight (by an average of 5.4 kg; p=0.0282) and height (by an average of 4.7 cm; p=0.0230) differed statistically significantly compared to the laparoscopic access group. Conclusion: The presented scientifically based approach enables specialists performing organ-removal surgeries for various benign and malignant kidney pathologies to effectively diagnose and select the optimal surgical treatment method depending on the specific situation, as well as the clinic's capabilities.

Objective: To describe rare clinical cases of congenital vaginal agenesis in sexually active women in urological practice. Materials and Methods: This retrospective study presents two clinical cases. The first is a 31-year-old patient, S., with congenital vaginal agenesis consistent with Mayer-Rokitansky-Küster-Hauser syndrome. The second is a 19-year-old patient, N., who underwent surgery to create and expand an artificial vagina from a segment of small intestine. Both patients were observed and treated at the Republican Scientific and Clinical Center of Urology. Results: In clinical practice, extremely rare cases are encountered in which, due to congenital vaginal agenesis, the urethra is used for sexual intercourse. This anatomical adaptation is accompanied by significant urological complications and requires a comprehensive medical approach, including consideration of surgical correction. In the second case, after the formation of an artificial vagina from a segment of the small intestine, dilation was performed, which ensures the achievement of the main functional effect - improving the quality of the woman's sexual life. Mayer-Rokitansky-Küster-Hauser syndrome (vaginal agenesis, Müllerian agenesis) is a rare congenital anomaly of the Müllerian ducts, characterized by aplasia of the uterus and upper two-thirds of the vagina, while the ovaries, female phenotype, and 46,XX karyotype remain normal. The incidence is 1 case per 4,000-5,000 female births, ranking it second among the most common causes of primary amenorrhea after hypogonadotropic hypogonadism. The etiology of the disease is multifactorial, but genetic factors with an autosomal dominant inheritance pattern predominate. Clinically, the syndrome manifests as primary amenorrhea in adolescents, despite normal puberty and the development of secondary sexual characteristics. The goal of treatment is to create a functional neovagina to solve the problem of absolute uterine factor infertility. Conclusion: Despite significant advances in this field, important questions remain unresolved, such as etiology and pathogenesis, long-term consequences of immunosuppression after transplantation, and optimization of psychological rehabilitation.

Objective: To evaluate the effectiveness of simultaneous videoendoscopic nephrectomies for pathologies of the kidneys and other organs of the abdominal cavity and retroperitoneal space, the quality of life of patients and the cost/effectiveness ratio of such operations using various methods. Materials and Methods: The study included 37 patients suffering from combined surgical diseases of the abdominal organs and retroperitoneum. Results: Laparoscopic nephrectomies offer the following advantages over staged and traditional methods: the average duration of surgery is reduced by 1.47 times (p<0.001); blood loss during operations using the LPN is reduced by 2.21 times compared to traditional methods, and by 1.19 times when using the new approach. Postoperative patient recovery time is reduced by 1.29 times, and the number of hospital days is reduced by 1.3 times. A reduction in intra- and postoperative complications is also noted, and cost effectiveness is increased by 1.2 times. Conclusion: The use of videoendoscopic simultaneous surgeries for the treatment of concomitant abdominal and retroperitoneal diseases, provided the appropriate treatment method is selected for selected patients, contributes to improved medical and social outcomes. This reduces the risk of complications, promotes faster patient recovery, shortens hospital stays, and increases the cost-effectiveness of treatment. As a result, patients significantly improve their health and return to a full life.

This article presents the clinical case of patient Sh.M. (35 years old), who was diagnosed with a giant ureteral stone. A urinary tract ultrasound revealed left-sided hydronephrosis and a hyperechoic lesion in the middle and lower portions of the left ureter. A plain urogram of the urinary system revealed a giant stone in the middle and lower third of the left ureter. It is 16.8 cm long and weighs 86 grams. A left-sided ureterolithotomy (11 cm) was performed above the stone, followed by drainage of the left kidney via a ureterostomy. The postoperative period was uneventful.

Objective. To compare the postoperative complications of open, laparoscopic and retroperitoneoscopic nephrectomies. Materials and methods. The study was conducted on 803 patients who underwent open, laparoscopic and retroperitoneoscopic nephrectomy on the basis of 3 clinics of the Medical Institute of the Peoples’ Friendship University of Russia and in Republican scientific-clinical center «Urology»; Dushanbe, Tajikistan in the period from 2008 to, 2022. Postoperative complications were recorded and classified according to the Clavien-Dindo Classification (CDC). All analyses were performed on SPSS version 21.0 (IBM Corp., Armonk, New York, USA). Results. In the examined groups, no statistically significant differences were found between the operated patients by age, weight, height, body mass index (BMI) and concomitant diseases. Based on the analysis of the table, it can be concluded that the most significant differences were found for the indicator of intestinal damage in the LN group in relation to the PH and TN groups (2.23% and 1.98 %; p = 0.0345 and p = 0.0127); the indicator «Intestinal paresis» in the LN and TN groups in relation to the PH group (3.43% and 7.9%; p = 0.0422 and p = 0.0077); pneumothorax index in the TN group compared to the LN and PH groups (2.08% and 2.45%; p = 0.0123 and p = 0.0177); wound suppuration index in the PH and TN groups relative to the LN group (6.02%) and 10.60%); p < 0.0001 and p < 0.0001); total the rate of complications in the TN group significantly differed in relation to the LN and PH groups (p = 0.0060). Conclusion. In this study, patients after open surgery had a higher percentage of complications, which is associated not only with traumatic access, but also the predominance in this group of patients with purulentinflammatory complications, as well as a large number of operations in the anamnesis.

Аnalysis of the world literature shows that sexual dysfunction is a common problem in patients with chronic renal failure and after kidney transplantation in both men and women, which requires proper attention of specialists. The etiology of sexual dysfunction remains multifactorial and is associated with the level of azotemia, comorbidities, age, anemia, hormonal disorders, autonomic neuropathy, vascular diseases, hyperparathyroidism, hyperprolactinemia, drug side effects, and psychosocial factors. Sexual dysfunctions have a serious impact on the quality of social and family life of patients. On the one hand, in most cases, there is an increase in life expectancy and an improvement in the quality of life of patients after kidney transplantation. Due to the normalization of hormonal disorders, it improves sexual health (libido), overall health and fertility. On the other hand, after kidney transplantation, the prevalence of sexual dysfunction still remains at 46 % in both men and women. After kidney transplantation, erectile function in many patients improves and some recover. However, not all authors note an improvement in sexual dysfunction after kidney transplantation and leave the problem open. Conservative therapy with oral forms of drugs is most advantageous compared to cavernous injections or surgical treatment, if it does not affect the function of the graft. Sexual disorders after kidney transplantation remain a multifactorial disorder, and methods of their correction, especially in young patients, remain an urgent problem and require further study.

Analysis of the world literature shows that sexual dysfunction is a common problem in patients with chronic kidney disease, both men and women, and this problem for known reasons has not received proper recognition and attention among health professionals and organizers. The prevalence of erectile dysfunction among men with chronic kidney failure ranges from 70 to 86 %. Sexual disorders are associated with uremic effects, comorbidities, anemia, hormonal disorders, autonomic neuropathy, vascular disorders, hyperparathyroidism, hyperprolactinemia, drug side effects, and psychosocial factors. Erectile dysfunction has a serious impact on the quality of life and this strongly affects the social and family life of affected patients. Sexual dysfunction is more common in men and women with chronic kidney disease and cardiovascular disease. Patients on hemodialysis have better sexual function than those without it. Sexual dysfunction has a negative impact on the quality of life of patients with chronic kidney disease and therefore they need high-quality therapy, taking into account the stage, desire and ability of patients.

The study objectiveis to perform comparative analysis of short-term results of retroperitoneoscopic and laparoscopic radical nephrectomy for large kidney tumors.Materials and methods. The study is based on the results of examination and treatment of 108 patients with stage Т1—3аrenal cell carcinoma.Results. For retroperitoneoscopic radical nephrectomy, significant decrease in operative time, ligation and transection of the renal hilum, lower carbon dioxide expenditure, less intense pain sensations on day 1 after the surgery, lower analgesics expenditure, and hospitalization time.Conclusion. The results show the advantages of retroperitoneoscopic radical nephrectomy compared to laparoscopic nephrectomy.

The objective is to perform comparative analysis of intra- and postoperative complications of retroperitoneoscopic radical nephrectomy (RRN) and laparoscopic radical nephrectomy (LRN) for large tumors.Materials and methods. The study includes examination and treatment data for 108 patients with stage T1—3a renal cell carcinoma.Results and conclusion. A number of advantages of RRN compared to LRN were demonstrated associated with shorter surgery duration with fast processing of the renal pedicle, lower blood loss, lower use of analgesics in the postoperative period, shorter duration of hospitalization, and quick recovery after the surgery. The rate of intra- and postoperative complications for RRN was 19.2 and 17.3 %, for LRN — 33.9 and 37.5 %, respectively. Complications associated with abdominal organs were absent for RRN. After LRN, the rate of serious complications was significantly higher than after RRN.