Oleg N. Vasilyev

Introduction. The choice between continent and incontinent heterotopic urinary diversion after cystectomy still depends on the surgeon's preferences and experience. It is necessary to increase urologists' awareness of the advantages of continent cutaneous urinary diversion methods, which will expand the range of urinary diversion options offered to patients and improve their safety. Objective. To compare the morbidity and safety of the modified Kock continent cutaneous urinary diversion with the «gold standard» – the Bricker conduit. Materials and methods. A comprehensive comparative analysis was performed of our modified Kock continent cutaneous urinary diversion (mKock) – 27 patients, versus the incontinent Bricker conduit – 86 patients, where cystectomy and urinary diversion were performed via open surgery. Results. No significant differences were revealed in the number of patients with complications – 48.8% in Bricker vs 55.5% in mKock, with a complication rate per patient of 0.779 vs 0.778, respectively. No significant differences were also revealed between the complications for the entire observation period, including delayed observation period (>90 days), 82.6% Bricker vs 77.8% mKock and 1.755 vs 1.629, respectively, including in the number of patients with severe complications (III–V according to Clavien-Dindo) – 33.7% Bricker vs 33.3% mKock (p>0.05), which proves comparable morbidity and safety of the modified mKock urine derivation and the Bricker conduit. Conclusion. The modified Kock continent cutaneous urinary diversion is a justified and safe alternative for selected, motivated patients wishing to avoid a wet stoma, provided they are informed about the long-term risks and the necessity of long-term monitoring.

BACKGROUND: Bladder cancer ranks tenth among all malignant neoplasms worldwide, with about 573,300 newly diagnosed cases and about 212,500 deaths annually. Patients with very high-risk non–muscle-invasive bladder cancer, as well as those with tumor progression, are eligible for the same treatment as patients with muscle-invasive bladder cancer—namely, immediate radical cystectomy. AIM: This study aimed to assess morbidity in patients undergoing radical cystectomy for non–muscle-invasive bladder cancer and bladder cancer with minimal muscle invasion. METHODS: The study analyzed outcomes of radical treatment in 151 patients who underwent radical cystectomy. Based on postoperative pathological examination, two study groups were formed: group 1 included 49 patients with non–muscle-invasive bladder cancer (pT1 stage), and group 2 included 102 patients with bladder cancer with minimal muscle invasion (pT2a stage). RESULTS: Early postoperative complications not related to urinary diversion were observed in 44.9% of patients in group 1 and in 32.4% of patients in group 2 (p = 0.135). The incidence of these complications was 77.6 ± 12.6 versus 51.0 ± 7.1 cases per 100 patients in the comparison groups, respectively (p 0.05). Urinary diversion–related complications occurred in 13.3% and 16.7% of patients in groups 1 and 2, respectively. The incidence of these complications in groups 1 and 2 was 14.3 ± 5.4 and 16.6 ± 4.0 cases per 100 patients, respectively. At the same time, significant differences were identified in the distribution of patients across Clavien–Dindo complication grades 1, 2–3a, 3b, and more severe complications: 43.5%, 21.7%, and 34.8% in group 1, and 23.8%, 42.9%, and 33.3% in group 2, respectively (p = 0.0025). CONCLUSION: Substantial differences in the pattern of early postoperative complications after radical cystectomy were identified in the pT1 group, likely attributable to multiple prior organ-sparing interventions and other treatment modalities. In addition, more severe Clavien–Dindo complications were more frequently observed in the pT2a group compared with group 1.

Introduction. There is evidence of a connection between infectious and inflammatory lesions of the lower urinary tract and bladder cancer (BCa). However, there is virtually no data on the urine microbiota of middle-aged and elderly men with suspected BCa. This knowledge is extremely important from the point of view of studying the role of the infectious-inflammatory hypothesis in the genesis of BCa.Objective. To conduct a comparative assessment of the microbiota of bladder urine obtained during natural urination and bladder catheterization through standard and extended cultural studies in men with a presumptive diagnosis of non-muscle-invasive bladder cancer (NMIBC).Materials & methods. The prospective comparative study with consecutive patient recruitment included 23 men older than 45 years with suspected NMIBC based on clinical, laboratory and sonographic data, as well as with no history of infectious and inflammatory diseases of the kidneys and urinary tract, including sexually transmitted infections and recurrent infections of other organs and systems. A midstream urine samples and catheter-drained urine immediately before urethrocystoscopy were subjected to bacteriological analysis. Urine culture study was carried out using a standard set of nutrient media under aerobic cultivation conditions and an expanded set of nutrient media under aerobic and anaerobic cultivation conditions.Results. An anaerobic spectrum of microorganisms was predominantly detected in the urine of patients with suspected NMIBC. Moreover, Peptococcus spp. was more often found among anaerobic taxa. (70%), Eubacterium spp., Propionibacterium spp. (45% each, respectively), among representatives of the aerobes — Corynebacterium spp. (60%), S. lentus (up to 45%), S. haemolyticus (35%) and E. faecalis (30%). Data from a comparative analysis of the detection frequencies of microorganisms depending on the method of collecting material and the set of media for cultivation showed that more isolates are isolated in the midstream urine samples than in the study of catheter urine (2.9- and 1.9-fold with the standard and extended sets of media, respectively). In addition, when performing an extended bacteriological study compared to the standard method, the detection of microorganisms is 3.5-fold higher when examining an average portion of urine and 5.1-fold higher when examining catheter urine. The average number of microorganisms per one patient is also higher when using the extended method (midstream portion — 4.7 ± 1.9; catheterised urine — 2.3 ± 1.0) in comparison with the standard one (midstream portion — 1.3 ± 0.9; catheterised urine — 0.3 ± 0.5).Conclusion. Middle-aged and older men with NMIBC are characterized by asymptomatic bacteriuria in the form of a wide range of aerobic and anaerobic microorganisms. The urine pattern obtained with a urethral catheter contains a significantly narrower range of bacteria compared to the sample obtained through natural urination. It is advisable to carry out an extended cultural urine examination to study the characteristics of the microbiota / microbiome of the urine of the bladder immediately before the urethrocystoscopy procedure by collecting urine with a urethral catheter.

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders.

Introduction. The adverse effects of urine on unadapted tissues are known. This is also entirely relevant for buccal grafts used in augmentation urethroplasty, where these effects have not been thoroughly studied so far.Objective. To assess the ongoing pathomorphosis in buccal grafts used for urethral augmentation of extensive strictures in the bulbous region and to evaluate how much urine influences their histological transformation following surgery.Materials & methods. The study included 15 patients with extensive strictures of the bulbous urethra, who underwent a two-stage augmentation urethroplasty with buccal grafts. The grafts pathomorphosis was studied 6 months after the first surgery stage where urethrotomy had been performed with graft augmentation of the dorsal semicircle and the formation of distal and proximal neomeatuses. Natural urination through the latter was restored on days 14 – 20 following the surgery. During the second stage, six months later, urethral tubularisation was performed with two preliminary biopsies of the proximal and distal segments of the grafts implanted in the areas of the neomeatuses formed earlier. The distal area of the graft had no contact with urine, while this contact has occurred in the proximal segment since restoration of natural urination. In biopsy specimens, pathomorphosis of the grafts was studied using immunohistochemical markers: vimentin, clone SRL33; CD34, clone QBEnd/10; MSA HHF-35; СD3, clone LN10; Bcl-2, clone bcl-2\100\D5; CK-HMW 34BE-12.Results. It was found that inflammation was minimal in areas of grafts implanted that had no contact with urine, while in areas where such contact occurred it was verified to be pronounced even 6 months after the operation. On the submucosal level, this was manifested by an uneven arrangement of collagen fibers, a dysplastically developed vascular network, uneven proliferation of the endothelium with swelling and loss of cellular connectivity, in contrast to areas where there was no contact with urine. In such areas, the graft submucosa had a dense collagen framework with organized microvasculature and uniform epithelial surface.Conclusion. The impact of urine on buccal grafts used in augmentation urethroplasty is characterised by the disorganisation of its collagen framework, with a pronounced inflammatory component and the “reactivity” of the epithelial lining to the “toxic agent” that persists even 6 months after surgery. This may underlie the risk of a stenosis relapse in the proximal anastomosis area.

BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations. AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures. MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months. RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases. CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.

Introduction. SARS-CoV-2 causes several negative processes in the body and complicates the course of chronic somatic diseases, causing dysfunction and having a negative effect on many organs and systems of the body, including organs of the reproductive system.Objective. To study morphological changes in testicles of patients who have undergone a new coronavirus infection.Materials and methods. Objects of morphological research were testicular tissues obtained by intraoperative biopsy under intravenous anesthesia served. Material sampling was carried out in 12 patients aged 25–29 years with idiopathic infertility who underwent COVID-19. Patients showed ultrasound signs of fibrosis in the testicles, which were absent before infection with SARS-CoV-2. The biopsy was performed 12 months after COVID-19.Results. In all observations, changes were observed that are characteristic of the inflammatory process, nonbacterial autoimmune genesis. Histio-lymphocytic infiltration of testicular tissue with destruction of single tubules and parenchyma atrophy, combined with varying degrees of sclerosis, was verified.Conclusion. In testicular biopsy specimens from patients who have undergone COVID-19, an autoimmune inflammatory process is recorded, manifested by lymphocytic infiltration of testicular tissue, which was combined with varying degrees of sclerosis.

The impact of COVID-19 on the organs of the genitourinary system is of particular interest to the urologist. There is insufficient information about this influence up to date. The studies are actively developing and require long-term data analysis to determine possible long-term complications, persistent changes in physiological parameters and anatomical and histological structures, as well as to establish the possibility of regression of these changes and complications. The results obtained will undoubtedly improve not only the diagnosis, treatment and prevention of coronavirus infection and its complications, but also make it possible to predict certain disease's outcomes and changes in the function of organs and systems. In turn, this will give an understanding of the measures that need to be taken to completely avoid or minimize these complications and changes.This review focuses on the impact of COVID-19 on genitourinary organs, particularly its place in the development of the lower urinary tract and reproductive organs lesions, as well as the role of androgens in the course of SARS-CoV-2.

Паллиативная цистэктомия. Есть ли место в хирургии рака мочевого пузыря?

The aim of the review was to systematize the evidence available in the world literature on the influence of the role of microbiota and urinary microbiome on the development of bladder cancer. Given the constant development of medical technologies, patient examination algorithms, an obligate range of diagnostic tools, and the appropriateness of using the latest laboratory techniques are being reviewed.