Suleyman I. Suleymanov

Background. Impacted stones in the proximal ureter are one of the most complex forms of urolithiasis, associated with a risk of ureterohydronephrotic transformation, obstructive pyelonephritis, and loss of renal functional reserve. The optimal minimally invasive approach is determined by a combination of the anatomical characteristics of the ureter, the density of the stone, and the degree of its fixation. Purpose. To evaluate the effectiveness of the authors’ technique for antegrade rigid ureterolithotripsy via a subapical upper-pole approach in the supine position. Materials and methods. We present the case of a 47-year-old female patient with an impacted stone in the upper third of the left ureter (13×9 mm, 1,100 Hounsfield units—HU), without signs of acute obstructive pyelonephritis or impaired renal nitrogen excretion. The procedure was performed in the Valdivia-Galdakao position. A subapical puncture of the upper calyx group was performed at a 40° angle to the skin surface under ultrasound guidance in color Doppler mapping (CDM) mode; the nephrostomy tract was dilated to 15/16 Ch. Antegrade rigid lithotripsy was performed using an Auriga XL 50W Ho:YAG holmium laser in fragmentation mode. A stone-free rate of 100% was achieved with a total operative time of 24 minutes and intraoperative blood loss of less than 30 mL. On the third day, the patient was discharged in satisfactory condition. Results. The postoperative period proceeded without complications. A follow-up MSCT scan 4 weeks later confirmed the absence of residual stones and dilation of the upper ureter. Conclusion. The subapical suprapolar approach in the supine position provides a direct path for the instrument to the stones in the upper third of the ureter, reduces procedure time, and allows for a high stone-free rate with minimal risk.

Background . Bladder cancer is the 10th most common cancer worldwide and the most common malignancy of the urinary tract. Non-muscle invasive bladder cancer accounts for approximately 80 % of cases. Tumors localized in the anterior bladder wall may be challenging to resect completely due to diffcult visual access. Here we present a case of non-muscle invasive bladder cancer localized in a diffcult-to-access area. Case report . A 67-year-old patient with a mass on the anterior wall of the bladder underwent Nd:YAG laser ablation of non-muscle-invasive bladder cancer of diffcult localization in the urological hospital of the Russian Railways-Medicine Central Clinical Hospital. The previous histological examination of the biopsy specimen of the bladder mass reveled bladder cancer. The superfcial tumor growth was confrmed by preoperative MRI fndings. The Nd:YAG laser with a wavelength of 1064 nm, a power of 40 W and an energy density of 100 J/cm ² was used. The laser beam was delivered through a side fre light guide. After surgery, a two-way catheter was inserted into the bladder for 12 hours. No intraoperative and postoperative complications were detected. Endoscopic evaluation of the effectiveness of the surgical stage was carried out at intervals of 3, 6 and 12 months from the date of surgery. Control cystoscopy revealed no cancer recurrence. Conclusion . Our clinical case demonstrated the high effcacy and safety of Nd:YAG laser ablation in the treatment of a patient with non-invasive bladder cancer located on the anterior wall of the bladder.

BACKGROUND: Bladder cancer is the most common urinary tract cancer. Transurethral resection of the bladder wall tumor is the gold standard for non-muscle-invasive bladder cancer. In recent years, laser technologies have been actively implemented into clinical practice, including the surgical treatment of bladder cancer, but there are still many questions regarding their use. AIM: To evaluate the efficacy and safety of bladder wall tumor resection followed by neodymium (Nd:YAG) laser ablation of the tumor. MATERIALS AND METHODS: Surgical treatment outcomes in 97 patients with non-muscle-invasive bladder cancer were analyzed for the period between 2012 and 2023. Group 1 (n = 49) underwent classical transurethral resection of the bladder wall. Group 2 (n = 47) underwent the same procedure followed by Nd:YAG laser ablation of the tumor bed. Treatment outcomes were evaluated at 3, 6, and 12 months after surgery. RESULTS: Analysis of complications using the Clavien–Dindo classification system showed a more favorable postoperative course in group 2. Within 1 year after surgery, the rate of bladder cancer recurrence was significantly lower in group 2 compared to group 1, with 4 and 13 cases, respectively (p 0.05). In addition, no patient in group 2 had a recurrence in the area of the resected tumor bed, whereas 9 patients in group 1 had such recurrence during the specified period. CONCLUSIONS: The study demonstrates the potential of using laser technologies in the treatment of bladder cancer. Its clinical implementation will facilitate personalized surgical treatment options for patients with urological cancers and reduce the risk of tumor recurrence.

BACKGROUND: Benign prostatic hyperplasia (BPH) is common middle-aged and elderly men. In modern urology, transurethral resection and its modifications are used in surgical treatment of BPH. In the last decades, an active tendency of laser technologies development in urology was noted. The search for the most appropriate techniques of transurethral removal of prostate adenoma by comparing the results of treatment of patients with the use of different technologies remains relevant. AIM: This study aimed to evaluate the clinical effectiveness of transurethral bipolar surgery and laser technologies in the treatment of BPH. MATERIALS AND METHODS: Transurethral enucleation of the prostate using various technologies was performed in 273 patients with BPH between 2021 and 2023: 94 patients underwent bipolar transurethral enucleation of the prostate, 87 underwent thulium enucleation of the prostate (ThuLEP), and 92 underwent holmium enucleation of the prostate (HoLEP). RESULTS: Clinical evaluation showed the absence of intraoperative complications. For ThuLEP, a trend toward shorter operative times compared to other techniques was observed. In the early postoperative period, significant bleeding was noted in six cases of using bipolar technology, three cases of using a thulium laser, and five cases of using a holmium laser. An examination of patients 6 months postsurgery showed pronounced positive dynamics in all three groups. No significant differences were found in clinical parameters 6 months postsurgery in patients of different groups. CONCLUSIONS: Bipolar enucleation of the prostate, ThuLEP, and HoLEP are comparable in effectiveness and the number of complications in the surgical treatment of BPH. Study results indicated that it is advisable to actively use these methods in wide clinical practice.

BACKGROUND: Studying the clinical features of different surgical approaches in patients with urolithiasis with stones localized in the kidney and the upper third of the ureter is an important practical issue in modern urology. AIM: The aim of the study is a clinical evaluation of the results of percutaneous surgery for urolithiasis with the patient in the supine position. MATERIALS AND METHODS: The results of surgical treatment of 316 patients with urolithiasis with stones localized in the kidney (more than 10 mm) and the upper third of the ureter (more than 8 mm) are presented. All patients underwent percutaneous nephrolithotripsy in the supine position. RESULTS: Complete elimination of stones was achieved in 91.3% of patients with stones of the upper third of the ureter and 96.2% of patients with kidney stones. Clinical evaluation of the surgical results showed that the frequency of intraoperative complications of traumatic origin is about 10%, the most common complication being bleeding. At the same time, complications of grades IV and V according to the Clavien–Dindo classification were noted. Performing percutaneous nephrolithotripsy in the supine position reduces the time required to position the patient, allows for the combination of transurethral and percutaneous interventions, is more effective for patients with increased weight and concomitant diseases, and also provides a significant advantage in the need for ventilation and possible resuscitation. CONCLUSIONS: It is advisable to introduce a personalized approach to the choice of surgical access when performing invasive interventions on the upper urinary tract.

The review article discusses modern methods for diagnosing and treating patients with non-muscle-invasive bladder cancer. The search and analysis of information was carried out in the databases PubMed, Google Scholar, eLibrary. Information about photodynamic diagnostics, narrow-band imaging, mono- and bipolar transurethral resection, transurethral thulium and holmium laser resection, en-bloc resection of neoplasms, Nd:YAG laser ablation of the tumor bed is presented. The features, advantages and disadvantages of each of these methods, as well as their combinations and modifications are described in detail. Particular attention is paid to the use of laser technologies in the surgical treatment of patients with non-muscle-invasive bladder cancer. An analysis of the results of studies of the efficacy and safety of various methods of surgical treatment of non-muscle-invasive bladder cancer was carried out. The significance of the problem of increasing the efficiency of treatment of such patients, which is one of the priority areas of modern oncourology, is indicated.

This article describes the clinical manifestations of testicular vein thrombosis, methods for diagnosing this disease, as well as possible complications and methods for their elimination. The presented nosology is a rare pathology with a clinical picture of an acute scrotum that can develop at any age. In most cases, the symptom group of acute scrotum syndrome is caused by orchiepididymitis, testicular torsion. In a small percentage of cases, according to the results of the examination, testicular vein thrombosis is detected. As an example, clearly illustrating the treatment options for a complicated course of testicular vein thrombosis, a clinical case of a patient admitted to the emergency department of a city hospital with edematous and pain reaction in the scrotum, hypertheremia is presented. The article describes in detail the clinical manifestations of the disease, options and treatment in a multidisciplinary hospital.

Despite numerous studies, the problem of escherichiosis in newborn calves remains one of the most urgent due to the extensive spread of the disease and high mortality of young animals. This paper presents results of experimental studies carried out at the FSBSI “All-Russian Veterinary Research Institute of Pathology, Pharmacology and Therapy”. The aim of the work was to conduct complex morphological studies using modern methods for a deeper understanding of escherichiosis etiology and pathogenesis. For that, pathological samples were collected from 28 1–10 day-old calves diagnosed with colibacteriosis at the initial disease stage, demonstrating pronounced clinical signs and having the terminal stage of the disease. Samples from 6 clinically healthy calves of a similar age were used as control. It was found that newborn calves at the initial stage of escherichiosis demonstrated early structural changes in the ultrastructure of mucosa cells of the rennet and small intestine, as well as in the liver parenchyma, and mild changes – in the exocrine part of the pancreas. The most profound morphofunctional changes were observed in digestive organs with apparent clinical signs of the disease. As the condition developed, the range of pathological processes expanded and involved the structural organization of the rennet, small and large intestines, liver and pancreas. At the terminal stage of escherichiosis, deep inflammatory processes occurred not only in digestive organs, but also in other systems of diseased calves. Structural changes in digestive organs had an alterative nature at the initial disease stage, whereas in case of clinically pronounced disease signs there were manifestations of catarrhal-necrotic inflammation with multiple hemorrhages in the gastrointestinal tract and parenchymal organs. Digestive organ pathology plays the leading role in formation of the clinical and morphological picture at the initial stage of escherichiosis in calves. As the disease developed, the calves demonstrated changes at molecular and subcellular levels that were detected using histochemical and ultrastructural tests.

The article describes the clinical manifestations of a solitary kidney cyst, methods for diagnosing this disease, as well as possible complications and videoendoscopic methods of surgical treatment. The presented nosology is a fairly common lesion of the kidneys with clinically significant symptoms that manifest at any age. In most cases, simple kidney cysts are an accidental finding on ultrasound examination and, with small sizes, do not require active observation and treatment. In a small percentage of cases, cysts can be complicated by bleeding, infection or rupture, after which there is a need for active surgical treatment. As a clinical example illustrating the options for endoscopic treatment of a complicated course of solitary kidney cyst, the data of 2 patients with a new coronavirus infection, in whom a hemorrhage into the cavity of a large cyst was diagnosed in the postcovid period against the background of continued anticoagulant therapy, are presented. The article describes in detail the clinical manifestations of the disease, options and stages of surgical treatment from laparoscopic and retroperitoneal approaches in a multidisciplinary hospital.

Testicular torsion refers to diseases of the acute scrotum group and requires early diagnosis and emergency surgical care. Despite the characteristic clinical signs, sometimes there are difficulties in diagnosis, which leads to delayed treatment and irreversible damage to the testicle. The article describes a clinical case of testicular torsion in a young patient with errors in diagnosis, which led to the removal of the testicle. As a result of a diagnostic error – an incorrect collected anamnesis and not timely execution of ultrasound dopplerography, conservative treatment for epididymoorchitis was carried out. The given example illustrates the importance of a thorough study of the anamnesis of the disease – the onset and nature of pain, nausea, as well as local symptoms that are not characteristic of other acute testicular diseases. In addition, if a testicular torsion is suspected, it is necessary to perform urgent, sometimes repeated ultrasound dopplerography of the scrotum organs, which is of irreplaceable value for solving the issue of emergency surgical treatment. At the slightest suspicion of testicular torsion, in particular the presence of several characteristic symptoms and ultrasound data, you need to resort to emergency surgery.