Modern Urology Research Articles

Evaluation of the effectiveness of buccal ureteroplasty in the late postoperative period

Surgical treatment of organic obstruction of the upper urinary tract is a complex problem in modern urology. The aim of the study was to analyze the assessment of the late postoperative period after ureteral replacement with a buccal graft. We followed up 32 patients who underwent buccal ureteroplasty (BU). The effectiveness of this surgical intervention was assessed by the absence of recurrence of the disease and the need to reuse ureteral stenting or percutaneous nephrostomy. Recurrence of urinary tract obstruction was later detected in 3 (9.4 %) patients. Also, after removal of the stent in 18 patients, the following indicators were evaluated: glomerular filtration rate, maximum systolic blood flow velocity in the interlobar arteries of the kidney, thickness of the kidney parenchyma, ureteroscopy, and pain in the lumbar region. After 6 months, the established parameters were re-determined, and in case of improvement or unchanged primary indicators, each of the parameters was scored 1 point, in case of deterioration of the primary indicators, each of the parameters was scored 0 points. If the total score is 3 or more, then the course of the postoperative period after reconstructive surgery on the upper urinary tract using a buccal graft is considered favorable and conservative therapy is continued. Two of the 18 patients had a score of 2, which led to a change in the tactics of postoperative follow-up. Thus, this method for assessing parameters in operated patients allows timely correction of renal dysfunction.

Application of 3D Bioprinting in Urology.

Tissue engineering is an emerging field to create functional tissue components and whole organs. The structural and functional defects caused by congenital malformation, trauma, inflammation or tumor are still the major clinical challenges facing modern urology, and the current treatment has not achieved the expected results. Recently, 3D bioprinting has gained attention for its ability to create highly specialized tissue models using biological materials, bridging the gap between artificially engineered and natural tissue structures. This paper reviews the research progress, application prospects and current challenges of 3D bioprinting in urology tissue engineering.

Treatment of Patients and Mechanisms of Development of Combined of Urolithiasis and Kidney Tumors (Literature review)

Urolithiasis is a disease which is characterized by the formation of stones in the urinary system and is one of the most actual problems in modern urology and medicine worldwide. Recently, there has been a steady spread of this disease. Urolithiasis ranks the second position in the structure of urological diseases in Ukraine, second only to infectious and inflammatory pathologies and accounts for 30-45 % of diseases of the genitourinary system. Urolithiasis is manifested by the appearance of stones in the urinary system (most often the kidneys). The most common type of kidney cancer (KC) is renal cell carcinoma. It accounts for about 97 % of all kidney tumors. With the increase in the number of patients with renal tumors and urolithiasis, there is a clear tendency to increase the number of patients with a combination of these two serious diseases. Unfortunately, the question of the relationship and interdependence between the development of urolithiasis and kidney tumor remains open today. The objective: to search, systematize and analyze scientific publications about the mechanisms of development and treatment of this combined pathology. Infection and chronic inflammation cause the development of urothelial proliferation and the emergence of malignant neoplasms. Inflammatory cells secrete cytokines and chemokines in response to a chronic recurrent infectious-inflammatory process that causes tumor cell growth and tumor progression. Special attention in the publications is paid to the role of endothelial dysfunction in the development of kidney tumors. The importance of vascular endothelial growth factor (VEGF) in the mechanism of neoangiogenesis of KC is demonstrated. Management of the patients with combined pathology of urolithiasis and KC involves the doctor’s choice of the optimal method. The analysis of literature publications demonstrates that today there are a number of issues devoted to the presence of KC and urolithiasis in one patient. These are the risks of such a combination, and the mechanisms of development, as well as determining the most rational and effective management in each case. All above mentioned cause the need for further study of the treatment of patients with urolithiasis and kidney tumor.

HF02-11 PROFESSOR IGLESIAS - PHYSICIAN, INVENTOR, AND POLITICAL PRISONER

You have accessJournal of UrologyCME1 May 2022HF02-11 PROFESSOR IGLESIAS - PHYSICIAN, INVENTOR, AND POLITICAL PRISONER Janmejay Hingu, Matthew Davis, Mubashir Billah, and Hossein Sadeghi-Nejad Janmejay HinguJanmejay Hingu More articles by this author , Matthew DavisMatthew Davis More articles by this author , Mubashir BillahMubashir Billah More articles by this author , and Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002540.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Even after many advances in the surgical management of benign prostatic hyperplasia, transurethral resection of the prostate remains the gold standard in no small part due to the Iglesias resectoscope, first invented by Dr. José Iglesias. We sought to bring an unpublished historical record detailing both the early development of the Iglesias resectoscope and also its political influence on Iglesias’s relationship with his native country of Cuba. METHODS: Various urologists who previously worked with Iglesias were interviewed in person or over telephone. Permission was obtained from the urologists who contributed to this project to publish these accounts. RESULTS: Although the Iglesias resectoscope can be found ubiquitously in modern urology practices, not many know that it facilitated Iglesias's escape from the Castro regime during the Cuban revolution. Iglesias’s passion for urology led him to develop the Iglesias resectoscope, which improved upon the previous, more cumbersome Stern-McCarthy resectoscope in several ways. Instead of requiring two hands to operate, the Iglesias resectoscope only required one hand by implementing a counter force steel spring against the resecting mechanism. He also engineered a continuous irrigation system, allowing the surgeon to resect tissue without intermittently stopping to empty the bladder. With these ingenious improvements, Iglesias naturally enlisted the help of American Cystoscope Manufacturing Inc. (ACMI) to market his product, leading to the widespread adoption we see today. Iglesias was also a physician well-regarded by the Batista government in Cuba. Unfortunately, he soon became entwined within the Cuban Revolution as the Castro regime imprisoned him and other allies of the Batistas. Soon after, the royalties that Iglesias had earned on his resectoscope were forcibly turned over to the Castro government in exchange for his release, leaving him almost penniless afterward. Resilient as ever, Iglesias then moved to New Jersey where he once again began as a urology professor at the University of Medicine and Dentistry of New Jersey (UMDNJ), now known as Rutgers New Jersey Medical School, and continued to engineer new scopes for the Karl Storz company. Residents who trained under Iglesias recount that “Boss was a superstar.” CONCLUSIONS: Iglesias made multiple contributions to the field of urology with the invention of the Iglesias resectoscope and its pioneering introduction of continuous flow irrigation. That same resectoscope would also save his life during the Cuban revolution. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e209 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janmejay Hingu More articles by this author Matthew Davis More articles by this author Mubashir Billah More articles by this author Hossein Sadeghi-Nejad More articles by this author Expand All Advertisement PDF DownloadLoading ...

From “Micro-“ Diagnosis to “Macro-“ Treatment, a Road Full of Colors

Introduction: From 1878 when the first working cystoscope was presented to today’s era of big data and artificial intelligence, colorful biomarkers remain one of the urologists’ strongest allies. We hereby review the current research frontiers in “color” informatics and their clinical translation in urology through methodologies and applications of visual augmentation of molecular feedback and theragnostic. Results: The multi-dimensional data approach involves firstly lasers’ rapid progress as an omnipresent part of modern urology in a variety of diseases, while color Doppler assists the depiction both of the urinary tract and the male genital tract. Both in molecular and systemic level screening, unique techniques using light, histochemical stain enabling color, and fluorescent tracers are improving morphological discrimination between malignant and benign cells, as well as providing anatomical and functional information preoperatively and intraoperatively. Conclusion: Technologies by exploiting the various lengths of the spectrum of light, which clinically it is translated, and it is evident as different color shades, have significantly toward improved our ability to both diagnose and treat urological entities. Thus, improving the management of light’s and color’s unique attributes could provide urologists with more effective clinical tools.

Buccal ureteroplasty options, techniques, long-term results

Purpose of the study. Surgical treatment of extended strictures and obliterations of the ureter is still a complicated problem of modern urology. The aim of the study was to analyze our own experience of ureteral replacement plastic surgery with buccal graft, i.e buccal ureteroplasty (BU) with its extended strictures/obliterations.Patients and methods. We’ve observed 25 patients who underwent BU. The lower third of the ureter was affected in 3 (12.0 %) cases, the lower third and the mouth of the ureter was affected in 7 people (28.0 %), the middle third in 2 (8.0 %), the upper third in 5 patients (20.0 %), the combined lesion of the upper third of the ureter and the pelvic‑ureteral segment (PUS) was in 8 (32.0 %) patients. All patients underwent repeated operations on a ureter, all revealed a significant comorbid background. The surgery was performed with a tubularized buccal graft in 13 (52.0 %), the onlay technique was applied in 12 (48.0 %). Laparoscopic surgery was performed in 10 (40.0 %) patients, surgical aid was carried out in an open way in 15 (60 %).Results. Severe complications according to the Clavien‑Dindo classification, requiring hospitalization of patients in the intensive care unit with organ dysfunction, as well as lethal outcomes were absent. The follow‑up period of patients ranged from 1 to 57 months (an average of 14.7 months). One patient after laparoscopic BU with a tubular graft had a short (1 mm) stenosis in the anastomosis area for 6 months of follow‑up, which was successfully eliminated by laser endoureterotomy. During the entire follow‑up period, residual hydronephrosis was recorded in 4 patients (16.0 %) against the background of complete patency of the anastomosis. A control flexible ureteroscopy performed in 16 (64.0 %) patients did not reveal rejection of the buccal graft. There are still 20 patients under our supervision.Conclusion. Our experience shows that the implementation of BU is possible on any part of the VMP using various techniques. This operation can be regarded as the "second" line of surgical treatment of strictures and obliterations of the ureter, especially after unsuccessful attempts of other reconstructions in a group of patients with severe concomitant pathology.

Mast cell hyperactivity as the factor in the pathogenesis of male infertility

The proportion of men with impaired sperm fertility is increasing every year, which is one of the factors in the decline in fertility and is becoming both a medical and social problem. Modern diagnostic methods make it possible to recognize many factors of male infertility: genetic, endocrine, infectious, extra-genital, etc. However, despite all modern biomedical advances, 1/3 of patients remain with an unrecognized cause (idiopathic) of male infertility. At the same time, we must not forget that most patients from this category do not want to resort to assisted reproductive technologies to realize paternity, and they strive to achieve pregnancy in a natural way. Therefore, the search for the causes of male infertility remains an urgent issue in modern urology field. This article reviews the literature on the role of mast cells in the formation of fibrosis in tissues, including the testis. Mast cells affect the proliferation, functioning and phenotype of fibroblasts put under hypoxic conditions. Fibroblast activation enhances collagen fibrillogenesis. Studies by Russian and foreign scientists have shown that with sperm pathology, the number of mast cells in the connective tissue of the testicle increases sharply. Against the background of an increase in the number of mast cells in the interstitium of the testis, fibrosis of the wall of the convoluted seminiferous tubules increases. Moreover, in severe spermatogenesis disorders (Sertoli cell-only syndrome, Germ cell aplasia), mast cells were found both in the peritubular space and in the lumen of the convoluted seminiferous tubules. Most infertile men have significant amounts of significant amounts of mast cells in their ejaculate. There are sporadic data on the negative correlation between the presence of mast cells in seminal plasma and the concentration and motility of spermatozoa. Conclusion. The negative effect of mast cells on spermatogenesis remains unknown to the end. Mast cells have a high ability to migrate to connective tissue, which levels increase during inflammation, and the production of many mediators, proteases and histamine, cytokines, which can be both a trigger in the formation of sperm pathology and the cause of the formation of fibrosis in the testicle.

Remote lithotripsy in the treatment of urolithiasis

Treatment of patients with urolithiasis (Urolithiasis) in modern urology is an important task associated with both medical and social and labor rehabilitation. According to NK Dzeranov's forecasts [5], in 2000 the number of patients with ICD will increase 1.8-2.0 times. The annual rate of primary morbidity of KSD is 0.1% [25]. Surgical intervention, being for several decades the leading method of treating KSD. fraught with serious complications. NK Dzeranov [5] indicates a high percentage of relapses of a more severe form of ICD, in which the number of nephrectomies increases to 11.5%. Poor surgical outcomes prompted clinicians to seek alternatives to open surgery.

THE CONSEQUINCES OF LONG TIRM RESULTS OF THE TREATMENT OF PATIENTS WITH BLUNT KIDNEY INJURIES

Currently the leading damage organs of the urinary system occupy closed kidney injuries and their number with each increases over the year. However, the problem of providing first aid to victims with closed kidney injuries, as well as their further treatments are among the most urgent in modern urology and cause wide discussion. Analysis have undergone closed kidney damage,allows us to conclude that the indications for operational organ-preserving treatment of victims should be expanded to reduce the number of complications in late post-traumatic period.

Predictive value of inflammatory indices LMR, PLR and NLR in patients with muscle-invasive bladder cancer

BACKGROUND: Increasing the efficiency of predicting the results of treatment of patients with bladder cancer is one of the important tasks of modern urology.
 AIM: Our aim was to identify and evaluate the association between the most significant clinical, morphological and immunological markers and survival of muscle-invasive bladder cancer patients treated with radical cystectomy. We also developed an algorithm for diagnosis and treatment of patients with muscle-invasive bladder cancer.
 MATERIALS AND METHODS: This retrospective study included 100 muscle-invasive bladder cancer patients, who underwent radical cystectomy between 1995 and 2013. The study endpoints were overall survival.
 RESULTS: Univariable analysis revealed that continuous (Lymphocyte-monocyte ratio), PLR (platelet-lymphocyte ratio) и NLR (neutrophil-lymphocyte ratio) were significantly associated with overall survival. On multivariable regression model analysis, continuous LMR, NLR, and PLR independently predicted both endpoints.
 CONCLUSIONS: Our findings indicate that the cheap and simple blood-based biomarkers may be valuable in identifying muscle-invasive bladder cancer patients treated with radical cystectomy, who are at higher risk of all-cause mortality.

Complex conservative therapy of chronic abacterial prostatitis

BACKGROUND: Improving the results of treatment of patients with chronic prostatitis is one of the important problems of modern urology.
 AIM: To compare the effect of ozone therapy and hypercapnic therapy on the hemodynamics of the prostate and immune status in patients with chronic abacterial prostatitis.
 MATERIALS AND METHODS: The study included 58 patients with chronic abacterial prostatitis, who were divided into three groups. Patients of the 1st group (n = 18) received standard therapy. Patients of the 2nd group additionally underwent a course of transrectal ozone therapy for 10 days. Patients of the 3rd group, in addition to the basic therapy, performed training on a breathing simulator to obtain the effect of hypercapnic hypoxia; the course of treatment consisted of 10 daily trainings. The effectiveness of therapy was assessed using the NIH-CPSI questionnaire. To assess the immune status of patients, we studied the content of IgA, IgG and IgM in the blood, the activity of the pro-inflammatory cytokines IL-1, TNF-, IL-6 in the blood serum and IL-8 in the urine. The state of blood flow in the prostate gland was assessed using laser Doppler flowmetry, as well as TRUS performed in the color Doppler imaging mode. The control group included 22 healthy men.
 RESULTS: In patients with chronic abacterial prostatitis hemodynamic and microcirculatory changes in the prostate gland were revealed, which were accompanied by characteristic clinical manifestations, urinary disorders, as well as impaired immune status in the form of an increase in the content of interleukins and tumor necrosis factor. The use of basic therapy (1st group) helps to reduce the clinical manifestations of chronic abacterial prostatitis, but its effect on the immune status, hemodynamics and microcirculation of the prostate gland is insufficiently expressed. Complex therapy, supplemented by training on a breathing simulator using the effect of hypercapnic hypoxia, has a positive effect on the course of the disease (3rd group). This type of therapy is able to improve the microcirculation of the prostate gland, increasing the index of microcirculation efficiency and average blood flow, reducing the shunting rates, but its effect on immunity is lower than in patients whose treatment included transrectal ozone therapy (2nd group). This type of treatment leads to a decrease in the activity of the pro-inflammatory cytokines IL-1, TNF-, IL-6 in the blood serum, and IL-8 in the urine, but at the same time does not have a sufficient effect on prostate hemodynamics and microcirculation.
 CONCLUSIONS: In patients with CAP with pronounced disorders of the immune status, complex treatment is indicated, supplemented by transrectal ozone therapy, and in the presence of pronounced hemodynamic disorders of the prostate gland, complex therapy is indicated, supplemented by the use of the effect of hypercapnic hypoxia.

Efficacy evaluation of entomological drug Adenoprosin® usage in combined treatment of patients with lower urinary tract symptoms due to benign prostate enlargement

BACKGROUND: Increasing the effectiveness of treatment of patients with symptoms of the lower urinary tract is one of the main problems of modern urology, which is associated both with their high prevalence and with a significant deterioration in the quality of life of patients.
 AIM: The article presents the results of the usage of the entomological drug Adenoprosin in the combined treatment of patients with lower urinary tract symptoms due to benign prostatic enlargement.
 MATERIALS AND METHODS: 80 patients were treated (mean age 63.6 6.4 years). At the initial phase of the study, all patients received Tamsulosin 0.4 mg once a day for 4 weeks. At the second phase, the patients were divided into two groups. Group 1 patients were prescribed a combination therapy with Adenoprosin (1 rectal suppository (150 mg) at night, for a course of 30 suppositories) and Tamsulosin (0.4 mg per day). Patients of the 2nd group continued monotherapy with Tamsulosin (0.4 mg per day). The duration of the second phase of treatment was 4 weeks.
 RESULTS: The results of the study showed a more pronounced positive dynamics of clinical indicators in patients of the 1st group, who received combination therapy with Adenoprosin and Tamsulosin, compared to patients of the 2nd group. There was a more pronounced decrease in the IPSS score, an improvement in the quality of life, an increase in the urine flow rate and a decrease in the volume of residual urine. The volume of the prostate gland did not change significantly. When examined 2 weeks after the end of treatment, the positive dynamics of clinical indicators in patients of the 1st group persisted. The tolerability of the treatment was satisfactory in patients of both groups.
 CONCLUSIONS: The results of the study indicate the advisability of including Adenoprosin in the combination therapy of patients with lower urinary tract symptoms due to benign enlargement of the prostate gland.

Modern urology is a one-day surgery. Features of patient management

In our country, up to 27 % of inpatient surgical beds are occupied by patients who can be assisted in one-day surgery departments and clinics. This innovative method of organizing treatment improves the quality of medical care, creating a situation in which everything is organized around patients and their interests. The patient’s discharge on the day of surgical treatment makes high demands on the level of professionalism of doctors. Therefore, we have analyzed modern scientific and practical achievements in the management of patients on the principle of one-day surgery.

Оценка электронной микроскопией иммунологических нарушений в секрете предстательной железы пациентов с хроническим рецидивирующим бактериальным простатитом

Introduction Chronic recurrent bacterial prostatitis (CRPD) is an urgent problem of modern urology and andrology. Objective To study the immunological features of the secretion of the prostate by electron microscopy in patients with chronic recurrent bacterial prostatitis. Materials and methods The analysis of the morphometric study of neutrophils in the secretion of the prostate was carried out in 90 patients with chronic bacterial prostatitis, who were divided into two groups. Group I (study) (n=51) with chronic recurrent bacterial prostatitis (CRBP) and group II (control) (n=39) with chronic primary diagnosed bacterial prostatitis (CPDBP). Results At electron microscopy of ALE in most patients with CRBP of the group, the cytological picture of ALE was represented by inactive neutrophils with pathology of phagocytosis. The cells are of the correct rounded shape, without pseudopodia, with light cytoplasm. The cytological picture of ALE in CPDBP is characterized by the absence of impaired local immunity. The normal process of phagocytosis is recorded, where many pseudopodia of the segmented neutrophil completely complete the process of opsonization of microorganisms in the area of the inflammatory process. Conclusions In patients with CRBP, in 100% of cases, dysfunction of immunocompetent prostate cells was noted, which is the basis for the appointment of immunoactive therapy for CRBP.

HF02-11 DR. CLYDE LEROY DEMING: VISIONARY DURING A TURBULENT TIME

You have accessJournal of UrologyHistory of Urology Forum II (HF02)1 Sep 2021HF02-11 DR. CLYDE LEROY DEMING: VISIONARY DURING A TURBULENT TIME Soum Lokeshwar, Jamil Syed, Jay Amin, Christine Merenda, Michael Leapman, and Robert Weiss Soum LokeshwarSoum Lokeshwar More articles by this author , Jamil SyedJamil Syed More articles by this author , Jay AminJay Amin More articles by this author , Christine MerendaChristine Merenda More articles by this author , Michael LeapmanMichael Leapman More articles by this author , and Robert WeissRobert Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001993.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The field of Urology, after WWII, in need of strong leadership elected Dr. Clyde Leroy Deming, as its 40th president of the AUA in 1946. His vision was crucial in the organization of modern urology. The objective of this study is to highlight the life and vision of Dr. Deming. METHODS: Sources from journals through PubMed, Medline, and Scopus and historical archives through the Yale Medical Library were analyzed for the contributions of Dr. Deming. RESULTS: Born in August 1885 in Cornish, NH, Dr. Deming attended Bowdoin College and then Yale Medical School, graduating cum laude in 1915. As an intern in the New Haven Hospital, he trained as the first resident surgeon at Yale. With an interest in urology, he apprenticed for two years with Dr. Hugh Hampton Young at Johns Hopkins. With the expanding niche for urology, Dr. Deming established the Section of Urology at Yale and served as the Chief of Urology from 1921-1954. He performed >3000 perineal prostatectomies, developed the “Deming Nephropexy”, studied hormonal therapy for urogenital cancers, and with his associate Dr. Harry S. N. Greene performed the heterologous transplantation of a human bladder papilloma into a guinea pig’s eye. Dr. Deming authored over 100 scientific papers.Dr. Deming was elected AUA President in 1946. It was a turbulent time for Urology with many returning injured soldiers, an influx of war weary surgeons, a need for clinical urologists, and a paucity of urologists involved in the formulation of medical policy. In this tempestuous time, Dr. Deming served as a visionary for the future of Urology. In his Presidential address in July 1946, he laid out the plans for the future of urology. He defined the next phase of urology as “Progress”. In his mind, to better serve patients, urologists had to unify to grow and standardize their practice. He cited the scarcity of state meetings and urological associations and urged urologists to return to their communities to improve urologic practice and to educate budding urologists. He concluded that the practice of urology was ready to take its place in every community.Dr. Deming served as president of the American Association of Genito-Urinary Surgeons in 1948. He continued to practice urology and serve his community through organizations and his church. He died in November 1969 in New Haven CT. CONCLUSIONS: Today, 75 years after the speech calling for structure within urology, there is national and state urological structure and advocacy. Urologic specialists practice in every community and formal guidelines for urology practice have been implemented. The legacy of “Progress” outlined by Dr. Deming lives on. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e240-e241 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Soum Lokeshwar More articles by this author Jamil Syed More articles by this author Jay Amin More articles by this author Christine Merenda More articles by this author Michael Leapman More articles by this author Robert Weiss More articles by this author Expand All Advertisement Loading ...

HF01-13 VENEREAL DISEASE AND THE BATTLEFIELD: FROM AMERICA'S FIRST CULTURAL EXPORT TO MILITARY RUN BROTHELS

You have accessJournal of UrologyHistory of Urology Forum I (HF01)1 Sep 2021HF01-13 VENEREAL DISEASE AND THE BATTLEFIELD: FROM AMERICA'S FIRST CULTURAL EXPORT TO MILITARY RUN BROTHELS Adam Russon, Kyle Waisanen, Ronald Rabinowitz, and Kevin Pranikoff Adam RussonAdam Russon More articles by this author , Kyle WaisanenKyle Waisanen More articles by this author , Ronald RabinowitzRonald Rabinowitz More articles by this author , and Kevin PranikoffKevin Pranikoff More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001992.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the history of venereal disease during America's wars and the way its rampant spread shaped US armed forces and military medicine. METHODS: In-depth review of public and government records on the history, prevention, epidemiology, treatment, military, and economic impact of venereal disease during American wars. Literature review via PubMed was implemented to gain access to journal articles, texts, and personal histories detailing efforts from clinical and scientific perspectives. Archival materials were utilized from the William P. Didusch Center for Urologic History and the National Museum of Health and Medicine. RESULTS: The rampant spread of venereal disease has long been associated with war; from Columbus’ crews returning to the old world carrying new and virulent strains of the disease, to World War II when sulfanilamide then penicillin revolutionized not only the method, but by whom the disease would be diagnosed and treated. We outline the fascinating history that follows the trail of the disease over the course of America's wars. We present not only the epidemiology within US troops of syphilis and gonorrhea (at one point considered to be the same disease), but the progression of treatment, prevention, and economical impact of the widespread affliction. The Revolutionary, Civil, and World Wars I and II, all were dramatically impacted by venereal disease and the leadership responsible for the American soldier became more and more creative with prevention and treatment. If the military sponsored brothels didn’t keep them safe, perhaps the first army produced film could urge the young men to remain “Fit to Fight.” The additional threat of lost wages or sharp excision of lesions provided additional impetus to avoid VD. Physicians such as Hugh Hampton Young, the father of modern urology, were responsible for the dramatic decrease in cases during World War I. The advent of penicillin during World War II resulted in the transfer of the treatment of VD from urologists to internal medicine. With hands free and much more time available, military urologists transitioned to their more surgical role as seen today. CONCLUSIONS: While it is important to learn about the impact that war and military medicine had on venereal disease over the history of America's wars, it is arguably more so to learn of the impact that VD had on military campaigns, military medicine, and public health throughout the decades. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e232-e232 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Russon More articles by this author Kyle Waisanen More articles by this author Ronald Rabinowitz More articles by this author Kevin Pranikoff More articles by this author Expand All Advertisement Loading ...

Theoretical Substantiation of the Use of Sildenafil in the Treatment of Chronic Prostatitis

Every year, the number of patients with chronic prostatitis (CP) in the world is increasing and improving the effectiveness of treatment of this pathology is becoming a priority topic in modern urology. One of the complications of CP is sexual dysfunction, primarily premature ejaculation, as well as erectile dysfunction (ED). Treatment of CP and its sexual complications is an individual and complex complication. It is undeniable that sildenafil citrate plays an important role in the treatment of ED as a complication of CP. The hypothetical mechanism of the effectiveness of PDE-5 in CP is mediated by the relaxation of the smooth muscles of the ducts of the software, the effect of increasing the drainage of the components that are formed due to reflux in the interstitial tissue. The above phenomenon can suppress inflammation and cause a reduction in prostatic symptoms. Increased activity of NO-synthetase and PDE-5 in the tissues of PO promotes the formation of muscle relaxant effects, drainage of the acinus, reduced activity of the autonomic nervous system and activation of vascular circulation in the PVC and structures of the lower urinary tract. Current scientific evidence indicates that PDE-5 inhibitors can improve lower urinary tract symptoms by relaxing bladder smooth muscle fibers and PO, by signaling NO / cGMPc, or by improving RhoA / Rho kinase. Some results suggest that in addition to the effects of reducing the hyperactivity of the autonomic nervous system, dilation of cavernous vessels and antiproliferative effect, PDE-5 have a direct anti-inflammatory effect, increasing the level of cGMP. The accumulation of the latter can inhibit inflammation and can be a potential mechanism for preventing the development of diseases in which inflammation plays a central role. Given that inflammation is a major factor in the progression of CP, sildenafil citrate is able to restore PO function because they act as potent anti-inflammatory drugs. Thus, PDE-5 inhibitors can not only mediate smooth muscle relaxation, but can also directly reduce inflammation in the software by increasing cGMP levels. Based on theoretical data on the positive effect of sildenafil on the erectile component and symptoms of the lower urinary tract in persons with CP with complications such as ED, it can be considered that the inclusion of sildenafil citrate in sequential standard therapy for CP reduces indicators of erectile function. The appointment of sildenafil citrate in patients with complications of CP in the form of ED improves the quality of erections in patients, and also has a positive effect on various other indicators of male sexual function (enhances orgasm, increases the duration of sexual intercourse).

Initial experience in the field of pediatric percutaneous nephrolitholapaxia in Bulgaria.

Pediatric urolithiasis is a very specific and challenging problem in the field of modern urology. Currently, there are three major methods for kidney stone removal: the extracorporeal shock wave lithotripsy (ESWL), the retrograde intrarenal surgery (RIRS), and the percutaneous nephrolithotomy (PCNL), the latter one proving to be an efficient and safe monotherapy of stones even with larger burden. Different sizes of nephroscopes are used (standard, mini, micro), where smaller size is logically correlated with safer profile, especially in pediatric population. To analyze the initial experience in using PCNL in children for the treatment of kidney concrements - rates of successful stone removal and registered complications. Twenty-six PCNL procedures of 25 children were performed - both standard and mini. The age ofpatients, size of the stones, operating time, changes in hemoglobin levels, duration of hospital stay, and the postoperative complications were recorded, analyzed and compared to data reported in current relevant literature. The mean age of patients was 9±5.2 years (15 boys and 10 girls). The average size of concrements subjected to nephrolitholapaxia was 16±0.7 mm, most of the cases being single stones. The average operative time was 150±33.4 min, and the average hospital stay was 4.1±1.5 days. The percentage of stone free children postoperatively was 94%. Complications included blood loss requiring transfusion in 1 patient (4%), postoperative urinary tract infection and fever (2 patients), and self-limiting hematuria in 16%. PCNL is an effective and safe alternative in the management of nephrolithiasis in children. It is a method of choice for the treatment of concretions not suitable to treat with extracorporeal lithotripsy and after a qualitative selection of patients.

Сечокам'яна хвороба як наслідок вторинної гіперурикемії у пацієнтів з діабетичним ураженням нирок

Urolithiasis is currently one of the most pressing problems of modern urology and medicine in general. The pathogenesis of urolithiasis is multifactorial and caused by various metabolic disorders, in particular carbohydrate, the main manifestation of which is diabetes mellitus. In connection with the above, a comparative approach to the study of metabolic disorders in patients with diabetic kidney damage, in particular hyperuricemia, is relevant in order to identify possible causes of lithogenesis. The purpose of the study is to study the effect of secondary hyperuricemia on the formation of urinary stones in patients with diabetic kidney damage, compared with non-diabetic nephropathies. Materials and methods. The study included 59 patients with chronic kidney disease, including 27 with diabetic nephropathy and 32 with non-diabetic nephropathy. All patients underwent a comprehensive clinical and laboratory study, which included glycosylated hemoglobin, glycemic profile, lipid complex, C-reactive protein, serum creatinine, urea, electrolytes, uric acid, uric acid clearance, glomerular filtration rate, and ultrasound examination of the urinary system. Results and discussion. Urolithiasis was detected in 70.3 % patients with diabetic kidney disease and in 29.6% patients with non-diabetic pathology. The stones had a renal localization: pelvic stones occurred in 38.9% patients, stones in calyces – in 61.1% patients. When assessing the biochemical parameters, the average level of uric acid in the blood serum of patients with diabetes mellitus significantly exceeded the same indicator in the group of patients with non-diabetic pathology. Also, the level of hyperuricemia was higher in diabetic patients with a glycosylated hemoglobin content of more than 8.5%, compared with patients with an HbA1 concentration of less than 7.5%. In patients of both groups compared with serum uric acid concentrations exceeding the level of 498.5 mmol/l in men and 384.2 mmol/L in women, there was a progression of arterial hypertension. In patients with diabetic nephropathy, there was a significant increase in the level of cholesterol, low-density lipoproteins and triglycerides, which provided an increase in the value of the atherogenicity index to 5.7±1.2. Conclusion. In patients with diabetic kidney damage, there are prerequisites for the development of urolithiasis, due to the development of a number of metabolic disorders that affect kidney function and the composition of urine. The key links in the pathogenesis of more frequent development of urolithiasis in this category of patients are secondary hyperuricemia, as well as disorders of carbohydrate and lipid metabolism in the form of hyperglycemia and hyperlipidemia

ELearning and transurethral prostate surgery: virtual tools for a real training.

In the recent two decades, technological breakthrough has tremendously expanded the scope of transurethral prostate surgery. New gadgets and energy devices keep emerging to tackle benign prostatic obstruction, which was dealt with mainly by transurethral resection of prostate in the old days. Although this trend appears fascinating, it also means that urologists need quality training to attain surgical safety in performing these new surgeries. E-learning and simulation training may play an important role in modern urology training. In this review, we would describe, using up-to-date evidence, the key components of simulation training, the types of simulators currently in use and their respective advantages and limitations. Modern simulation technology enables surgical training in a realistic, reproducible and risk-free environment. Simulation training has been proven to improve both performers' confidence and objective scores in various transurethral prostate surgeries. Its use should therefore be advocated.