Urological Problems Research Articles

Retrograde Intrarenal Surgery versus Mini-Percutaneous Nephrolithotomy for Lower Calyceal Stones of ≤ 2 cm

Introduction: Renal stones are one of the common urological problems. The optimal management of lower calyceal renal calculi of 1-2 cm is still debatable. The objective of this research is to assess the safety, efficacy, and stone-free rate of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for the management of lower calyceal stones of 1-2 cm. Methods: A prospective comparative study was conducted among 30 patients which were divided in two group (A and B) prospectively with lower calyceal stones of 1-2 cm. Group A were treated with retrograde intra renal surgery while Group B were treated with mini percutaneous nephrolithotomy. Results: The mean age of patient in Group-A was 44.27±17.10 year and in Group-B was 45.27±16.11 year. The hospital stay in Group-A was 3.47±0.62 and in Group-B was 4.50±0.73 days. The stone size in Group-A was 13.30±2.21 mm and in Group-B was 15.60±2.55 with p-value of 0.381. The duration of operation time in Group-A was79.37±13.96 minutes and in Group-B was 62.53±7.41 minutes with p value of 0.091. Conclusions: Both retrograde intrarenal surgery and mini-percutaneous nephrolithotomy procedure are comparable. Mini percutaneous nephrolithotomy has a better stone free rate and haematuria is more common but retrograde intrarenal surgery has less hospital stay and post operative pyrexia is more common.

The role of interferential current electrical stimulation in pediatric urology: A systematic review of randomized controlled trials.

In recent years, interferential current (IFC) electrical stimulation has been studied as a novel treatment for various lower urinary tract dysfunctions in children. As the findings of multiple studies may vary, we aimed to evaluate the current view on IFC in pediatric urology problems based on the findings of randomized clinical trials (RCTs). We performed a systematic search in the Embase, Medline, and SCOPUS databases in accordance with the latest Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies comprised studies evaluating IFC for lower urinary tract problems in children. The studies' quality was assessed using the Cochrane risk of bias (RoB) tool 2. A total of 125 articles were initially obtained, among which 40 articles were duplicates. There were six eligible RCTs with an overall low RoB. All subjects underwent 10-18 sessions of treatment. The outcomes measured consisted of the alleviation of symptoms and urodynamic parameters. The trials reported that 61-90% of patients responded positively to the treatment. Both IFC and transcutaneous electrical nerve stimulation generated improvements in the subjects. However, overall the IFC group showed better immediate and short-term improvement. IFC is a promising therapy for bladder dysfunction and enuresis in children. More comparative RCTs are required in the future to quantitatively determine the superiority of IFC to other alternatives. The safety aspects of the treatment should also be studied further before it can be used in a clinical setting as the standard and protocol for children are still unclear.

Experience of the 193 small intestine reconstructions of ureters

BACKGROUND: The ureteral plastic surgery with their extended constrictions and obliterations remains one of the most difficult problems of reconstructive urology. This is especially true in cases where it is impossible to repair the patency of the ureter due to unchanged urinary tract sections. In such cases, various segments of the gastrointestinal tract and, above all, the ileum proved to be the best plastic material. However, the number of such operations in the world is not enough, which requires further accumulation of experience and study of long-term results of ileoureteroplasty.
 AIM: The aim of the research is to present the technical features and results of intestinal plastic surgery of ureters.
 MATERIALS AND METHODS: From 2001 to 2023 ileoureteroplasty was performed in 193 patients of the Clinic of the North-Western State Medical University named after I.I. Mechnikov on the basis of the urological department of City Multidisciplinary Hospital No. 2. The panel consisted of 71 men (36.8%), 122 women (63.2%). The average age was 51 ± 3.2 years. Indications for these operations were extensive defects of the ureters as a result of complications of surgical intervention on the upper urinary tract in 69 (35.8%) of patients, radiation therapy — in 54 (28.0%) and the consequences of iatrogenic damage to the ureters — in 40 (20.7%). Megaureter (6.2%), Ormond’s disease (7.3%) and neoplasms of the ureters (2.0%) were observed less frequently.
 RESULTS: Unilateral ileoureteroplasty was performed 153 (79.3%), bilateral — 40 (20.7%). The total number of ureteralsurgeries is 235. Since 2013 ileureteroplasty has also been performed with laparoscopic method, and the share of such operations for this period was 35.9%. The early postoperative complications occurred in 18 (9.3%) patients. There were no fatal outcomes. Late complications developed in 16 (11.2%) of 143 examined patients.
 CONCLUSIONS: This surgical tactics may be recommended in the clinical practice of large urological hospital due to our 22-year experience in using small intestine segments to replace extended ureteral constrictions with a minimum number of postoperative complications, no deaths and good long-term results allows us to recommend.

Effect of COVID-19 Pandemic on Urology Clinic Attendance: Which Diseases are Important for Patients?

Introduction: We assessed whether there were changes in the characteristics of the patient population attending our urology clinic during the COVID-19 pandemic. 
 Material and Method: Patients attending the general urology clinic of SB-ODU Education and Research Hospital were assessed. Dates from 3 February 2020-10 March 2020 were accepted as before the pandemic, with 11 March 2020-29 May 2020 accepted as after the pandemic. Complaints of patients on attendance were grouped as follows: benign prostate hyperplasia, ureteral diseases, kidney diseases, testis and scrotum diseases, incontinence, bladder diseases, sexually transmitted diseases, penile diseases, emergency urologic problems, sexual problems, urethral diseases, kidney and ureter stones, pediatric diseases and urologic tumors. 
 Results: While 638 patients attended the urology clinic in the 1.5-month period before the pandemic, 398 patients attended in the 2.5-month period after the pandemic. Additionally, 30.9% of patients attending the clinic before the pandemic were women, while this rate fell to 23.6% after the pandemic. After the pandemic, there were statistically significant reductions identified for attendance due to BPH, ureteral diseases, kidney diseases, incontinence, bladder diseases and urethra diseases. There was no significant difference in attendance due to urinary system tumors, pediatric urologic patient group, attendance due to kidney and ureter stones, sexual problems and emergency urology problems. There were increases identified for attendance for testis and scrotum diseases and sexually-transmitted diseases. 
 Conclusion: During the pandemic, the numbers of patients attending the urology clinic significantly reduced. During the pandemic, there were increases identified for attendance at our clinic for testis and scrotum diseases and sexually-transmitted diseases. While attendance reduced for many disease groups, rates of attendance for urologic emergencies, urinary tumors, pediatric patient group, stone disease and sexual problems continued as usual.

Informativeness of the doppler twinkling artifact in the diagnosis of urinary tract calculi

The kidney stone disease (nephrolithiasis, urolithiasis) is a common urological problem that affects both adults and children and has a high recurrence rate. Early and reliable imaging diagnosis of urolithiasis is important for early pain relief and the avoidance of complications that require surgical intervention. Non-contrast computed tomography is considered the method of choice in the diagnosis of urolithiasis, however, this method is associated with exposure to ionizing radiation. Ultrasound diagnostics or sonography, in contrast, is considered as the method of early diagnosis of urolithiasis that is widely spread, highly accessible and does not use ionizing radiation. Recently, the attention of sonographers has been attracted by the so-called twinkling artifact or the artifact of the colored comet tail, which occurs in the Doppler color flow mapping behind a calculus in the urinary tract. The twinkling artifact is a phenomenon of a rapid change (twinkle) of red and blue behind the calculus. Among adult patients, the artifact shows high sensitivity in finding urinary stones, but at the same time a high level of false-positive results. However, the sensitivity of the artifact in children is higher than in adults, whereas the rate of false-positive findings is much lower. According to many authors, the sensitivity and specificity of the twinkling artifact as an independent diagnostic sign of urolithiasis are both very heterogeneous, especially compared to non-contrast computed tomography. Nevertheless, the artifact is known to increase the diagnostic efficiency in stone detection to more than 90%. We believe that the twinkling artifact in the Doppler color flow mapping should always be considered as an additional diagnostic tool, which is complementary to B-mode ultrasonography and increases its sensitivity and specificity.

P394 Impact of gastrointestinal and urological problems in children with myotonic dystrophy type 1

P394 Impact of gastrointestinal and urological problems in children with myotonic dystrophy type 1

B-308 Focal Adhesion Kinase Activation is Involved in Tension Development During Contractile Stimulation of Mouse Detrusor Smooth Muscle to Modulate Bladder Dysfunction-Related Lower Urinary Tract Symptoms

Abstract Background The function of the bladder is to store and expel urine. Bladder dysfunction-related lower urinary tract symptoms (LUTS) is a common urological problem and negatively affects health-related quality of life. Investigation of detrusor muscle contraction mechanisms is necessary to understand its underlying pathophysiology. Voiding occurs through bladder muscle contraction, which is mediated primarily by the increased intracellular Ca2+ concentration-induced myosin regulatory light chain (MLC) phosphorylation. Recent studies showed that focal adhesion kinase (FAK)-regulated focal adhesion assembly and actin polymerization are involved in vascular and airway smooth muscle contraction. However, the role of FAK activation in visceral smooth muscle contraction is not well documented. This study aims to determine if FAK activation is involved in mouse detrusor smooth muscle contraction. Methods Normal adult male and female mouse bladders were harvested. The trigone and dome areas were cut, and the bladder body was used. The mucosa was carefully removed. Detrusor muscle strips (1.5–2 × 8–10 mm) were prepared and then suspended in a 20 mL tissue bath filled with physiological Krebs solution and bubbled with 95% O2 and 5% CO2 to obtain a pH of 7.4 at 37 °C. The isometric contraction was recorded. After establishing a stable baseline, the strips were stimulated with 120 mM potassium chloride (KCl), which was used to normalize the contractility induced by subsequent stimuli. One of the following specific inhibitors or the same volume of vehicle (DMSO) was applied and incubated for 30 min: PF-573228 (2 µM, a FAK inhibitor) or latrunculin B (1 µM, an inhibitor of actin polymerization). Then, the contractile responses to KCl (90 mM), electrical field stimulation (EFS, 2–32 Hz), or carbachol (CCh, 10−7.5–10−4.5 M ) were measured. In a separate experiment, the detrusor strips were stimulated with CCh (10 µM) after incubation with PF-573228 (2 µM) or vehicle (DMSO) for 30 min. Once the peak contraction was reached, the strips were snap-frozen for immunoblotting analysis of the phosphorylated FAK (p-FAK) and MLC (p-MLC). Statistical analysis was performed (GraphPad Prism 6). The contractile responses to KCl and EFS between vehicle and inhibitor groups were compared using a paired t-test. Nonlinear regression was used to compare CCh-induced dose-response curves. For the expression of phosphorylated proteins, one-way ANOVA, followed by Tukey’s posthoc test, was used for analysis. Results KCl-induced contractile responses decreased significantly after incubation with PF-573228 or latrunculin B compared to the corresponding vehicle group (P < 0.0001). The contractile responses induced by EFS were significantly inhibited by preincubation with PF-573228 at 8, 16, and 32 Hz (P < 0.05) or latrunculin B at 16 and 32 Hz (P < 0.01). Following the application of PF-573228 or latrunculin B, CCh-induced dose-response contractions were significantly lower than those in the corresponding vehicle-treated strips (P = 0.0021 and 0.0003, respectively). Immunoblotting analysis demonstrated that CCh stimulation caused increased expression of p-FAK and p-MLC, whereas preincubation with PF-573228 led to decreased expression of p-FAK but not p-MLC Conclusion FAK activation is involved in tension development induced by contractile stimulation in mouse detrusor muscle, probably through enhancing actin polymerization, but not MLC phosphorylation.

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU).

Uterine fibroids are the most common benign tumors of the uterus. Approximately 20-50% of women with myomas experience a variety of symptoms such as vaginal bleeding, abdominal pain, pelvic pain and pressure, and urological problems, possibly interfering with fertility and pregnancy. Although surgery remains the standard treatment option for fibroids, non-invasive therapeutic options, such as high-intensity focused ultrasound (HIFU), have emerged over the last dec ade. During HIFU, ultrasound is focused on the target tissue causing coagulation necrosis. HIFU has, meanwhile, become an established method for treating uterine fibroids in many countries. Clinical data have shown that it effectively alleviates fibroid-related symptoms and reduces fibroid size with a very low rate of side effects. However, there is a lack of data on how this treatment affects laboratory parameters and structural features of uterine tissue. As our center is the only one in German-speaking countries where ultrasound-guided HIFU technology is currently established, the aim of this prospective, monocentric, single-arm trial is not only to evaluate the safety and efficacy of local US-guided HIFU in symptomatic uterine fibroid patients according to GCP standards but also to explore its effects on blood parameters and the structural integrity of uterine tissue using elastographic methods.

Postmenopausal bleeding with a diadelphic uterus: A case report

: Simple uterine anomalies to more complicated multisystem derangements can all fall under the broad category of congenital abnormalities known as mullerian duct anomalies. Urological and caudal gastrointestinal abnormalities may be linked to complete uterine, cervix, and vaginal duplication.: This case report aims to raise awareness of the challenges surgeons face while treating Mullerian abnormalities and to foresee ureter and artery supply duplication.: In this case report, 59 year old, P1L1, Previous LSCS with diadelphic uterus with longitudinal vaginal septum presented with postmenopausal bleeding. MRI of the patient showed endometrial hyperplasia in both uteri with no obvious myometrial infiltration. Patient was planned for hysterectomy frozen section and proceed SOS to staging laparotomy in view of recurrent postmenopausal bleeding and morbid obesity. Total abdominal hysterectomy with bilateral salphingophorectomy with frozen section done. During surgery bladder was adherent to previous c section scar on the left horn, left sub total hysterectomy was done and sent for frozen followed by right total hysterectomy. Along with the right total hysterectomy sample both cervices were delivered. Frozen section showed a simple hyperplasia without atypia in left horn and hyperplasia with foci of intraepithelial neoplasia in right horn, Final histopathology further confirmed the same report. : It's important to have a full awareness of any potential related deformities when managing patients with Mullerian defects and irregular uterine haemorrhage. To prevent urological problems and surgical mishaps, a thorough preoperative evaluation, meticulous surgical investigation, and multidisciplinary approach may be required.

Comparison of Ureteral Stent Biomaterials: Encrustation Profile in Lithogenic Artificial Urine Models.

Ureteral stent encrustation significantly limits indwelling time and can lead to downstream urological problems. However, no ideal polymeric biomaterials have been shown to completely resist encrustation in long-term urine exposure. Recently, 2-hydroxyethyl methacrylate (HEMA)-coated Pellethane was reported as a promising biomaterial resistant to encrustation. This study compared HEMA-coated Pellethane to commercially available stents under two different artificial urine environments. To evaluate the degree and composition of encrustation on HEMA-coated Pellethane, Boston Scientific Tria, Bard InLay Optima, Cook Universa Hydrogel, and Cook Black Silicone stents were used at various dwelling times in two different artificial urine environments. In a batch-flow model, samples of stents were suspended in an artificial urine solution (AUS) at 37 °C. Every 24 h for 11 weeks, 50% of the AUS would be replaced with fresh components using a programmable peristaltic pump system. The stent materials were removed at suitable time intervals and air-dried for 24 h under sterile conditions before follow-up analysis. SEM was used to assess the degree of encrustation, and inductively coupled plasma mass spectrometry (ICP-MS) was employed to quantify the encrusted compositions, specifically for calcium, magnesium, and phosphorus. We measured the weight gain over time due to encrusted deposits on the stents and quantified the amount of Ca, Mg, and P deposited on each encrusted stent. After the 11 week trial, HEMA-coated Pellethane showed the most average mass change. SEM showed that HEMA-coated Pellethane was fully encrusted in just 2 weeks in the AUS environments, and ICP-MS showed that Ca is the most abundant deposit. Among all the tested stents, Black Silicone performed the best. The two AUSs were formulated to encrust more rapidly than physiological conditions. HEMA-coated Pellethane is not an ideal stent material, while silicone is a promising material for advancing ureteral stents.

In silico docking and Molecular Dynamic (MD) simulations studies of selected phytochemicals against Human Glycolate Oxidase (hGOX) and Oxalate oxidase (OxO).

Globally, Urolithiasis is the most prevalent urological problem which affects the populations across the ages and races. In recent years, several phytochemicals are being investigated to improve the efficacy and safety of anti-urolithiasis formulations. To develop drugs based on traditional medicines, it is essential to understand the molecular mechanism of action of these drugs. We present the results of in silico docking and molecular dynamic (MD) simulation studies on selected phytochemical including catechin, epicatechin, gallic acid, gallocatechin, epigallocatechin, epigallocatechin 3-o-gallate, 4-methoxy-nor-securine, nor-securinine, and fisetin with human glycolate oxidase (hGOX) and oxalate oxidase (OxO). Gallic acid, gallocatechin and fisetin showed better docking scores than the rest. In MD simulation analysis, stable interactions of the gallic acid with hGOX and OxO; gallocatechin and fisetin with hGOX were observed. It was found that, gallic acid stably interacts withTYR26, LYS 236, ARG 315, and ASP 291 residues of hGOX. On other hand, gallic acid stably interacs with GLU 58 residue of OxO. Gallocatechin, forms stable interactions with TYR 26, ASP 170, ARG 167 and THR 161 of HGOX. In MD simulations, fisetin stably interacted with TYR 26, TRP110 and ARG 263 as we predicted in molecular docking. None of the interactions was formed during the MD simulation of OxO with gallocatechin and fisetin. Together, these results suggest that gallic acid, gallocatechin and fisetin are the potential candidates for the development of phytochemicals for the management of urolithiasis in humans.

Retrospective Evaluation of Urological Problems in Rare Childhood Syndromes.

Objective Rare syndromes are defined as diseases that affect a small number of people compared to the general population. In the literature, rare syndromes have variable definitions according to countries. In this study, patients diagnosed with various rare syndromes who were referred to the pediatric urology clinic were examined in terms of associated urological anomalies. Patients and methods In this study, patients who were referred to our outpatient clinic between 2017 and 2022 with a diagnosis of a rare syndromewith or without urological or urogenital findingswere retrospectively analyzed. The urinary system ultrasonography and scrotal ultrasonography of the patients were also recorded. Comorbidities, diseases, and surgeries they had undergone were determined through detailed medical history. Results A total of 32 patients were identified. Eleven (35%) of the patients were female and 21 (65%) were male. The average age of the patients was 6.5 years. The syndromes observed in the patients, in order of frequency, were microdeletion syndromes (n = 4), Roberts syndrome (n = 3), and Ehlers-Danlos syndrome (n = 2), and a variety of different syndromes were found in the remaining 22 patients.Despite having no symptoms, the second patient was found to have left hydronephrosis, and the third patient was found to have right renal ectopia on their urinary system ultrasound. Pathological findings were observed in 10 (31.2%) patients on their urinary system ultrasound. Conclusion Although only a small portion of these findings require surgery, the presence of urological anomalies should be investigated. Therefore, we recommend urological evaluation for all patients with rare syndromes, regardless of whether they have symptoms or not.

A Pandemic of Retained Forgotten Stents

Purpose: To review the management of a forgotten/ retained double J stent and attempt to suggest protocols to prevent this scenario. Materials & methods: We included 12 patients with forgotten DJ stents who had their primary surgery done at our hospital between September 2019 and March 2021 and were unable to follow up due to the lockdown imposed for the COVID19 pandemic. Results: Twelve patients underwent their forgotten DJ stent removal by a combination of ESWL, cystolithotripsy, and percutaneous nephrolithotomy. All the patients achieved complete clearance of the encrustations/stone and removal of forgotten DJ stent in a single sitting. Conclusion: A forgotten DJ stent with encrustations and stone formation is a serious urological problem for the patient and the treating doctor. A stent is usually said to be forgotten if the indwelling time period is more than 3-6 months which was not intended by the treating doctor. In our series, the management and intervention depended on the patients' preop status, the severity of the encrustations, location, and the size of the stone. In patients with moderate-to-severe encrustations and stone presence, procedures such as CLT, ureteroscopy, and PCNL were performed. Forgotten/retained stents are a source of severe morbidity and additional/unnecessary hospitalization. In our series, we suggested a few protocols that could be followed in order to prevent a forgotten DJ stent.

The Association of Asymptomatic Urinary Tract Infection (UTI) with Diabetes Mellitus (DM) in Pregnant Women

Background: Urinary tract infection (UTI) is a common infection of diabetic pregnant women because of excess urine glucose excretion and lowered immunity. UTI during pregnancy is directly proportionate to maternal and neonatal complications. Diabetes mellitus (DM) and urological health problems are closely related during pregnancy. DM patients are prone to UTI, bladder issues and sexual dysfunction. The intent of the study was to find out the association of asymptomatic urinary tract infection (UTI) with diabetes mellitus (DM) in pregnant women. Material & Methods: A prospective cross-sectional study was carried out in the Department of Public Health of Varendra University in Bangladesh for the duration of 4 months in the summer session from May 2018 to August 2018. All the pregnant mothers (N=119) with diabetes mellitus in Chapai Nawabganj during the study period constituted the study population. Ethical clearance was taken from the hospital. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Results: Among the study population (N=119), the mean age of the respondents was 25.14 ± 4.82 years, and most of the respondents were in the age group of below 25 years. It was observed that around one-third of the respondents (36,30.3%) monthly income was up to 15,000 taka. Regarding the duration of gestation, it was observed that the mean duration of gestation was 19.06 ± 5.62 weeks. Around one-fourth of the respondents (33,27.7%) had good but unhygienic sanitation and the majority of them (78,65.5%) had good and hygienic sanitation conditions. It was recognized that the majority of the respondents (82,68.9%) had 6-8 times of micturition per day. Sixty-two respondents who had DM did not know about UTI and the relationship between the pattern of DM and urinary tract infection was not found statistically significant (p>0.05). Conclusion: In the case of pregnancy, in women with DM, UTI is the most commonly noticed maternal infection. The findings provided by the analysis might help in the management of asymptomatic urinary tract infections during pregnancy.

Lower urinary tract dysfunction in cases of anorectal malformations

Association of genitourinary anomalies in patients with ano-rectal malformations (ARM) is well known and its incidence is reported to be 30 -50%. Many of these anomalies either have less number of functioning renal units or have conditions with risk of continuous damage to renal units, increasing the risk of developing End stage renal disease (ESRD) in adolescence or adulthood. Although frequently described as associated malformations but few of these entities like Vesico ureteric reflux (VUR) could be the result of lower urinary tract dysfunctions.: To study incidence and spectrum of Lower urinary tract dysfunction in toilet trained patients of ARM. To find whether LUTD is the cause of worsening of VUR/HUN/ renal functions in patients with ARM. 2 years (October 2018 to 30 September 2020): Department of Paediatric surgery, Chacha Nehru Bal Chikitsalaya, Geeta Colony Delhi Prospective observational study. : Forty-two patients of ARM, meeting all inclusion criteria were enrolled in the study. All the following criteria were checked for enrolment of patient in the study. 1. Patients of all categories of anorectal malformations who were toilet trained; 2. Age more than 4 years; 3. Completed set of investigations planned for diagnosis of LUTD. 4. Consented to participate in the study and for follow up as and when required.Central cause of neurological deficits.A total of 125 patients who underwent PSARP during our study period. However only 42 patients met the inclusion criteria and got their work up completed for urological problems. 1.LUTD and renal failure can be seen even in absence of spinal malformations in patients with ARM; 2. Severity of LUTD in absence of neurological involvement changes with time; 3. Thorough history and clinical evaluation may provide important clues in suspecting presence of occult LUTD.

Evaluation of the clinical efficacy of the use of oxidized dextran in the form of suppositories in the treatment of patients with chronic prostatitis

BACKGROUND: Increasing the efficacy of treatment of patients with chronic prostatitis / chronic pelvic pain syndrome remains an urgent problem of modern urology.
 AIM: The aim of the study is to evaluate the clinical efficacy of rectal suppositories with oxidized dextran in the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.
 MATERIALS AND METHODS: 52 patients with chronic prostatitis / chronic pelvic pain syndrome were treated (mean age 33.1 1.7 years). The patients were divided into 2 groups. Patients of the 1st group (n = 25) received oxidized dextran in the form of rectal suppositories for 50 days according to the following scheme: for the first 10 days, 1 rectal suppository at night, daily; the next 40 days 1 rectal suppository every other day. A total of 30 rectal suppositories per course. Patients of the 2nd group (n = 27) received a placebo in the form of rectal suppositories according to the same scheme. Treatment efficacy was assessed on the basis of the original IPPS-MS Genitourinary Disease Assessment questionnaire, the NIH-CPSI and IIEF-5 questionnaires, as well as the results of microscopic examination of prostate secretions.
 RESULTS: In patients of the 1st group a significant clinical improvement was revealed by the end of treatment. According to the IPPS-MS questionnaire there was a decrease in the severity of dysuria by 67%, pain syndrome by 80%, psychosomatic disorders by 47.6%. There was a decrease in the total score of the NIH-CPSI questionnaire by 66.2% (from 25.4 2.4 to 8.6 2.1 points, p 0.05) and an increase in the total score of the IIEF-5 questionnaire by 79.3 % (from 11.6 1.8 to 20.8 2.1 points, p 0.05). Positive changes in the clinical parameters of patients of the 1st group were accompanied by an improvement in the results of microscopy of the secretion of the prostate a decrease in the number of leukocytes and an increase in the number of lecithin grains. There were no significant changes in any of the studied parameters in patients of the 2nd group. None of the patients in both groups had side effects from the therapy.
 CONCLUSIONS: Oxidized dextran in the form of rectal suppositories has a pronounced anti-inflammatory activity and significantly reduces the severity of dysuria, pain and psychosomatic disorders in patients with chronic prostatitis / chronic pelvic pain syndrome. The results of the study indicate the promise of using oxidized dextran in the form of rectal suppositories for the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.

Cross-fused dystopia of the right kidney with cystic dysplasia of the non-functioning left kidney associated with an ureterocele

Cross-dystopia is a rare type of congenital anomaly and is characterized by a displacement of the kidney to the opposite side; as a result, they are both located on the same side, and in approximately 85% of such cases, a fusion of the parenchyma of two kidneys can be observed. We have not found reports of cases in which a nonfunctioning orthotopic cystic dysplastic kidney associated with ureterovesical segment pathology (ureterocele) was fused with the lower pole of a cross-dystopian normally formed kidney in the literature. The patient, 8 days old, had a preliminary diagnosis of agenesis of the right kidney, doubling of the left kidney, cystic dysplasia, doubled left kidney with an ureterohydronephrosis in the lower half and ureterocele. To restore the urine outflow and function of the lower half of the presumably doubled left kidney, a cystourethroscopy was performed. In a typical place on the right, there was a correctly formed ureteral orifice, i.e., an ureterocele on the left, which occupies half of the bladder volume. With a holmium laser, an artificial orifice was formed in the ureterocele to restore the urine passage. At 9 months old, tomography urinary tract was performed, which revealed cross-dystopia of the right kidney with a fusion of the lower pole and a cystic dysplastic orthotopic left kidney. Laparoscopic nephroureterectomy of a non-functioning orthotopic kidney was performed.
 The control examination indicated complete clinical remission and social adaptation of the patient after discharge. Cross-dystopia of the kidney with fusion, cystic dysplastic kidney, and a ureterocele are rare congenital anomalies that require timely examination in a specialized clinic and drawing up an individual treatment plan. The surgical method should focus on a symptomatic urological problem, emphasizing preserving kidney function.

Features of the Genitourinary System in Anorectal Malformations in Children

In anorectal anomalies, combined malformations of the urogenital system are often observed [1,5,7]. This can be explained by the close relationship between the embryonic development of these organs and systems. It is no coincidence that a lot of attention in the literature of the last decade is paid to urological problems of anorectal anomalies [ 12,15,20]. However, the true frequency has not yet been established and the structure of pathological conditions of urogenital system in anorectal anomalies has not been fully studied, the consequences of their delayed diagnosis have not been analyzed, treatment and tactical and operative technical aspects have not been developed and the organizational side of the issue needs improvement

Chronic Kidney Disease Prediction

Abstract: Kidney stones play a role in the development of chronic kidney disease. Recurrent kidney stones should be avoided not only because of their immediate clinical manifestations but also because of their long-term predisposition to CKD progression. A lot of people confess to emergency departments with excruciating pain due to kidney stones, which are prevalent ailments around the world. The diagnosis of kidney stone illness involves the use of many imaging modalities. For the entire diagnosis and interpretation of these photos, specialists are required. Systems for computer-aided diagnosis are useful methods that can be utilized as supplemental tools to aid clinicians in their diagnosis. The deep learning (DL) technique, which has lately achieved considerable advancements in the field of artificial intelligence, is offered in this work as a means of automating the detection of kidney stones (containing stones or not) using coronal computed tomography (CT) scans. Different cross-sectional CT images were taken for every individual, resulting in a total of 1453 images. Using CT scans, we have seen that even little kidney stones are accurately detected by our model. This study demonstrates that other difficult urological problems can be addressed using newly popular DL approaches

19 mm Urolithiasis expelled with Homoeopathic medicine: a case report.

Renal calculi are a typical urological system problem. It involves the urinary tract's crystallization process. An obstruction in the ureter can produce renal or ureteric colic, an acute and debilitating pain. It typically happens in the ureter's more constrained regions. It may also be accompanied by other symptoms like hydronephrosis, haematuria, acute pain, nausea, and vomiting. Case Summary: A case of multiple renal calculi in both kidneys with a 19mm calculus lodged at the PU (Ureteropelvic) Junction of the right kidney. The patient presented with severe cutting pain in the lumbar region in the abdomen with radiating pain from the right loin to left. The patient had pain before and after urination. After case-taking, based on the totality of symptoms and repertorization, Homoeopathic medicine, Lycopodium clavatum 200C was prescribed. That proved that Homoeopathic medicines are effective for the expulsion of renal stones.