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Aim: To evaluate the effectiveness of laparoscopic repair of primary strictures of ureteropelvic junction (UPJ) depending on baseline renal function of the ipsilateral kidney., Materials and Methods: The study analyzed results of 134 patients (78 women and 56 men, age from 18 to 56 years) who underwent various types of laparoscopic repair of the UPJ stricture from 2012 to 2015. Depending on the surgical technique all patients were divided into three groups: group 1 (n=34) underwent spiral flap technique by Culp and DeWeerd, group 2 (n=59) - Anderson-Hynes pyeloplasty and group 3 (n=41) had antevasal dismembered pyeloplasty. All interventions ended with internal ureteral stenting for up to 6-8 weeks. Also, all patients were divided into three subgroups, depending on the degree of renal function deficiency - less than 25%, 25-50%, and 51-75%. Treatment effectiveness criteria included the following parameters: complete relief of the pain syndrome, a decrease in the degree of pyeloectasia, stabilization or improvement of the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPJ stricture., Results: The overall effectiveness of UPJ laparoscopic reconstruction was 94.7% (127 of 134). The effectiveness of the treatment was independent of the surgical technique, the initial thickness of the renal parenchyma and the degree of PCS dilatation. There was an inverse correlation between the treatment effectiveness the degree of kidney function deficiency., Conclusion: In patients with hydronephrosis secondary to UPJ stricture, the effectiveness of surgical treatment is mainly determined by its timeliness. The best treatment results were observed in patients with better renal function. The degree of renal function deficiency should be considered the main prognostic factor for the effectiveness of the forthcoming operation.

The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.

Urethral strictures and anomalies remain a challenging urological problem. Reconstructive plastic surgery has been shown to be the most effective way to treat them. There are two main types of urethroplasty: anastomosis (anastomotic urethroplasty) and expansion of the urethral lumen using of flaps and grafts (substitution urethroplasty). Currently the ideal material for substitution urethroplasty does not exist. Tissue engineering of the urethra seems to be one of the most promising approaches to address this problem. Various tissues-engineering techniques were proposed for substitution urethroplasty. In this study, tissue-engineering design was based on the decellularized cadaveric arterial wall. The study results demonstrated the feasibility of creating stable tissue-engineered structures with autologous cultured epithelial cells of the buccal mucosa and decellularized matrix from human cadaveric arterial wall (DMCAW). There was a complete engraftment of tissue-engineering design based on DMCAW and buccal mucosa cells, used for substitution urethroplasty in a patient with the bulbar urethral stricture. Postoperatively (within 4 months after surgery) no complications and/or adverse events were observed. However, in the late postoperative period (12 months) there was recurrence of urethral stricture in the middle of the tissue-engineering design and the native urethra that warranted another surgery. Tissue-engineering design based on DMCAW and autologous buccal mucosa is safe as a material for substitution urethroplasty. Further research is required to ascertain the effectiveness of the method.

The article presents a comprehensive study of 121 patients with stricture disease of the male urethra. Diagnosis and staging of the disease were made on the basis of medical imaging, namely retrograde urethrography, voiding cystourethrography and magnetic resonance imaging with complex pulse sequences developed by the authors. The results were compared with surgical findings and morphological study of surgical specimens. Detailed semiotics of magnetic resonance imaging of stricture disease, differences in the visualization of traumatic and inflammatory strictures of various locations, as well as features of primary and recurrent lesions are described. Detailed analysis of the data shows significant advantages of MRI in identifying stricture disease of the male urethra over traditional methods of endoscopic visualization. It makes possible to increase the diagnostic accuracy for detection of the disease and better surgical planning strategy.

The article introduces the clinical and statistical analysis of 113 patients treated for urethral strictures (US) in the urological clinic of the Rostov State Medical University in 2011. 58% of patients experienced a recurrent course of the disease. Radical curative surgery was possible in 93 (82.3%) patients. In other cases, non-invasive strategy was indicated (13.3%) or surgery for urethral stricture was impossible due to comorbidities (4.4%). Resection with urethral end-to-end anastomosis, which is the most effective approach to the treatment of patients with US, was possible in only half of the patients (51.8%). In the rest of the patients, one-, two- or more stage urethroplasty substitution was carried out. By the end of 2013, treatment of 84 (90.3%) patients was completed with a total of 110 operations. 9 (9.7%) patients were scheduled for operation in 2014.

Objective: To determine the risk factors for anterior urethral strictures after transurethral resection of benign prostatic hyperplasia., Materials and Methods: The present study consists of a prospective and retrospective part. Prospective analysis of 110 patients who had undergone, at the urology clinic of First MSMU named after I.M. Sechenov in the period from January 2009 to February 2014 was performed transurethral resection (TUR) of the prostate. In the retrospective part, the case histories of 85 patients who were treated in the urology clinic First MSMU named after I.M. Sechenov from 2009 to 2013 with a diagnosis of urethral stricture were analysed. Of them, 29 cases urethral stricture occurred earlier after undergoing TURP. Patients from both sides were divided into two groups: group number 1 patients undergoing TURP for BPH who have not formed a urethral stricture, and group number 2 - patients who had urethral stricture formed., Results: According to the criteria for inclusion in group number 1 there were 40 patients who did not form a urethral stricture after TURP and 33 patients were included in the group number 2, in which the late postoperative period was complicated by the formation of a stricture of the urethra. Prostate volume was significantly different in both groups. In group number 1 prostate volume averaged 60 cm3±23 cm3 in group number 2 prostate size equaled an average of 80 cm3±24 cm3. (p<0,05). Having a urethral catheter or cystostomic drainage before surgery was observed in 12% (n=5) in the first group and 27% (n=9) in the second group. Duration of operative benefits was assessed at intervals up to 60 minutes and more than 60 minutes. Thus, the results in the first group are divided into 75% (30) 25% (10), respectively. In the second group, these values were 24,2% (n=8) and 75.8% (n=25). Diabetes mellitus was noted in a first group in 12.5% (n=5) of the patients, in the second group - 30% (n=10). The number of patients seen earlier for hypertension in the group, which did not form a urethral stricture, was 37,5% (n=13) and in the group with urethral strictures - 60,6% (n=20). Having chronic inflammation, which was confirmed upon subsequent morphologic examination of prostate tissue resection, were detected in the first group at 32,5% (n=13) patients and in the group number 2 at 66,6% (n=22) patients and was significantly higher in the second group (p<0,05)., Conclusions: The duration of TURP more than 60 minutes, prostate volume of more than 70 cm3, the presence of diabetes mellitus, and also chronic inflammation of the prostate significantly increases the risk of urethral stricture in the late postoperative period.

Urethral strictures are urgent urological problem. Anastomotic and substitution urethroplasty are the most effective treatments. For substitution urethroplasty, buccal mucosa is most often used. There are the following difficulties associated with the substitution urethroplasty: complications in the donor area, the lack of tissue for substitution, an additional incision, and increased timing of surgery due to the need to obtain a flap or graft. Tissue engineering can be useful in solving the above problems. Tissue engineering involves the use a matrix without cells and matrix with one or more types of cells (tissue-engineering designs). In our study we have evaluated the ability to create a matrix for the substitution urethroplasty in animal experiments. The decellularized cadaveric arterial wall was used as a matrix. Decellularization was performed using enzymatic method. At the first stage, we transplanted matrix fragments in interscapular region in rats. An extremely weak bioactivity dof decellularized matrix of cadaveric arterial wall (DMCAW) due to the low immunogenicity of the material was revealed. Thus resorption of DMCAW was quite slow (60-90 days). At the second stage, in an experiment on rabbits, substitution urethroplasty using tubular DMCAW was successfully performed. Intraoperative urethral defect up to 1.8 cm was created, which was replaced by a tubular DMCAW. The use of this type of matrix has showed good structural and functional results: urethral strictures did not arise, the rejection of the matrix was not observed. A slow degradation of the matrix and progressive epithelialization of onnective tissue capsule were revealed. Decellularized matrix based on cadaveric arterial wall can be considered as a material for substitution urethroplasty.

The results of open reconstructive operations performed in 86 patients with traumatic urethral stricture show that the efficacy of these operations and frequency of complications are lower in using urethroplasty as a primary treatment while primary internal optic urethrotomy significantly reduces possibility of effective surgery without complications.

The membranous part of the urethra has anatomic specificity influencing its trauma mechanism and allowed for in the trauma treatment policy. In 239 patients with an injured membranous part of the urethra described in the paper, the rupture was mainly due to the hip fracture. 85% of the patients developed a complete rupture with subsequent obliteration, 15% had strictures. Cicatrization involved the whole membranous part in 74% of the cases. In relevant traumas common are severe rectourethral and peritoneal fistulas surgical treatment of which as well as obliterations involves great technical difficulties. There is a variety of operative approaches and techniques (perineal, original anteropubic and anorectal). Urethral reconstruction should not be followed by bougienage. Typical are also frequent renal and genital complications (phlegmons, nephroliths, ureteroliths, epididymitis, orchitis, prostatitis, pyelonephritis). The number of complications depends on the choice of the adequate operative technique and due consideration of anatomical characteristics of the membranous part of the urethra.

Morphological changes were examined in the distal urethra with its stenosis in 40 girls aged under 10 years. Intraoperative (urethromeatotomy) biopsy specimens were taken via a wedge cut made in the inferior meatal wall. The specimens were stained with hematoxylin and eosin, as well as with picrofuxin by the van Gieson method. Histological investigations showed that during urethral stenosis, the underlying pathological process in 35 patients was chronic urethritis with extended leukocyte infiltration onto the mucosal and submucosal layers. Leukocyte infiltration was diffuse in 14 girls, whereas in 21 it was focal to form microabscesses in some cases. In addition, the submucosal layer of the distal urethra displayed vegetations of the connective tissue that had been sclerosing. The frequency of abundant vegetations in the connective tissue, its fibrosis and sclerosis increased in relation to a history of the disease, which corresponded to the age of children in most cases. The distal urethral stenoses were classified as acquired narrowings of inflammatory genesis. In 5 patients, the mucosal and submucosal layers underwent no inflammatory changes and their distal urethral stenoses were applied to congenital or hereditary ones. With irreversible sclerotic changes, urethromeatotomy along with disruption of the fibrous annulus is one of the major tools for treating distal urethral stenosis.

Immediate and long-term results of treatment were evaluated for 211 males who had pelvic and urethral injuries. Most common were the methods: primary epicystostomy followed by urethroplasty, healing on a permanent catheter from the bladder, the primary suture. The material of 12 autopsies was investigated to characterize morphohistological features of pelvic and urethral traumas with consequent pathomorphological substantiation of the ways to recover urethral patency. It is revealed that urethral injuries especially in hip bone fractures should be considered as severe. An individual surgical approach in the condition is to allow for its severity, presence of combined injuries, diagnostic evidence on urethral involvement.

The urogenital tract has been examined in 35 patients who required 3 or more years of therapy. A range of studies revealed a short urethral stricture in 11, long urethral stricture in 26, megalocystis in 6, domicile urinary bladder in 2 and bladder diverticulosis in 6 patients. Simple and diuretic excretory urography showed normal bilateral renal function in 5, moderately impaired function in 14 and severe loss of function in 6 patients. Single-kidney functional impairment was seen in 10 patients. Over 504 of patients showed prolonged urographic retention of urine in the pelvis and ureter. Bilateral ureterohydronephrosis was found in 3 and unilateral one in 3 patients. Descending, ascending and micturitional urethrocystography revealed urinary reflux into the prostate (n = 13), seminiferous ducts (n = 3), seminal vesicles (n = 4) and ureters (n = 4). Vasovesiculographic sizes and shapes of the seminal vesicles were normal in 2 patients while the vesicles were uni- or bilaterally dilated or constricted in other patients. The treatment was operative in 34 patients. Histological examination of scars and resected tissues showed fibrous sclerotic lesions in the prostate and suppurative inflammatory and fibrous lesions in seminal vesicular walls. With long treatment of urethral strictures, micturition disorders were superimposed by reflux of infected urine into the prostate, seminal vesicles and ureters, inducing inflammation and functional abnormalities; these caused shrinkage and compression of the posterior urethra, bladder cervix, intramural and prevesical ureteral segments, resulting in chronic renal failure. An early and radical plastic operation on the urethra may prevent the mentioned disorders.

In spite of the fact that the operations after B. N. Khol'tsov, P. D. Solovov, and V. I. Rusakov have found a wide recognition and use, the rate of complications and poor results remains still high, reaching 3-29%. The authors consider that one of the reasons for poor outcomes in such operations is evolving urethral ischemia at the site of anastomosis, which is caused by compression of tissues with suturing material with the routine suturing of urethral ends through all its layers. The experiment with the male dogs and human cadavers provided evidence for this assumption. The mathematical calculation indicated that with the sutures applied, over 12-16% of the urethral tissue volume became ischemic at the site of anastomosis. A new technique was proposed to attach the ends of the resected urethra, which eliminates the suture of the urethral ends through all the layers. The essence of the technique is that after resection, the ends of the urethra are opposed and fixed with the outer layers without suturing the urethra via all the layers with 6 stitches. Twenty nine patients were operated on in this fashion. Twenty eight patients were discharged with recovered micturition. A relapse occurred in one patient with inflammatory urethral stricture. For 3 months to 3 years, 22 subjects were examined, another patient had a relapse 3 months following surgery. The two patients were reoperated, with a good effect. The remaining patients reported normal micturition and presented no complaints.