E.Kh. Abdulkhalygov Abdulkhalygov

Pirogov Russian National Research Medical University

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РИ

Р. И. Гуспанов

Pirogov Russian National Research Medical University

МК

М К Семенов

Pirogov Russian National Research Medical University

СВ

С. В. Котов

Pirogov Russian National Research Medical University

M M Iritsyan

Pirogov Russian National Research Medical University

I.I. Survillo Survillo

Pirogov Russian National Research Medical University

A. G. Yusufov

Pirogov Russian National Research Medical University

АП

А. П. Ракша

Pirogov Russian National Research Medical University

S. A. Pulbere

National Medical and Surgical Center named after N.I. Pirogov

T.N. Sotnikova Sotnikova

Pirogov Russian National Research Medical University

I I Survillo

National Medical and Surgical Center named after N.I. Pirogov

Cooperative Institutions

Pirogov Russian National Research Medical University

City Clinical Hospital

National Medical and Surgical Center named after N.I. Pirogov

Ministry of Health of the Russian Federation

Sechenov University

Moscow City Clinical Hospital after V.M. Buyanov

Peoples' Friendship University of Russia

Bashkir State Medical University

City Clinical Oncology Center

Moscow State University of Medicine and Dentistry

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Urethral Strictures after Transurethral Surgery: Treatment and Histological Issues

Creative Surgery and Oncology (2020)

С. В. Котов Р. И. Гуспанов A. G. Yusufov М К Семенов E.Kh. Abdulkhalygov Abdulkhalygov

Introduction. The development of upper and lower urinary endoscopic surgery has brought about an increase in the number of urethral strictures after transurethral procedures. Material and methods . A retrospective analysis was performed involving the treatment results of 72 patients with urethral strictures after transurethral surgery in 2011-2016. All the patients underwent standard examination, including US, residual urine analysis, uroflowmetry, retrograde and micturating urethrography, IPSS and QoL questioning and general clinical tests. Results and discussion . The median of observation comprised 28 months. Bulbous urethra appeared to be the most frequent localisation of urethral strictures (87.5 %). The median stricture length was 2 cm with the mean maximum urine flow rate equal to 5.9 ± 2.7 mL/s. The median IPSS score counted 25 points. The type and number of surgical procedures were as follows: internal optic urethrotonomy (29), anastomotic urethroplasty (18), single-stage skin flap urethroplasty (3), single-stage urethroplasty using buccal mucosa graft (17), multiple-stage urethroplasty using buccal mucosa graft (1), meatotomy (1), single-stage navicular fossa urethroplasty using buccal mucosa graft (1). Internal optic urethrotonomy was to be effective in 52 % cases, while other surgical procedures showed 89 % effectiveness. The pathomorpho-logic studies revealed severe inflammation without signs of stroma fibrosis within urethral strictures. Conclusion. Transurethral endoscopic procedures appear to be the main causative factor (in 54 % cases) for iatrogenic urethral strictures.

Buccal mucosa

10.24060/2076-3093-2020-10-1-10-15

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Pathomorphological aspects of urethral strictures of various etiologies

Urologiia (2021)

С. В. Котов А. П. Ракша Р. И. Гуспанов М К Семенов T.N. Sotnikova Sotnikova

Introduction The study of the structure of strictures of various etiologies is an open and uncertain issue of modern urology. Aim To evaluate the morphological and immunohistochemical structure of strictures of various etiologies. Materials and methods The study involved postoperative tissue of a pathologically altered urethra of 110 patients aged 23 to 74 years who underwent treatment at the University Clinic of Urology, Russian National Research Medical University. N.I. Pirogova (2014-2018) with Ds: urethral stricture. Morphological study: Van-Gieson staining; hemotoxylin - eosin. Immunohistochemical study: mouse monoclonal antibodies to muscle and connective tissue markers (Smooth Muscle Actin, Vimentin, Calponin) and inflammation markers (CD45R, CD58, CD138, CD20, CD3) were used as primary antibodies in all reactions. Results According to the revealed morphological changes, the material was divided into three groups: group I (n=27) - active inflammation; group II (n=33) - the predominant development of connective tissue with low activity of inflammation; group III (n=50) - mixed (chronic mild inflammation, an even amount of connective tissue). In a morphological study of idiopathic urethral strictures, it was noted that the multicolumnar epithelium was replaced by a multi-layer flat epithelium with a weakly pronounced keratinization. Inflammatory changes were mild, including the submucosal connective tissue and the spongy body. Spongiofibrosis is accompanied by a significant reduction in the vascular bed of both venous sinuses and arteries. The same changes were observed in the inflammatory genesis of urethral strictures. In the study of strictures with traumatic etiology, a restructuring of the cylindrical epithelium was observed. In cases with severe inflammation in the mucosa, the changes were atrophic-hyperplastic in nature with reactive cell atypia. Conclusion urethral Strictures in men have a specific etiological factor, but the pathogenesis of urethral lesions can be divided into: post-traumatic and post-inflammatory.

Etiology

10.18565/urology.2021.2.5-13

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Внутренняя оптическая уретротомия: эффективность и место в современной урологии

Experimental and Сlinical Urology (2017)

С В Котов С В Беломытцев Д Н Суренков S. A. Pulbere Р. И. Гуспанов

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[Pathomorphological aspects of urethral strictures of various etiologies].

PubMed (2021)

С. В. Котов А. П. Ракша Р. И. Гуспанов М К Семенов T.N. Sotnikova Sotnikova

The study of the structure of strictures of various etiologies is an open and uncertain issue of modern urology.To evaluate the morphological and immunohistochemical structure of strictures of various etiologies.The study involved postoperative tissue of a pathologically altered urethra of 110 patients aged 23 to 74 years who underwent treatment at the University Clinic of Urology, Russian National Research Medical University. N.I. Pirogova (2014-2018) with Ds: urethral stricture. Morphological study: Van-Gieson staining; hemotoxylin - eosin. Immunohistochemical study: mouse monoclonal antibodies to muscle and connective tissue markers (Smooth Muscle Actin, Vimentin, Calponin) and inflammation markers (CD45R, CD58, CD138, CD20, CD3) were used as primary antibodies in all reactions.According to the revealed morphological changes, the material was divided into three groups: group I (n=27) - active inflammation; group II (n=33) - the predominant development of connective tissue with low activity of inflammation; group III (n=50) - mixed (chronic mild inflammation, an even amount of connective tissue). In a morphological study of idiopathic urethral strictures, it was noted that the multicolumnar epithelium was replaced by a multi-layer flat epithelium with a weakly pronounced keratinization. Inflammatory changes were mild, including the submucosal connective tissue and the spongy body. Spongiofibrosis is accompanied by a significant reduction in the vascular bed of both venous sinuses and arteries. The same changes were observed in the inflammatory genesis of urethral strictures. In the study of strictures with traumatic etiology, a restructuring of the cylindrical epithelium was observed. In cases with severe inflammation in the mucosa, the changes were atrophic-hyperplastic in nature with reactive cell atypia.urethral Strictures in men have a specific etiological factor, but the pathogenesis of urethral lesions can be divided into: post-traumatic and post-inflammatory.

Van Gieson's stain

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[Evaluation of the effectiveness of surgical treatment of recurrent urethral stricture].

PubMed (2021)

С. В. Котов M M Iritsyan A. G. Yusufov E.Kh. Abdulkhalygov Abdulkhalygov А. А. Клименко

The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers.To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures.At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients.The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%.Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

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The choice of treatment for recurrent urethral structure after the direct vision internal urethro-tomy

Urologiia (2020)

С. В. Котов Р. И. Гуспанов S. A. Pulbere M M Iritsyan М К Семенов

10.18565/urology.2020.5.10-14

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