Institute of Urology of the National Academy of Medical Sciences of Ukraine

Generalised periodontitis is a chronic inflammatory disease with a multifactorial pathogenesis, the progression of which is substantially modulated by systemic comorbidities, including atherosclerosis, with which it exhibits shared pathobiological pathways, including chronic systemic inflammation, endothelial dysfunction, and alterations in bone remodelling. Consequently, there is growing interest in investigating genetic factors that may influence the individual severity of periodontitis, particularly in patients with concomitant vascular diseases. Aim: To determine the distribution of of polymorphisms in VDR (BsmI), CASR (A986S), PTH (rs6256), CALCR (C/T), MTHFR (C677T), and OPN (C/T) in patients presenting with generalized periodontitis and concomitant atherosclerosis, and to assess association of these variants with clinical severity of periodontal disease. Materials and Methods. A total of fifteen patients diagnosed with generalized periodontitis and confirmed atherosclerosis were included. Participants were classified according to clinical severity into stages I-II (n = 9) and stages II, II-III (n = 6) periodontitis subgroups. Genotyping of VDR (BsmI), CASR (A986S), PTH (rs6256), CALCR (C/T), MTHFR (C677T), and OPN (C/T) was performed by means of allele-specific triprimer polymerase chain reaction with agarose gel electrophoresis. Genotype frequencies were compared between the two clinical subgroups. This study has a pilot character. The study was conducted in compliance with the principles of the World Medical Association's Ethical Code (Declaration of Helsinki), as confirmed by the conclusion of the Bioethics Committee of the State Institution «Institute of Stomatology and Maxillofacial Surgery of the NAMS» (Protocol No. 1011 dated 14 April 2022). The study forms part of the research project entitled «Correction of Impairments in Osteogenesis Processes in the Treatment and Prevention of Complications of Dental Diseases During Wartime», State Registration No. 0123U103247. Results. A statistically significant association with disease severity was observed exclusively for the CALCR (C/T) polymorphism. The TT genotype was detected in 83.3% of individuals with severe periodontitis, whereas the CT genotype predominated in the I-II stage subgroup. The polymorphisms VDR (BsmI), CASR (A986S), MTHFR (C677T), and OPN (C/T) did not demonstrate a significant association with clinical manifestations. The PTH rs6256 (G>A) polymorphism exhibited a trend towards a higher frequency of the AA genotype in patients with milder forms of periodontitis, which may indicate a potential modulatory effect of the A allele. The universal presence of atherosclerosis across the cohort may have exerted a systemic inflammatory influence capable of modifying the phenotypic expression of genetic variants. Conclusions. The CALCR (C/T) polymorphism may serve as a potential genetic marker predictive of severe generalized periodontitis in patients with concomitant atherosclerosis. No clinically meaningful associations were demonstrated for polymorphisms in VDR, CASR, MTHFR, or OPN. The PTH rs6256 polymorphism demonstrated a trend towards a protective effect of the A allele. The genetic influence on the course of periodontitis may be modified by systemic inflammation associated with atherosclerosis; further studies with larger sample sizes are required.

Prostate cancer (PC) occupies a leading position in the structure of the incidence of malignant neoplasms among the male population. In addition, there is a tendency to increase both the incidence and mortality from PC. Multifocal puncture biopsy (MFPB) of the prostate gland with subsequent histological verification is currently an integral part of the diagnosis of PC, but advances in the field of multiparametric magnetic resonance imaging (mpMRI) have led to improved detection of prostate tumors. The variety of available prostate biopsy methods poses a difficult task for the clinician to choose the most optimal one, taking into account the clinical data of the patient and the capabilities of the medical institution. The objective: to compare the frequency of detection of clinically significant PC according to fusion biopsy and MFPB of the prostate. Materials and methods. From September 2023 to November 2024, a retrospective randomized comparative study was conducted at the SI “Academician O. F. Vozianov Institute of Urology of NAMS of Ukraine” to assess the clinical effectiveness of fusion biopsy and MFPB of the prostate gland. According to the inclusion criteria, the study included 202 patients who were divided into 2 groups. The first (main) group included 101 patients who underwent fusion biopsy of the prostate under the control of mpMRI. The second (control) group included 101 patients who underwent MFPB of the prostate. To assess the effectiveness of biopsies, the following indicators were determined: blood test for total prostate-specific antigen (PSA) (ng/mL); prostate volume according to magnetic resonance imaging (cm3); PSA density (ng/mL/cm3); localization of the lesion according to magnetic resonance imaging; size of the lesion; the need to perform of magnetic resonance imaging in detecting PC. Results. The main factors that increase the detection of PC by fusion biopsy are: total blood PSA ≥ 9.44 ng/mL (p = 0.017), PSA density ≥ 0.16 ng/mL/cm3 (p = 0.03), prostate lesion size ≥ 9.31 mm (p = 0.025), and lesion location in the peripheral prostate (p = 0.006). Factors that do not affect the detection of PC by fusion biopsy: prostate volume and lesion location in the transitional prostate. The main factors that increase the detection of PC using MFPB are: total blood PSA ≥ 12.79 ng/mL (p = 0.044), prostate volume ≥ 42.91 cm3 (p = 0.019), PSA density ≥ 0.33 ng/mL/cm3 (p = 0.027), prostate lesion size ≥ 10.74 mm (p = 0.045), and lesion location in the peripheral prostate (p = 0.004). Conclusions. Based on the results of the study, an algorithm for diagnosing PC has been developed, according to which all patients should undergo mpMRI before biopsy. In the presence of a suspicious lesion, a combined biopsy should be performed, consisting of an MR-targeted method (fusion biopsy) and a systematic method (MFPB), which allows to increase the detection of clinically significant PC by 10.9–14.5%.

Інфекція COVID-19 (COronaVIrus Disease 2019) пов’язана з дисліпідемією та серцево-судинними ускладненнями. Доведено, що високий вміст ліпопротеїнів низької густини (LDL) та, особливо, окислених LDL (oxLDL) спричиняє накопичення холестерину на стінках судин і значно збільшує ризик атеросклерозу та інших серцево-судинних захворювань (ССЗ). Мета. Метою роботи було визначення вмісту oxLDL у крові 82 хворих на цукровий діабет (ЦД), які в період із 2020 по 2022 р. перенесли коронавірусну інфекцію. Матеріал і методи. Кров отримували шляхом стандартної венепункції та зберігали в пробірках з ЕДТА. Плазму відділяли центрифугуванням протягом 10 хвилин після забору крові. Зразки зберігали при температурі -80 °C до використання. ОxLDL визначали за допомогою наборів для імуноферментного аналізу (Elabscience, США). Результати. Показано, що рівень oxLDL у крові хворих на цукровий діабет 2-го типу і, особливо, пацієнтів, що перехворіли COVID-19 був значно вищим, ніж у крові здорових людей. Існує також достовірна різниця між пацієнтами з легкою і важкою формами COVID-19. За відсутності лікування цукрознижувальними препаратами (ЦЗП) у пацієнтів, що перехворіли COVID-19, рівень oxLDL значно зростає, особливо за відсутності лікування інсуліном. Ефект лікування був більш виражений саме у хворих на COVID-19, а при лікуванні інгібіторами натрійзалежного котранспортера глюкози 2-го типу (iНЗКТГ-2) рівень oxLDL знижувався майже до контрольних значень. Отже, концентрація oxLDL залишається високою у крові хворих на ЦД, які перехворіли COVID-19, хоча і нижчою ніж при гострому захворюванні. Висновки. Рівень oxLDL у крові пацієнтів із діабетом, які одужали від COVID-19, залишається високим, хоча й нижчим, ніж при гострій формі захворювання. Лікування ЦЗП може бути перспективною стратегією щодо зниження рівня oxLDL, а отже і ризику атеросклерозу, в осіб, що перехворіли COVID-19. Рівень oxLDL може бути одним із важливих маркерів пост-ковідного синдрому.

Prostate cancer (PCa) is the second most frequently diagnosed malignancy among men and the fifth leading cause of cancer death in the world. PC remains a heterogeneous disease with an unpredictable course, ranging from indolent forms that may never progress, to initially high and very-high risk of progression, where the mortality associated with PCa remains significant despite optimal treatment. The objective: to evaluate the impact of neoadjuvant androgen-deprivation therapy (NADT) prior to radical prostatectomy (RP) on biochemical recurrence-free, overall, and cancer-specific survival, considering the duration, type, and intensity of NADT, National Comprehensive Cancer Network (NCCN) risk stratification, and the role of adjuvant or salvage external beam radiation therapy (EBRT). Materials and methods. This study included 175 PCa patients who underwent RP between 2015 and 2021. Among them, 84 received NADT and 91 did not. Patients were stratified by NCCN risk groups and EBRT status. Oncological outcomes included biochemical recurrence-free survival (BCRFS), overall survival (OS), cancer-specific survival (CSS), and EBRT-free survival (EBRTFS). Kaplan–Meier and Cox regression analyses were performed. Results. NADT significantly improved BCRFS (hazard ratio = 0.45; p < 0.001), especially in patients who received maximal androgen blockade for ≥ 3 months. The combination of NADT and EBRT showed the most favorable OS and CSS. Patients without NADT or EBRT had the poorest outcomes. NADT was also associated with significantly longer EBRTFS (39 vs 12 months; p < 0.001). Multivariable analysis identified NCCN risk group and EBRT as independent predictors of survival. Conclusions. NADT prior to RP improves BCRFS and potentially enhances long-term oncological outcomes when combined with EBRT. Treatment duration and intensity are key factors in optimizing patient outcomes, especially in high-risk PCa.

Benign prostatic hyperplasia (BPH) is a common condition among elderly men that significantly affects their quality of life. Although monopolar transurethral resection of the prostate (TURP) has long remained the gold standard for surgical treatment, advances in technology have led to the development of modern alternative approaches. The objective: the aim of the study was to analyse the course of the intraoperative period inpatients with BPH of large and very large volumes, depending on the method of invasive intervention, taking into account anatomical features of vesicourethral segment. Materials and methods. This retrospective single-center study included patients who underwent interventional procedures for BPH between 2019 and 2021. Depending on the surgical technique used, all patients were divided into four groups: the first group (n = 106) – mechanical methods of enucleation of hyperplastic prostate tissue; the second group (n = 51) – monopolar TURP of the prostate; the third group (n = 302) – bipolar TURP of the prostate; and the fourth group (n = 104) – bipolar transurethral enucleoresection of the prostate. Results. Studied groups did not differ significantly in age (H = 2.8, p = 0.380) or body weight (F = 1.7, p = 0.409). Patients in the fourth group had significantly shorter durations of surgical intervention compared to the first (p = 0.0001) and second groups (p = 0.029). The fourth group also showed a 6.8-fold lower (p = 0.0003) volume of intraoperative blood loss compared to the first group, 3.13 times lower (p = 0.0002) than the second group, and 2.79 times lower (p = 0.0011) than the third group. Thus, a clear correlation is observed between the chosen surgical method and the volume of intraoperative blood loss. The use of certain surgical techniques significantly reduced the need for transfusion therapy: patients in the fourth group required erythrocyte mass transfusions (χ2 = 6.93, p = 0.032) and fresh frozen plasma transfusions (χ2 = 17.5, p = 0.005) significantly less frequently compared to other groups. Patients in the fourth group also required a shorter duration of urethral bladder drainage (51 (156; 72) hours) compared to the other groups (H = 13.2, p = 0.0011). The postoperative hospitalization period was also shorter in the fourth group (5 (4; 6) days) compared to the first (8 (5; 14) days, p = 0.003), second (7 (4.25; 10) days, p = 0.0031), and third groups (7 (6; 9) days, p = 0.0012). Conclusions. The highest efficacy of hyperplastic tissue removal was demonstrated in group of patients with bipolar enucleoresection of the prostate, characterized by lower intraoperative blood loss, shorter urethral drainage duration, and shorter hospitalization compared to groups with mechanical enucleation (adenomectomia), monopolar and bipolar TURP.

ANNOTATION. The information about the frequency and structure of complications in patients with hard erectile dysfunction, who have undergone the surgical treatment — penile prosthesis implantation, was analized. Received data prove that the variety of factors, that lead to irreversible damage of cavernous tissue, and a large number of forms of concomitant somatic pathology, is that platform on which the reasons, that lead to the postoperative complications, are based. In 9.6% of operated patients the dissatisfaction, as complication after penile prosthesis implantation, doesn’t have somatic reasons and is considered to be a decompensation of psycho-emotional status, that requires subsequent psychotherapeutic measures.

Mesial occlusion is a complex orthodontic pathology that adversely affects facial aesthetics, masticatory function, and patient quality of life, making timely treatment critical. One of the modern methods of correction is distraction osteogenesis, which allows gradual expansion of bone structures while minimizing the risk of relapse. The choice of treatment is based on the patient's clinical presentation, with distraction being a priority in cases where traditional surgery is contraindicated. Aim of the study was a detailed analysis of the effectiveness and safety of various treatment methods for mesial occlusion in adult patients with maxillary underdevelopment. Material and methods. The study included 15 adolescent patients between the ages of 19 and 23 with skeletal mesial occlusion. Baseline diagnostic data were obtained for each patient, and the volume of bone tissue in the vestibulo-oral direction at the site of planned implant placement was assessed during preparation for implant placement. Statistically significant differences between alternative quantitative characteristics with normal distributions were evaluated using Student's t-test. A difference was considered statistically significant at p<0.01. The study was carried out in compliance with the main provisions of the Council of Europe Convention on Human Rights and Biomedicine (4 April 1997), the World Medical Association Declaration of Helsinki on the Ethical Principles for Scientific Medical Research Involving Human Subjects (1964-2013), ICH GCP (1996), orders of the Ministry of Health of Ukraine No. 690 of 23.09.2009, No. 944 of 14.12.2009, No. 616 of 03.08.2012. The work is a fragment of the research project “Correction of violations of osteogenesis processes in the treatment and prevention of complications of dental diseases wartime” state registration No. 0123U103247. Results. The results of the study showed that in adult patients, orthognathic surgery ensures favorable skeletal outcomes for maxillary mesialization. However, when the replacement of lateral incisors with canines is feasible, this treatment approach may reduce the number of rehabilitation stages while achieving dentoalveolar relationships that conform to normal standards. The use of distraction osteogenesis in adult patients has yielded good results and may be justified in cases of critical reduction of maxillary body dimensions or contraindications to conventional orthognathic surgery. Conclusion. Distraction osteogenesis and orthognathic procedures effectively correct mesial occlusion, ensuring a stable increase in the sagittal dimension of the maxilla and improving occlusion. Replacement of lateral incisors with canines minimizes the need for additional surgery in cases of agenesis. The choice of treatment method should be based on individual clinical indications and risk assessment for each patient.

Stricture of the ureteropelvic junction (UPJ) is one of the most common pathologies in urology, which can cause hydronephrosis. For a long time the disease can be asymptomatic, thus patients visit a physician at the late stages of the disease, when severe structural and functional changes in the kidney are developed. Early diagnosis makes it possible to stop or slow down the progression of loss of kidney functions and facilitate the effectiveness of treatment. The objective: analyze the effectiveness of diagnosis and treatment of the late stages of hydronephrosis, caused by UPJ stricture. Materials and methods. Since 2013 to 2021 37 patients with late stages of hydronephrosis (23 men and 14 women) in DU “Institute of Urology named after Academic O. F. Vozianov” of NAMS of Ukraine have been examined and treated. The age of the patients ranged from 10 to 71 years. The cause of hydronephrosis in all patients was UPJ stricture. Results. 30 patients (81%) underwent laparoscopic plasty of the UPJ with the Anderson-Hines method. The postoperative period was uneventful. In the long-term postoperative period, no recurrence of the UPS stricture was diagnosed. The effectiveness of the treatment method was 96.7%. In all patients, the secretory function of the operated kidney significantly improved. However, in 7 (19%) patients out of 37 it was not possible to preserve a kidney. Conclusions. The use of laparoscopic Laparoscopic plasty of the UPJ with the Anderson-Hines method in the treatment of late stages of hydronephrosis makes it possible to achieve good clinical results both in the short-term and in the long-term postoperative period. Further development of scientific data in terms of studying pathogenetically based methods of early diagnosis, searching for new criteria for assessing the functional reserve of a blocked kidney, identifying biomarkers that will allow predicting the risk of recurrence of UPJ stricture and monitoring the effectiveness of treatment, which is a relevant and promising area.