Publications by authors named "B G Guliev"

67 Publications

[Intestinal and appendicular ureteral substitution].

Urologiia 2021 May(2):14-20

Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.

Aim: To present the technical features and results of intestinal and appendicular ureteral replacement.

Material And Methods: From 1998 to 2020, a total of 196 patients aged 18 to 77 years (mean age 49.5 +/- 1.2 years) were undergone to intestinal and appendicular ureteral reconstruction in our clinic. There were 123 women (62.8%). The most frequent indications for surgery were complications of open and endoscopic ureteral procedures, radiation-induced ureteral stricture, and iatrogenic injuries of the ureters during gynecological and surgical interventions (81.6%). In 165 (84.2%) patients, for ureteral replacement the ileal segment was used, while in 4 (2.0%) and 27 (13.8%) cases the colon segment and the appendix were chosen, respectively. Unilateral ileal ureteral replacement was performed in 131 (79.4%) cases, while in 34 (26.6%) patients a bilateral procedure was done. Partial and complete ureteral replacement was performed in 107 (81.7%) and 24 (18.3%) cases, respectively. Laparoscopic intestinal and appendicular ureteral replacement was performed in 44 (22.4%) patients, while two patients were undergone to robot-assisted procedure (1.0%).

Results: Early postoperative complications were noted in 17 (8.7%) cases. The most severe included acute bowel obstruction, leakage of entero-ureteral anastomoses, necrosis of the ileal graft and bleeding in 10 (5.1%) patients. In all cases, repeat intervention was performed. There were no lethal complications. Late postoperative complications developed in 24 (14.3%) patients.

Conclusion: Today our clinic has the worlds largest experience in intestinal and appendicular ureteral reconstruction, including original procedures, confirmed by 5 patents for inventions. The minimum number of postoperative complications, the absence of deaths and good long-term results provide the basis for the introduction of ileal and appendicular ureteral replacement into clinical practice.
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May 2021

[InsKid Mobile application for the reconstruction of the internal view of the collecting system].

Urologiia 2021 Mar(1):56-59

Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.

Introduction: patients with urinary stone disease during consultation often cannot realize their condition and features of upcoming procedure. Creation of 3D printed models is also not always available or too expensive.

Aim: to create a special program that allows for virtual intrarenal visualization of the collecting system and kidney stone on devices based on the Android operating system and evaluate its efficiency in counseling patients before the upcoming percutaneous nephrolithotomy (PCNL).

Materials And Methods: a total of 15 patients who were scheduled to PCNL, were included in the study. All of them had two consultations. During the second consultation, the newly developed program was used. Patient data from DICOM (computed tomography) format were converted to stereolithography (STL) format in order to display it in the application. Each patient assessed the quality of the consultation using a questionnaire.

Results: patients understanding of the kidney anatomy improved by 55% (from 34 to 75 points, p=0.0001), and stone localization by 51% (from 37 to 75 points, p=0.0001). The stages of PCNL became clearer by 57% (from 32 points to 75, p=0.0001), and understanding of possible intra- and postoperative complications was improved by 48% (from 38 to 73 points, p=0.0002). Overall patient satisfaction with counseling improved by 53% (from 35 to 74 points, p=0.0001), and the number of patients who desired for better repeated counseling decreased by 89% (from 9 to 1, p=0.006).

Conclusion: The InsKid app is an affordable and easy-to-use program, which doesnt require significant costs and allows patients to understand their disease and upcoming procedure.
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March 2021

Interior definition of the calyceal orientation suitable for percutaneous nephrolithotripsy via mobile software.

Urolithiasis 2021 Feb 12. Epub 2021 Feb 12.

Department of Urology, The head of the Urology Center with Robot-Assisted Surgery of the Mariinsky Hospital, North-Western State Medical University Named After I. I. Mechnikov, Piskarevskiy pr. 47, 195067, Saint Petersburg, Russia.

To date, there is no paper on defining the puncture of a kidney from the interior view of the pelvicalyceal system (PCS) to alleviate its performance. The objective of this study is to define the usefulness of the Rubik's Cube method determining calyceal orientation from inside via mobile software for the percutaneous nephrolithotripsy (PCNL). Over September 2019-September 2020, 25 patients with indications for PCNL were enrolled in this single-arm study. All patients underwent computed tomography (CT)-urography. Primary endpoints were the duration of renal cavity puncture, number of attempts and success rate. Complication rate ordered according to Clavien-Dindo classification was analyzed as a secondary endpoint. The stone-free rate was 91%. The same experienced urologist performed all procedures through the single-access PCNL without puncture site reposition. The puncture was made through the upper, middle, and lower calyx in 9, 12 and 4 cases, respectively. The mean duration of cavity puncture was 2.8 ± 1.1 min. The mean number of attempts to reach desirable calyx was 1.4 ± 0.6. It should be noted that there were no cases with three and more punctures. The overall complication rate was 28% (7/25) when only one patient experienced ≥ 3 Grade. The proposed Rubik's Cube method facilitates preoperative planning of PCNL and makes that procedure easier for specialists and safer for the patients.
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http://dx.doi.org/10.1007/s00240-021-01253-7DOI Listing
February 2021

[Robot-assisted radical cystectomy with neobladder formation].

Urologiia 2020 11(5):54-60

Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.

Introduction: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure.

Aim: To describe the main stages of RARC and to analyze its short-term results.

Materials And Methods: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique.

Results: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction.

Conclusion: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.
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November 2020

InsKid-a new mobile application (app) that measures the infundibulopelvic angle before retrograde intrarenal surgery more reliably than does other approaches: pilot study.

Clin Exp Nephrol 2021 Feb 29;25(2):207-212. Epub 2020 Oct 29.

Department of Urology, North-Western State Medical University Named After I.I.Mechnikov, Piskarevskiy pr. 47, 195067, Saint Petersburg, Russia.

Objective: This study compared our program's ("InsKid") capability for measuring the infundibulopelvic angle (IPA) with existing ones.

Methods: Prospectively, data from 50 patients with lower pole kidney stones with indications for retrograde intrarenal surgery (RIRS) were collected. All patients underwent computed tomography (CT)-urography. The IPA of each pelvicalyceal (PCS) unit was measured with the Elbahnasy's, Sampaio's, and "InsKid" methods. Results were compared. Finally, we compared the area under the receiver operating characteristic (ROC) curve (AUC) for predicting stone-free status after RIRS. We defined success as stone fragments ≤ 2 mm on the CT scan on the first postoperative day (POD1). The stone-free rate refers to no identifiable stone fragments on the POD1 CT. Test-retest reliability and face validity were defined to estimate psychometric properties of InsKid.

Results: The success rate after first procedure was 87.5%. The average value of IPA using the Elbahnasy and Sampaio methods and our program were 85.2° ± 11.9°, 95.1° ± 10.1°, and 79.9° ± 13.0, respectively. There was a significant difference among the InsKid, Elbahnasy, and Sampaio (AUC = 0.762, 0.601, and 0.629, respectively) approaches with respect to the capability of predicting the immediate success of RIRS. Repeated measurement did not affect values of IPA (1.3° ± 0.7, p = 0.67). All specialist appreciated proposed software as highly useful (5/5).

Conclusion: This new application reproduces the intraoperative aspects of the PCS more clearly than the other methods and also provides an easy solution for clearly defining the IPA without relying on the central axes.
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http://dx.doi.org/10.1007/s10157-020-01987-5DOI Listing
February 2021