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The aim of the work was to experimentally study the effect of the created injectable drug basic fibroblast growth factor (bFGF) with the controlled release on morphological changes and indicators of renospecific enzymes in the ischemic kidney (experiment on rabbits). Methods. Studies on the release dynamics of the created bFGF drug were performed in vitro and the study of the induction of bFGF angiogenesis in the model of the chick chorioallantoic membrane of the chicken was performed. The experimental model was performed in 25 rabbits: in 10 rabbits we studied the effect of 1-8 months of "pure ischemia" of the kidney without injection of the drug (control); in 12 rabbits 1 month after the creation of the model of ischemia in the renal parenchyma was injected the prolonged-acting drug bFGF, deposited on our polymeric carrier at a dose of 5 μg (experiment). The reference group consisted of 3 intact rabbits. Histological examinations of renal tissue and morphometric examinations with the determination of vascular coefficient (VC) and interstitial coefficient (IC) were performed. Enzymological indicators of enzyme activity in the homogenate of the renal parenchyma were determined by biochemical methods; statistical analysis was performed. Results. Using chick chorioallantoic membrane as a model it was preliminarily demonstrated that developed injectable prolonged-acting drug bFGF deposited on a polymeric carrier based on cross-linked modified heparin, effectively enhances neoangiogenesis. The results of morphological and morphometric studies with the determination of vascular and interstitial coefficients showed, that the injection of the prolonged-acting drug bFGF in all cases was accompanied by an increased blood supply in the kidneys and neoangiogenesis, which reduced the effects of ischemia. Injection of bFGF at a dose of 5 μg in the model of chronic segmental renal ischemia for 3-4 months completely prevented the development of initial sclerotic and atrophic changes, that developed in the kidney during this period under the influence of chronic ischemia without bFGF. Injection of prolonged-acting bFGF at a dose of 5 μg in the model of chronic segmental renal ischemia for 5-8 months prevented expressed sclerotic and atrophic changes, that developed under the influence of chronic ischemia during this period without the use of bFGF. As a result of biochemical studies, the activation and normalization of indicators of renospecific tubular enzymes in the ischemic kidney under the action of the created experimental drug bFGF were determined. Conclusions. Therapy of ischemic changes in the kidney with the developed injectable long-acting drug bFGF at a dose of 5 µg in the experimental model of chronic ischemia protects the organ from hypoxic damage, has a positive effect on the structural and functional state and metabolism of the kidney, and prevents the development of nephrosclerosis.

The objective: to determine the effectiveness of herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon) to normalize kidney function in patients with active tuberculosis (TB). Materials and methods. During 6 years, 738 patients from 6 till 81 years old with active TB of various localizations, including kidneys, were examined and treated. We evaluated symptoms, anamnesis, clinical, biochemical tests of blood, urine, glomerular filtration rate, bacteriological analysis, polymerase chain reaction for DNA of Mycobacterium tuberculosis, immunological studies, methods of radiological diagnosis (sonography, radiography, multislice computed tomography, magnetic resonance imaging, radioisotope method), endoscopic research methods with targeted aspiration and biopsy to obtain biological material. The participants of the research were divided into two groups: main and control ones. Patients in the main group (n=73) were prescribed herbal medicine, which includes yarrow, lovage root and rosemary leaves, hepatoprotector with field artichoke and intestinal dialysis (a mixture of electrolytes, macrogol and activated carbon). The patients in the control group (n=70) used only herbal medicine, which includes yarrow, lovage root and rosemary leaves and hepatoprotector with artichoke. Variation statistics methods were used to process the obtained data. Results. According to the result of the study, 68 (93.1%) patients out of 73 persons in the main group with active TB, had symptoms of the improvement. In the control group, only 37 (52.8%) patients reported positive results. In 68 patients of the main group, normalization of renal function was achieved: normalization of blood creatinine levels, glomerular filtration rate, reduction of protein, leukocytes, erythrocyturia. Conclusions. The proposed method of treatment of patients with active tuberculosis of different localization, including kidneys, on the background of antimycobacterial therapy is one of the possible treatment options. It is proved that normalization of renal function was determined in 93.1% of patients, which is on 40% higher compared to the control group.

Currently, there is no doubt about the feasibility of determining the frequency of HLA and analysis of genetic associations, including those that determine the state of immunity, in patients with the genitourinary disease. The study aimed to evaluate HLA phenotypes in patients with the most common diseases of the genitourinary system and identify risk antigens or protectors. Methods. HLA distribution was studied in 384 patients with pyelonephritis and glomerulonephritis and 464 patients with urological diseases (chronic cystitis, chronic proliferative cystitis, chronic prostatitis, prostate sclerosis, prostatic hyperplasia, and prostate cancer). HLAs were defined using a standard microlymphocytotoxic test (Terasaki’s test) on the Terasakiґs planchette with panels of anti-HLA serums (20 antigens of locus A, 31 – B and 9 – DR). The control group consisted of 350 healthy donors from Ukraine. The HLA frequencies in healthy and diseased subjects were compared taking each antigen separately, using the χ2 test. The value of the relative risk of disease (RR) was determined by the coefficient: RR = ab/cd, where a is the number of patients positive for this antigen, b is the number of persons in control, negative for this antigen; c is the number of patients negative for this antigen, d is the number of persons in control positive for this antigen. Indicators RR≥ 2.0 were considered significant. Absolute (attributive) risk of the disease as an etiological fraction, which was determined by the formula: s = x - y/1 - y, where x is the frequency of antigen in patients, y is the frequency in healthy people. The indicator s> 0,1 was considered reliable. Results. The association of the most common genitourinary diseases with certain histocompatibility antigens (RR≥2) is shown. The causal role of HLA with a significant absolute risk of pyelonephritis (А10, А11; В14, В16) and glomerulonephritis (A24, А28; B8; DR4, DR52), chronic cystitis, (including proliferative) (A10, B14, B16), chronic prostatitis (including with an autoimmune component or impaired fertility) (А24, В8, В52), sclerosis of the prostate (А24, А28), hyperplasia (А29, В38) and prostate cancer (А25, А29, В40, В44, В49) has been established. HLA-antigens associated with protection against these pathologies have also been identified - А2, А24, В21, В35 for pyelonephritis and А9, В12, В16, В18 for glomerulonephritis; А25, А26, В5, В14, В16, В17 for chronic prostatitis with its complications, А10, B15, B17 for prostate sclerosis, А9, А10, В17 for prostate hyperplasia, A1, B5, B13, B15 for prostate cancer. Conclusion. The study proves the feasibility of identifying antigens of the HLA system and analysis of their associations with different genitourinary diseases, which allows for predicting the risks of the disease and treatment optimization.

Efficacy of different approaches to the treatment in patients with ureteral calculi and predictive factors for the success are the objects of contemporary studies. However, only few on them studied the duration factor of typical ureterolithiasis symptoms and changes of the ureter wall as predictive factors of extracorporeal shock wave lithotripsy (ESWL) failure in patients with ureteral stones. The aim of the study was to determine the peculiarities of histological changes in the ureter wall as a result of calculus presence and to evaluate the predictive factors of ESWL failure in patients with ureterolithiasis. Materials and methods. An analysis of the treatment by ESWL in 662 patients with ureterolithiasis was performed. The patients were divided into two groups: Group 1, n = 629 (95.0 %) individuals with effective ESWL and Group 2, n = 33 (5.0 %) patients with ESWL failure when calculi were not eliminated. Stones were found in 378 (57.0 %) patients in the upper third of the ureter, in 50 (7.6 %) – in the middle and in 234 (35.4 %) – in the lower third. For determining the predictors of ESWL failure, the Spearman’s Rank Correlation Coefficient was used. Results. The overall ESWL efficacy in our study was 95.0 %. The strong inverse correlation was found between the ESWL success and duration of symptoms (r = -0.92) and stone size (r = -0.68). Stone localization in the ureter did not influence the ESWL outcomes (r = 0.27). Conclusions. Increasing of the period from the manifestation of primary clinical symptoms to the implementation of ESWL reduces the treatment efficacy. Patients with ureteral stones more than 15 mm have lower stone-free rates after ESWL.

Introduction. Prostate cancer antigen-3 (PCA3) is a genetic biomarker, which got widespread and demonstrated high diagnostic potential. This gene expresses only in prostate gland tissue, furthermore, malignant prostate neoplastic transformation leads to 70 – 100 time overexpression of it. Polyadenylated matrix RNA (mRNA) is a functional product of this gene, which do not translating into protein. Gene contains of four introns and three exon. Product of PCA’s gene detecting in post massage urine using polymerase chain reaction (PCR) in combination with reverse transcription. It could use as prognostic biomarker in patients with first negative biopsy or before it performing. Moreover, index of PCA3 can be useful in detecting tumor aggressiveness and decisions about further treatment options. Taking into account these facts, patients with high initial PSA level can avoid unnecessary biopsies. Objective: to determine critical cut-off value of PCA3 index as prognostic biomarker of PCa development. Materials and methods. Research based on routine and special test’s data of 243 men in Institute of Urology, National Academy of Medical Sciences of Ukraine in period of 2015–2020 year. RNA extraction from postmassage urine samples performed using RNeasy (Qiagen) kit. Statistical analysis performed using SPSS Statistics 19.0 (IBM SPSS Statistics 19.0) та SAS 12.0 (IBM Statistical Analysis System 12.0). Critical cut-off values determined using three methods: calculating of average value and (Xave) and standard deviation (SD) of it, Heiner index, and Youden’s index. Evaluation of optimality of determined critical cut-off values performed by comparative analysis using index of positive prognosis (IPP), index of negative prognosis (INP), diagnostic accuracy of method (DAM), Sp and Se for each of used methods. Results and discussion. First method demonstrated than 97,5 % of all results, which means absent of disease, was below critical cut-off values, due to statistical deviations and accurate demonstrate than in case of asymmetry or multimodal distribution this method was unsatisfied. Wherein IPP was 95 %, INP – 72 %, DAM – 78 %, Sp – 97,5 % and Se – 52 %. Calculation of PCA3 index area under ROC-curve was 0,810 (0,771–0,849). Using Heiner’s method critical cut-off value of PCA3 index was 14,0 с. u., where in IPP was 75 %, INP – 82 %, DAM – 78 %, Sp – 78 % and Se – 78 %. Critical cut-off values of PCA3 index 33,4 c. u. which calculated by Youden’s index demonstrated IPP – 98 %, INP – 73 %, DAM – 80 %, Sp – 99 % and Se – 57 %. Conclusions. The most optimal critical cut-off value for PCA3 index was determined using Youden’s index and was 33,4 c. u. Keywords: prostate cancer, PCA , prostate cancer antigen-3, PCA3, prostate cancer antigen-3 index, PCA3 index, critical cut-off values of PCA3 index.

Актуальность. Изучение проблемы уролитиаза в последние годы вышло на качественно новый уровень в связи с использованием мультидисциплинарного подхода и принципов доказательной медицины. В отечественной литературе имеются единичные сообщения о значении и методах коррекции метаболических нарушений при мочекаменной болезни. До сих пор нет единого мнения по поводу целесообразности и эффективности профилактических методов после удаления конкрементов. Цель исследования:. оценка влияния фитотерапии (препарата Уролесан®)) на метаболический статус и микробиоту мочи у пациентов с мочекаменной болезнью — оксалатно-кальциевым нефролитиазом после проведения ударно-волновой литотрипсии. Материалы и методы. У 50 больных с оксалатно-кальциевым нефролитиазом после проведения ударно-волновой литотрипсии в возрасте от 18 до 65 лет (средний возраст — 41,1 ± 1,6 года) изучали влияние препарата Уролесан® на метаболический статус пациентов (влияние на рН мочи, уровень экскреции оксалатов, кальция, мочевой кислоты, показатели биохимического исследования крови), особенности микробиоты мочи и предупреждение рецидивного образования конкрементов. Результаты. Анализ динамики уровня рН мочи, измерямого на 2, 5, 10, 20 и 30-е сутки лечения Уролесаном®, показал, что пациенты при контрольном обследовании имели постепенное повышение уровня рН мочи с 5,80 ± 0,04 до 6,13 ± 0,04 на 5-е сутки (р

Recurrent urinary tract infection (UTI) is a highly prevalent, costly, and burdensome condition affecting women of all ages, races, and ethnicities without regard for socioeconomic status, or educational level. Modern strategies aimed at preventing recurrent UTI are still not optimal, as evidenced by the relatively high prevalence of this nosology in women. The purpose of this article was to highlight and discuss both the evidence base and a number of unresolved issues in the management of recurrent UTI. The following topics of clinical interest are considered: diagnosis, age-related associations, continuous and intermittent antimicrobial prophylaxis, the effectiveness of modern non-antimicrobial prophylaxis, the potential role of forinal (a complex of D-mannose and cranberry fruit extract) in the prevention of recurrent UTI., Рецидивирующая инфекция мочевой системы (ИМС) является распространенным, дорогим и обременительным состоянием, которое касается женщин всех возрастных категорий, рас и этнических групп без учета социально-экономического статуса или образовательного уровня. Современные стратегии, направленные на профилактику рецидивирующих ИМС, как и раньше, не являются оптимальными, о чем свидетельствует относительно высокая распространенность данной нозологии у женщин. Цель данной статьи заключалась в освещении и обсуждении как доказательной базы, так и ряда нерешенных вопросов менеджмента рецидивирующих ИМС. Рассмотрены темы, вызывающие клинический интерес: диагностика, возрастные ассоциации, постоянная и интермиттирующая антимикробная профилактика, эффективность современных мероприятий неантимикробной профилактики, потенциальная роль форинала (комплекс D-маннозы и экстракта плодов клюквы) в профилактике рецидивирующих ИМС., Рецидивуюча інфекція сечової системи (ІСС) є поширеним, дорогим й обтяжливим станом, що торкається жінок усіх вікових категорій, рас та етнічних груп без урахування соціально-економічного статусу або освітнього рівня. Сучасні стратегії, спрямовані на профілактику рецидивуючих ІСС, як і раніше, не є оптимальними, про що свідчить відносно висока поширеність даної нозології у жінок. Мета даної статті полягала у висвітленні й обговоренні як доказової бази, так і низки невирішених питань менеджменту рецидивуючих ІСС. Розглянуті теми, які викликають клінічну зацікавленість: діагностика, вікові асоціації, постійна та інтермітуюча антимікробна профілактика, ефективність сучасних заходів неантимікробної профілактики, потенційна роль форіналу (комплекс D-манози та екстракту плодів журавлини) в профілактиці рецидивуючих ІСС.

The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p

The objective: to evaluate the effectiveness of portable pneumatic contact lithotripter LMA StoneBreaker in endoscopic contact ureterolithotripsy of ureteral stones of different localization depending on their density and search for opportunities to increase it. Materials and methods. Contact pneumatic ureterolithotripsy was performed in 89 patients (49 men, 40 women), 39 (43.8%) patients (I group) underwent standard contact pneumoureterolithotripsy, and 50 (56.2%) patients (11 group) – modified (with prior fixation of the stone in the ureter loop Dormia), which allowed urethrolithotripsy in situ and prevented the migration of stones and their fragments proximally. The number of strokes required to initiate fragmentation, complete fragmentation, and total ureterolithotripcy time for stones of different localization and density were determined. The integrity of the stones was determined by computed tomography in units of Haunsfield (HU). The mineral composition of stone fragments after their removal was diagnosed by X-ray diffraction analysis. The effectiveness of the applied methods was evaluated in groups of patients by complete (100%) removal of stone fragments from the ureter and by the number of cases of retrograde migration of stones into the renal cavity. Results. No intraoperative complications were observed. The number of strokes for the initial and complete disintegration of the stone, regardless of the method of ureterolithotripsy and their localization, depended on their density, ie its mineral composition. The minimum number of strokes for start and complete fragmentation of the stone was recorded in patients with a stone density of 480+54 HU and diagnosed as phosphates. Oxalate and uric acid stones, as well as their combinations (density 1310–1580 HU) required the maximum number of blows. Stone migration was noted in 8 (8.99%) patients. Thanks to intraoperative stone fixation was able to reduce the average time of lithotripsy (from 15,65±6.9 min to 12.3±6,15 min) and reduce the frequency of retrograde stone migration from 15.4% (in 6 patients of group 1) to 4% (2 patients of ІI group). The dependence of lithotripsy efficiency on stone localization is established. It was highest in patients with stones of the lower third of the ureter (95% in patients of group 1 and 100% of patients in group II) and with low density (480–840 HU). The lowest efficacy was observed in patients whose stones were localized in the upper third of the ureter (66.3% in group I and 90% in group II) and had a high density (more than 1200 HU). Due to the fixation of the stone with modified pneumoureterolithotripsy, the overall effectiveness of the method increased from 84.6% to 96%. Conclusions. Traneurethral contact pneumoureterolithotrysis using a portable pneumatic lithotripter LMA Stonebreaker – is effective, safe, minimally costly and easy to use. The effectiveness of contact pneumatic ureterolithotripsy depends on the location and density of the stone. The number of strokes required for the initial and complete fragmentation of the stone directly depends on the density of the stone and does not depend on its location and method of performing pneumoureterolithotripsy. The use of a modified technique with fixation of the stone in the ureter during the process of lithotripsy reduces the time of the operation and increases its effectiveness.

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Urolithiasis is one of the most common disease encountered in the daily practice of a urologist. Depending on the severity of the course, patients with urolithiasis and, in particular, kidney stones, are often required to have the surgical treatment. The greater problem is deemed to be staghorn nephrolithiasis and the choice of the optimal surgical technique for the elimination of kidney stones. The objective: to evaluate the efficacy and safety of the combined method of fragmentation of coral kidney stones in comparison with standard ultrasound lithotripsy. Materials and methods. A total of 352 percutaneous nephrolithotripsies (PCNL) were performed: 187 (53,1%) – patients who were diagnosed with staghorn calculi. The age of the patients ranged from 26 to 66 (mean age 42,5 years). There were 89 men and 98 women. 78 (41.7%) patients had previously undergone surgical treatment (open surgery or PCNL) of kidney stones, in which recurrent staghorn stones were subsequently identified. Nine (4,8%) patients had bilateral coral calculi. The size of the stone varied from 3,5 to 11,0 cm. Their density ranged from 300 to 1500 Hounsfield units. The most frequent complication of the underlying disease was chronic pyelonephritis – 145 (77,5%) patients. Hydronephrosis on the affected side was diagnosed in 98 (52,4%) patients. A combined pneumatic and ultrasonic lithotripter ShockPulse-SE from Olympus (Japan) was used for breaking kidney stones. We performed PCNL in a combined mode in 41 (21,9%) patients with staghorn nephrolithiasis. Results. In the group of patients using combined pneumatic and ultrasonic lithotripsy, complete removal of the staghorn calculus was achieved in 97,6% of cases (in 40 of 41 patients), whereas in the opposite group, using an ultrasonic lithotripter only in 84,9% (in 124 of 146 patients). The duration of the PCNL operation using the ShockPulse-SE device was from 35 to 130 minutes, on average – 48±5 minutes. The duration of the surgical intervention using an ultrasound lithotripter is from 90 to 180 minutes, an average –105±7 minutes. Blood loss during PCNL using an ultrasonic lithotripter was 200–400 ml, whereas with the ShockPulse-SE apparatus – 100–200 ml. An exacerbation of pyelonephritis was noted in 7 patients (in two patients after PCNL in a combined mode and in five after PCNL using an ultrasonic lithotripter). The mean length of patient hospitalization after surgery ranged from 4 to 10 days. At the same time, the average duration after PCNL using the combined ShockPulse-SE technique was 4±1 days, while after PCNL using an ultrasonic lithotripter it was 6±1 days. Conclusions. The combined technique of lithotripsy with a combined probe for simultaneous pneumatic and ultrasound lithotripsy has shown better results in terms of safety and efficacy compared to using only an ultrasound lithotripter. Used for decades, ultrasound lithotripsy for staghorn stone PCNL is both effective and safe moreover it’s a traditional technique. Thus, in comparison with ultrasound lithotripsy, the combined technique showed a shorter operation time, with less blood loss, a shorter length of patient hospitalization and less pyelonephritis in the postoperative period, as a result of maintaining a lower intrarenal pressure gradient during the operation. At the same time, the cost of the procedure using a combined probe was estimated, which turned out to be higher than traditional ultrasound lithotripsy. The use of combined lithotripsy with simultaneous aspiration of stone fragments is an indisputable advantage of this kind of PCNL in patients with staghorn nephrolithiasis, which brings the effectiveness of this technique closer to 100%.

РЕЗЮМЕ. Мета – підвищення ефективності лікування хворих із нейрогенними розладами сечовипускання. Матеріал і методи. Обстежено 56 хворих із нейрогенними порушеннями сечовипускання. Функціональний стан детрузора, внутрішнього сфінктера сечового міхура, зовнішнього сфінктера уретри визначали за допомогою електроміографічного дослідження. Електростимуляцію сечового міхура проводили за стимулювальною методикою з частотою 70 Гц, модуляцією 100 %, посилка-пауза 4–6 с, протягом 15 хв, курсом 2 тижні. Результати. Встановлено, що електроміографія відображає функціональний стан сечовивідних шляхів. Призначення електростимуляції дозволило досягти достовірної позитивної динаміки в клініко-функціональному стані пацієнтів. Висновки. Лікування пацієнтів із нейрогенними розладами сечовипускання за допомогою електростимуляції є ефективним.

Contains fulltext : 237261.pdf (Publisher’s version ) (Closed access) Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project "IMAGINE" (IMpact Assessment of Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.

Objective. Аnalysis of the treatment results in patients, suffering ureteric calculi, using the contact ureterolithotripsy procedure. Маterials and methods. In 104 patients with ureteric calculi, in whom ureteroscopy with further laser contact ureterolithotripsy was conducted, symptoms of the disease were analyzed, as well as the diagnostic methods value, peculiarities and efficacy of surgical treatment. Results. In all the patients endoscopic extraction of calculi have been succeeded. Calculus does not cause significant macroscopic changes in ureter, if symptoms, characteristic for ureterolithiasis, persists up to one week. Local edema is formed, if a calculus persists in ureter longer than a week. Long-term (more than two months) local ureteric persistence of calculi enhances the risk of its intramucosal intraureteric «ingrowth» greatly. Conclusion. The contact ureterolithotripsy constitutes a highly effective and miniinvasive method of surgical intervention in ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the calculi ureteric insertion time without a process of a stone discharge causes the ureteric wall changes, complicating performance of miniinvasive interventions (the contact ureterolithotripsy and a distant shock-wave lithotripsy).

Extracorporeal shock wave lithotripsy (ESWL) has been used in the treatment of urolithiasis since 1980s. The method has proven to be effective and minimally invasive, but in last years the effectiveness of the method has decreased significantly from 90 % to 60 %. Studying of the causes of this phenomenon and methods of improving treatment outcomes are important problems of modern minimally invasive urology. The objective: to evaluate the effectiveness of the application of ESWL on Siemens Modularis Uro in the treatment of patients with ureterolithiasis. Materials and methods. ESWL was performed in 662 patients with ureteral stones ranging in size from 5 mm to 19 mm on Siemens Modularis Uro. Results. In 95.01 % of cases, the urinary tract was free of stones by the method of ESWL, the removal of stones in 1 session occurred in 376 (56.8 %) patients, with repeated – in 253 (43.2 %) patients. In 33 (4.99 %) patients the result of ESWL was unsatisfactory, fragmentation or elimination of stone fragments did not occur and for these patients ureteroscopy (ureterolithotripsy) was performed as second stage of treatment. During endoscopic intervention in 78.8 % of patients the fragmentation was satisfactory (fragments were smaller than 4 mm), but the elimination of fragments did not occur due to changes of the wall of the ureter in the area of its primary location. The overall rate of stone fragmentation after ESWL sessions in the patients in the trial was 98.94 %. Conducting ESWL with the proposed parameters did not affect the effectiveness of the method (p>0.1), but allowed to significantly increase the life of medical equipment. No complications directly related to lithotripsy were detected. Conclusion. The obtained results make possible to consider ESWL as a priority method of treatment for patients with ureteral stones up to 15 mm, taking into account the risk factors of inefficiency.

Derivatives markets have long ago started to be an important part of the global market in general and international monetary relations in particular. They make the process of risk management more advanced. It helps bringing the global monetary relations to a higher development level. Global trade in derivatives performs the functions of integration of regional capital markets and helps the global economy participants reduce available risks and concentrate on the further development of international trade and monetary relations. Therefore, the derivatives market contributes to reducing the risk level and balancing the international capital flow. Modern world trends in the derivatives’ market development are studied. The structure of the world derivatives market is determined with the separation of its exchange and over-the-counter parts. The instrumental structure of the market is analyzed with the separation of the most popular underlying assets among the derivatives market participants. The author notes that the share of interest rate and foreign exchange derivatives is constantly growing, with an advantage on the side of interest rate derivatives. The paper determines that there is a gradual shift of trade from exchanges to the over-the-counter market in the market of interest derivatives due to the passage of transactions through central counterparties, as well as the growing share of electronic and automatic trading. Analysis of the dynamics of foreign exchange derivatives reveals that contracts increasingly include currencies that do not belong to the top four (USD, EUR, JPY, GBP). At the same time, the US dollar remains the leading currency in operations with interest rate and foreign exchange derivatives. The cross-border operations with derivatives are analyzed. The paper proves that the global nature of the modern derivatives market can be supported by the recognition and implementation of global standards and the cooperation of regulators around the world.

Summary Background Healthcare-associated infections (HAIs) are among the most common adverse events in patient care, and account for substantial morbidity and mortality. Aim To obtain the first estimates of the current prevalence of HAIs and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine. Methods Prospective surveillance was conducted from January 2014 to December 2016 in five acute care hospitals in Kyiv. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Findings Among 53,884 patients, 3753 (7%) HAIs were observed. The most frequently reported HAIs were respiratory tract infections (pneumonia 19.4%, lower respiratory tract infections 4.1%), surgical site infections (19.6%), urinary tract infections (17.5%) and bloodstream infections (10.6%). Death during hospitalization was reported in 7.2% cases of HAI. The micro-organisms most frequently isolated from HAIs were Escherichia coli (15.9%), Staphylococcus aureus (14.8%), Enterococcus spp. (10.2%), Pseudomonas aeruginosa (8.9%) and Klebsiella spp. (8.9%). Meticillin resistance was reported in 28.2% of S. aureus, and 14.2% of enterococci were resistant to vancomycin. Overall, 35.1% of all Enterobacteriaceae were resistant to third-generation cephalosporins, with the highest resistance rates seen in K. pneumoniae (53.8%) and E. coli (32.1%). Conclusions Infection control priorities in hospitals should include prevention of surgical site infections, pneumonia, bloodstream infections and urinary tract infections. These results may help to delineate the requirements for infection prevention and control in acute care hospitals.

Introduction: Placement of a nephrostomy tube at the conclusion of percutaneous nephrolithotomy (PCNL) has been traditionally considered a standard practice. However, in the past decade, t...

Goal. Improving short- and long-term cancer outcomes, quality of life, and reduce complication rate after treatment of patients with muscle-invasive bladder cancer by justifying the indications for organ-sparing surgery with adjuvant chemotherapy. Materials and methods. A retrospective analysis of 120 patients who underwent organ-sparing surgery was performed. Patients were divided into 3 groups. In the comparative analysis of the studied groups, the assessment of oncological results, quality of life and postoperative complications Results. Patients who underwent partial cystectomy of bladder with adjuvant chemotherapy, showed better in comparison to two other groups remote oncological results by 20%. The mean follow-up was 6 years. The evaluation of oncological results was performed due to the guidelines of the European Association of Urology for patients with MIBC after organ-preserving multimodality treatment. Indicators of erectile function and quality of life in the main group were better than in two other groups. Conclusions. The presented results of the study suggest that organ-preserving treatment with chemo-radiation therapy of muscle-invasive bladder cancer is an alternative method of treatment.

The Objective of study is to investigate an integral analysis of the effectiveness of modified endoscopic radical prostatectomy by applying the concept of conditions of the National Cancer Institute of USA (CCNCI USA). Material and methods. A total of 34 patients who had undergone endoscopic radical prostatectomy with a new method of forming a vesico-urethral anastomosis during 2015–2017. The median of follow-up time was 45.5 months (95% CI 43–51). The results were evaluated using the CCNCI USA after 12, 24 and 36 months from the moment of operation. Due to the presence of severe erectile dysfunction before surgery, four patients were excluded from the analysis. According to the CCNCI USA, the following variants of results of radical prostatectomy are provided: optimal condition (continence, preservation of erectile function and biochemical recurrence free); suboptimal condition (urinary incontinence and/or erectile dysfunction with the absence of biochemical recurrence); biochemical recurrence. Results. There were 19 (63.3%) patients in optimal condition after 12 months, 9 (30%) patients remained in suboptimal condition, and 2 (6.7%) had biochemical recurrence. Only 3 (10%) patients had a biochemical recurrence after 24 months, and 20 (66.7%) and 7 (23.3%) were in optimal and suboptimal conditions, respectively. There were 22 (73.3%) patients in optimal condition after 36 months after radical prostatectomy, 4 (13.3%) remained in suboptimal condition, and three-year recurrence-free survival was 86.7%. Conclusions. In sum, 73.3% of patients in the study group had been reached the optimal condition according to the CCNCI USA during the three-year follow up, and the main reason for constanting a suboptimal functional result had been postoperative erectile dysfunction. Modified endoscopic radical prostatectomy demonstrates a comparable indicator of modern foreign sources of three year recurrence-free survival of patients with localized prostate cancer, due to which this technical modification can continue to be widely used in clinical practice.

The article is devoted to is compare the main modern methods of kidney cysts treatment, to determine their indications for use, and to formulate an algorithm for optimal treatment tactics.Cysts are common in the structure of renal disease. Their prevalence is about 5%. Cysts of small size (

Aim. To detect ETS fusion transcripts in Ukrainian population and to analyze a possible relationship between the ETS fusion transcripts and clinical characteristics of prostate cancer. Methods. Quantitative PCR (q-PCR) was used to analyze the expression of six fusion transcripts at the mRNA level. The amplified products were analyzed by gel electrophoresis and direct sequencing. We analyzed 37 fresh frozen samples of prostate cancer tissues, 37 paired conventionally normal prostate tissue samples and 20 samples of adenomas. Results. Six ETS fusion transcripts of TMPRSS2 with ERG, ETV1, ETV4, ETV5 were analyzed. Only one out of six fusion ETS transcripts was detected in a cohort of 37 Ukrainian patients with prostate adenocarcinoma. The frequency of detection of the TMPRSS2-ERG fusion transcript in prostate cancer tissues was 56.8 %. The TMPRSS2-ERG expression was also detected in 16 normal prostate tissue samples (43.2 %) and in 4 prostate adenoma samples (20 %). No correlation was found between the frequency of the TMPRSS2-ERG in carcinoma samples and clinical characteristics of the samples. However, an analysis of relative gene expression in all the investigated groups has shown the altered TMPRSS2-ERG expression in some groups with different Gleason scores of prostate adenocarcinoma compared to adenomas and normal tissue samples. The most elevatedTMPRSS2-ERG expression was found in the prostate adenocarcinoma group with the Gleason score > 7. Conclusions. We detected the TMPRSS2-ERG fusion transcript (EF194202.1) in prostate tumor samples as adenocarcinoma (the frequency was 56.8 %) with different Gleason score and some paired normal prostate tissues as adenoma samples in our group of Ukrainian population. The obtained results show that the TMPRSS2-ERG fusion transcript is present at early stages of cancer development. In the further studies we plan to test whether the TMPRSS2-ERG fusion transcript can be used as a diagnostic marker of prostate cancer development. Мета. Виявити типи злитих транскриптів в українській популяції та проаналізувати можливий зв›язок між наявніс-тю злитих транскриптів ETS та клінічними характеристиками раку передміхурової залози. Методи. Кількісний ПЛР (q-PCR) використовували для аналізу експресії 6 злитих транскриптів на рівні мРНК. Ампліфіковані продукти перевіряли за допомогою гель-електрофорезу та секвенуванням. Нами було проаналізовано 37 свіжо заморожених зразків тканин раку передміхурової залози, 37 парних до них умовно нормальних зразків тканини передміху-рової залози та 20 зразків аденоми. Результати. Нами було проаналізовано 6 злитих транскриптів ETS: злиття TMPRSS2 з ERG, ETV1, ETV4, ETV5. У вибірці із 37 пацієнтів з аденокарциномою передміхурової залози було виявлено лише один з шести злитих транскриптів. Частота детекції злитого транскрипту TMPRSS2-ERG в тканинах раку передміхурової залози становила 56,8 %. Експресія TMPRSS2-ERGтакож була виявлена у 16 зразках умовно нормальних тканин передміхурової залози (43,2 %) та у 4 зразках аденоми передміхурової залози (20 %). Не було виявлено кореляції між частотою TMPRSS2-ERG та клінічними характеристиками пухлин у зразках карцином. Проте аналіз відносної експресії генів у всіх досліджених групах показав змінену експресію TMPRSS2-ERG у деяких групах з різними показниками ступеня Глісона в зразках аденокарцином порівняно з аденомами та зразками умовно нормальних тканин. Найбільш висока експресія TMPRSS2-ERG була виявлена в групі аденокарцином передміхурової залози з оцінками ступеня Глісона > 7. Висновки. У нашій досліджуваній групі населення України нами було детектовано злитий транскрипт TMPRSS2-ERG (EF194202.1) у пухлинних зразках передміхурової зало-зи як аденокарцином (частота 56,8 %) з різним ступенем Глісона та парним до них умовно нормальних тканинах передміхурової залози, так і в зразках аденом. Отримані результати показують, що злитий транскрипт TMPRSS2-ERG присутній вже на ранніх стадіях розвитку ракового захворювання. У подальших дослідженнях ми плануємо перевірити, чи може злитий транскрипт TMPRSS2-ERG бути використаний як діагностичний маркер утворення злитих транскриптів та можливого розвиток раку передміхурової залози. Цель. Выявить типы слитых транскриптов в украинской популяции и проанализировать возможную связь между наличием слитых транскриптов ETS и клиническими характеристиками рака простаты. Методы. Количественный ПЦР (q-PCR) использовали для анализа экспрессии 6 слитых транскриптов на уровне мРНК. Амплифицированные продукты проверяли с помощью гель-электрофореза и секвенированием. Нами были проанализированы 37 свежо замороженных образцов тканей рака простаты, 37 парных к ним условно нормальных образцов ткани простаты и 20 образцов аденомы. Результаты. Нами были проанализированы 6 слитых транскриптов ETS: слияние TMPRSS2 с ERG, ETV1, ETV4, ETV5. В выборке из 37 пациентов с аденокарциномой простаты было выявлено лишь один из шести слитых транскриптов. Частота детекции слитного транскрипта TMPRSS2-ERG в тканях рака простаты составляла 56,8 %. Экспрессия TMPRSS2-ERG также была обнаружена в 16 образцах условно нормальных тканей простаты (43,2 %) и в 4 образцах аденомы простаты (20 %). Не было обнаружено корреляции между частотой TMPRSS2-ERG и клиническими характеристиками опухолей в образцах карцином. Однако анализ относительной экспрессии генов во всех исследованных группах показал измененную экспрессию TMPRSS2-ERG в некоторых группах с различными показателями степени Глисона в образцах аденокарцином по сравнению с аденомы и образцами условно нормальных тканей. Наиболее высокая экспрессия TMPRSS2-ERG была обнаружена в группе аденокарцином простаты по оценкам степени Глисона > 7. Выводы. В нашей исследуемой группе населения Украины нами было детектируемого слитый транскрипт TMPRSS2-ERG (EF194202.1) в опухолевых образцах простаты как аденокарцином (частота 56,8 %) с разной степенью Глисона и парным к ним условно нормальных тканях простаты, так и в образцах аденом. Полученные результаты показывают, что слитый транскрипт TMPRSS2-ERG присутствует уже на ранних стадиях развития ракового заболевания. В дальнейших исследованиях мы планируем проверить, может ли слитый транскрипт TMPRSS2-ERG быть использован как диагностический маркер образования слитых транскриптов и возможного развитие рака простаты.

The objective: to study the state of the glycemic profile in patients with ureterolithiasis and concomitant diabetes mellitus (DM) who underwent various methods of minimally invasive surgical treatment. Patients and methods. The study involved 204 people, 130 (63.7%) men and 74 (36.3%) women, the average age – 34.6±5.5 years. Subjects were divided into VI clinical groups: I – persons with diabetes and ureterolithiasis, who underwent TUСL and CS therapy per os (n=57); II – persons with DM and ureterolithiasis, who underwent TUСL without HS therapy (n=44); III – persons with DM and ureterolithiasis who were treated with ECU without HS therapy (n=32); IV – persons with ureterolithiasis without diabetes who underwent TUСL without HS therapy (n=41); V (control 1) – of the person with diabetes, who had an independent passage of stones from the ureter (n=18); VI (control 2) – healthy volunteers, with no signs of pathology (n=12). The diagnosis of ureterolithiasis was verified using clinico-anamnestic, laboratory and instrumental methods of investigation, according to the MHP protocols, before and after the disintegration of the stones by the method of transurethral contact lithotripsy (TUСL) and ESWL. Results. Elevated levels of HbA1c indicated chronic hyperglycemia for a long time, with the presence of violations of carbohydrate homeostasis and the need for its correction before and during surgery for ureterolithiasis. At this minimally invasive treatment of ureterolithiasis, the presence of an operational injury factor, with manifestations of permanent obstruction in the upper urinary tract (ESWL operation) did not contribute to a decrease in glucose levels in plasma and urine, unlike states with rapid elimination of acute calculous process (TUCL operation). Conclusion. Assistance to patients with diabetes mellitus, which is planned surgical treatment, allows to improve the condition of patients in the postoperative period and reduce the risk of postoperative сomplications. Key words: ureterolithiasis, diabetes mellitus, glycosylated hemoglobin, glucosuria, minimally invasive methods of lithotripsy.

Oncologic outcomes of radical prostatectomy in 106 patients with clinically locally advanced prostate cancer were demonstrated. The mean follow-up was 50.6 (12-129) months. 5-year recurrence-free survival was 47.7 %, 5-year cancer-specific and overall survival - 85.8 %. Patients were devided into three different risk groups: low risk patients had PSA level

Introduction: Bloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However data of BSI from Ukraine are scarce. The aim: To obtain the first national estimates of the current incidence of BSI and antimicrobial resistance of responsible pathogens, and associated mortality in Ukraine.Materials and methods: A retrospective multicenter cohort study was conducted at the 14 hospitals of Ukraine between January 2013 to December 2015. Definitions of BSIs were adapted from the CDC. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing.Results: Among 20,544 patients, 3816 (18.6%) BSIs were observed. The rate of health care associated BSI was 92.4%. Death was reported in 68.4% BSI cases. The predominant pathogens were: Klebsiella pneumoniae (25.1%), Escherichia coli (17.5%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), and Acinetobacter spp.(8.5%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 24.8% and of methicillin-resistance in S. aureus (MRSA) 38.2%. Vancomycin resistance was observwd in 9.2% of isolated enterococci (VRE). Carbapenem resistance was identified in 33.1% of P.aeruginosa isolates and 63.2% of A. baumannii isolates. Resistance to third-generation cephalosporins was observed in 14.2% K. pneumoniae and E.coli 55% isolates.Conclusions: Healthcare-associated BSIs and antimicrobial resistance of responsible pathogens together with their associated impact on mortality, presents a significant burden to the Ukraine hospital system. Surveillance of BSIs may help to delineate the requirements for infection prevention and control.

Objective Introduction: Bloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However data of BSI from Ukraine are scarce. The aim: To obtain the first national estimates of the current incidence of BSI and antimicrobial resistance of responsible pathogens, and associated mortality in Ukraine. Patients and methods Materials and methods: A retrospective multicenter cohort study was conducted at the 14 hospitals of Ukraine between January 2013 to December 2015. Definitions of BSIs were adapted from the CDC. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Results Results: Among 20,544 patients, 3816 (18.6%) BSIs were observed. The rate of health care associated BSI was 92.4%. Death was reported in 68.4% BSI cases. The predominant pathogens were: Klebsiella pneumoniae (25.1%), Escherichia coli (17.5%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), and Acinetobacter spp.(8.5%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 24.8% and of methicillin-resistance in S. aureus (MRSA) 38.2%. Vancomycin resistance was observwd in 9.2% of isolated enterococci (VRE). Carbapenem resistance was identified in 33.1% of P.aeruginosa isolates and 63.2% of A. baumannii isolates. Resistance to third-generation cephalosporins was observed in 14.2% K. pneumoniae and E.coli 55% isolates. Conclusion Conclusions: Healthcare-associated BSIs and antimicrobial resistance of responsible pathogens together with their associated impact on mortality, presents a significant burden to the Ukraine hospital system. Surveillance of BSIs may help to delineate the requirements for infection prevention and control.

New biologically active polyurethanes with silver and copper nanoparticles in their composition were prepared by saturation of liquid polyether (the initial component for polyurethane synthesis) with nanoparticles (Ag, Cu), followed by synthesis of polyurethane. The results of these studies allow consideration of these materials as medical suppliers with antibacterial properties. The main problem of their creation is uniform distribution of the metal nanoparticles inside the polymer matrix without changing the physico-chemical properties of the latter. Obtaining of metal nanoparticles’ colloid in a liquid polyoxytetramethylene glycol, MM 1000 was carried out by electron beam evaporation technology and vacuum deposition. This method allowed creating, on the basis of obtained colloids, the metal-containing polyurethane materials with targeted properties and structure that are determined by diisocyanates and chain extenders nature. Biological study has shown that polyurethanes containing Cu and Ag nanoparticles possess bactericidal/bacteriostatic effect against bacteria, fungi and yeast-like fungi. Polymer samples did not exhibit toxicity to the tissue culture cells and there were no biodegradation products observed in the culture medium. Resulting biologically active metal-containing polyurethane materials can be processed into products for medical purposes (implants, drug delivery systems, antimicrobial coatings for biomedical devices and antimicrobial packaging) by standard methods of polyurethane processing, since the presence of metal nanoparticles in their composition does not affect the physical properties of the polymer.

The article presents the results of treatment of patients with combined neurogenic pathology of the lower urinary tract and the distal part of the large intestine. The objective: increase the effectiveness of treatment for women with combined neurogenic pathology of the lower urinary tract and distal colon. Materials and methods. All patients with combined neurogenic pathology of the lower parts of the urinary system and lower colon were examined comprehensively using both conventional and special diagnostic methods. The study group included 30 women, whose average age was 41.8±2.1 years, the average duration of the disease was 18.4 ± 1.6 months. Efficacy was assessed using clinical and urodynamic studies. Results. The obtained results were the basis for substantiating the principles of differentiated treatment of patients with combined neurogenic pathology of the lower urinary tract and distal colon, which allowed to increase the effectiveness of treatment. Conclusions. The above data of clinical and urodynamic studies allowed to develop and optimize the methods of treatment depending on the state of the tone of the neuromuscular structures of the lower urinary tract and the distal parts of the large intestine. Key words: neurogenic disorders of urination, neurogenic bowel dysfunction, detrusor, uroflowmetry, electrostimulation.

The objective: increase the effectiveness of diagnosis and treatment of women with a hyperactive bladder, combined neurogenic pathology of the lower urinary tract and distal colon. Patients and methods. The study included 73 women. In assessing the symptoms of clinical manifestations and EMG and UFS data, two groups of patients were identified: the first group – women with increased tone of the neuro-muscular structures of the hyperkinetic type; the second group - women with an increased tone of the neuromuscular structures of the hypokinetic type. In the first group, 37 women were examined, whose mean age was 44.5±2.3 years, and the duration of the disease was 16.7±1.6 months. The second group included 36 women, whose average age was 43.4±2.1 years, and the average duration of the disease was 19.7±1.5 months. Results. The performed treatment showed clinically high efficiency of electrostimulation application depending on the state of the tone of the neuromuscular structures of the lower urinary tract and the distal part of the large intestine, which is confirmed by the data of UFS and EMG. Conclusion. The obtained data allowed to develop and optimize methods of treatment of women with hyperactive urinary bladder with a combined neurogenic pathology of the lower urinary tract and distal division of the large intestine. Key words: neurogenic disorders in urination, intestine neurogenic dysfunction, detrusor, uroflowmetry, electromyography.

Мета дослідження. Удосконалити методику формування везико-уретрального анастамоза (ВУА) при виконанні ендоскопічної радикальної простатектомії (ЕРПЕ) і оцінити її безпосередні результати. Матеріали та методи. В даному дослідженні оцінені найближчі результати різних способів формування ВУА у хворих локалізованість раком передміхурової залози (n = 101), які перенесли радикальне хірургічне втручання в одному центрі третинного рівня надання медичної допомоги протягом 2015-2016 рр. Хворі були розділені на три групи. У I групу увійшли 24 (23,8%) хворих, які перенесли модифіковану ЕРПЕ. У I групу - 49 (48,5%) хворих, яким проводилося формування ВУА за способом R.F. Van Velthoven. У III групу - 28 (27,7%), у яких формування ВУА проводилося за способом.-U. Stolzenburg. Проаналізовано 75 параметрів (клінічні, біохімічні, патологічні, результати інструментальних досліджень та ін.) По кожному з пацієнтів. Ускладнення розподілені: за кількістю; за ступенем тяжкості відповідно до шкали P.A. Clavien і ін. (2009); за типом по G. Novara і ін. (2010); прогностичні групи формувалися за P.M. Pierorazio і ін. (2013). Дані оброблені методами параметричної та непараметричної статистики (критерій Шапіро-Уілкі, U-критерій Манна-Уїтні, c2 Пірсона, точний критерій Фішера). Результати. Медіана часу катетеризації сечового міхура в групі нового способу формування ВУА становила 7 (7, 10) днів і була на 41,7% менше аналогічного показника в групі однорядного безперервного шва - 12 (10; 14,5) днів (p 0,05). Кількість генітоурінарних ускладнень в групі ЕРПЕ з виконанням запропонованого способу формування ВУА склало 33,3 ± 9,6% і було статистично значимо меншим за аналогічний показник в групі безперервного шва ВУА: 65,3 ± 6,8% (p = 0,013), переважно за рахунок зниження рівня виникнення негерметичність ВУА (p = 0,047) і зменшення частоти післяопераційного нетримання сечі (p = 0,041). Незважаючи на більшу кількість генітоурінарніх ускладнень в групі однорядного шва - 57,1 ± 9,4% статистично групи III і I не відрізнялися (p = 0,102). У всіх групах хворих превалюють «малі» ускладнення по P. A. Clavien, так для групи I цей показник становив 37,5%, для групи II - 75,5% і 64,3% для групи III. У хворих всіх досліджуваних груп в якості супутньої патології переважали захворювання серцево-судинної системи. Висновки. Отримані в результаті цього дослідження дані про зменшення кількості післяопераційних ускладнень при виконанні нового способу формування ВУА при ЕРПЕ свідчать про перспективність подальшого вивчення даної проблеми в аспекті мінімізації ускладнень ЕРПЕ і поліпшення якості життя хворих на рак передміхурової залози.

Experience of performance of a drainless transcutaneous nephrolitotripsy (DTN) for renal concrements was summarized. In 245 patients mini—DTN was done, оperation was finished with the nephrostomic drain installation — in 224 (91.4%), and without such procedure — in 21 (8.6%), in these patients an ureteric JJ—stent was installed in antegrade fashion. Indications for the DTN performance were substantiated, the patients for such treatment were selected, peculiarities of the DTN performance are adduced. JJ—stents were removed from ureter on the 2—nd — 7—th postoperative day, and in some patients — in ambulatory setting. After the operation the patients with out nephrostomic drain needed anesthesia in twice rarely. DTN constitutes a secure procedure, which must be conducted by experienced surgeon, сomplient with all demands and criteria of renal transcutaneous surgery, what permits to reduce the pain syndrome severity in patients in the early postoperative period stationary state.

The aim of the study was to develop a mathematical model for predicting the outcome of the early postoperative period in patients with musculo-invasive bladder cancer. Materials and Methods.Treatment of 120 patients that underwent open radical cystectomy (ORC) became the basis for the retrospective research with every 3rd patient having postoperative complications. To identify the predictors for the development of intra- and postoperative complications, all patients were divided into two groups according to the Clavien-Dindo classification: the first group comprised 76 (63.3%) patients with uncomplicated postoperative period; the second group included 44 (67.7%) patients who developed complications of various severity and required additional instrumental or operational intraoperative procedures. The value of the diagnostic coefficient (DK) was used to assess the objective parameters studied. The results are based on the method of the inhomogeneous sequential recognition procedure, which is based on the Bayes method. The calculation of the informativeness of both the individual ranges of characteristics and their total informativeness was carried out. Results. 60 indicators were analyzed in both groups of patients, 50 (83.3%) of which were uninformative. It was discovered and statistically confirmed that several factors play a role in the development of postoperative complications. Among them: surgical intervention, where the risk factors are its traumatism and duration (SI = 0.5), the volume of intraoperative blood loss (SI = 0.8), the choice of the method of urine diversion, and the duration of abdominal drainage and the initial nutritional insufficiency (SI = 6.15). The revealed factors of the negative prognosis of the course of the early postoperative period require preoperative correction, which can increase the cohort of patients who will be able to undergo radical surgical treatment of muscle-invasive bladder cancer. Conclusion. The mathematical model for predicting the outcome of the early postoperative period after ORC provides an objective quantitative assessment of the patient’s body parameters, allows for the mutual influence of different parameters on each other, and stratifies each individual patient in the appropriate group of postoperative course. It objectifies the tactics of surgical treatment based on the biological parameters of the patient’s organism on the development of complications of radical cystectomy. Further improvements of the proposed method for predicting postoperative complications of radical cystectomy in the form of computer software will improve the quality and accuracy of decision making in the choice of tactics for treating this category of patients.

Study purpose: to assess the possibility of antegrade percutaneous ureterolithotripsy as an alternative treatment for patients with large calculi of the proximal part of ureter. Patients and methods Results of 75 mini percutaneous antegrade ureterolithotripsy with contact lithotripsy were studied. The mean size of the ureteral calculus was 1,8±0,7 cm. At the same time, in 4 (5,3%) cases, concrements of the proximal ureter of the single kidney. The operations were performed with epidural anesthesia with intravenous sedation, in the patient’s position «on the abdomen» in 62 (82,7%) cases and in the patient’s position «on the back» in 13 (17,3%) cases. Puncture of the renal cavity system was performed with combined ultrasound and fluoroscopic guidance. Accesses were performed through the lower calix group in 24 (32,0%) cases, through the middle calix group in 39 (52,0%), and through the upper calix group in 12 (16,0%) cases. Results. The mean time of antegrade mini percutaneous ureterolithotripsy was 58.5±15.4 min, while the stone free rate was achieved in all 75 (100%) of patients. The mean level of hemoglobin drop was not more than 15,5±5.4 GM/DL In the postoperative period, aggravation of pyelonephritis was noted in 6 (8,0%) patients. The operations were ended with the installation of nephrostomy drainage in 29 (38,7%) cases, nephrostomy drainage and internal ureteral JJ stent in 35 (46,7%), and the operation was ended with a tubeless method with installation only ureteral JJ stent in 11 (14,6%) cases. Nephrostomy drainage were removed in 1–3 days. Ureteral stent removed in 14,0±7,0 days. The mean period of postoperative stay of patients in the hospital was 2,3 ± 0,8 days. It was noted that antegrade fibroureteropyeloscopy is an extremely time-consuming and cost-demanding method, which alternative may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes. Conclusions. Analysis of the treatment of proximal ureterolithiasis with the method of antegrade mini percutaneous ureterolithotripsy indicates that this method is an attractive direction in the treatment of patients with large calculi of the proximal parts of ureter that allows achievement of the full state of the stone free rate, reduction of the time of surgical treatment and hospital stay for patients with this pathology.

Мета дослідження: вивчення еволюції методів діагностики туберкульозу статевих органів чоловіків за останні десятиріччя. Матеріал і методи дослідження. Обстежено 467 чоловіків на туберкульоз статевих органів віком від 16 до 82 років (середній вік склав 49±14 року). Оцінювали симптоматику, дані анамнезу, клінічних, біохімічних і бактеріологічних аналізів, полімеразної ланцюгової реакції на ДНК мікобактерій туберкульозу, імунологічних досліджень, променевої діагностики: (сонографії, рентгенографії, мультиспіральної комп’ютерної томографії, магнітно-резонансної томографії, радіоізотопних) і ендоскопічних методів дослідження, з прицільною аспірацією і біопсією для здобуття біологічного матеріалу. Результати. У 372 (79,7%) пацієнтів з туберкульозом органів мошонки, у 305 (65,3%) діагностовано туберкульоз передміхурової залози та у 280 (59,9%) – сім’яних міхурців. У 94 (20,1%) виявлено туберкульоз внутрішньотазових статевих органів без залучання в процес органів мошонки, простатит діагностовано у 93 (19,9%) спостереженнях, а везикуліт – у 74 (15,8%) хворих. У 2 (2,2%) пацієнтів виявлено туберкульоз статевого члена. Алгоритм діагностики туберкульозу статевих органів чоловіків за останні десятиріччя зазнав змін: замість очищеного туберкуліну застосовували алерген туберкульозний рекомбінантний. З імунологічних методів використовували: визначення в крові протитуберкульозних антитіл по моноклональних антитілах до мікобактерій туберкульозу за допомогою ІФА і методи імунофенотипування з визначенням кількості CD4, CD8 клітин. Також досліджували інші поверхневі маркери Т-лімфоцитів за наявності у пацієнтів поєднання ТБ і ВІЛ інфекції. Провідне місце для візуалізації анатомії статевих органів чоловіків зайняли сонографічні дослідження з проведенням прицільної аспірації біологічних матеріалів і біопсії тканин. На перше місце серед методів верифікації мікобактерій туберкульозу вийшли молекулярно-генетичні дослідження біологічних матеріалів за допомогою ПЛР. Вивчення біоптатів тканин проводиться не лише з використанням класичної гістології, але і мікроскопії тканин на наявність кислотостійких бактерій і ПЛР. Також застосовували фіброуретроцистоскопію з катетеризацією сім’явиприскуючих проток і сім’яних міхурців. Висновки. Ці еволюційні зміни методів діагностики дозволили більш швидко, безпечно і точно обстежувати всі статеві органи чоловіків і виявляти ураження їх туберкульозом.

Мета: підвищити ефективність діагностики та лікування хворих із підвищеним тонусом нервово-м’язових структур сечового міхура та дистальних відділів товстої кишки за гіперкінетичним типом.Матеріали і методи. В групу дослідження увійшло 33 особи з поєднаною нейрогенною патологією нижніх відділів сечовивідної системи і нижніх відділів товстої кишки. Діагностику функціональних порушень сечового міхура та товстої кишки проводили з визначенням латентного періоду бульбокавернозного рефлексу під контролем електроміографії.Результати. Проведені дослідження дозволили оцінити показники латентного періоду бульбокавернозного рефлексу і електроміографії в діагностиці хворих із підвищеним тонусом нервово-м’язових структур сечового міхура і дистальних відділів товстої кишки за гіперкінетичним типом. Дані електроміографічних досліджень дозволили розробити і оптимізувати методи лікування залежно від тонусу нервово-м’язових структур нижніх сечових шляхів і дистальних відділів товстої кишки.Висновок. Проведене консервативне лікування пацієнтів із підвищеним тонусом нервово-м’язових структур сечового міхура і дистальних відділів товстої кишки за гіперкінетичним типом шляхом електростимуляції за гальмівною методикою є ефективним, забезпечує позитивний ефект в 91,4 % випадків.

Study purpose – to improve the solitary nephrolithiasis treatment effectiveness by determining the optimal conditions for ESWL or mini PNL application in the treatment of kidney calculi 1.0 to2.5 cm in size. Patients and methods. A comparative analysis of the results of minimally invasive methods application for nephrolithiasis treatment was performed in 210 patients treated with mini PNL (the group I) and 190 patients treated with ESWL (the group II). Patients with calculi more than 1.5 cm predominated in the group of mini PNL and with calculi less than 1.5 cm – in the ESWL group. The number of patients with calculi 1.5–2.0 cm in both groups was the same: 24.3 % and 24.2 % (P > 0.05). Results. It was noted that the calculi destruction effectiveness after 1–4 or more sessions of ESWL took place in 182 patients (95.8 %). At the same time, an increase in the mean density of calculi above 600 HU caused reduction (P < 0.001) of the primary ESWL session efficiency almost twofold. When performing the 221 mPNL, 97.1 % of the patients required one surgical treatment. The number of complications (bleeding, attack of pyelonephritis) in the group II was insignificantly higher in contrast to the group I – 26 (12.3 %) and 45 (14.1 %), respectively (P < 0.05). The stone-free status (up to one month) was noted in 62.6 % of patients after the completion of ESWL sessions that increases the risk of nephrolithiasis recurrence from 37.4 %. In treatment with mPNL, the stone-free status reached 97.1 % (P < 0.001), and in repeated mPNL applying in 2.8 % of cases – 100 %. The mean clinic postoperative treatment periods in the group I were lower in contrast to patients of the group II – 3.0 ± 1.5 and 12.5 ± 3.6, respectively (P < 0.001). Conclusions. This comparative analysis of features and results of uncomplicated nephrolithiasis with mPNL and ESWL treatment indicates that mPNL is the most preferred method for kidney calculi 1.0 to2.5 cm and more in size treatment.

Вступ. Нейрогенні розлади сечовипускання об’єднують велику групу порушень сечовипускання, що виникають при ураженні головного і спиного мозку, провідних шляхів і центрів сечового міхура. Це вказує на актуальність проблеми та необхідність розробки методів діагностики і одночасного їх лікуванняМета дослідження – Підвищення ефективності лікування жінок з поєднаною нейрогенною патологією нижніх сечових шляхів та дистального відділу товстої кишки.Матеріали та методи. Всі хворі на поєднану нейрогенну патологію нижніх відділів сечовивідної системи і нижніх відділів товстої кишки проходили комплексне обстеження з використанням як загальноприйнятих, так і спеціальних методів діагностики.Для дослідження функціонального стану м’язів які забезпечують динамічну активність нижніх сечових шляхів та дистальних відділів товстої кишки ми використовували електроміографію (ЕМГ) сечового міхура і сфінктерного апарата, анального сфінктера, м’язів тазового дна. Для підсилення біоелектричної активності м’язів нижніх відділів сечової системи та дистальних відділів товстої кишки використовувся електроміограф 4-х канальний фірми «Медікор» (Угорщина). Дані ЕМГ оцінювали за показниками середнього значення сумарної біоелектричної активності.Результати й обговорення. У статті представлені результати лікування хворих з поєднаною нейрогенною патологією нижніх сечових шляхів і дистального відділу товстої кишки. Оцінка ефективності проводилася за допомогою клінічних та уродинамических обстежень. Встановлено, що електроміографія урофлоуметрия відображають функціональний стан сечовивідних шляхів і дистальних відділів товстої кишки при їх поєднаної патології. Отримані результати були основою для обґрунтування принципів диференційованого лікування хворих з поєднаною нейрогенною патологією нижніх сечовивідних шляхів і дистальних відділів товстої кишки, що дозволило підвищити ефективність лікування. Консервативне лікування пацієнтів даної категорії за допомогою електростимуляції є ефективним.Висновки. 1. Дані електроміографічних та уродинамічних досліджень дозволили розробити та оптимізувати методи лікування в залежності від стану тонусу нервово-м’язових структур нижніх сечових шляхів та дистальних відділів товстої кишки. 2. Комплексний диференційний підхід до консервативного лікування спрямован на корекцію виявлених при електрофізіологічному та уродинамічному обстеженні порушень функціонального стану нижніх сечовивідних шляхів і дистальних відділів товстої кишки.

The aim of the study – improving the treatment efficiency of patients with combined neurogenic pathology of the lower urinary tract and distal colon. Materials and Methods. All patients with a combined neurogenic pathology of the lower sections of the urinary system and the lower sections of the colon had a comprehensive examination using both conventional and special diagnostic methods. We used electromy­ography (EMG) of the bladder and sphincter apparatus, anal sphincter, pelvic floor muscles to qualitatively and quantitatively evaluate the function of the muscles that provide the dynamic activity of the lower urinary tract and distal colonies. To strengthen the bioelectric activity of the muscles of the lower sections of the urinary system and distal colonies, 4-channel electromyograph, "Medikor" (Hun­gary), was used. Quantitative evaluation of muscle function, according to EMG, was performed on the basis of the mean values of total bioelectric activity and the frequency of passage of pulses. Results and Discussion. The study group included 30 women with an average age of (41.8±2.1) years, where the duration of the disease was (18.4±1.6) months. The average indicator of poliovirus in this group of patients before treatment was (3.4±1.2) times, nocturia was (2.8±0.6) times a day, imperative demands were (2.4±0.5) times a day, and imperative urinary incontinence was noted (3.1±0.67) times a day. PPBC question­naire rating was (4.5±1.0) points. The evaluation of the symptoms of clinical manifestations of the distal colon pathology in women before treatment showed that con­stipation was noted in patients with (5.1±0.09) times, incontinence of gases – (4.8±0.7) times, incontinence of liquid feces in patients (2.7±0.5) times, incontinence of hard feces – (1.2±0.2) times. When evaluating the questionnaire CRADI-8 we received in this group of patients before treatment (19.8±1.2) points.

The article presents the role of testing the functions of the spinal centers of urination and defecation in the choice of treatment methods for patients with a combined neurogenic pathology of the lower urinary tract and distal colonies, depending on the tone of the neuromuscular structures. The aim of the study – to increase the effectiveness of treatment of patients with combined neurogenic pathology of the lower urinary tract and distal colon. Materials and Methods. To achieve the goal, 127 patients with combined neurogenic pathology of the lower urinary tract and distal colon were examined. Men and women were divided into two main groups, depending on the state of the tone of the detrusor and the distal colon. An electromyograph "Medikor M-440" was used for the recording of electromyography (EMG ) with the study of bulbocavernous reflex (BCR). With this device, 19 healthy men and 18 women who were in the control group were pre-screened. The need to create this group resulted from the need to study the normal functional parameters of the bulbous coronary muscle (BCM). Using the electromyograph "Medikor M-440", the following methods of research were conducted: the determination of the potential of BCM alone in order to exclude changes in the muscle under study, then directly determined BCM, and then measured the latent period (LP ) of BCM. Results and Discussion. In the examination of men in the first group, the average indicator of polycurial treatment was (5.2±1.1), nocturia (4.1±0.9) times a day, imperative calls were (2.1±0.4) times a day, and imperative urinary incontinence was marked (1.9±0.3) times a day. PPB C questionnaire rating was (4.4±0.5) points. In assessing the symptoms of clinical manifestations of the pathology of distal colon in men, we observed the following, namely the constipation was noted in patients (4.5±0.2) times, incontinence of gases – (4.6±0.2) times, incontinence of liquid stool in patients (2.7±0.1) times, incontinence of hard feces in men (1.6±0.1) times. When evaluating the questionnaire CRAD I-8, we received in this group of patients before treatment (18.8±0.2) points. During carrying out of a bulbocavernous reflex evaluation, its latent period in patients in this group was (41.8±1.7) m / sec. The obtained data allowed to develop and optimize treatment methods depending on the state of tone of the neuromuscular structures of the lower urinary tract and distal colonies. Conclusions. Thus, in patients of the second group, the increase in the tone of the neuromuscular structures in the hyperreflex type with small volumes of urine and feces may be the pathogenetic mechanism of neurogenic disorders of the NSA of the pathways and of the distal parts of the colon. The obtained results were the basis for substantiation of the principles of differential treatment of patients with a combined neurogenic pathology of the lower urinary tract and distal colon.

In 2014 - 2016 yrs transcutaneous nephrolithotripsy was performed in 245 patients for nephrolithiasis, of them in 228 (93.1%) - in position of patient lying on the abdomen (1st group), in 17 (6.9%) - lying on the back (2nd group) because of various concur- rent cardio-vascular and respiratory diseases present. Mini- transcutaneous nephro- lithotripsy was performed under regional epidural anesthesia in 224 (91.4%) patients, and under endotracheal narcosis - in 21 (8.6%). While conduction of mini- transcu- taneous nephrolithotripsy in position of patient lying on the back the operation duration is reducing, and it is possible to perform simultant endoscopic interventions (trans- ureteric, transcutaneous). Position of patient lying on the back while performing tran- scutaneous nephrolithotripsy in a complex with regional (epidural) anesthesia consti- tutes a relatively secure procedure. Hemodynamical and respiratory parameters are simply intraoperatively controlled, what is important for the patients, urologists and anesthesiologists. The complications rate and results of treatment are comparable with such while performing transcutaneous nephrolithotripsy in accordance to standard in position of patient lying on the abdomen.

Визначена роль черезшкірної пункційної нефростомії в лікуванні пацієнтів із повною обструкцією верхніх сечових шляхів та нирковою недостатністю. Виявлено найшвидшу позитивну динаміку періопераційних показників та рівень виживаності у пацієнтів, пролікованих за допомогою черезшкірної пункційної нефростомії, порівняно з традиційними методами лікування цієї патології (ретроградне стентування, відкрита нефростомія, гемодіаліз). Обґрунтовано необхідність першочергового використання черезшкірної пункційної нефростомії як доступного, малоінвазивного, з мінімальною кількістю ускладнень, а головне — з низьким рівнем (2,7 %) летальних випадків методу лікування пацієнтів із повною обструкцією верхніх сечових шляхів та нирковою недостатністю.

Серед клінічних рекомендацій одним зі стандартних підходів у лікуванні раку передміхурової залози є тактика активного спостереження. Протягом 13 років під спостереженням знаходилися 85,7 % хворих. Загальна 3-, 5- і 7-річна виживаність становила 93,2 ± 4,6 %, 70,8 ± 9,1 % та 50,9 ± 10,2 % відповідно. Від супутніх захворювань померли 14,3 % хворих. Середній час доживання становив 136 міс.Отримані дані обґрунтовують доцільність тактики активного спостереження з медичної, соціальної та економічної точки зору. Оптимальних результатів можна досягти при правильному доборі, критеріями якого є: рівень простатспецифічного антигену ≤ 10 нг/мл, градація за Глісоном ≤ 6 балів, вік, наявність поліорганної патології.

The critical point for successful treatment of cancer is diagnosis at early stages of tumor development. Cancer cell-specific methylated DNA has been found in the blood of cancer patients, indicating that cell-free DNA (cfDNA) circulating in the blood is a convenient tumor-associated DNA marker. Therefore methylated cfDNA can be used as a minimally invasive diagnostic marker. We analysed the concentration of plasma cfDNA and methylation of six tumor suppressor genes in samples of 27 patients with renal cancer and 15 healthy donors as controls. The cfDNA concentrations in samples from cancer patients and healthy donors was measured using two different methods, the SYBR Green I fluorescence test and quantitative real-time PCR. Both methods revealed a statistically significant increase of cfDNA concentrations in cancer patients. Hypermethylation on cfDNA was detected for theLRRC3B(74.1%),APC(51.9%),FHIT(55.6%), andRASSF1(62.9%) genes in patients with renal cancer. Promoter methylation ofVHLandITGA9genes was not found on cfDNA. Our results confirmed that the cfDNA level and methylation of CpG islands ofRASSF1A,FHIT, andAPCgenes in blood plasma can be used as noninvasive diagnostic markers of cancer.

During the 25-year period subsequent to the Chernobyl accident, the morbidity of malignant renal tumors in Ukraine has increased from 4.7 to 10.7 per 100,000 of the total population. Recent studies of our group have shown that increases in morbidity, aggressiveness, and proliferative activity of renal cell carcinomas (RCCs), especially clear-cell renal cell carcinoma (CCRCC), in Ukrainian patients continuously inhabiting the radio-contaminated areas could be explained by specific molecular changes influenced by the so-called "chronic persistent low-dose ionizing radiation" (CPLDIR) exposure. This study aimed to examine the role of angiogenesis in CCRCC carcinogenesis associated with CPLDIR in patients living more than 20 years in cesium 137 ((137)Cs) contaminated areas after the Chernobyl accident in Ukraine. Paraffin-embedded specimens of 106 CCRCs were studied: Control cases were 18 tumors from Spanish patients (group 1), 25 tumors from Ukrainian patients from so-called clean areas without known radio-contamination (group 2), and 63 tumors from Ukrainian patients from radio-contaminated areas (group 3). For intratumoral microvessel density (MVD) determination, anti-CD31 antibody was used. A computerized image analysis program was used to quantitatively calculate the vascular density. Seventy-three percent of group 3 and 72 % of group 2 CCRCCs displayed the highest MVD. A striking increase in MVD was seen in group 3 CCRCCs, in comparison with groups 1 and 2 (p 0.001). The majority of the hot spot vessels in group 3 was poorly differentiated. Moreover, MVD values for total vessels as well as for capillaries and tumor grade were strongly correlated. When we compared only tumor-node-metastasis tumor stages I and II, the differences remained statistically significant (p 0.1). The ratio of the average total vessels and capillaries in the Ukrainian groups combined was 1.65:1 in comparison to the Spanish group. Our results provide evidence that CPLDIR exposure increases MVD (particularly capillary) in CCRCCs and is associated with a higher histological grade.

The most commonly used expression platform for production of recombinant proteins in the methylotrophic yeast Hansenula polymorpha relies on the strong and strictly regulated promoter from the gene encoding peroxisomal enzyme alcohol (or methanol) oxidase (P(MOX)). Expression from P(MOX) is induced by methanol and is partially derepressed in glycerol or xylose medium, whereas in the presence of hexoses, disaccharides or ethanol, it is repressed. The need for methanol for maximal induction of gene expression in large-scale fermentation is a significant drawback, as this compound is toxic, flammable, supports a slow growth rate and requires extensive aeration. We isolated H. polymorpha mutants deficient in glucose repression of P(MOX) due to an impaired HpGCR1 gene, and other yet unidentified secondary mutations. The mutants exhibited pronounced defects in P(MOX) regulation only by hexoses and xylose, but not by disaccharides or ethanol. With one of these mutant strains as hosts, we developed a modified two-carbon source mode expression platform that utilizes convenient sugar substrates for growth (sucrose) and induction of recombinant protein expression (glucose or xylose). We demonstrate efficient regulatable by sugar carbon sources expression of three recombinant proteins: a secreted glucose oxidase from the fungus Aspergillus niger, a secreted mini pro-insulin, and an intracellular hepatitis B virus surface antigen in these mutant hosts. The modified expression platform preserves the favorable regulatable nature of P(MOX) without methanol, making a convenient alternative to the traditional system.