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Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient's desire and physician's experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

Prostate cancer occupies 2nd place on the prevalence and 6th place on mortality among all cancers in men. That is not to deny the social importance of prostate cancer, but attention is drawn to significant advantage of newly detected cases above the cancer-specific mortality. "Gold standard" for diagnosis includes morphological study of tissue fragments after transrectal multifocal prostate biopsy. The importance of the differential diagnosis is particularly relevant when analyzing fragments of prostate tissue obtained from biopsies as a false positive result may cause unnecessary and excessive treatment. This article presents the most common benign processes that can simulate various grade adenocarcinoma. Awareness about the presence of such cancer mimics and careful examination of micropreparations in most cases allows to come to the correct conclusion.

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

The effectiveness of perineal biopsy for the detection of prostate cancer (PC) using an array for brachytherapy/cryotherapy was evaluated. It is shown that perineal saturation biopsy provides high detection rate of prostate cancer in patients with suspected cancer after negative transrectal biopsies, does not increase the detection of clinically insignificant cancer and incidence of complications, but requires a lot of time and cost.

The study presents an analysis of the experience of treatment of urinary incontinence in women using free synthetic suburethral sling. Between 2001 and 2008, 1081 patients underwent surgery. Of these, 841 (77.8%) suffered from stress urinary incontinence, 202 (18.62%) suffered from the mixed form of urinary incontinence with a predominance of the stress component, and 38 (3.52%) had recurrent urinary incontinence. Group 1 included patients with stress urinary incontinence who underwent surgery using suburethral synthetic sling with retropubic access (TVT operation); Group 2 included patients, who underwent surgery using suburethral sling implanted with transobturator access (TVT-O operation). Group 3 consisted of patients with mixed urinary incontinence, who underwent TVT-O operation. Retropubic suburethral TVT sling was implanted in 273 (25.25%) patients, transobturator TVT-O sling--in 740 (68,45%) patients, and other synthetic suburethral slings--in 68 (6.3%) patients. The average follow-up period was 50.1, 31.1 and 32,6 months in each group, respectively. Cough test was used for the objective evaluation of the effectiveness, and visual analogue scale--for the subjective evaluation of effectiveness. In the TVT group, the negative cough test in the postoperative period remained at 85.58% of the patients, and in in TVT-O group--in 84.36% of patients. Analysis of the frequency of intraoperative complications showed that the probability of occurrence of complications was not associated with age, body mass index and obstetric history of patients. It was noted that the perforation of the bladder and pelvic hematoma were more likely to occur when using the retropubic access. Transobturator access is associated with a higher risk of injury of the lateral vaginal fornix, although bladder injury is not ruled out. Objective and subjective indicators of efficacy of treatment of mixed form of urinary incontinence were 86.15 and 87.69%, respectively. The study suggests that the operations using suburethral TVT and TVT-O slings are safe and effective methods of treatment of stress urinary incontinence in women.

An open non-comparative multicenter study-observation according the program involving 190 patients (mean age--62.3 +/- 9.7 years) with benign prostatic hyperplasia (BPH) and severe urination disorders was performed. All of the patients received alfuzosin (dalfaz SR) 10 mg daily for 12 months. The primary criterion for evaluation of treatment effectiveness was the change of the total IPSS score. As secondary criteria, change of QoL score, total number of urination per day and subjective patient's satisfaction with the treatment results were registered. Safety was assessed by recording the adverse events. The treatment led to the progressive decrease in the total IPSS score--from 16.4 +/- 4.8 at baseline to 7.7 +/- 2.6 at the final visit (P < 0.001). The average QoL score has decreased by 67% - from 3.9 +/- 1.1 to 1.3 +/- 0.7 at the end of the study (P < 0.001). In general, 94.2% of respondents positively assessed the results of treatment. The frequency of urination at night has decreased by 56%. Adverse effects (dizziness and slight fatigue) were recorded only in 1 (0.5%) patient. The present study has demonstrated a high efficacy and a favorable safety profile of dalfaz SR at a dose of 10 mg in the treatment of patients with BPH. Of particular note is the high proportion of patients who continued to receive the drug for 12 months, showing a good tolerability ofdalfaz SR and high treatment compliance.

The wide introduction of prostatic specific antigen (PSA) determination into clinical practice has resulted in a larger number of prostate biopsies, while the lower age threshold for PSA has led to a larger number of unnecessary prostate biopsies. Hence, there is a need for new biomarkers that can detect prostate cancer. PCA3 is a noncoding messenger ribonucleic acid (mRNA) that is expressed exclusively in prostate cells. The aim of the study has been to develop a diagnostic test system for early non-invasive detection of prostate cancer based on PCA3 mRNA levels in urine sediment using quantitative reverse transcription polymerase chain reaction (qRT-PCR). As part of the study, a laboratory diagnostic test system prototype has been designed, an application methodology has been developed and specificity and sensitivity data of the method has been assessed. The diagnostic system has demonstrated its ability to detect significantly elevated levels of PCA 3/KLK 3 in samples from prostate cancer (PCa) patients compared with those from healthy men. The findings have shown relatively high diagnostic sensitivity, specificity and negative-predictive values for an early non-invasive screening of prostate cancer

The present study was dedicated to the analysis of the incidence, prevalence and mortality from diseases of the urogenital system. The data on the effectiveness of the hospital bed usage, the patient profile at hospital, the treatment timing and outcomes, surgical activities in urological hospitals, the state of staff assistance in urological service, the efficacy of usage of working time of urologist and human resource of Russian urological service were analyzed. Data analysis revealed a number of issues of administrative and legal nature, which cause modest efficiency of activity of urological service. The ways for solutions of these problems are presented.

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

A retrospective multicenter trial with participation of 7 large clinics of Moscow and Moscow Region has been performed to characterize complications after correction of genital prolapse with application of the PROLIFT system. The trial enrolled women with uterine and vaginal prolapse of stage II-IV by POP-Q classification. The women also had anatomic and functional defects of the adjacent organs. From January 2005 to March 2008 all the patients have undergone vaginal extraperitoneal colpopexy using Prolift system. The results of the trial showed that extraperitoneal colpopexy with application of the Prolift system should not be considered as a low-invasive intervention and therefore it is not valid to use this technique as a routine method of genital prolapse treatment as in 29.5% cases the operation is accompanied with complications of different severity.

To investigate the effect of Herpes Simplex virus (HSV) on spermatogenesis, HSV in ejaculate was detected by a rapid cultural method in 268 infertile males and 47 healthy ones. The number of mobile spermatozoa in HSV infected samples was less than in non-infected samples (21 mln/mlversus 40 mln/ml, p = 0.0001). The relative number of morphologically normal gametes was 13% versus 19% (p = 0.002), respectively. The quantitative karyological test discovered that males with HSV-infected ejaculate have more degenerating sex cells while in high virus contamination (more than 10 virus particles in 1 ml) the number of spermatides and spermatocytes of the 1 order at diploten stage is low. Organic testicular culture was used for more detailed study of pathogenetic mechanisms of HSV impact on spermatogenesis. Testicular explants infection was associated with reduction in the number of spermatogones, spermatocytes and spermatides on culturing week 2. The above findings reveal some pathogenetic mechanisms underling fertility disorders in males with HSV infection: a gametotoxic effect of the virus reducing populations of spermatogones, spermatocytes and spermatide; affected mobility and morphological characteristics of spermatozoa. Detection of the mechanisms of HSV action on spermatogenesis opens a perspective of antivirus drug administration in combined treatment of male infertility.

Functional results of surgical correction of genital prolapse were compared with those of transvaginal implantation of the prolift in 26 and 22 women, respectively. Standard protocol required gynecological examination, cough test, complex urodynamic investigation. Patients of both groups were matched by anthropometric parameters. All the patients were reexamined 1, 3 and 6 months after surgery. Comparison of the results showed that most of the urodynamic parameters changed insignificantly in patients treated surgically for prolapse of the urinary bladder. Moreover, there was no significant association between these findings and surgical methods of the prolapse treatment. Stress urinary incontinence arose in 13.64% (3/22) patients who had undergone prolift implantation and in 3.85% (1/26) patients after colporraphy. Postoperative overactive bladder was observed in 9.09% (2/22) and 11.54% (3/26) patients, respectively. No significant difference by the above symptoms between the groups were registered in relation to the operation type. Similar data were obtained in respect of incidence of lower urinary tract infections. Thus, it is found that prolift plastic operations for cystocele do not increase the incidence of urinary incontinence, overactive bladder, lower urinary tract infection. Further studies with greater number of patients and longer follow-up are needed.

We compared efficacy of surgical treatment of urinary incontinence in women depending on the size of the synthetic sling and technique of its installation. From January to September 2009 we made 75 operations with synthetic suburethral slings: TVT-SECUR (TVT-S)--group 1 (n = 35) and TVT-O- group 2 (n = 40). The sling was installed in U position in 14 patients of group 1 and in H position in 21 patients. The control examinations included questionnaire survey, cough stress test (in bladder volume more than 150 ml), vaginal investigation, uroflowmetry, in urgency--complex urodynamic examination. A total of 32 patients of group 1 and 40 patients of group 2 were examined postoperatively. A positive result was achieved in 20 (62%) and 38 (95%) (p = 0.0006) patients of group 1 and 2, respectively. Quality of life was assessed as good and very good by 22 (68%) and 37 (93%) patients of groups 1 and 2 (p = 0.0105), respectively. The control examination after 6 months of follow-up showed good result in 7 (53%) and 13 (68%) patients of group 1 (subgroups U and H, respectively). Reoperation for urinary incontinence was made in 4 (30%) patients of subgroup U and 1 (5%)--of subgroup H. Thus, surgical treatment of urinary incontinence in women according to TVT-0 technique is more effective than in TVT-S surgery, but minisling TVT-S is more effective in patients with bad somatic status and in H position.

Radical prostatectomy is now widely practiced in the treatment of prostatic cancer (PC). If PC patients have inguinal hernia, hernioplasty can be made simultaneously with radical prostatectomy without one more surgical approach. The article presents pathogenetic rationale of hernioplasty from preperitoneal approach and an original technique of the simultaneous operation. Positive experience with 32 radical prostatectomies with hernioplasty is described.

We introduced an original simple anonymous questionnaire for urological patients in Moscow and Omsk outpatient clinics and hospitals. A total of 580 patients aged between 40 and 70 years (mean age 61.48 years) responded from February to June 2008. The questions concerned PSA test. In Omsk more men were tested for PSA: 77% against 67 in Moscow. Men with higher education made PSA test more often (88 and 60%, respectively). Only 31% responders know why PSA test is made. Of men over 70 years of age in Moscow, 43% responders made PSA test for the first time at the age from 60 to 69 years, the rest patients made it at the age 70 years and older. In Omsk, 88% responders made PSA test at the age of 70 and older. In men aged 40-49 years a mean IPSS point was 4, QOL--3. The highest IPSS (20 points) and QOL (4 points) were registered in men over 70. Among the responders over 70 years old, 38% were sexually active. The results of our questionnaire survey demonstrate that age of the patients who undergo PSA test in Moscow and Omsk is over 70. Quality of life is not adequately understandable for elderly questionnaire responders and should be simplified. Regular check-ups are effective for early detection of prostatic cancer and other diseases.

Out of 21 female patients who had undergone TVT operation for stress urinary incontinence from March 2000 to February 2001, 15 females responded to the interview in the telephone survey conducted in 2009. A Russian version of the King's Health Questionnaire was used. Seven (46.8%) patients assessed the effect of the operation as good, 4 (26.6%) patients--as satisfactory, 2 (13.3%) and 2 (13.3%) as bad and poor, respectively. Thus, a positive effect was achieved in 11 (73.4%) responders, while a negative effect was seen in 4 (26.6%) patients. Nine (60%) patients experienced no effect of urination problem on quality of life, 3 (20%) and 3(20%) patients experienced moderate and strong effect, respectively. Frequent voiding, urgencies at night, imperative voiding and urgent urinary incontinence were recorded in 3 (20%), 4 (26.7%), 2 (13.3%) and 2 (13.3%) patients, respectively. All 15 (100%) responders stated no incontinence in cough, sneezing and physical activity. Thus, our 8-year follow-up confirms that TVT operation is highly effective in stress urinary incontinence in women.

A total of 116 female patients with painful bladder syndrome/interstitial cystitis aged 32-78 years (mean age 56 +/- 2.4 years) entered the trial. They were divided into two groups according to treatment. Group 1 (n = 54) received 10-day combined conservative treatment consisting of antimicrobial drugs (if urinary infection was diagnosed), angioprotectors, mast cell activity stabilizers and bladder instillation with combined solution. Group 2 included 62 patients whose treatment included complex anti-inflammatory therapy in combination with HBO sessions (7-10 sessions in barochamber OKA-MT, 2.0 +/- 0.2 atm). Subjective (the disease course, pain intensity, 24-h and nocturnal pollakiuria, effective urine volume) and objective (microcirculation in the bladder wall) results were assessed. Dopplerograms revealed venous stagnation. Patients of group 2 had a persistent improvement of microcirculation in bladder mucosa as shown by better blood flow in the veins and arterioles. In group 1 the above improvement was less pronounced. Thus, HBO in combined treatment of interstitial cystitis improves treatment results and promotes long-term remission of the disease.

The aim of our study was assessment of efficacy of PLFT technique on ProstaLund CoreTHerm unit in nanagement of acute urine retention in patients with prostatic adenoma. We treated 31 patients with prostatic adenoma (age 58-97, mean age 74 years, volume of the prostatic gland from 32 to 188 ml); 11 patients had suprapubic fistula, 8 carried urethral catheter for acute urinary retention. All the patients were inoperable because of a high surgical-anasthetic risk. All of them were exposed to PLFT for 9-15 min. Efficacy of the treatment was assessed by recovery of physiological urination, by IPSS tests and quality of life (QoL). PLFT destroyed 15 +/- 5% prostatic tissue in each of the treated patients. The procedure was well tolerated. Physiological voiding was achieved in all the cases. Such complications typical for TUR as urethral stricture, vesical stenosis, urinary incontinence were not registered. On month 6 after the treatment QoL was assessed by the patients as 1-2 points, Qmax exceeded 15.2 +/- 1.9 ml/s. Thus, PLFT is a highly effective and save treatment of prostatic adenoma and can be recommended as a standard management of patients with acute urinary retention at high surgical risk.

Acute urinary retention in males is often caused by infravesical obstruction due to enlargement of the prostatic gland. Recently it was found that alpha-adrenoblockers promote recovery of physiological voiding in patients with benign prostatic hyperplasia. In our study urinary bladder draining with urethral catheter in 136 patients with acute urinary retention was immediately followed by simultaneous administration of two alpha1-adrenoblockers--alfuzosine (10 mg once a day) (dalfaz CP) and tamsulosine (0.4 mg once a day) (omnik okas). The control group of 96 patients received monotherapy with alfuzosine. Physiological voiding recovered in 42.7% patients on alfuzosine monotherapy and in 64% patients on alfuzosine+tamsulosine.

In current practice of pharmacotherapy of prostatic adenoma alpha1-adrenoblockers are first-line drugs the efficacy and safety of which have been proved in many randomized studies. Because of the appearance of a large amount of generic analogues of tamsulozine on the market we studied the ability of tamsulozine analogues to bind with alpha-adrenoreceptors on rat and human prostate affected by adenoma. Significant differences on the receptor level of interaction were found. Omnik, compared to other generic analogues of tamsulozine, has the highest affinity to alpha1-adrenoreceptors.

The aim of the trial was investigation of urethral function in women with urinary stress incontinence (USI) using the method of registration of urethral retro-resistance pressure (URRP) versus such parameters in healthy women and definition of this method reproducibility. All the participants of the trial (n = 54) were divided into two groups: group 1--healthy females (n = 19); group 2--USI women (n = 35). The protocol included physical examination, gynecological examination, laboratory tests, urodynamic examination with URRP assessment. Reproducibility of URRP was tested by a repeat test 2 weeks later in group 1 the results of which were comparable with the results of the first test. A comparative analysis of the findings showed that women with URRP under 40 cm H2O. suffer from USI in 100% cases while those with RURP over 100 cm H2O had no USI. URRP proved reproducible and can be used in preoperative examination in urogynecology. To confirm diagnostic value of this method further investigations should be made.

Patients with impaired micturition caused by prostatic adenoma received revocarin for 12-weeks. After the treatment all the patients showed relief of clinical symptoms proved by subjective assessment of urination quality (IPSS and QoL) and objective data (uroflowmetry, ultrasonography). Allergic reactions or other serious side effects were not registered. Thus, a 12-week course of revocarin demonstrated good clinical efficacy and safety in patients with urination problems because of prostatic adenoma. Revocarin can be recommended as an alternative to an original drug omnik.

We studied safety and topographic characteristics of a transobturative approach in application of an "inside out" tension free tape (TFT) for management of stress urinary incontinence (SUI) in women. The anatomic sections were made on 6 fresh female cadavers (mean age of the deceased 78.5 +/- 4 years). After the tape placement a femoral section was made with its extension to the perineum and retropelvic section. We found that the TFT passes far from the major femoral structures. The distance from the obturator canal to the TFT averaged 24.4 mm +/- 1.8 mm (from 23.9 to 30.4 mm, median 21.4 mm). Dissection of the dorsal nerve and artery of the clitoris as well as the pudendal nerve showed that these structures are not damaged in correct operative technique. Moreover, the tape passes beneath the pelvic fascia and levators, it does not penetrate the pelvic cavity. Thus, the transobturative approach is safe, does not damage vital organs and anatomic structures in the treatment of women with SUI.

A course of longidase (3000 IU, 10 injections, once in 5 days) is recommended for correction of disorders caused by inflammation, to prevent progressive fibrous process in the bladder wall and reduction of the bladder capacity, to restore detrusor elasticity in patients with interstitial cystitis or chronic recurrent cystitis.

Safety of testosterone undecanoate in relation to initiation of cancer and prostatic adenoma (PA) in patients with androgenic deficiency and erectile dysfunction (ED) was studied for 12 months in 49 patients aged 57 to 73 years treated with intramuscular testosteron injections. The size of the prostate in patients with adenoma was 46.34 +/- 21.12 cm3 while in adenoma-free patients--19.11 +/- 6.57 sm3. Diabetes mellitus of type 2 (DM-2) was diagnosed in 46.9% patients. All the patients had documented hypogonadism and ED. Tests for PSA and transrectal ultrasound investigation was made in all the patients. 12 month testosterone therapy produced normalization of a mean level of testosterone in both groups, index of erectile function increased. In one patient PSA rose higher than normal value. None of the patients developed obstruction of the urinary tract. Body mass index, lipid spectrum and carbohydrate metabolism also improved. Thus, long-term therapy with testosterone undecanoate has no effect on PSA level, does not induce urinary obstruction with enlarged prostate. The presence of DM-2 is not a contraindication for androgen therapy in adenoma patients. By reducing body mass index, total cholesterol, triglycerides and LDLP, testosterone therapy lowers the risk of prostatic cancer.

From 2003 to 2006 we examined and treated 73 females with paraurethral lesions. The differential diagnosis was made using gynecological and US examinations, urethral profilometry, miction cystourethrography, high-pressure urethrography, MR imaging. All the patients have undergone extirpation of paraurethral cyst/diverticulectomy. The diagnosis of paraurethral lesions should be made with application of all available methods. Gynecological examination is the first procedure in complex diagnostic investigation, ultrasound must be also used in all the patients with addition of x-ray in case of insufficient data. MR imaging is used in large size of paraurethral lesions, their connection with urethra. Treatment of such patients is surgical.

We made a multivariate analysis of efficacy of different techniques of radical retropubic prostatectomy (RRP) for prevention of postoperative urine incontinence. A total of 226 patients operated (RRP) in the urological clinic of the Medical University from September 1998 to March 2004 were examined before and after the operation and followed up for 12-46 months. Complete urine retention in the postoperative period after removal of urethral catheter was achieved in 42% patients. By classification of F. Coakly (2002), complete urine retention 1 year after RRP (type 1) was registered in 189 (83.6%) patients. Urine incontinence (UI) of type 2 was observed in 18 (8%) patients, UI of type 3--in 8 (3.5%), of type 4--in 6 (2.7%) patients, total UI was in 5 (2.2%) patients. Earlier restoration of urine retention can be achieved if the surgeon uses careful isolation of apical urethra, saved puboperineal fibers m. levator ani, urinary bladder cervix, special technique of creation of the urethrovesical anastomosis. One year after RRP, 96% operated patients were satisfied with surgical outcomes. Thus, updating RRP technique radically improved treatment outcomes and, therefore, quality of life for patients with prostatic cancer. Nerve- and sphincter-saving, ablastic variant of this surgery is now widely applied in the world and is a method of choice for treatment of patients with prostatic cancer without extracapsular invasion.

Radical retropubic prostatectomy (RPPE) for local prostatic cancer was made in 226 patients. Neurovascular bundles were preserved on one or both sides in 68 (30%) of them. Sixty one (90%) of these patients filled in questionnaires. In 37 (61%) of them the bundles were preserved unilaterally, in 24 (39%)--bilaterally. Only 7 (19%) patients had 4-5 score erection after unilateral nerve-preserving RPPE, 16 (43%) had tumescence. 0 score tumescence was detected in 14 (38%) patients of this group. Thirteen (54%) patients after RPPE with bilateral preservation of the bundles had 4-5 score erection. 0 score erection was in 3 (12%) patients of this group. Comparison of the patients under and over 60 years of age has shown that younger patients' erectile function recovers more quickly: in unilateral nerve-preserving RPPE in 20 and 12%, respectively; in bilateral operation--in 47 and 39%, respectively. Thus, erectile function can be preserved in patients after RPPE in careful preoperative selection of the candidates and in conduction of surgery meeting all modern requirements.

Twenty eight patients with documented chronic prostatitis (CP) received standard therapy (a control group) while a study group of 28 patients received standard therapy plus a 10 longidase injections in a dose of 3000 IU. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate. Thus, a domestic drug longidase is effective and safe in CP. It can be widely used in combined therapy of CP.

The aims of present study were to evaluate the quality of women's life (QoL) after surgical treatment of stress urinary incontinence (SUI) and to compare long follow-up results of two different procedures. Quality of life questionnaire represents a useful and cheap tool in the investigation of outcomes of the surgical treatment of stress incontinence. By providing an objective measure of the impact of results on women's lives, quality of life questionnaires allow more comprehensive understanding of disease severity and its effect on psychosocial function. In addition, they have an increasingly important role in clinical research, allow comparing two and more different methods of treatment. QoL of patients after TVT was significantly higher, then after pubovaginal sling using short skin flap (subjective cure 80% versus 66% after 48 months follow up). These benefits in QoL, coupled with the minimally invasive nature of the procedure, suggest that TVT could become a favored treatment option in women with SUI.

The paper gives a clinical observation of a 52 year-old male with a rare histological urinary bladder tumor primary grandular-squamous-cell carcinoma (pT3N IM0). The tumor is represented by two components large acinic-cell adenocarcinoma and squamous-cell carcinoma with keratinization, which smoothly pass one into another; the tumor has grown through all layers of the urinary bladder wall but it has failed to grow into the peritoneum. A microscopic study has indicated that the urachus is intact. Metastases were found in 3 of 8 lymph nodes: one showed high-grade adenocarcinoma and two others displayed average-grade squamous-cell carcinoma.

Operations with application of a free synthetic loop were made in 504 female patients with urinary stress incontinence (USI). The patients were divided into two groups. Patients after TVT operation, not operated with reconstruction of the pelvic fundus entered group 1 (n = 207). Patients after TVT-0 operations (n = 109) entered group 2. The data were processed with the criterium chi-square, significance was stated in p < = 0.05. The following intra- and postoperative complications were registered: de novo imperative symptoms, pelvic hematoma, perforation of the urinary bladder. The latter complication occurred in 1 (0.48%) patient of group 1 and in none from group 2. Pelvic hematomas were in 2.9 and 0.92% patients, respectively. De novo imperative symptoms were observed in 2.9 and 1.83%, respectively. It was stated that differences in complications between the groups were insignificant. Further multicenter controlled randomized studies are necessary.

We have analysed literature data and own experience with management of premature ejaculation (PE) in 3200 patients. This gave grounds for formulation of this phenomenon, creation of the classification and the examination algorithm. We applied the proposed methods in the treatment of 258 PE patients and made the conclusion about their adequacy and efficacy. PE is a polyetiological phenomenon and a multidisciplinary problem. Urological examination must be used as the first stage of the diagnostic process.

The results of 526 transrectal prostatic biopsies are available. Mean age of the patients was 64.6 years, mean level of PSA--10.4 ng/ml, mean size of the prostate--56 cm3. Biopsy was made in visualization of the prostate in the sagittal projection (ultrasound devices Bruel & Kjaer 1846 and Kretz Voluson 730). Application of Bruel & Kjaer Medical 2102 Hawk provides visualization of the prostate during biopsy both in sagittal and cross projection. Double visualization significantly improved detectability of prostatic cancer in patients with PSA 4-10 ng/ml. In biopsy of the top and peripheral zone there was lengthening of prostatic tissue fragments, reduced fragmentation of the columns, less frequent blank shots of the biopsy gun. The data obtained supports the importance of isolated placement and marking of prostatic tissue fragments in biopsy and allow to recommend wide clinical use of ultrasonic facilities with biplanic sensors providing online sagittal and cross visualization of the prostate.