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Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis.

Introduction Daytime and nighttime urinary frequency is a common complaint in patients with benign prostatic hyperplasia (BPH). The most common reason for seeking elective surgery is an ineffective treatment with alpha-blockers. The aim of the study was to evaluate the efficacy and safety of combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg in patients with BPH and predominant irritative symptoms. Materials and methods from January 2018 to December 2019 in the outpatient department of the city clinical hospital named after D.D. Pletnev, a total of 64 patients with BPH with complains of frequent nighttime and daytime frequency and a desire to undergo surgery were followed. The patients underwent a comprehensive clinical and laboratory examination, according to which 10 patients had indications for surgery, and they were excluded from the study. In 6 patients, the prevalence of nocturnal over daytime diuresis was revealed and they were also excluded. Combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg a day was prescribed to 48 patients. The average duration of therapy was 15.4 +/- 3.1 months. Patients underwent a follow-up examination to evaluate the efficiency and safety after 3, 6 and 12 months of therapy. Adverse events, possibly treatment-related, were recorded. Results there was an additional decrease in irritative complaints according to the I-PSS, namely 2 points after 3 months and 4 points after 6 and 12 months. In addition, a decrease in the number of nocturnal urinations by one, a decrease in daytime urination by one after 3 months and by two after 6 and 12 months, as well as an increase in the average voided volume from 150 +/- 33 to 240 +/- 40 ml after 12 months of therapy was seen. The change in other parameters was not significant. Two patients stopped taking the drug due to non-medical reasons. In other 2 patients, the development of sinus tachycardia and a transient increase in blood pressure were noted, which did not require discontinuation of the drug. Conclusions Combination therapy with tamsulosin 0.4 mg and mirabegron 50 mg reduces the frequency of daytime and night urination with the maximum effect after 6-12 months, improves the quality of life and has a good safety profile.

INTRODUCTION: Insufficient efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors with subsequent proceeding to surgical treatment in the absence of absolute indications is a prerequisite for poor postoperative results AIM: to evaluate the efficiency of changing standard combination therapy to -adrenergic blockers + m-cholinoblockers instead of proceeding to surgical treatment MATERIALS AND METHODS: From January 2019 to December 2019, a total of 137 patients with lower urinary treatment were referred to the Pletnev City Clinical Hospital due to limited efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors in order to undergone laser enucleation/vaporization of the prostate After evaluation, 41 patients with absolute indications for surgical treatment or with suspected prostate cancer were excluded After a comprehensive examination, 96 patients were prescribed tamsulosin 0 4 mg daily in combination with solifenacin 10 mg daily All patients were followed up for 12 months RESULTS: As a result of using solifenacin, better control over storage symptoms was achieved according to the I-PSS scale (-4 points), which also led to a significant decrease in the total I-PSS score after 12 months of therapy There was an increase in the mean voided volume (by 53%) after 6 months Neither Qmax, nor residual urine volume did not change significantly According to the MIEF-5 scale, an improvement in erectile function was revealed There was a slight decrease in the average prostate volume and an increase in the PSA level from 3 1 to 4 1 ng/ml There was no acute urinary retention However, 6 patients discontinued taking of m-cholinoblockers due to dry mouth CONCLUSIONS: If there are no absolute indications for surgical treatment, changing the combination of -adrenergic blockers + 5-Reductase inhibitors to a combination of -adrenergic blockers + m-cholinoblockers results in a pronounced symptomatic improvement due to alleviation of storage symptoms

Objective : to develop a method of laparoscopic resection of a kidney tumor with super selective balloon occlusion of the segmental renal artery and targeted chemoembolization. Another purpose is to estimate the degree of fixation of the chemotherapy drug in the kidney parenchyma. Materials and methods . The study included the results of experiments on 14 laboratory rabbits, who underwent an intra-arterial injection of the coloring substance of Ponceau S and there were determined its concentration in the renal parenchyma after fixation with a hemostatic suture for 8 days after the injection of the marker. Besides, there were included the results of 13 studies of the contrast substance of ultraravist and gadovist concentration in the renal tissue of patients after resection of the neoplasm with intra-arterial injection of the contrast substance into the parenchyma of the operated kidney. Results. The implemented study showed the presence of a high concentration of a substance injected into the renal artery and a hemostatic suture fixed to the wound edges in the kidney tissue for 6-8 days of the postoperative period. Conclusion . Laparoscopic resection of a malignant kidney tumor with a super-selective balloon occlusion of the segmental renal artery, supplemented by the injection of a targeted chemotherapy agent into the renal artery is a highly effective, safe and simple method of surgical treatment of kidney cancer with enhanced anti-relapse protection due to high concentrations of chemotherapy in the resection area.

Bladder exstrophy is a complex of urogenital malformations, varying in severity from epispadias to classical bladder exstrophy. The main aim of correcting bladder exstrophy in childhood is to achieve urine continence with the prevention of upper urinary tract disorders and to provide penile reconstruction. However, by the time of puberty, it is not always possible to achieve optimal anatomical features of the penis, and usually, by the end of puberty, the penile length is no more than 7 cm, which subsequently leads to psychosocial and sexual problems during puberty. Neither patient, nor urologist in most cases do not satisfy final result of the treatment of exstrophy and a number of epispadias forms. A clinical case of the surgical rehabilitation of a patient after undergoing multi-stage surgical treatment for a congenital malformation of the genitourinary system is presented in the article. MATERIALS AND METHODS: At the admission, the size of the penis was 3 cm (microfallia), urethral meatus was located in the area of the penoscrotal junction. From 2016 to 2019, the patient underwent neofallos formation, urethroplasty, and implantation of prostheses in the neophallos. RESULTS: According to the results, urinary and sexual function was completely restored, as well as anatomical relationships and dimensional parameters of the genitals.

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

Urinary incontinence (UI) represents one of the most common urogenital diseases in women. Considering a progressing of UI with ageing, there is a growing interest in minimally invasive treatment methods including monopolar radio wave remodeling. The results of the largest clinical trials and our own experience of using monopolar radio wave remodeling in treatment of stress UI in women of reproductive age are presented in the review.

Background chronic prostatitis is a common disease that significantly influence on the quality of life. Aim Our aim was to assess the prevalence of particular domains of UPOINT classification and determine the efficiency of prostate-selective cytomedins in complex therapy of chronic prostatitis with the predominance of organic component. Materials and methods a total of 96 patients aged from 24 to 48 years were treated in City clinical hospital named after D.D. Pletnev in 2017-2018 yy. with a previously diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The mean duration of the disease was 18.0+/-6.2 months. The total NIH-CPSI score was 24+/-7.3 (pain score 9+/-4.9, urinary score 7+/-2,7, quality of life 8+/-2.3), Qmax was 16+/-4.2 ml/s, prostate volume - 34+/-12 cc. Leukocyturia in post-massage urine was found in 52 patients (54%). Positive urine culture after prostate massage or positive bacterial semen study were found in 22 patients (23%). Prostate-specific therapy consisted of 20 days of rectal suppositories Vitaprost-forte followed by oral therapy by Vitaprost tablet of the same duration. Results Follow-up examination of 72 patients (75%) was performed after 3 months of therapy. The total NIH-CSPI score decreased to 15.6+/-5.1 (pain score 6.3+/-3.8, urinary score 4.6+/-2.2, quality of life 4.7+/-2), Qmax was 16+/-3.8 ml/s and mean prostate volume was 24+/-6 cc. The normalization of laboratory parameters was achieved in all cases. Conclusion using the UPOINT classification allows to optimize the treatment of patients with chronic prostatitis. Use of prostate-specific cytomedins (Vitaprost) is highly effective in case of prostatic involvement according to the UPOINT classification.

The article reflects the history of treatment of benign prostatic hyperplasia from the age of antiquity to the present day. Approaches to surgical treatment have undergone significant changes in the last century – from traumatic open operations to minimally invasive surgical interventions using innovative endoscopic technologies. However, some issues in the treatment of benign prostatic hyperplasia remain unresolved which leads to the search for new, safer and more effective methods of surgical treatment of the disease.

Introduction.Contemporary diagnosis of prostate cancer is crucial to the patient’s further fate. Difficulties in the histological verification of the final diagnosis and false-negative results of biopsy research are often associated with the similarity of the prostate adenocarcinoma`s micromorphological picture and its benign lesions.Purpose of the study.Comprehending the possibilities of immunohistochemical identification of tumor cells and the basal epithelial layer of prostate glandular structures in prostate cancer suspected cases.Materials and methods.A biopsy material was taken from 134 patients. Prostate adenocarcinoma was verified by routine histological examination in 72 samples, in 62 samples there were no signs of malignant transformation. Subsequently, immunohistochemical analysis of biopsy specimens was performed using antibodies to α-methylacyl-CoA racemase, nuclear p63 protein and high-molecular cytokeratin.Results.The AMACR-positive reaction of malignant cells and a negative reaction of the basal epithelium to nuclear p63 protein antibodies and high-molecular cytokeratin were detected during prostate adenocarcinoma.Conclusion.If prostate cancer is suspected, immunohistochemical assays with monoclonal antibodies to AMACR, p63 and high-molecular cytokeratin greatly facilitate the detection of adenocarcinoma.

Introduction Numerous publications on the successful use of NefraDoz (Stada, Germany) in the metaphylaxis of urolithiasis after extracorporeal lithotripsy, and the prevention and treatment of infectious inflammatory diseases of the lower and upper urinary tracts, served as the rationale for a study aimed to evaluate the effectiveness and safety of long-term use of NefraDoz in patients after transurethral and percutaneous interventions performed for urological diseases. Patients and methods The study analyzed results of 116 transurethral and percutaneous endoscopic operations for urolithiasis performed in 62 men and 54 women aged 21 to 84 years from November to December 2017 at the D.D. Pletnev City Clinical Hospital. Depending on the localization of the stones, all patients were divided into three groups: kidney stones (n=68), ureteral stones (n=28), and bladder stones (n=21). In each group, patients were assigned either to receive (study group, n=50) or not to receive (control group, n=66) postoperative NefraDoz, which was administered at a dose of 1 capsule three times daily for one month. Patients in the control group (n=66) received standard antibacterial therapy for one month. The analysis included leukocyturia, 24-hour diuresis, the severity of the symptoms of the disease and the patients quality of life. Results The use of NefraDoz after transurethral lower urinary tract procedures, reduced the severity of irritative symptoms, improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis. The use of NefraDoz after upper urinary tract procedures improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis, and improved the clearance of residual fragments. There were no adverse events associated with NefraDoz. Conclusions We have proved the advantage of using the NefraDoz complex in the rehabilitation of patients after endourologic procedures.

This review article presents the data on the epidemiology of renal cell carcinoma and describes minimally invasive surgery for this disease. The authors discuss the use of warm and cold ischemia, vascular microdissection, and artery embolization in renal tumor surgery, and analyze treatment outcomes.

Introduction Concurrent chronic prostatitis (CP) plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH), increasing the severity of lower urinary tract symptoms (LUTS), lowering the quality of life, and increasing the risk of acute urinary retention. However, in the management of patients with BPH, the role of CP is not always taken into account. Aim To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate. Materials and methods Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I-II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern. Results Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate-specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH. Conclusion In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I-II stage BPH.

INTRODUCTION Monopolar transurethral resection (M-TUR) is a standard for comparing various endoscopic techniques for benign prostatic hyperplasia (BPH), including extraperitoneoscopic adenomectomy (EA). AIM To compare the effectiveness and safety of M-TUR and EA in the surgical management of BPH with a prostate volume of 100-180 cm3. MATERIALS AND METHODS Medical records of 797 patients, who underwent surgery for BPH from 2011 to 2016, were retrospectively evaluated. The study comprised patients with a prostate volume of 100-180 cm3, who received either EA (group 1, n=34) or M-TUR (group 2, n=24). RESULTS The groups did not statistically significantly differ in age (69.3+/-6.9 vs 71.4+/-6.4 years in group and 2, p=0.328); complication rate (4 (11.7%) and 6 (25%), respectively, p=0.31); increase in the maximum urinary flow (10 ml/ s (Q1-Q3: 10.0-10.5), 13.5 ml/s (Q1-Q3: 7.5-17), respectively, p=0.538); postoperative hospital stay (11 (Q1-Q3: 10-14) and 10.5 (Q1-Q3: 8-17), respectively, p=0.875). There was statistically significant difference in operative time (190 and 82.5 min in the 1st and 2nd groups, respectively, p=0.041), and in blood loss (200 ml (Q1-Q3: 150-300) and 400 ml (Q1-Q3: 400-500), respectively, p=0.008). During 12 month follow-up, only 5 (20.8%) patients in the 2nd group (p=0.012) needed repeat surgery. Urinary incontinence of different severity at the time of discharge from hospital was also observed only in 4 (16.6%) patients the 2nd group (p=0.036). CONCLUSION EA and M-TUR have similar safety and effectiveness in the surgical management of patients with BPH with the prostate volume of 100-180 cm3. EA is associated with longer operative time than M-TUR, but is accompanied by less blood loss, does not require repeat surgery, and confers less risk for urinary incontinence.

Currently, prostate biopsy remains the main method used to diagnose prostate cancer (PCa). The indication for the procedure is an elevated level of the serum level of the total prostate-specific antigen (PSA). However, the PSA test is organ- but not cancer-specific, and patients may undergo an unnecessary biopsy, which is an invasive procedure associated with a risk of complications. Additional tests have been developed aimed to improve the diagnostic performance of PSA for detecting PCa. They include PSA derivatives such as free PSA fraction, -2proPSA, PSA density, PHI and the free /total PSA fraction. Aim To investigate the diagnostic accuracy of PSA and its derivatives in detecting benign and malignant diseases of the prostate after an initial prostate biopsy. Materials and methods The current study analyzed 65 initial biopsies performed due to an elevated serum PSA level and compared them with the results of extended PSA testing with the use of PSA derivatives. Results The histological findings consistent with PCa were found in about 30% of initial biopsies performed due to elevated serum levels of total PSA. The incidence of histologically confirmed PCa increased with age, and 70-79 year old men were more likely to have it than 60-69 years old patients. PSA density in 85% of PCa cases exceeded that for benign prostatic hyperplasia (BPH). In all PCa patients, PHI and free /total PSA fraction were greater than 25 and less than 0.15, respectively. In most patients with BPH, the PHI and free /total PSA fraction did not exceed 25 and were greater than 0.15. Conclusions 1. Initial biopsy triggered by elevated serum level of total PSA allows detection of PCa in about 30% of cases. 2. The age of 60 years and older should be regarded as a risk factor for PCa. The probability of malignant transformation of prostate epithelial cells in men over 70 years of age is greater than in 60-69-year-olds. 3. The density of PSA in men with morphologically verified PCa is statistically significantly greater than that in men with BPH and the threshold value in 85% of cases. 4. Determination of PHI and free/total PSA fraction can improve the accuracy of predicting malignant lesions of the prostate and adjust the indications for histological examination, reduce the number of unnecessary biopsies. 5. When defining indications for initial prostate biopsy in cases with serum PSA varying from 2 to 10 ng/ml, PSA derivatives should be used, including PSA density, prostate health index, and the free /total PSA fraction.

Internal drainage of the upper urinary tract by stenting is a common urological procedure. The use of stenting in modern urological practice is on the rise due to widespread adoption of modern endourological, laparoscopic, percutaneous and high-tech robotic interventions. The presence of a stent in the patients body may cause stent-related symptoms and negatively affect the quality of life, resulting in additional outpatient visits and hospitalizations. The review provides an analysis of the causes, diagnostic evaluation, prevention and treatment of stent-related symptoms. The authors describe the management options including -blockers, anticholinergics, and their combinations.

Introduction Surgery in patients with large prostates due to benign prostatic hyperplasia (BPH) results in severe dysuria manifesting as frequent or urgent need to urinate and urinary incontinence. Traditionally, these conditions are treated with alpha blockers. Recently, alpha-blockers and the anticholinergic combination have been used showing additional advantages. This study aimed to investigate the comparative effectiveness of monotherapy versus combination therapy in the treatment of postoperative dysuria in BPH patients with large prostates undergoing transurethral surgery. Materials and methods From September 2016 to March 2017, 94 BPH patients with prostates greater than 100 cc underwent transurethral surgery at the Department of Urology of D.D. Pletnev Clinical Hospital; 22 patients had exclusion criteria. In the postoperative period, 36 patients received 0.4 mg of modified release tamsulosin (Omnik) for a month, and 36 patients were administered controlled release tablets tamsulosin 0.4 mg + solifenacin 6 mg (Vezomni) as fixed-dose combination therapy. At one month postoperatively, patients were asked to rate their symptoms on a visual analogue scale and fill out I-PSS and QoL questionnaires. Preoperative parameters of the groups were: visual analogue scale scores were 5.1 and 5.2, I-PSS scores were 24 and 24.2, QoL scores were 4.5 in both groups. Prostate volumes were 114 and 118 cc; maximum urinary flow rates were 7.7 vs. 7.5 ml/sec, residual urine volumes were 110 vs. 105 ml, respectively. Results Visual analogue scale scores were 6.5 versus 9.2 points, I-PSS scores were 16.3 versus 12.1. The patients of the second group had greater mean micturition volume (150 versus 240 ml); other variables did not differ statistically significantly between the groups. Adverse reactions were mild, and drugs were not discontinued in any case. Conclusion In BPH patients with dysuria after transurethral resection of large prostates, Vezomni administration results in a better quality of life due to an improvement in urgency and nocturia.

AIM To evaluate the functional state of the renal parenchyma after partial nephrectomy, depending on surgical technique. MATERIALS AND METHODS The study comprised 21 patients with kidney neoplasms of stage T1-2N0M0. The patients underwent either laparoscopic partial nephrectomy with superselective balloon embolization of the renal artery (study group, n=11), or partial nephrectomy with vascular clamping (control group, n=10). The mean age of the patients in the study group (3 men and 8 women) was 56.8 years. The tumor was located in the right kidney in 5 patients and in the left kidney in 6 patients. The size of the neoplasm ranged from 0.9 to 3.8 cm, averaging 1.9 cm. The complexity of the surgery was evaluated using R.E.N.A.L. Nephrometry Scoring System based on MSCT findings. The mean nephrometry score was 5.1, which corresponds to low complexity of the intervention. Patients of the control group underwent partial nephrectomy with vascular clamping and renal ischemia time of no more than 20 minutes. The mean age of the control group patients was 57.3 years. The tumor was located in the right kidney in 4 patients and in the left kidney in 6 patients. The tumor size ranged from 1 to 4.1 cm, averaging 2.2 cm. The mean nephrometry score based on MSCT findings was 6.1. In both groups, the difference in creatinine clearance between the operated and intact kidney was estimated before the operation and in the early postoperative period to assess the changes in glomerular filtration. RESULTS AND DISCUSSION The level of serum creatinine remained within the normal range throughout the study period in both groups. In the postoperative period, the creatinine clearance of the operated kidneys showed 1.02-fold decrease after super selective embolization and 1.92-fold decrease after vascular clamping. The 1-minute diuresis of the operated kidney decreased by 83.21% and 43.53% after vascular clamping and embolization, respectively. CONCLUSION The studys findings show there was no significant dysfunction of operated kidneys after superselective balloon embolization of the renal artery.

An injury of major vessels is a life - threating complication in laparoscopic urology. Review of the literature and analysis of own cases have been performed. The authors offer original surgical management with using hand-assistant technic. It has advantages of open and laparoscopic approach.

The "gold standard" for the diagnosis and evaluation of urinary stones is native computed tomography, which allows determining stone localization and size of with high accuracy. However, this imaging technique has limited diagnostic usefulness in determining the stone chemical composition. The newly introduced method of dual-energy computed tomography, based on obtaining images at two different energy levels is highly effective in determining the composition of urinary stones. The review outlines the principles and methods of performing dual-energy computed tomography using various scanners. The authors analyze the results of using this method for diagnosing urolithiasis, determining the stone chemical composition and point out the limitations and difficulties encountered in its application.

AIM To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. MATERIALS AND METHODS From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. RESULTS AND DISCUSSION The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. CONCLUSION The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.

This article provides summarized and statistical data about the impact of transurethral surgery for benign hyperplasia of the prostate on erectile function. It analyzes etiopathogenesis, reviews the dynamics of fluctuations of the erectile function after transurethral interventions.

Background. The high incidence of recurrent non-muscle-invasive bladder carcinoma (BC) necessitates searches for new surgical methods. Objective: to comparatively evaluate the efficiency and safety of en block resection of bladder tumors versus transurethral resection (TUR). Subjects and methods. In January 2010 to June 2013, a total of 292 patients with primary and recurrent bladder tumor stages, cTa-T2, underwent transurethral endoscopic treatment (as TUR) at the Unit of Minimally Invasive Urology, Moscow City Clinical Hospital Fifty-Seven. A major portion of these patients were included in the study of the efficiency and safety of en bloc TUR of bladder tumors. The criteria for study inclusion were primary or recurrent non-muscle-invasive bladder tumor measuring 1 to 3 cm, stage pTa-T1, signed informed consent to participate in the study and patients» readiness to undergo control examinations in inpatient setting for one year. The exclusion criteria were a confirmed or detected muscleinvasive tumor, multiple bladder involvement (> 3 tumors), as well as detected tumors spreading to the ureter, bladder neck, and prostatic urethra. The primary study endpoint was considered to be a recurrence of a tumor after TUR of the bladder (TURB). The secondary endpoint was the frequency of concealed bladder perforation, blood transfusions, recystoscopies for bladder tamponade, early recystoscopies to specify a BC stage, and the frequency of immediate intravesical injection of a chemical. For final analysis, the investigators selected 106 patients in a group where tumors were removed en bloc (a study group) and 133 patients in a group where tumors were retrieved using traditional TURB (a control group). In the study group, the tumor was removed en bloc by a monopolar J-shaped electrode (sand wedge electrode) in 45 patients, by a hook-like electrode in 14, by a hybrid procedure (hydropreparation and monopolar electrosurgery by a water-jet hybrid knife) in 10, and by holmium laser in the remaining 37 patients. Results. The recurrence rates in the study and control groups were 10.4 and 21.8 %, respectively (p ≤ 0.05). There were no significant differences in the time of surgery, the periods of bladder drainage, and the frequency of complications. In the study group, the immediate instillation of a chemical was possible in 54.7 % of the patients versus 24 % in the control group (р ≤ 0.05), indirectly suggesting that en bloc TUR of the bladder was less safe (the bladder resection area, concealed perforations, hemorrhagic complications, etc. were less.). Early recystoscopy and biopsy were required in 9.4 % of the patients in the study group versus 24 % of those in the control group (p ≤ 0.05), which is mainly attributable to more qualitative histological material obtained during en bloc TUR. According to the visual analogue scale, the quality of the histological materials obtained by retrieving the tumor en block was 93 versus 61 scores during standard TUR. Conclusion. En bloc TUR of the bladder is more effective and safer than standard TUR in the group of patients with non-muscle-invasive BC and 1–3-cm tumors. Histological material obtained by removing the tumor en bloc can provide a more qualitative morphological opinion.

The incidence of urethral strictures and their recurrences is high. The effectiveness of optical urethrotomy is insufficient. Reconstructive urethroplasty is traumatic and accompanied by a prolonged period of rehabilitation. The results of metal endourethral stents using were unsatisfactory due to the granulation tissue ingrowth through the metallic threads, stent incrustation, and migration. Authors present the personal experience of bulbous urethral strictures treatment in 32 patients, who underwent visual optical urethrotomy with temporary placement of a new generation polyurethane-covered nitinol stents. After removing the stents from 4 to 10 months after implantation, a stable effect of urethral lumen preserving was achieved. The stricture recurrence occurred in 3 cases (9,4%) 3-5 month following the stent removal. Clinical success was 80,6%. Authors consider the stent implantation as an alternative adjunctive treatment of the patients with urethral strictures.

This review article summarizes new data on mono- and combination therapy for male urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). A special attention is paid to the reports made at the 32nd Annual EAU Congress and published in the congress proceedings. The article outlines new data on the epidemiology of LUTS secondary to BPH, recent changes in the pathogenesis of LUTS, provides a critical analysis of the latest publications on -blockers, 5-reductase inhibitors, antimuscarinics and phosphodiesterase type 5 inhibitors in pharmacological management of LUTS. The authors analyze recent data on the effectiveness of surgical methods for treating BPH.

Aim To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. Materials and methods A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. Inclusion criteria patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. Results A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. Conclusion In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

The high rate of recurrences after transurethral resection of the bladder is a key problem in the treatment of patients with superficial tumors. The main reasons for the high rate of recurrences are diffuse urothelial neoplastic changes, cancer in situ, possible tumor cell implantation at surgery, and non-radical removal of a tumor itself. As of now, the most important ways of solving the problem, among which there are a lot of endoscopic modes, include increased radicality of primary tumor removal (bipolar electrosurgery, electrovaporization, laser resection and ablation), more precise intraoperative disease staging (Raman spectroscopy, optical coherence tomography), identification of invisible neoplasms by standard methods (photodynamic diagnosis, narrow-spectrum imaging), monitoring of primary tumor removal radicality (early recystoscopy and bladder biopsy), photodynamic therapy, urinary retention elimination, by saving the patient from infravesical obstruction, as well as urinary cytology, use of diagnostic markers (BTA test and others), adjuvant immunochemotherapy, radiotherapy, etc. By taking into account the data available in the literature and their findings, the authors consider possible ways of reducing the recurrence rate of superficial bladder carcinoma.

S-shaped catheter-stents, when introduced in the upper urinary tract (UUT), facilitate the removal of stones from the kidney and ureter during endoscopic procedures and extracorporeal lithotfipsy [4-6]. The stents are effective in preventing and liquidating a UUT obstruction and associated complications. However, undesirable consequences of internal drainage of the UUT, such as chronic inflammations and hypertrophy of the smooth muscle wall, have also been described, especially in the l ong term [3,7]. The purpose of the present work was to study the consequences of UUT internal drainage by gents with respect to UUT urodynamics and the contractile function of the ureteric wall.

The article is devoted to analysis of results of exposing and treatment chronic prostatitis in patients with benign prostatic hyperplasia.

Warm ischemia of the renal parenchyma is a forced feature of laparoscopic partial nephrectomy. It is accompanied by oxygen deprivation of the organ and followed by re-oxygenation, which can cause additional damage to the renal tissue. This damage can result in acute functional and structural disorders of individual parts of the nephron, increasing the risk for a renal dysfunction. Timely diagnosis of the dysfunction is vital for the success of the treatment. The article provides an overview of current scientific data on the mechanisms of ischemic and reperfusion injuries at the molecular-cellular level and describes the current methods of their detection. Experimental and clinical study of the molecular-cellular mechanisms of ischemic-reperfusion injury of the renal tissue made it possible, first, to determine the main targets of alteration (cytolemma, mitochondria, lysosomes), and second, to establish its consequences, among which the most important are hypoergosis, DNA damage, simultaneous activation of intracellular systems of the suicidal program and induction of electrical breakdown of membranes of target nephrocytes; thirdly, to reveal the range of possibilities for limiting the consequences of hypoxia and/or re-oxygenation, among which interference in the metabolism of purines, measures ensuring the preservation of colloid osmotic pressure inside and outside the cell and membrane stabilization, antioxidant defense and inhibition of cysteine proteinases, etc. However, despite the advances in understanding the pathogenesis of cell damage, including ischemic-hypoxic injury, the problem of intraoperative ischemia-reperfusion safety remains relevant.

Interstitial Cystitis (IC) or Painful Bladder Syndrome (PBS) is a heterogeneous disease which pathogenetic mode development is not fully studied. In the presented literature review IC/PBS is considered as urothelial dysfunction. The main issues discussed relate to IC/PBS diagnosis and minimally invasive methods of its treatment including intravesical instillations of therapeutic agents, botulinum toxin injections into bladder wall and hydrodistension. Efficacy of the above therapeutic methods is far from the desired what gives rise to search novel minimally invasive technologies and protocols to improve the outcomes of traditional treatment methods.