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Aim: To evaluate the possibility of performing transurethral carboxycryobiopsy (CCB) and carboxycryoextraction (CCE) of a bladder tumor for pathomorphological examination, as well as to perform a comparative analysis of the safety (quality) of biopsy material (tumor tissue) during standard transurethral biopsy and carboxycryobiopsy., Materials and Methods: In the first experiment in vitro, CCE of bladder tumor fragments obtained after transurethral resection was performed. In the second pilot study, cystoscopy followed by CCB and CCE in a patient with multiple bladder tumors was done. The procedure was performed by transurethral access. During cryopreservation of the bladder tumor, a biopsy was performed. After freezing, the tumor was removed from the bladder and sent for histological examination., Results: The first experiment showed that cryoextraction of the fragments of a bladder tumor using carbon dioxide (CCE) in vitro is a feasible procedure and allows the evacuation of tumor tissues of various sizes. According to the second experiment, CCB and CCE of the bladder tumor using carbon dioxide allows to obtain a biopsy of a bladder tumor of sufficient size without compression or coagulation artifacts, which contributes to a more accurate histological evaluation., Conclusion: Our experiments showed that CCB and CCE of a bladder tumor using carbon dioxide are feasible procedures that contribute to obtaining better biopsy material for pathomorphological examination, and also allows to evaluate the effect of low temperatures of carbon dioxide on the biopsy material (tumor tissue).

Introduction: Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy., Purpose: in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender., Materials and Methods: the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018-2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction., Results: The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted., Conclusion: The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.

Introduction: An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and perirenal tissues., Aim: To determine the efficiency and safety of renal puncture during mini-PCNL with a new atraumatic needle MG., Materials and Methods: A total of 67 patients who underwent mini-percutaneous nephrolithotomy at the Institute of Urology and Human Reproductive Health of Sechenov University were included in the prospective study. For the purpose of homogeneity of the groups, those with staghorn nephrolithiasis, nephrostomy, a history of prior kidney surgery (including PCNL), renal and collecting system anomalies, acute pyelonephritis, and blood clotting disorders were not included. The main group consisted of 34 (50.7%) patients who underwent atraumatic kidney puncture with a new needle MG (MIT, Russia), while in the control group there were 33 (49.3%) patients, who underwent standard puncture with Chiba or Troakar needles (Coloplast A/S, Denmark). The outer diameter of all needles was 18 G., Results: In patients with a standard access, a hemoglobin decrease in the early postoperative period was more pronounced (p=0.024). The incidence of complications according to the Clavien-Dindo classification did not differ significantly (p=0.351), however, a JJ stent was placed in two patients from the control group due to impaired urine flow and the development of urinoma., Conclusion: Together with a similar stone-free rate, atraumatic needle allows to reduce a hemoglobin drop, as well as less development of severe complications.

Bleeding is a serious complication of percutaneous nephrolithotomy (PCNL). A rare cause of gross hematuria is a calico-venous fistula. A clinical case of successful intraoperative diagnosis and treatment of calico-venous fistula during PCNL is presented in the article. Description of a clinical case. A patient J., 53 years old, underwent examination and treatment at the Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University with a diagnosis of staghorn stone of the right kidney, a stone of the left kidney, chronic right-side pyelonephritis. On June 15, 2021, mini-PCNL was performed for the staghorn stone of the right kidney. The procedure seemed to be unremarkable, but during intraoperative antegrade pyelography, the inflow of contrast agent from the lower calyxes into the posterior segmental vein of the right kidney was detected, which was managed by creating sufficient traction of the nephrostomy drainage. Communication of the collecting and venous systems of the kidney is associated with a risk of both severe gross hematuria and urine flow into the venous bed. The urine flow into the bloodstream may result in hemodynamic disturbances, up to collapse followed by cardiac arrest. In order to prevent complications of PCNL it is necessary to analyze the kidney anatomy based on three-dimensional modeling of contrast- enhanced computed tomography. A calicovenous fistula can be a source of risk of bleeding and severe complications. To minimize intraoperative damage to parenchymal structures, an analysis of three-dimensional modeling of a kidney in patients with staghorn calculus based on computed tomography is required, which allows rational planning of surgical tactics.

Introduction: Urolithiasis is one of the most common urological diseases in adults. Increased life expectancy of the population in developed countries, make urolithiasis topical issue and requires close attention. Due to the high risk of recurrent stone formation causing repeated surgical interventions, the issue of effective urinary stone metaphylaxis is very important today., Materials and Methods: To study the current state of the problem of urolithiasis metaphylaxis among Russian urologists, an anonymous questionnaire was applied. A 25-question questionnaire was sent to e-mail to more than 4,000 Russian urologists. A total of 1,238 specialists completed the questionnaire. The database compiled from the received responses was processed and presented with descriptive statistics in the form of tables and charts., Results: According to the survey, more than half of the 831 (67.1%) specialists specialized in the treatment of urolithiasis. It was noted that 626 (86%) inpatient urologists and 205 (40%) outpatient urologists specialized in the treatment of urolithiasis. Only 521 (69.6%) urologists specializing in surgical treatment of urolithiasis give a patient a stone fragment to analyze its chemical composition. At the same time, half of the respondents reported that less than 10% of patients come to them for further metaphylaxis. One of the main reasons for not analyzing the chemical composition of the stone was the fact that 877 (70,84%) specialists indicated the inaccessibility of analysis under the state guarantee program, 503 (40,63%) specialists indicated the patients satisfaction with the results of minimally invasive surgical treatment and lack of sufficient motivation for further examinations. At the same time, less than 3% of specialists can perform stone analysis within the framework of the state guaranty program. 1180 (96,8%) respondents practiced the prophylaxis of recurrent calculi formation, but only 336 (28,47%) performed comprehensive metabolic examination of all patients followed by prescription of drug therapy and appropriate diet., Conclusions: Our survey revealed low involvement of urologists at the outpatient level in the process of conservative treatment and metaphylaxis of urolithiasis, low activity of urologists in performing complex metabolic study and comprehensive prevention of recurrent stone formation, low percentage of performing chemical composition analysis of stone and low activity of urologists in performing primary litholytic therapy of urate stones. Based on this analysis of the responses of most Russian urologists, it is possible to formulate recommendations to remove the obstacles to providing patients with urolithiasis with quality medical care in terms of conservative therapy and metaphylaxis of urolithiasis.

Background: Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results., Aim: To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery)., Materials and Methods: Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF)., Results: There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery., Conclusions: The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

Aim: The aim of this experimental study was to evaluate the effect of low temperatures of carbon dioxide on a "living" blood-supplying organ (pig kidney), to determine the possibility of performing cryoablation of kidney tissue with carbon dioxide (carboxycryoablation), as well as to establish experimentally modes of carboxycryoablation of the kidney., Materials and Methods: To carry out this experimental study, a female of the mini-pig line was used. We performed laparoscopic access to the kidney for carboxycryoablation. During the freezing of the kidney, three modes were compared: 60, 90, and 120 s on one kidney of one animal. Immediately after the completion of cryoablation, nephrectomy was performed, and the removed kidney was sent for histological examination. According to the histological study, the results of the use of carbon dioxide during cryoablation of porcine kidney tissue were evaluated., Results: Cryoablation based on carbon dioxide (carboxycryoablation) leads to irreversible death (necrosis) and destruction of the affected tissue. A direct relationship between the exposure mode and the size of the cryonecrosis zone was noted. Thus, the most extensive zone of necrosis with a diameter of 10 mm was achieved when performing cryoablation in the exposure mode of 120 s., Conclusion: This experiment showed that carbon dioxide-based cryoablation remains a feasible procedure that leads to irreversible death (necrosis) and destruction of the affected tissue. However, further studies on the safety and efficacy of cryoablation of kidney tissue with carbon dioxide are required.

Introduction: Despite the low invasiveness of percutaneous nephrolithotripsy, this surgery is not without complications. One of the most important stages of the operation, on which depends not only the success of the patient completely getting rid of calculus, but the likelihood of complications, is the puncture of the pelvic-pelvic system., Purpose: Determination of the effectiveness and security of the new less-traumatic puncture needle MG under experimental conditions., Materials and Methods: A series of pork kidney punctures with a new less-traumatic needle MG and standard Chiba and Troakar needles (Coloplast A/S, Denmark) were performed under experimental conditions, followed by a comparative morphological assessment. The staining of the slides was performed with hematoxylin and eosin. For the purpose of additional assessment of the structures of the kidney punctured with a low-traumatic MG needle, a morphological assessment of the parenchyma stained with picrofuchsin according to Van Gieson was performed., Results: On parenchymal slides with punctures with Chiba and Trocar needles, the passage places with multiple large fragments of desquamated (damaged) epithelium are visualized. On preparations of the parenchyma punctured with a less-traumatic needle MG, the place of passage of the needle is presented with clear contours. The damaged epithelium in the lumen of the formed defect is practically absent. With additional staining according to Van Gieson (magnification x200), the integrity of the full-blooded vessel adjacent to the limited focus of the needle MG was visualized. Output. The new less-traumatic puncture needle MG is an innovative development in urology. The design of the needle with an atraumatic mandrel-bulb atraumatic mandrel-bulb on a spring basis made it possible to significantly reduce the trauma to the structures of the kidney and perirenal tissues due to the bougienage effect.

Outpatient urodynamic monitoring (AUM) - registration of the patients urination parameters for a certain time (for example, during the day), which is carried out in natural conditions for him. Monitoring allows you to identify hidden or periodically occurring (circadian) changes, which are not always possible to record with a single study. The research was searched in the PubMed and Elibrary.ru databases using the keywords "home uroflowmetry", "outpatient urodynamic examination", "outpatient urodynamic monitoring", "outpatient uroflowmetric monitoring". The difficulties in performing AUM lie not only in the hardware (the presence of a portable device, minimally invasive or non-invasive research, software that guarantees the storage and transmission of data), but also the difficulties associated with teaching patients and overcoming conservatism on the part of medical personnel. Today, there are several urodynamic devices and uroflowmeters designed for research at home. Outpatient (home) urodynamic monitoring is one of the most promising studies for implementation in everyday clinical practice in the provision of medical care to patients with urination disorders on the background of benign prostatic hyperplasia. The integration of home uroflowmetric monitoring into the eHealth system, of course, remains an inevitable trend in the development of modern healthcare.

Introduction: Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the "patient-doctor" format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed., Aim: To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation., Materials and Methods: A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer "ETTA AMP-01" on dipstick. Data transmission was performed through a mobile application, which is part of the "NetHealth" information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used., Results: By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high., Conclusion: A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.

Aim: To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP)., Material and Methods: A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA., Results: One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast., Conclusion: The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.

Introduction: The SuperPulse Thulium (Tm) fiber laser (wavelength of 1.94 m) has been recently introduced as a directed-energy source for urology. Preclinical studies have shown a significant potential of the SuperPulse Tm fiber laser (SP TFL) for lithotripsy. However, clinical reports of using SP TFL to treat urolithiasis are still few and limited. Of special interest are challenging cases, e.g., lower pole stones, when extreme deflection of the instrument is required., Objective: To evaluate the effectiveness of the SuperPulse Tm fiber laser in the management of lower pole small calyceal stones during flexible ureteroscopy (F-URS)., Method: s. The SuperPulse Tm fiber laser device (Urolase 2, IRE Polus, Fryazino, Russia) has been cleared for clinical use by the Ministry of Health of Russian Federation. Study protocol has been approved by the Ethical Review Committee. Between January 2018 and February 2019, 130 patients with kidney stones have undergone Thulium fiber laser lithotripsy during F-URS. We retrospectively analyzed 15 of this patients with a single radiopaque lower pole calculus that were included in the present study. Stone size, stone density, lithotripsy time (from the first to last footswitch press) and "lasering" (laser emission) time were measured. The SP TFL was used for stone disintegration with different settings in dusting and fragmentation modes (0.1 - 4J, 7-300Hz, 6-40W) via a fiber with a 200-m core diameter. Low dose CT scanning was performed on POD 90 to assess SFR., Results: Stone size ranged from 4 to 17 mm and stone density varied from 350 to 1459 HU. The average lithotripsy time was 12 min (3-30 min). The average "lasering" time was 1.3 min (0.4-2.5 min) and the mean hospital stay was 1.1+/-0.3 days. In all cases we reached the lower pole stone containing calyx with a laser fiber. The complication rates were evaluated by using the Clavien-Dindo grading system and did not exceed GII (6.6%). SFR on POD 90 was achieved in 86.6% of cases., Conclusions: F-URS with SuperPulse Tm fiber laser is safe and effective option in the management of lower pole small calyceal stones. The possibility of using small laser fibers gives better instrument deflection which make possible to reach lower pole calyceal stones even with acute lower pole infundibulopelvic angle (IPA).

Aim: Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs., Materials and Methods: A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay)., Results: All patients in both groups had successful results with flow rate of 8-12 ml/sec., Conclusions: The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.

Aim: Buccal mucosa and preputial skin grafts are used for staged urethroplasty in proximal forms of hypospadias in children. Aim of our study was to carry out a comparative histological analysis of preputial skin and buccal mucosa., Method: s and materials: Histological analysis of urethral tissue samples from 10 patients with proximal forms of hypospadias was conducted. All patients were treated with staged Brackas technique using free grafts at the Russian Childrens Clinical Hospital from 2013 to 2016. Patients were divided into two groups. In Group I (n=5), preputial skin graft was used for urethroplasty, while in Group II (n=5) buccal mucosa was taken. A histological study of both materials with comparison to a native urethra was performed., Results: In Group I, the histological analysis showed keratinizing multilayered squamous epithelium, large number of dilated sweat and sebaceous glands with signs of inflammation, and hair follicles. In Group II, histological analysis revealed the presence of the typical structure for mucosal tissue, including multilayered flat non-keratinizing epithelium, as well as full absence of sweat, sebaceous glands, and hair follicles., Conclusion: comparative histological analysis of neourethra has shown the absence of sweat and sebaceous glands, hair follicles, and areas of chronic inflammation in buccal mucosa vs preputial skin, showing that buccal mucosa is more similar to native urethra. Therefore, buccal mucosa is favored as the material for urethroplasty.

Introduction: Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions., Aim: to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion., Materials and Methods: From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system., Results: In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis., Conclusion: CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.

A solving diagnostic and therapeutic problems in patients with various urologic diseases often requires a cooperation between different specialists which emphasizes the interdisciplinarity of our discipline. A number of clinical manifestations and diseases that urologists have to deal with and in which they definitely need a timely assistance from other specialists are described in the article. Determining the connecting links in the work of different specialists, we tried to recall the main " intersection points" and draw attention to the necessary cooperation.

Currently, thorough understanding of multidisciplinary approach is required in all areas of healthcare, including education, science and practice. This article is dedicated to the actual problem of interdisciplinary communications in current educational process in the Medical University.

The stages of postoperative metaphylaxis, drugs used for correction of metabolic disturbances are reviewed. In addition, the basic principles of drug metaphylaxis in various types of stone formation are described.

The place and indications for recurrence prevention of urinary stone disease, general principles of recurrence prevention, role of mineral water and changes of dietary habits during recurrence prevention are reviewed in the article.

All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

Urinary stone disease is one of the most actively progressing diseases, which are associated with metabolic disturbances and are influenced by the genetic, environmental factors and lifestyle \. In the article the current views on initiation factors of stone formation and theories of stone formation are reviewed. The factors that play an important role in the activation and inhibition of nucleation and aggregation of stone-forming substances are discussed. All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

Urinary stone disease is the current issue for healthcare system worldwide. High prevalence of urinary stone disease (at least 5% of the population of developed countries) determines clinical significance of the studying of its etiology and pathogenesis, improving of diagnostic methods and novel treatment technologies. The development of endoscopic devices, creation of new eswl machines and improvement of endourology interventions under X-ray guidance allowed to solve the problem of surgical treatment. Therefore, one of the actual issue is the choice of X-ray method for predicting and evaluating of treatment efficiency in patients with urinary stone disease. The changes of renal blood flow depend on urodynamic disturbances, stone location and size, the duration of disease, complications, patients age. Therefore, for comprehensive studying of renal function the hemodynamics evaluation is needed. In this review the advantages, drawbacks and perspective on developing of different radiologic methods for renal hemodynamic assessment are given.

Urolithiasis is one of the most actively progressing diseases, a metabolic disorder that is strongly associated with a combination of genetic, lifestyle, and environmental factors. The first part presents current views on the factors triggering the formation of stones and the theory of stone formation. More specifically, the article discusses factors that contribute to the activation and inhibition of nucleation and aggregation of stone-forming substances.

This literature review presents current data on epidemiology and views on the pathogenesis of male lower urinary tract symptoms. The authors discuss current options for the management of male lower urinary tract symptoms using a fixed-dose combination drug that includes one of the most selective and safe 1-blockers tamsulosin OCAS and the most selective of anticholinergic agent solifenacin.

Aim: To assess the results of organ-sparing endoscopic treatment of patients with tumors of the upper urinary tract (UUT)., Materials and Methods: Twenty four patients underwent percutaneous and ureteropyeloscopic interventions for tumors of the upper urinary tract and were followed up at the Urology Clinic, I.M. Sechenov First MSMU. Retrograde removal of benign tumors of the renal pelvis and ureter (tumors sized from 5 to 35 mm), percutaneous removal of papillary carcinoma of renal pelvis of a solitary kidney, percutaneous removal of papillary carcinoma of renal pelvis of only one functioning kidney and percutaneous removal of papillary carcinoma of the lower calyx of the L-shaped kidney were performed in 21, 1, 1 and 1 patients, respectively. The patients had stage T1 papillary cancer of the upper urinary tract. There were 7 (29.2%) men and 17 (70.8%) women with mean age 64+/-5 years. Electroresection/vaporization was carried out in 18 patients, and 6 patients were treated using Holmium laser., Results: None of the endoscopic procedures required conversion to open surgery or a more extended surgical operation. There were no recurrences or impaired UUT urinary flow in patients with benign UUT tumors at different points of follow-up. In 3 cases of malignant UUT tumors no recurrences occurred during 12-20 months follow-up., Conclusion: and discussion. Nephroureterectomy with resection of the urinary bladder is the standard radical treatment of patients with tumors of the UUT. Technological advances in endoscopic and percutaneous surgery for UUT have allowed for organ-sparing procedures in patients with neoplasms of pelvicalyceal system and ureter. The absolute indications for such organ-sparing operations now include solitary kidney or only one functioning kidney and chronic renal failure. Endoscopic resection of the tumor and renal pelvic wall within healthy tissue, including by holmium laser, with tumor stage not exceeding T1 and followed by trans-fistula chemotherapy can be regarded as an effective treatment for patients with tumors of pelvicalyceal system.

Urinary stone disease is a metabolic disorder tending to recur and having a growing proportion of younger patients. Current methods of surgical treatment do not guarantee the disease non-recurrence without effective subsequent metaphylaxis. At present, the principles of general and special (medical) metaphylaxis of urolithiasis have been developed and widely applied according to underlying metabolic disorders, the type of stone formation and risk factors for recurrence. Oversaturation of the urine with stone forming substances is a major factor in stone formation. Recommendations for using mineral water should not be given without a clear understanding of the expected effect of particular water. Its selection for treating urolithiasis depends on the chemical composition of the stones, underlying metabolic disorders, urine pH, the functional state of the gastrointestinal tract, concomitant diseases, etc.

In article experience of application of low-energy shock and wave therapy for men with a chronic pelvic pain syndrome is described.

Inflammatory diseases of the prostate are common among men. These diseases are frequently characterized by long-term course and relapses. Prostatitis-associated symptoms significantly reduce the quality of life of patients. Due to the lack of generally accepted criteria for the diagnosis of prostatitis, the frequency of inflammatory diseases of the prostate is difficult to establish. Inflammatory diseases of the prostate should be differentiated from chronic pelvic pain syndrome. The mainstay of treatment of infectious and inflammatory processes in the prostate are antibacterial drugs (generations III and IV fluoroquinolones). The recommended course of treatment includes 4-6 weeks. Prostate peptides from bovine (cytomedines) have proven efficacy in the treatment of patients with prostatitis; cytomedines influence the differentiation and proliferation of prostate cells, have anti-inflammatory and immunomodulatory properties. In clinical trials, high efficiency of cytomedines in prostatitis and prostate adenoma, as well as long-term remission of the diseases is demonstrated.

The pneumatic lithotripter LMA StoneBreaker has been tested and proved effective in removal of uroliths of different location. It is a reliable and comfortable in use modality of contact destruction of the stones of the upper and lower urinary tracts. This lithotripter is perspective for wide urological practice.

Acute gestational pyelonephritis (AGP) is considered to be a complicated urinary tract infection with altered urodynamics on the affected side. We analyzed minimally invasive treatment results achieved in 57 females with AGP. Pyelonephritis has been diagnosed basing on the results of physical examination, urinalysis and urine culturing. Conventional, Doppler ultrasound and MR tomography provided early diagnosis and AGP staging. A timely upper urinary tract drainage with an ureteral stent and adequate antibacterial and antiinflammatory treatment made it possible to avoid open surgical treatment and effectively treat 56 of 57 patients (98.2%). Out of 55 patients with 39-40 week pregnancy, 43 women had normal vaginal delivery and 12 delivered by the cesarian section. In two cases delivery by cesarian section at weeks 36-37 was performed because of individual intolerance of an ureteral stent. All the neonates were born healthy (7-9 points by Apgar score). Recently gained experience in early diagnosis and treatment of AGP and good follow-up results demonstrate a clear benefit from the use of minimally invasive diagnostic and treatment methods.

A new technique of urinary tracts visualization--magnetoresonance urography (MRU)--for a year (2000) was applied in examination of 25 patients aged 17 to 63 years with ureteral concrements (n = 11), ureteropelvic stenosis (n = 10), ureteral stenosis (n = 2), urinary bladder tumor (n = 1), Ormond's disease (n = 1). MRU provides the same information about the obstruction and dilatation of the urinary tracts as excretory urography (EU). In cases of EU contraindication (allergy, renal failure) or lack of contrast substance excretion, MRU allows to avoid additional invasive diagnostic procedures. It also enables visualization of non-dilated urinary tracts in medicinal polyuria. Non-invasiveness, no need to contrast, absence of radiation load open wide perspectives for MRU application in various groups of patients including pregnant women.

Potential of modern examinations in differential diagnosis of renal colic and other emergency states is considered. Renal ultrasonography permits in the majority of cases to make diagnosis based on dilatation of caliceal-pelvic system, sometimes with detection of obstruction cause. It is necessary to differentiate parapelvical cysts from dilatation of caliceal-pelvic system, therefore pharmacultrasonic examination of the kidneys with lasix is recommended. Color dopplerography of the urinary bladder with detection of urine ejection from ureters ostia is analogue of conventional invasive diagnostic method--chromocystoscopy. Magnetic-resonance urography is updated non-invasive, non-contrast and non-radiation method of diagnosis of urinary tract dilatation.

The results of operations on the organs of the abdominal cavity and the small pelvis in 70 men are analyzed. For evaluation of the condition of the urogenital system and urination parameters preoperatively all patients underwent ultrasound examination of the urine bladder and the prostate with the residual urine evaluation, uroflowmetry. Summary value of the symptoms was evaluated according to international system IPSS and the quality of life was assessed (QOL). 30 patients administered doxazosin according to the scheme: 2 preoperative days 2 mg/day, then 3 days--4 mg/day, and 3 postoperative days--4 mg/day. 5 patients dook tamsulosin 0.4 mg/day for 5 preoperative days and 3 postoperative days. 35 men took placebo, in this group acute anuria in postop period was detected in 4 patients (11.4%). All of them were over 60 years and had benign hyperplasy of the prostate, they initially had disturbances in urination (in average Qmax = 9.7 ml/sec, IPSS = 7, QOL = 3). Ischuria was absent in patients administered alpha 1-adrenoblockers. The authors suggest that probability of the development of acute retention of urine in postoperative period is higher in persons, suffering from benign hyperplasy of the prostate and in those, who have initial disturbances in urination. The use of alpha 1-adrenoblockers preoperatively and in early postoperative period allows minimizing probability of development of ischuria paradoxa in men.