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Physiotherapy is a treatment method for a wide range of diseases of various organs and systems. Its efficacy and practicability are of the great discussions during the past few decades. In urology, this method is used for treatment of erectile dysfunction (ED) caused by a violation of the trophism of genitalia due to radical prostatectomy, atherosclerosis, diabetes mellitus, Peyronie's disease. Shock wave therapy based on the remote action of a low-intensity focused acoustic wave is one of the widely used effective physiotherapeutic methods for the treatment of vasculogenic ED. The main effects of shock waves are neoangiogenesis, nerve fibers regeneration, deceleration of the cavernous fibrosis and reduction of the sympathetic outflow. Some technologies (e.g. radio waves) in addition to those effects also warm the tissues, what accelerates metabolism and improves regenerative processes. All shockwave and radiowave technologies have already demonstrated their efficacy compared with sham control. However, in the few comparative studies, no significant difference was found in efficacy between different technologies. Clinical guidelines consider physiotherapy only as an alternative treatment for patients with mild vasculogenic ED who are refractory or unresponsive to oral vasoactive therapy. Nevertheless, some studies make it possible to judge the efficacy of physiotherapy for treatment of patients with either etiology of the ED. The result of the ED treatment does not depend on the number of treatment courses, their duration, the number of pulses per course and the periodicity of therapy sessions. Also, the original studies have some major shortcomings (i.e. a large percentage of patients dropping out of follow-up). These factors cast doubt on the organotropism of physiotherapy. So, additional comparative studies are required to determine the optimal dosing regimen and to explore the influence of physiotherapy organotropic and psychological components on the results of the treatment. The study aimed to summarize the currently available data evaluating the efficacy of different physiotherapeutic technologies, to compare the efficacy of different technologies for ED treatment.

Renal cell carcinoma with inferior vena cava (IVC) thrombosis is a rare disease with a poor prognosis without surgical treatment. The presence of a tumor thrombus in the cavity of the main vessel in most cases is accompanied by massive bleeding during thrombectomy. To reduce the volume of blood loss, it is possible to use cardiopulmonary bypassto reduce the potential risks associated with blood loss and unstable hemodynamics. Sometimes tumor thrombosis can be growth into the vein wall or lead to occlusion IVC, we consider that it’s indication for resection of the IVC. Thrombectomy with laparotomy access can be performed even with type IV tumor thrombosis, if the thrombus is not fixed to the wall of the suprarenal IVC and surgeon have enough view of suprarenal segment.This article presents a variant of surgical treatment of patients with right kidney cancer, type IV IVC thrombosis, occlusion infrarenal IVC and ileofemoral thrombosis. In both cases we made resection IVC – infrarenal segment in first case and suprarenal segment in second case.

Steatocystoma multiplex is a disorder of the pilosebaceous unit characterized by multiple sebum-containing dermal cysts. We report the case of a 64-year-old male presented with multiple skin-colored, partially hyperemic cystic located in the scrotum area. They were accompanied by an active inflammatory process in the form of pain, swelling, hyperemia. The lesion was present for about 1 month. Previously, this patient had diagnosed with multiple steatocystoma located in the hip area and received surgical treatment.At present, such reports in the scientific databases are presented sporadically, therefore we report on multiple steatocystoma of the scrotal localization due to its rarity.

Kidney stones develop silently. Several markers revealing the activation of lithogenic process were proposed. Here we review the technologies behind these diagnostic tests and describe six groups of lithogenic activity markers: 1) indices and calculated supersaturations, based on concentration of stone forming and inhibiting ions in 24h-urine; 2) macromolecules or specific molecules in urine; 3) urine physical properties, 4) blood markers; 5) instrumental methods; 6) induced urinary crystal formation tests. The induced urinary crystal formation group is the most promising and successful. These tests can be used for revealing the periods of high lithogenic activity and guiding prompt treatment intensification. Convenient and affordable markers of lithogenic activity, applied regularly and remotely, make effective personalized recurrence prevention programs feasible.

Nowadays, the most notable negative effects of SARS-CoV-2 are the pulmonary manifestations as well as cardiovascular system damage. Evaluation of postvaccination changes in the male reproductive system and analysis of their mechanisms seem to be important because of their direct effect on fertility. Thus, it may play a significant role in perspective. Studies based on the application of fluorescence in situ hybridization showed that most acini epithelial cells, as well as some mesenchymal and endothelial cells were positive for SARS-CoV-2 RNA. As for co-expression of the ACE2 cell receptor and the serine protease TMPRSS2, which the virus uses to enter cells, it was also detected in most prostate epithelial and stromal cells. The mechanism of prostate damage in COVID-19 may also be related to dysregulation of the renin-angiotensin system. Increased levels of angiotensin-2 secretion in the prostate in patients with benign prostatic hyperplasia may increase the effect of the virus directly on the cells of the organ. These mechanisms may explain the elevated serum prostatic specific antigen levels in patients with benign prostatic hyperplasia during the active period of COVID-19. Non-specific mechanism of prostate damage is connected with coagulopathy development – thrombosis of venous plexus and hemodynamic disturbances, which can cause secondary damage of parenchyma. There is a definite relationship between the hormonal status of the patient and the severity of the infection – low levels of both testosterone and dihydrotestosterone contribute to the development of severe complications in patients infected with SARS-CoV-2. The possibility of using testosterone drugs in patients with hypogonadism and COVID-19 as an alternative treatment option – to suppress the cytokine storm phenomenon – is being considered. Patients with a history of prostate cancer, with localized prostate cancer in the absence of metastases participated in vaccine studies – among the side effects of vaccination in several cases only regional lymphadenopathy on the injection side of the drug was noted.

The purpose of this work is to study the functional and oncological results of minimally invasive methods in patients with verified prostate cancer.Materials and methods. In our study, 160 patients with identified prostate cancer were presented, treatment was carried out with minimally invasive methods (methods of cryoablation (n = 53), brachytherapy (n = 52) and HIFU therapy (n = 55)). A qualitative assessment of the oncological outcome revealed high levels of prostate-specific antigen (PSA) and the results of repeated transrectal prostate biopsies. The evaluation of functional indicators and quality of life was carried out according to the results of the IIEF-5 (International Index of Erectile Function), IPSS (International Prostate Symptom Score), QoL (Quality of Life), Qmax (maximum urination rate of function).Results. The results of oncological control according to the data of positive repeated biopsies were worse in patients after cryoablation (7.54 %), the best indicators of oncological results were observed in patients after brachytherapy. Looking at the IPSS results, it is possible to detect statistical signs of higher scores in the brachytherapy group when various signs are found in the postoperative period, however, these differences do not reach statistical signs in the late period in patients of group brachytherapy and cryoablation. Patients of the cryoablation group showed higher levels of the IIEF-5 in the postoperative period, in the late period of observation of erectile function in patients of the cryoablation group, the statistical data did not differ from those in patients after brachytherapy. Patients after HIFU therapy showed a decrease in de novo erectile dysfunction over a 3-year follow-up period, above average IIEF5 scores, below IPSS scores, and better QoL results.Conclusion. Long-term oncological results are, in general, revisions, however, the recurrence rate is slightly higher in patients after cryoablation. Prostate cancer recurrence was detected in patients of the ISUP 3 group. In patients after HIFU therapy, the quality of urination is higher than in patients of other groups, which can be associated with the laser enucleation of prostate hyperplasia performed by him. The advantage in patients after HIFU therapy was observed in the detection of IIEF-5, thus HIFU therapy had a better effect on the quality of life of patients with pathological prostate cancer.

Introduction. Transvaginal mesh-reconstruction of urogenital prolapse remains a controversial trend in modern urogynecology. We have seen growth in transvaginal mesh surgery since 2004, followed by a sharp decline after 2011 due to FDA restrictions related to imperfections in previously available prostheses and implantation techniques. Improving the efficacy and minimizing complications of transvaginal mesh-surgery is at the forefront of research in the field of modern urogynecology.Purpose of the study. To optimize the indications for transvaginal mesh-reconstruction of anterior apical prolapse.Materials and methods. The study enrolled 375 patients with anterior apical prolapse. The grade of prolapse was assessed using POP-Q. In patients with endopelvic pelvic fascia insufficiency, severe cystocele (Aa ≥ +1) and hysteroptosis grade II – IV, the correction was carried out using the six-arm OPUR® («ABISS», Saint-Étienne, France). lightweight polypropylene monofilament implant (n = 290). When the cystocele was not prominent (Aa ≤ -1) and grade III – IV hysteroptosis, posterior sacrospinal hysteropexy was preferred with the CYRENE® («ABISS», Saint-Étienne, France) tape (n = 85). In 35 patients, the operation was combined with anterior colporrhaphy. In 5 patients, a simultaneous conization/amputation of the cervix was performed. The examination was performed 1 month after surgery and then annually. Prolapse ≥ grade II was as recurrent. The follow-up period of 67 patients was more than 4 years.Results. After OPUR® prosthesis implantation, recurrent hysteroptosis was detected in 6 women with cervical hypertrophy / elongation within a period of 1 mo to 3.5 yr and cystocele in 4 patients. The efficacy was 96%. In 9 patients, an postoperative ischuria was found associated with extensive dissection and hypotension of the bladder wall due to chronic urinary retention in severe cystocele. Urination improved in 88% of cases. In the remaining cases, long-term mediator and hormone replacement therapy were continued., One recurrent hysteroptosis was observed during the implantation of the CYRENE® prosthesis. No damage to the bladder was observed. Acute urinary retention was detected in 1 case, which resolved after intermittent catheterization. Conclusion. The availability of 2 types of transvaginal prostheses for various degrees and configurations of urogenital prolapses allows a differentiated approach to their choice. Both prostheses suggest reliable «reconstruction-imitation» of the sacroiliac ligament by sacrospinal hysteropexy. If necessary, the operation can be supplemented with anterior colporrhaphy. The prevalence of anterior prolapse with endopelvic fascia insufficiency requires more extensive reconstruction, which can be performed relatively safely and effectively by implantation of a 6-arm OPUR® prosthesis.

The study objective is to improve results of treatment of patients with low-risk prostate cancer (PC).Materials and methods. In the study, comparative analysis of data from 84 patients with low-risk PC was performed: 40 patients were included in the active observation group (group 1) and 44 patients underwent radical prostatectomy (group 2). For evaluation of functional responses the following questionnaires were used: Short Form 36 Health Quality Survey (SF-36), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26). For control of oncological results, tests for prostate-specific antigen, digital rectal examination, magnetic resonance imaging of the pelvic organs with intravenous contrast, and confirmation biopsy of the prostate were preformed.Results. Mean score for the SF-36 questionnaire in the group 1 (active observation) at the beginning of the study was 63.2 ± 11.5 for mental health (MH) and 57.1 ± 9.8 for physical health (PH), while in the group 2 MH score was 63.1± 6.8, PH score was 56.2 ± 8.6. However, 18 months later in the group 1 mean MH score increased to 68.2 ± 10.1, mean PH score to 62.4 ± 7.8; in the group 2 PH score increased insignificantly to 64.2 ± 7.4 and PH score decreased to 54.8 ± 5.4 (p

Introduction. An original research work was performed to assess split kidney function by glomerular filtration rate (GFR) with mathematical analysis of the kidneys computed tomography (CT) data in patients with kidney stone disease (KSD). Objective was to evaluate the GFR and the parenchyma structure of each kidney and identify the possible patterns of contrast medium intrarenal transport with mathematical analysis of the kidneys CT data in patients with KSD.Materials and methods. Data of 27 patients of both genders with KSD were retrospectively analyzed. To evaluate GFR separately for each kidney we analyzed the data of contrast-enhanced CT (GFR reference values are 0.55 % of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size ≤1,5-2,0 cm, no obstruction of the urine flow registered; 3) no kidney or upper urinary tract surgical history; 4) age - ≤45 years; 5) no severe chronic diseases. All of these allowed to minimize influence of any other disorders on split renal function except for SKD and conduct per se research.Results. The mathematic analysis of the contrast-enhanced CT data revealed GFR changes in 26 (96.3 %) out of 27 patients. Hyperfiltration was found in 12 (44.4 %) patients: right kidney GFR - 0.6-0.77 %, mean value - 0.65 %; left kidney GFR - 0.59-0.79 %, mean value - 0.67 %. Hypofiltration was found in 13 (48.1 %) patients: right kidney GFR - 0.2-0.54 %, mean value - 0.37 %; left kidney GFR - 0.2-0.53 %, mean value - 0.4 %. The GFR values significantly differed between the groups both for the right (p = 0.000014) and left (p = 0.000045) kidneys. We found no significant age-related difference between the groups (p = 0.895). As well as that no significant differences in Resistance Index both in magistral (right kidney: p = 0.221; left kidney: p = 0.850) and segmental (right kidney: p = 0.306; left kidney: p = 0.957) arteries between the groups with hyperfiltration and hypofiltration were observed. One patient demonstrated no changes in GFR, and the other one had hyperfiltration (0,62 %) in one kidney and hypofiltration (0,48 %) in another.Conclusion. Most of the patients (92.6 %) with SKD demonstrate GFR changes (either hyperfiltration or hypofiltration) that may indicate the disturbed intrarenal blood and urine flow through the kidney.

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p

The study objective is to study the role of multiparametric magnetic resonance imaging (mpMRI), to predict extracapsular extension, infiltration of the seminal vesicles, neurovascular bundles and status of positive surgical margin (PSM) in robot-assisted radical prostatectomy (RARP) with fascio- and nerve-sparing and anatomy-sparing techniques in patients with low and intermediate oncological risk; to evaluate safety of RARP with anatomy-sparing techniques in the context of oncological results in the studied patient cohort.Materials and methods. Fifty-four males underwent mpMRI in the device with magnetic field density 3 Tesla without endorectal coil. Results of mpMRI were analyzed using PI-RADS v.2. Prostate-specific antigen level, results of prostate biopsy, nomogram were analyzed. All patients were included into groups with low and intermediate oncological risk. The patients underwent RARP with anatomy-sparing techniques. Gross specimen removed during the surgery was stained with tissue stain DECOLA and subjected to stepwise pathomorphological analysis. Comparative analysis of tumor lesion localization was performed for mpMRI and pathomorphological examination. The study concentrated on the largest tumor lesion locations. The anterior surface of the prostate was examined in detail. Patients were classified per risk groups in accordance with the National Comprehensive Cancer Network (NCCN) and D'Amico criteria.Results. Full or partial overlap of the lesions per mpMRI and pathomorphological examination were observed in 48 (88.9 %) patients; locations of tumor lesions disagreed in 6 (11.1 %) patients. PSM was detected in 8 (14.8 %) patients; among them in 7 (12.9 %) the size was between 0.1 and 0.4 cm. On the anterior surface of the prostate 3 (5.5 %) PSM were observed, 2 of which were between 0.14 and 0.4 cm, 1 was multifocal, larger than 0.3 cm. Per mpMRI results and histological examination, the anterior surface (fibromuscular stroma) was affected in 14 (25.9 %) and 11 (20.4 %) cases, respectively. Among them, lesion locations overlapped in 11 observations. Results of anatomy-sparing RARP show increased PSM rate compared to traditional nerve-sparing based on the anterior surface of the prostate.Conclusion. Routine mpMRI for patients who are planned to undergo RARP allows to justify selection of anatomy-sparing RARP or rejection of modification in favor of more thorough dissection. mpMRI plays a significant role on planning of anatomy-sparing RARP, achievement of negative surgical margin in patients with low and intermediate risk of oncological progression. Evaluation of the location and size of cancer lesion in the prostate allows to plan for special aspects of anatomy- and/or nerve-sparing techniques, achieve lower PSM rate, optimize oncological and functional surgical results in localized prostate cancer.

The study objective is to improve results of treatment of patients with prostate cancer (PC) and low oncological risk.Materials and methods. Since November of 2019 at the Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University 40 patients with PC and low oncological risk were included in the protocol of active observation. In all patients, the level of prostate-specific antigen was evaluated every 3 months, digital rectal examination was performed every 6 months, magnetic resonance tomography of the pelvis with intravenous contrast was performed every 12 months. Confirming biopsy of the prostate was performed once, 1 year after the beginning of observation. Every 6 months patients' quality of life was evaluated using the SF-36 (Short Form 36 Health Quality Survey), IIEF-5 (International Index of Erectile Function), IPSS (International Prostate Symptom Score), EPIC-26 (Expanded Prostate Cancer Index Composite) questionnaires.Results. Two (5 %) patients underwent surgical treatment due to PC progression. One (2.5 %) patient preferred treatment due to oncological anxiety. Mean value per the SF-36 questionnaire at the beginning of the study was 63.2 ± 11.5 for psychological component of health and 57.1 ± 9.8 for physical component of health. At the moment, the assessment of the psychological and physical components of health according to SF-36 is 69.5 ± 12.4 and 66.3 ± 8.9 points, respectively. Mean IIEF-5 value at the beginning of the study was 18.8 ± 4.2, currently it is 18.6 ± 3.9. At the beginning of the study mean IPSS value was 9.1 ± 2.1, currently it is 9.4 ± 1.9. For the EPIC-26 questionnaire mean value for all criteria initially was 56.1 ± 5.1, currently it is 68.2 ± 4.6.Conclusion. First results of active observation of patients with PC and low oncological risk demonstrated that this approach allows to avoid unnecessary treatment of patients who do not require immediate intervention and to start treatment on time in cases where it is required while preserving high quality of life for the patients.

Objective of the study. To evaluate results of robot-assisted laparoscopic radical prostatectomy in the framework of a surgeon’s learning curve; to evaluate the effect of reconstruction of the ligamentous apparatus of the lower pelvis on early recovery of urine retention.Materials and methods. 246 patients were divided into 3 groups depending on the surgery date. The analyzed data was accumulated prospectively and retrospectively. Preoperative characteristics (TNM stage, PSA, ISUP), intraoperative characteristics (surgical time, blood loss volume, surgery type and character, type of reconstruction of the ligamentous apparatus of the lower pelvis) and postoperative characteristics (duration of bladder drainage with a urethral catheter, level and time of recovery for urine retention and erectile function) were evaluated. Reconstruction of the ligamentous apparatus of the lower pelvis was performed through reconstruction of the Denonvillier fascia (Rocco stitch), as well as through suturing fibers of the bladder neck with periurethral tissues and residual puboprostatic ligaments for stabilization of the urethrovesical complex.Results. All operations were successfully completed without conversions or transfusions. Median surgical time was 160 minutes (p = 0.0001). Median blood loss was 173.3 cm3 (p = 0.0002). Mean prostatic volume was 36 cm3 (29–47.5 cm3), and overall frequency of positive surgical margin was 12.82 %. Overall frequency of urine retention recovery was 51.6 % after 3 months, 63.7 % after 6 months (p >0.05). In the patient group with reconstruction of the ligamentous apparatus of the lower pelvis, frequency of urine retention recovery was higher than in the group without reconstruction: 64.1 % vs 45.3 % (after 3 months, р = 0.041) and 74.7 % vs 62.3 % (after 6 months, р = 0.034). Conclusion. Surgical time, blood loss were significantly decreased with the number of performed operative interventions. Significant improvement of early urine retention recovery was observed in the patient group with reconstruction of the ligamentous apparatus of the lower pelvis.

Introduction. Currently, a large number of different surgical methods have been developed for the treatment of postcoital dysuria caused by hypospadias and urethral hypermobility. However, the literature does not reflect clear criteria and indications for a particular treatment method. Various modifications of the traditional urethral transposition can be accompanied by traumatic injury to the abundantly innervated paraclittoral and paraurethral zones, which provokes sexual disorders, up to anorgasmia. The search continues for new, effective, but less invasive techniques compared to traditional surgical transposition.Purpose of the study. To assess the efficacy and safety of a combined technique: removal of urethra-hymenal adhesions along with a paraurethral injection of gel filler.Materials and methods. 83 patients with hypospadias and urethral hypermobility complicated by postcoital dysuria were treated since 2015. The age ranged from 17 to 40 years. Examination revealed urethro-hymenal adhesions of varying severity and positive O’Donnell-Hirschhorn test in all women. One patient had previously undergone urethral transposition with a temporary effect. All women underwent surgical treatment, which consisted of the urethro-hymenal adhesions removal and suburethral injection of hyaluronic acid-based filler. The bulking gel (1-2 ml) was injected in a fan-shaped manner paraurethrally in from the point at 6 o'clock of the conventional dial. Thus, a «gel pad» was created, which lifts the meatus and the distal urethra, limiting their mobility and traumatization during intercourse. No complications were observed. The postoperative examination was performed after 1, 6, 12 months.Results. An improvement in the quality of life was noted in 74 patients (89%) (UDI 6 and PISQ-12 questionnaires). The external urethral orifice was not displaced inwards, the urethra projected above the vaginal entrance during the vaginal examination and the O’Donnell-Hirschhorn test. In 13 (15.5%) patients, the biodegradation of the gel was accompanied by the return of symptoms of various degrees in different terms after the operation (from 8 to 13 months). 8 women required repeat injections of the filler; four patients needed 2 injections and 1 patient needed three injections. The repeated manipulations were performed under local anaesthesia. In 8 cases (9.6%), continued urination disorders were noted despite the termination of the dominance of postcoital dysuria, which required additional complex treatment. Improvement of sexual life was observed in 89% of all operated women according to the described technique. Urethral transposition was not required in any of the patients.Conclusions. The combined technique improves the treatment's results of female hypospadias and urethral hypermobility complicated by postcoital dysuria with minimal development risk of complications. The disadvantage is the natural bulking gel biodegradation, which may necessitate its reimplantation.

The article presents a review of Russian and international literature dedicated to the problem of painful ejaculation. Mentions of this type of disorders are quite rare. Its real incidence remains unknown. Connections between painful ejaculation and infectious and inflammatory diseases (orchitis, epididymitis, prostatitis, vesiculitis, urethritis), previous surgeries (in particular, transurethral resection of the prostate), administration of certain drugs (for example, antidepressants), rare congenital developmental anomalies are considered. Data on the effectiveness of conservative and surgical treatment are presented.

Introduction. Urethral transposition remains the most popular operation for postcoital cystitis, however, traumatism and complications, especially such as pudendal neuropathies, dyspareunia and anorgasmia, make us continue to search for effective, but safer techniques.The study objective is to evaluate the efficacy and safety of the proposed treatment of postcoital cystitis, including removal of urethrogymenal adhesions and subsequent paraurethral filler implantation, in comparison with isolated hymenoplasty.Materials and methods. Since 2013, 75 patients with postcoital cystitis have been treated. Patients were divided into two groups: main group – hymenoplasty (removal of urethral adhesions) with paraurethral filler implantation (n = 45), control group – hymenoplasty (n = 30). The gel was injected paraurethrically, fan-shaped, in the volume of 1–2 ml, from a point on the 6-hour conditional dial, creating a gel cushion and thus raising the meautus and distal urethra. To assess the quality of treatment, profile questionnaires were used.Results. In the main group of patient, the quality of life improved in 35 (78 %); in 5 patients, due to the process of biodegradation of the gel during 1 year, the cystitis recidivated, which required the filler reimplantation. In 5 patients, the operation was not effective. In the control group the efficiency of isolated hymenoplasty was noted in 3 (10 %) patients, relapse of cystitis occurred in 27 (90 %) patients, which later required the implantation of a filler. No complications were observed.Conclusions. The suggested combined technique allows to improve the results of treatment of patients with postcoital cystitis. The operation does not carry the risk of damage to the sprigs of the genital nerve, can serve as an alternative to traditional urethral transposition. The main disadvantage is the natural biodegradation of the gel, which may create the need for its reintroduction.

The study objective is to evaluate the effectiveness and safety of the 6-arm mesh OPUR implant in treatment of anterior apical prolapse. Materials and methods. Three hundred patients with anterior apical prolapse (grade III–IV cystocele, grade II–IV hysteroptosis) underwent surgery. Prolapse repair was performed using the 6-arm mesh OPUR implant.Results. In 290 patients, the intended result was achieved (full prolapse elimination or stage I prolapse per the POP-Q (Pelvic Organ Prolapse Quantification System)). However, in 6 cases recurrences of hysteroptosis, in 4 cases recurrences of cystocele were diagnosed. The following postoperative complications were observed: hematoma of the anterior vaginal wall with spontaneous resorption in 12 patients; acute urinary retention resolved in 3–7 days after the surgery in 5.8 % cases; vaginal mucosa erosion in 4 cases (in 2 cases, fragment resection was necessary); intraoperative injury of the bladder in 3 patients (in 2 cases, prolapse repair after defect suturing was finished with transvaginal contralateral sacrospinous hysteropexy supplemented by anterior colporrhaphy; in 1 case, bladder defect was sutured prior to implantation). Conclusion. Transvaginal repair of anterior apical prolapse of the pelvic organs in women using the 6-arm implant is effective and relatively safe. Satisfactory anatomical results persisting for a long time (4–5 years) after implantation were achieved.

The study objective is to evaluate effectiveness and safety of Tadalafil-SZ (NJSC “Northern Star”) at 5 mg / day in treatment of patients with symptoms of voiding dysfunction due to prostatic hyperplasia.Materials and methods. The study was conducted at the “Family Polyclinic No. 4” between January and June of 2019 and included 74 patients. Effectiveness was evaluated using the International Prostatic Symptom Score, International Index of Erectile Function, maximum urine flow rate and transrectal ultrasound examination.Results. After 3 months of therapy with tadalafil, positive dynamics of all characteristics were observed. Symptom severity prior to treatment was 11.50 ± 0.27 points, after treatment it was 10.00 ± 0.31 points. Maximum urine flow rate prior to treatment was 10.80 ± 0.20 ml / s, after treatment it was 11.10 ± 0.19 ml / s. The International Index of Erectile Function increased from 16.60 ± 0.30 prior to treatment to 20.20 ± 0.24 after treatment. Prostate volume before treatment was 43.70 ± 0.87 cm3, after treatment it was 40.30 ± 0.72 cm3.Conclusion. Tadalafil at 5 mg / day significantly decreases symptoms of voiding dysfunction and prostate volume, improves erectile function.

Prostate cancer (PCa) is the most common oncological disease among men. It is important to note that over 50% of the first identified primary malignant neoplasms of prostate are low - risk PCa. Recently, radical prostatectomy and external beam radiation therapy have been the standard treatment options for PCa. According to recent data, patients with low - risk PCa have a favourable prognosis because of the slow progression of the disease. Some studies show no links between 10-year cancer - specific survival and treatment modalities and no progression even in the absence of therapy. Active surveillance (AS) allows avoiding unnecessary treatment in men who do not require immediate intervention but achieves the correct timing for curative treatment in those who eventually need it. According to the guidelines of the European Association of Urology, AS is one of the standard treatment options for low - risk PCa and should be consideredfor all patients in this category. The advantage of AS is to improve the quality of life in men with low - risk PCa and to delay surgical interventions as much as possible. However, despite widespread AS worldwide, there are only a few centres, which use it routinely in Russia. In this review, we would like to shed some light on the most important questions of AS strategy: what criteria should we use for selection of patients for AS strategy? How often should patient visit the urologist, control PSA level, and undergo prostate biopsy? When should a doctor change strategy and turn to active treatment? In this article, we considered indications for AS in men with PCa and showed the most recent data on the efficacy and relevance of this modality.

The study objective is to compare the effectiveness and safety of using 4-and 6-arm mesh prostheses in transvaginal correction of urogenital prolapse.Materials and methods. From 2013 to 2018, 164female patients with grade II—IV prolapse of the pelvic muscles underwent surgery. Reconstruction of the pelvic floor using 4-arm prosthesis Prolift anterior was performed in 54 (33 %) patients (group 1), 6-arm prosthesis OPUR — in 110 (67 %) patients (group 2). The patients’ age varied between 45 and 76years (mean age 56.3 years). All women previously delivered children (69 % delivered 2 or more children). In 73 % patients, labor was complicated by raptured cervix and/or groin, episioto-my, fetal skull remaining stationary above the pelvic brim. In 25 % of women, grade IV cystocele was diagnosed at the time of examination, in 62 % — grade III, in 13 % — grade II; grade IVhysteroptosis was diagnosed in 12 % of women, grade III — in 54 %, grade II — in 34 %.Results. In the group 1, cystocele was corrected in 90 % of cases, hysteroptosis — in 75 %. Mean blood loss was 150.0 + 69.6 ml. Operative time varied between 60 and 169 min. In the group 2, cystocele was corrected in 100 % of cases, hysteroptosis — in 98 %. Mean blood loss was 125.0 + 59.6 ml. Operative time varied between 38 and 143 min. Women noted decreased emotional tension during sex.Conclusion. Disadvantages of 4-arm meshes include worse correction of hysteroptosis and significant complications, rate and grade of which lead to a decrease in manufacture of the prosthesis. Modern 6-arm mesh prosthesis OPUR is safer and more effective. Its construction and method of implantation were developed with the goal to eliminate the main disadvantages of 4-arm prostheses.

The study objective is to perform comparative analysis of the effectiveness of enucleation, enucleoresection, and resection in renal sinus tumors.Materials and methods. Examination and treatment of 55 patients aged 28–74 years with intrasinous neoplasms of the kidneys of T1–T3 stage was carried out to perform a comparative analysis of the various operations effectiveness: 28 patients underwent organ-preserving operations (enucleation and enucleoresection), 27 – resection. Both groups were statistically comparable by sex, age, location, tumor volume. The most frequent histological variant of the tumor for any type of operation was clear-cell carcinoma (73 %).Results and conclusion. It is established that organ-preserving operations, unlike resection, involve a significantly shorter time of thermal ischemia, allowing the operation to be performed under conditions of zero-ischemia. This was accompanied by an improvement in treatment outcomes, a significant regression in the number of intraoperative and postoperative complications.

Introduction. In recent years, due to the progressive increase in the prevalence of castration-resistant prostate cancer (CRPC), the question of the sequence of prescription drugs is becoming more acute.Objective is to compare the effectiveness of various regimens of treatment of CRPC with the use of abirateron acetate and docetaxel. Materials and methods. The analysis included 83 patients with CRPC, which were divided into 2 groups depending on the sequence of appointment of abiraterone acetate and docetaxel.Results. Differences in the level of 2-year survival were statistically insignificant (73,2 % in the 1st group, 69 % in the 2nd group), and 3-year survival significantly differed: in the 1st group – 29,3 %, in the 2nd group – 16,7 % (p

This review analyze data of clinical trials, systematic reviews and meta-analyses, which evaluated the sensitivity and specificity of any biomarkers using for diagnostics of prostate cancer before an initial prostate biopsy or after a negative initial biopsy.

Introduction. Renal cancer constitutes 2–3 % of all tumors of the human body. Annually worldwide renal cancer morbidity increases by 2 %, about 90 % of cases are localized in the parenchyma. Currently, treatment of localized forms of kidney cancer increasingly incorporates kidney-preserving technologies.The objective is to evaluate the rate and causes of local renal cancer recurrence after laparoscopic resections of the organ for treatment of localized renal parenchymal cancer.Materials and methods. Retrospective analysis of 459 laparoscopic resections performed between June of 2011 to May of 2017 at the R. M. Fronstein Urology Clinic of the I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia was performed.Results. Of 459 patients who underwent endoscopic surgical kidney resections with video, 399 patients were diagnosed with renal cancer during planned histological examination, among them 3 (0.75 %) patients had local recurrence. All patients were operated on with laparoscopic access, in 1 case the surgery was complicated by intraoperative bleeding which required conversion to nephrectomy. At the time of primary surgery, all patients with cancer recurrence were diagnosed with stage Т1b. Clear cell renal cell carcinoma was verified in all patients by morphological examination, and malignancy grade (nuclear differentiation) per the Furman grading system was 2 (in 2 patients) and 3 (in 1 patient). In 2 patients, local recurrence was diagnosed 6 months after the surgery, in 1 patient – 12 months after the surgery. One case of local recurrence in the area of previous resection was detected, in 1 case dissemination of the process through paranephric tissue (apart from local recurrence) was observed, and 1 case of recurrence in the bed of the removed kidney was diagnosed. All patients underwent repeat surgery in the clinic: 2 patients were operated on laparoscopically, 1 patient underwent open surgery.Conclusion. In our opinion, prevention of local recurrences requires careful selection of patients for laparoscopic kidney resections, especially if patients have stage Т1b or higher. Technically complicated resections for deep tumor invasion into the sinus, as well as for wide tumor base, are recommended for patients with invariable indications. Nephrectomy is preferable for relative indications for resection. In the preoperative period, the presence and thickness of tumor pseudocapsule must be evaluated, and multicenter localization should be ruled out. Good technical equipment for laparoscopic kidney resection and observation of oncological principles during surgery decrease renal cancer recurrence risk. During morphological verification of renal parenchymal tumors with high oncological potential for progression and in the presence of positive surgical margin and tumor pseudocapsule invasion, control spiral computer tomography of the abdominal organs with intravenous contrast should be performed in the first 3 months after the surgery.

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical removal of prostate adenoma. It allows to quickly remove infravesical urinary tract obstruction, but at the same time it increases the risk of erectile dysfunction, one of the most important possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in urological practice.The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution of modern laser technologies and changes in approaches to preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of EF disorders after endoscopic surgeries for BPH removal, as well as to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its recovery is significantly quicker after ThuLEP; therefore, the last method is recommended for patients interested in quick EF recovery.

The composition, structure and specific features of urate calculi are discussed in the article. It was shown that they consist of 95% of uric acid and its salts on an average by the X-ray phase and energy dispersive analysis of a number of samples extracted from the urinary tract of 24 urological patients. The mechanism of formation of urate stones is considered. It is noted that urate stones are formed at a urine under pH below 5.5. The factors reducing the development of urinary urolythiasis and uraturia are indicated. The drugs commonly used for the treatment and prevention of urate nephrolithiasis are listed. The role of phytotherapy is underlined in the treatment of urolithiasis in general and urate nephrolithiasis in particular. It is concluded that the composition of plant compositions should include natural compounds of the alkaloid class. The most promising compositions of medicinal plants were determined, and the effect of herbal extracts of various compositions on the pH of the solution and the loss of stone mass

The latest guideline of the European Association of Urology (2016) for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH).Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium) of the prostate according to the literature data and own observations.Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP), 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP). All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS), patients’ quality of life (QoL), peak flow rate (Qmax), and residual urine volume prior to surgery and 1 month after it.Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05)Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

Holmium laser enucleation of the prostate (HoLEP) was first described by doctor P.J. Gilling et al. from New Zealand in 1996. The operation involves anatomical dissection of the prostatic tissue off the surgical capsule using a high-powered holmium laser followed by intravesical morsellation. The objective of this article is to explain the techniques for HoLEP.

Prostate cancer (PC) is the most frequent cancer among men in the world. At current PC takes 2nd place in men mortality among all oncological diseases. Histological grading is an important part of the diagnostic evaluation. The most commonly used grading system is the one described by Gleason. The choice of optimal PC treatment becomes complicated due to the fact that different methods have the same oncological results but differ in their complications. From a prognostic point of view, it is of considerable interest to know how accurate the needle biopsy Gleason score is in predicting the final score of the radical prostatectomy specimen. This paper describes comparative analysis of the histologic data before and after radical prostatectomy patients with low pre-operative cancer risk.

Hydronephrosis (HN) is a disease characterized by progressive distention and dilation of the pyelocaliceal system, which are caused by pelvoureteral segment stenosis and urine outflow problems. Increased hydrostatic pressure in the pyelocaliceal system gives rise to parenchymal atrophy and diminished renal function. Prior to the end of puberty, HN is more common in boys than in girls. In 20-to-40-year-old adults, HN occurs in 1 % of cases; being 1.5 times greater in women than in men. Modern urology has achieved a notable advance in treating patients with HN. Highly informative diagnostic techniques allow the detection of this disease at early stages and the choice of the most effective approach to managing the patients. The first laparoscopic pyeloplasty was performed by W. Schuessler in 1993. Up to date, it is the gold standard for HN surgery. Pelvoureteral segment stenosis and HN are often complicated by secondary lithogenesis. The quest of novel effective procedures for pyelocaliceal litholapaxy is due to technical complexities and a large number of residual calculi. This paper describes the use of flexible pyelocaliceal lithoextraction in a patient with secondary renal calculi during laparoscopic pyeloplasty.

Even in the mid-twentieth century, Huggins and Hodges proved the susceptibility of prostate cancer cells to hormonal manipulations, by using surgical castration as an example. An average of 18–36 months after initiation of first-line hormonal therapy, patients develop the castration resistance in prostate cancer, one of the causes of which was hyperproduction of the tumor receptors of prostate cancer cells and their hypersusceptibility to the castration levels of testosterone. Long-term treatment in patients with castration-refractory prostate cancer was extremely symptomatic and quality of life and overall survival were low. In the 2000s, investigations aimed at designing drugs to treat this category of patients were underway, which have culminated in the advent of three drugs (two of which belong to chemotherapy) that are now used in the Russian Federation. The second-line hormonal agent abiraterone acetate (Zytiga) is one of these drugs, which was officially registered in 2011. Its mechanism of action is due to inhibition of the enzyme CYP17, leading to the blocked synthesis of testosterone at all levels, including at the intracrine level, and achieving testosterone levels below the postcastration ones. The paper reviews the literature regarding abiraterone acetate and the first experience in using second-line hormonal therapy in three patients.

The work presents the results of a research on the effect of water extracts of herbal preparations on phosphate concrements of different phase composition taken in vitro from 56 patients. Interrelation between the composition of the extracts and the pH of urine was found. Recommendations on the selection of herbal preparations providing favorable conditions for the litholysis of phosphate concrements were given.

Most patients lower urinary tract symptoms (LUTS) caused both mechanical and functional factors. Timely identification of the nature of urodynamics, primarily of bladder outlet obstruction and detrusor overactivity, in patients with benign prostatic hyperplasia is of practical importance, since without this factor significantly worse functional outcome of surgical treatment. α1-adrenoblockers are the first line therapy for men with bothersome LUTS. They should be offered to patients with moderate to severe LUTS. Choosing α1-adrenoblocker should lean toward more selective class representatives. Selectivity α1-adrenoblocker provides high efficiency along with a low percentage of adverse effects, especially for cardiovascular system.As well as α-adrenoblockers, M-cholinobloсkers varying degrees of selectivity of the impact is on the bladder. Solifenacin is more selective for the bladder than tolterodine and oxybutynin. The selectivity of the drug with respect to the bladder is reflected in the relatively low frequency of adverse effects, especially occurrence of dry mouth in its application, as well as the possibility of long term therapy. Combined treatment with α1-adrenoreceptor antagonist with M-cholinergic antagonists may be considered in patients with moderate to severe LUTS with a predominance of filling symptoms, especially if monotherapy led to relief of symptoms.

The article describes a novel technique of performing transurethral cystolithotripsy in gas (carbon dioxide) medium, and the results of its first usage in 30 patients with bladder stones, compared to transurethral cystolithotripsy in conventional liquid medium in 30 patients. Data analysis shows that the rate of stone destruction in gas media was 1.47 times higher in small (less than 10 g) stones and 2.3 times higher in large (more than 10 g) stones as compared to surgeries conducted in liquid media. Also, we concluded that our proposed technique is safe and has advantages when compared to conventional surgery in liquid media. This is absence of increased stone mobility, better visualization during surgery and higher economic efficacy (5 times on average).

This article dedicated to features of retropubic adenomectomy after penile prosthesis.

Buserelin is one of the first synthetic gonadotropin-releasing hormone agonists. The R.M. Fronshtein Clinic of Urology, I.M. Sechenov First Moscow State Medical University, has experience in using Buserelin depot in 32 patients with metastatic prostate cancer. The results of using Buserelin depot for 12 months are described. There was a significant reduction in prostate-specific antigen levels in the entire group.Twenty-seven (84.4 %) patients could achieve tumor stabilization. Twenty (62.5 %) of the 32 patients treated with Buserelin depot at the Clinic of Urology showed decreased residual urine; 9 (28.1%) had no changes and 3 (9.4 %) displayed increased residual urine. The administration of the drug caused significant bone pain relief in 76.5 % of the cases.All the Buserelin depot-treated patients satisfactorily tolerated the given treatment. There was either concomitant disease progression or treatment discontinuation in none of the cases. Thus, Buserelin depot proved to be an effective drug with a good safety profile.

Training of muscles of a pelvic bottom under control of biofeedback is applied at 87 patients with an urinary incontinence after a radical prostatectomy. Biofeedback increases management and control of a pelvic floor. At good ability of management of muscles of a pelvic floor the median of restoration was 4 months. Without opportunity of management of muscles of pelvic floor restoration was 9.4 months.

The adequate varicocele treatment is still unclear. After the comparison of clinical and morphological data (results of physical examination of the patients, value of resistive index in Doppler sonography, morphological analysis of incision biopsies obtained during left-sided varicocele operative treatment from 35 boys with age from 10 to 15 years and 10 adults) we conclude about compensatory reactions in scrotal vein walls at all stages of varicocele development, especially in 3rd type veins. In adult patients with varicocele morphological changes in veins were more significant – vein wall prominent sclerosis was found, therefore operative treatment of this group patients seems to be more expedient.

We investigated biosises obtained from children with different varicocele stages and showed the possibility of remodeling development in different type vein walls. Most typical changes were found in the third type vein walls – multiple rolls, composed of muscular and collagen bundles; in the larger first and second type veins markers of arterialization were seen. These processes are the manifestations of adaptive response, which is connected with elevated venous pressure; they can improve testicular hemodynamic.

Kidney biopsies obtained from 3 days – 12 years children with congenital hydronephrosis during nephrectomy operation were investigated under the light microscopy in our study. Also we did immunohistochemical reactions. The aim of our study was to reveal the growth factor influence on maturation and vascularisation of kidney parenchyma. We showed, that the low VEGF expression in association with higher expression of TGF-β1 and its receptors – R1 and R2 – on different structures of nonfunctioning or hypoplastic kidneys in children might be a criterion of abnormal angio- and nephrogenesis.

The case presented is a demonstrative example of dangerous complication after penile prothesis implantation. Pelvic abscess with purulent fistula was a result of incorrect three-piece implant usage. Infectious complication was caused by the reservoir of the implant. In the event of such complications is necessary to use the full range of modern methods of radiation diagnosis.

30 patients with congenital hydronephrosis were divided into two groups according to the degree of morphological changes. The first group consisted of 12 men with age from 23 to 57 years; the second one – of 18 men with age from 21 to 61 years.We did morphometry studying of kidney structure main parameters and proved an important role of vessel malformation – it was the background for secondary morphological changes, which were more expressed in the second patient group. Intraparenchymal vessel Doppler sonography study correlated with congenital morphological changes.Therefore Doppler sonography confirmed an important role of vessel malformation in congenital hydronephrosis and secondary morphological changes development without the correlation between these processes and age of the patients.

At a choice of a way of treatment of the localized prostate cancer not the last place is occupied by an assessment of possible complications after the executed operation. In structure of all postoperative complications cicatricial changes take only the third place, however at calculation of absolute figures are represented as a serious world problem. The article presents the global data and our own data for the prevention of complications after performing open radical prostatectomy and also experience with Mitomycin.

The aim of this work was to search for and study new phytopreparations based on natural plant materials (medicinal plants) that are necessary for effective litholysis of oxalate stones in patients with urolithiasis. New phytomedications were proposed and studied in which litholytic action is due to the presence of certain combinations of flavonoids and some other types of biologically active substances. In a study carried out to obtain total extracts of natural flavonoids from several medicinal plants obtained and studied litholytic properties of new pharmaceutical compositions together with previously known herbal remedies. The effectiveness of the new phytopreparations demonstrated by native oxalate calculi different composition isolated from patients with urolithiasis after surgical management.

This article describes the using of flexible retrograde ureteropyeloscopy and nephroscopy with patient who has underwent reconstructive operation about bladder cancer (radical cystectomy with ileal conduit urinary diversion Brikker`s operation).

A tormentil (Tormentilla erecta L.) composition for litholysis of urinary calculi of various types has been developed. The suggested composition allows to prevent precipitation of Ksidifon and to keep its high complexing ability.

Study of urinary stones of surgical removal has been fulfiled by complex methods. Information of phase and element composition have been received, microstructural examination has been made, causes of anomalous hardness of some stones have been found.