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Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its effect on ejaculatory function.Objectives. To evaluate the effect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials & methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The first group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions specifically characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No significant differences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a significant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p < 0.0001). No change was observed in the IIEF-5 questionnaire (p > 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p < 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a specific surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders.

Introduction. Many methods have been proposed for the surgical treatment of varicocele, the most of which is of historical significance. At present, there is no consensus in favor of one or another method of surgical treatment of varicocele, which determines the relevance of further research.Objective. To evaluate the effectiveness of a new minimally invasive method of surgical treatment of varicocele using the author's method.Materials & methods. The study enrolled 763 patients aged 18 – 46 years (mean age 26.3 years) with varicocele who underwent testicular vein subinguinal ligation according to the author's technique. Inclusion criteria: varicocele grades 1 – 3, aged ≥ 18 years, semen abnormalities according to semen analysis and dilated spermatic cord veins according to ultrasound, retrograde blood flow according to Doppler ultrasound. Exclusion criteria: previously operated patients with recurrent varicocele, patients with May-Thurner syndrome and bilateral varicocele. The examination included eight control points: before surgery and 3, 6, 12, 24, 36, 48, and 60 months after surgery. Physical scrotal examination with Valsalva test, semen analysis, and Dopper scrotal ultrasound were performed at the control dates.Results. The average surgery time was 15 min (10 – 30 min). All patients were discharged 1 to 2 days after surgery. At follow-up for 60 months, patients showed improvement in spermatogenesis / or no progression of semen abnormalities during follow-up after surgery based on clinical, laboratory and instrumental studies (semen analysis, ultrasound / Doppler ultrasound); no data on testicular hypotrophy, hydrocele were revealed. A scrotal haematoma was detected in one patient in the early postoperative period. Recurrent varicocele (1.4%) was detected in 11 patients during the follow-up period.Conclusion. The technique is effective, easily reproducible, characterised by a low rate of recurrence and postoperative complications.

Background. Peyronie’s disease is a disease characterized by chronic inflammation of the protein membrane of the fibrous tissue of the penis. Oral pharmacotherapy allows a long-term effect on the mechanisms of formation of fibrous plaque.Aim. To evaluate the degree of change in complaints against the background of the complex drug Peyroflex® and its effectiveness.Materials and methods. The study was conducted as a prospective observational study. The study included 43 patients with complaints of pain in the penis area during erection or at rest, curvature of the penis, the presence of palpable plaque in the area of the cavernous bodies. Men took Peyroflex® on a regular basis, one capsule (410 mg) 2 times a day for 6 months or until the pain disappeared during erection, but not less than 6 months.Results. The intensity of pain after 3 and 6 months of taking Peyroflex® decreased by 47.8 and 78.3 %, respectively. The severity of penile curvature showed a tendency to decrease by 7.5 % after 3 doses of Peyroflex® and remained stable after 6 months. The plaque area according to the results of ultrasound examination after 3 and 6 months of taking Peyroflex® decreased by 14.7 and 17.2 %, respectively.Conclusion. Peyroflex® can be recommended for use in the active phase of Peyronie’s disease both in monotherapy and in combination with other methods of treatment (extracorporeal shock wave therapy, physiotherapy, etc.).

Purpose of the study. The aim of this work was to study the effect of conservation in various cryoprotectants on the biomechanical and morphological properties of the umbilical cord (UCA) arteries.Materials and methods. The material for this work was 12 umbilical arteries, which were divided into 4 study groups: (1) native UCA – control without freezing; (2) APC frozen in 5 % dextran with the addition of dimethyl sulfoxide (DMSO) to 10 % and 7.5 % human serum albumin (HSA); (3) APC frozen in glycerin and (4) UCA frozen in propanediol. For all groups, morphological and biomechanical studies were carried out. The statistical data were processed using the GraphPad Prism 9.2.0 program. Analysis of variance was used to find significant differences.Results. Freezing with 5 % dextran, 10 % DMSO and 7.5 % human albumin did not lead to significant changes in the morphology of vascular tissue compared to control. The conserved vascular tissue retains a moderate level of type I collagen, regardless of the method of conservation. The presence of statistically significant differences between the control and frozen UCAs was shown for Young's modulus (p < 0.05; 6.9 [6.8; 7.0] for the native artery; 2.3 [2.0; 2.6] for the artery preserved with the use of dextran, DMSO and human albumin; 2.3 [1.4; 3.2] for the artery preserved in glycerin and 0.8 [0.6; 1.0] – in propanediol, respectively).Conclusion. 1) Freezing and storage of UCA at 5 % dextran, 10 % DMSO and 7.5 % HSA does not lead to a significant change in the morphology of vascular membranes and cell nuclei; 2) The preservation of type I collagen according to the results of IHC is qualitatively reduced from a conditional indicator of +2 to +1 for frozen agroindustrial complexes compared with control ones; 3) Conservation leads to a significant decrease in the modulus of elasticity of the walls of the agroindustrial complex compared with control vessels (p < 0.05).

Erectile dysfunction, remaining an urgent problem of our time, is pushing the world urological community to develop new methods of diagnosis and treatment. Currently, urologists have in their arsenal a variety of both conservative and surgical methods for correcting erectile dysfunction. This manuscript provides an overview of modern surgical treatment methods based on world literature data.

This work presents a clinical case of a successful surgical treatment of arteriogenic erectile dysfunction by antegrade retroperitoneoscopic penile revascularization. This method has been developed, tested, patented and clinically implemented in the center of urology and andrology of State Scientific Center - A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia. The method was developed on the basis of a thorough analysis of the complications and disadvantages of previous revascularization methods.

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

RETRACTED ARTICLEThe review provides an analysis of domestic and foreign sources devoted to the study of the sperm chromatin structure. The pathogenetic pathways of the sperm DNA fragmentation formation are described. The relationship between sperm DNA damage in pregnancy, live birth rate and the recurrent pregnancy losses in the assisted reproductive technique are presented. The prognostic determination's value of the sperm DNA fragmentation in male infertility cases is noted.

Penile prosthetics is the «gold standard» for treatment of severe or drug-induced refractory erectile dysfunction. One of the most formidable postoperative complications of penile prosthetics is periprosthetic infection. Currently, infusion and topical application of broad-spectrum antibacterial drugs is used for the prevention of prosthetic infectious complications. One of the means for the prevention of postoperative infectious complications is the Alexis retractor (Applied Medical, Rancho Santa Margarita, CA). It is a port that is installed in the surgical area and limits the contact of the prosthesis components with the surrounding tissues and skin, achieving optimal wound visualization. The use of Alexis provides atraumatic retraction of the wound edges and 360-degree protection of the wound from the contact of the implant components with adjacent tissues and skin.

The analysis of literature data (PubMed and RSCI databases) is presented, which is devoted to new approaches and technologies in the diagnosis and treatment of various forms of erectile dysfunction (ED). ED is a very significant clinical and social problem at the present stage, which has a significant negative impact on the quality of life of men. The importance and relevance of the ED problem dictate the need to search for and develop new, more effective technologies for ED verification and treatment. This review study confirms the fact that the main diagnostic task in ED is to establish its true etiological component. A rational approach is to use research methods with proven effectiveness since this circumstance will ensure effective treatment of ED. Currently, there is a need to create a personalized diagnostic algorithm aimed at assessing the state of the cardiovascular system, endothelium, androgen status, angioarchitectonics, etc. This will increase the effectiveness and safety of treatment for men suffering from various forms of ED. X-ray endovascular, cellular and new technologies in the field of falloprosthesis are very promising with encouraging primary results.

This article reviews currently available data on complications after penile implant surgery (using one-, two-, and three-piece devices) to decrease the frequency of perioperative complications and improve cosmetic and functional results of the surgery. Furthermore, we found that the level of surgical experience has a significant impact on the efficacy of penile implant surgery, if a special regimen of asepsis and antiseptics is strictly followed.

Reconstruction of the penis in transgender operations, amputation of the penis, congenital deformities and anomalies of the penis was and remains today an important issue in plastic surgery of the urogenital region. The only method to restore the penis is phalloplasty. In general, over the past decades, generations of clinicians have different ways and flaps for total fallouretheral reconstruction. Thus was formulated the characteristics of an ideal flap for the formation of neophallos, which should be safe, sensitive, without hair, and with long leg. However, despite the fact that the characteristics of a perfect flap, nowadays there is no “gold standard” in the formation of neophallos, as phalloplasty is a fairly complicated surgery, and the choice of method depends on many factors. The choice of methodology is determined by the plastics surgeon and to each patient is individual, depends on the etiology of the disease and the possibility of choosing the form of the donor’s transplant. This article presents a literature review devoted to the historical aspects of phalloplasty. In the article, in chronological order reflected the evolution of the different forming methods neofallos, phallourethrоplasty, describes their advantages and disadvantages.

Relevance. Absence of studies on the effect of various transurethral and endovideosurgical methods (EVS) of operative treatment of benign prostatic hyperplasia (BPH) on the state of the copulative function, which includes the analysis of its main components within the framework of a single study.Aim. Study the effect of the above methods of correction of BPH on the state of the main components of the copulatory function.Materials and methods. Analysis of the results of surgical treatment of 220 patients with BPH who underwent transurethral resection-TUR (n = 80), transurethral enucleation with bipolar TUEB (n = 51), holmium laser enucleation of the prostate-HoLEP (n = 43), and endovideosurgical adenomectomy- EVS AE (n = 46). The study included: the international index of erectile function, the scale of the male copulative function score, the score of the questionnaire for the aging males symptoms (AMS), the quality of life index for erectile dysfunction, the degree of bulbocavernosis reflex, the testosterone fraction and the globulin binding sex hormones (GBSG). Patients were examined before the operation, and also after 3 and 6 months. Results. The number of patients with decreased libido was significantly lower in the TUR groups (from 56.3% to 53, 75% (3 months) and 47.5% (6 months)) and EVS AE (from 43.4% to 39.1% (3 months) and 32.6% (6 months)). A decrease in the specific gravity of ED in the postoperative period (group TUR BPH (from 50% to 45% (3 months) and 42.5% (6 months), group TUEB (from 52.9% to 51.5% (3 months) and 49.2% ( 6 months), the HoLEP group (from 69% to 66.6% (3 months) and 60% (6 months) and EVS AE (from 68.75% to 65% (3 months) and 62.5% (6 months)) with a parallel improvement in severity (from 40% to 37.5% (3 months), 35% (6 months), and EVS AE (from 31.25% to 28.3% (3 months) and 25% (6 months)), the number of patients with hyporgasmia. With respect to retrograde ejaculation, there was a decrease in the incidence of its occurrence in the TUR group (from 25% to 22.5% (3 months) and 19.6% (6 months) and EVS AE (from 18.75% to 15.3% (3 months) and 12% (6 months.) In addition, there was no statistically significant difference in the level of testosterone and GBSG fractions in the pre- and postoperative period (3 months), but when monitoring at a more distant time (6 months), there was a tendency to increase testosterone fractions with a parallel decrease in the concentration of GBSG.Conclusions. Surgical correction of BPH with endoscopic and EVS methods has a positive effect on the copulatory function and hormonal status, which is especially pronounced in the groups of TUR BPH and EVS AE.

This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.

The article presents the approximate calculations of working time of physician to work with the patient and documentation. On the base of these calculations they outline the possible ways to optimize the work of the medical staff.