Persistent Mullerian duct syndrome is a rare form of internal male pseudohermaphroditism in which a phenotypic male patient with a 46,XY karyotype has derivatives of the Mullerian ducts, including the uterus, fallopian tubes, and a vaginal outgrowth of the urogenital sinus. A rare clinical case of late diagnosis of persistent Mullerian duct syndrome in a 42-year-old man is presented in the article.
INTRODUCTION:Varicocele (VC) is one of the main causes of male infertility; however, it is not always associated with infertility. In addition to surgical correction of pathospermia in VC, adjuvant antioxidant therapy has been proposed. It is known from experience that not all patients are immediately treated with surgery, and, similar to cancer, neoadjuvant therapy may be beneficial. The optimal method for assessing the effectiveness of this hypothesis is to conduct a study using a varicocele model in a chronic experimental setting. THE PURPOSE OF THE STUDY:to study the effect of the timing of initiation of antioxidant therapy on spermogram parameters and testicular structure in a varicocele model. MATERIALS AND METHODS:The chronic experiment involved 20 mature male rabbits randomized into 4 groups: Group I (N) - intact animals to provide normal anatomy of the testis and spermogram indicators (n=5). Group II - control group (GC) - VC model without drug exposure, withdrawal 2 months after VC formation (n=5). Group III - main group 1 (MG1) - VC model and drug exposure during the first month from the formation of VC and seven-day daily administration of progesterone (n=5). Group IV - main group 2 (OG2) - VC model and delayed drug exposure during the second month from the moment of VC formation and seven-day daily administration of progesterone (n=5). The drug was administered intragastrically at a dose of L-carnitine 26.15 mg/day, taking into account the species characteristics of the rabbit. Seminal fluid was examined using light microscopy to assess the quantity and quality of sperm. The removed testes were subjected to morphological examination using Mallory staining and hematoxylin and eosin. A semi-quantitative count of fibroblasts in a microslide was carried out. RESULTS AND DISCUSSION:After 14 days from the creation of the model, dilated spermatic veins were visualized in all animals of experimental groups II-IV (on average up to 1.8 mm, without differences between groups) and hemodynamic reflux was recorded in them. The average diameter of the spermatic veins (up to 2.1 mm) was 2.1 mm on the 30th day; 2.0 mm on the 60th day. A progressive decrease in the volume of the left testicle was noted over 60 days by an average of 1.1 cm3 (p>0.05 between all groups). In group I (N), the initial characteristics of the general spermogram parameters were significantly higher than in experimental groups II-IV (p<0.05-0.01). The total number of spermatozoa was 310.2 million (in group N) versus 199.3 million (in GC), 247.6 million (in OG1) and 221.3 million (in OG2). In group N: 94.3% of live sperm, total sperm motility (PR+NP) - 91.4%, progressive sperm motility (PR) - 87.2%, sperm velocity - 13 /sec. Between groups OG1 and OG2, there was a difference in spermogram results with a predominance for the better in group OG1: the total sperm count was 247.6 million (in OG1) / 221.3 million (in OG2); live sperm - 80.6% / 74.4%, respectively; PR+NP - 73.4% / 67.1%, respectively; PR - 65.4% / 56.7%, respectively, and sperm velocity of 8 / 6 /sec, respectively) (p<0.05 vs N). The spermogram parameters in the GC group were significantly worse than in OG 1 and OG2: total sperm count - 199.3 million (in GC) / 247.6 million (in OG1) and 221.3 million (in OG2); live forms - 68.3% (in GC) / 80.6% (in OG1) / 74.4% (in OG2); PR+NP - 61.5% / 73.4% / 67.1%, respectively, PR - 48.7% / 65.4% / 56.7%, respectively, sperm velocity - 4 / 8 / 6 g/sec. respectively (p<0.01). Evaluation of the morphology of the spermatogenic epithelium according to Johnsen S.G. (1970) as modified (2014): Group I (N) - 10 points; GK - heterogeneous histological picture with significant reduction of spermatogenesis, 6-7 points; OG1 - heterogeneous picture with slight reduction of spermatogenesis, 8-9 points; OG2 - heterogeneous picture with noticeable reduction of spermatogenesis, 7-8 points. CONCLUSION:The varicocele formed in the experiment had a negative effect on testicular function and structure, confirming the effectiveness of the modeling method. L-Carnitine had a protective effect on gonadal tissue and ejaculate quality. This effect was greater with earlier administration of the drug after the model was formed. This effect may be useful in clinical practice and requires further study.
INTRODUCTION:Acquired proximal seminal tract obstruction may develop as a result of infectious-inflammatory, post-traumatic, or iatrogenic lesions of the epididymis and proximal segments of the vas deferens. In bilateral disease, it leads to obstructive azoospermia. Surgical sperm retrieval and microsurgical reconstruction remain the principal approaches to infertility management; however, conservative treatment targeting the inflammatory and fibrotic component of obstruction is of practical interest. AIM:To carry out a pilot assessment of the potential effect of different dosage forms of bovhyaluronidase azoximer on semen parameters in patients with acquired proximal seminal tract obstruction. MATERIAL AND METHODS:A total of 80 men with obstructive azoospermia caused by proximal seminal tract obstruction and associated infertility were examined. The patients were divided into two groups of 40 patients each. In the first group, bovhyaluronidase azoximer was administered as rectal suppositories at a dose of 3000 IU; in the second group, it was administered as a lyophilizate for intramuscular injection at a dose of 3000 IU. Follow-up examination and semen analysis were performed once, 95-105 days after the start of therapy. Statistical analysis was primarily descriptive; the proportions of patients with spermatozoa detected in the ejaculate were compared using Fishers exact test. RESULTS:Spermatozoa appeared in the ejaculate in 10 of 80 patients (12.5%). The median sperm concentration was 0.85 million/mL, the median total sperm count was 1.65 million, and the median total motile sperm count was 0.1815 million. In the suppository group, spermatozoa appeared in 6 of 40 patients (15.0%); in the intramuscular injection group, spermatozoa were detected in 4 of 40 patients (10.0%). The between-group difference was not statistically significant (p=0.737). DISCUSSION:The number of spermatozoa obtained was insufficient for natural conception; however, in selected cases it could be of practical value for cryopreservation and subsequent use in intracytoplasmic sperm injection programs. These results should be considered preliminary because of the pilot design, absence of a control group, and limited number of patients with a positive response. CONCLUSION:The obtained data suggest that bovhyaluronidase azoximer may be considered a potentially pathogenetically substantiated component of complex therapy in patients with proximal seminal tract obstruction. Further studies of appropriate methodological quality are required to clarify the clinical significance of these findings.
Three clinical observations in patients with various manifestations of pyelonephritis are presented. Using 18F-FDG PET/CT and transmission electron microscopy of the renal parenchyma at 10,000x magnification, the ultrastructural and molecular-cellular features of acute purulent pyelonephritis, chronic pyelonephritis with neurogenic hypertension, and chronic pyelonephritis resulting in secondary contracted kidney are identified. The clinical significance of the identified changes, the reliability of the obtained results, and the prospects for their further application are discussed.
Cystitis in women is one of the most common urological diseases and requires a multidisciplinary approach. Depending on the stage of a womans life, her gynecological status, including hormonal levels, the condition of the vaginal microflora, and anatomical features, has a significant impact on the course of cystitis and its treatment. Underestimation of gynecological factors is sometimes a cause of treatment failure. The clinical features of cystitis in women of reproductive age and in perimenopause are discussed in the article. The need to assess estrogen status and vaginal flora are substantiated. In addition, current principles of therapy, including the use of nitrofurans, particularly potassium furazidin (Furamag), are outlined.
BACKGROUND:Urolithiasis is one of the most common diseases of the urinary system, accounting for up to 50% of the capacity of urology departments in the Russian Federation. Modern minimally invasive technologies, including micro-percutaneous nephrolithotomy (PCNL), offer opportunities to optimize surgical strategy; however, the indications for its use remain controversial. AIM:To perform a comparative analysis of the outcomes of micro-percutaneous procedures versus other minimally invasive interventions in patients with kidney stones up to 2 cm in size. MATERIALS AND METHODS:The study included 172 patients with kidney stones up to 2 cm, divided into three groups: micro-PCNL (n=51), mini-PCNL (n=58), and retrograde intrarenal surgery (RIRS, n=63). A comparative assessment was performed of treatment efficacy, complication rates, additional interventions, and postoperative length of stay. The analysis also took into account stone location and size, as well as the anatomy of the renal collecting system according to the R. Takazawa classification (2018). RESULTS:The overall treatment efficacy was 88.2% for micro-PCNL, 93.1% for mini-PCNL, and 87.3% for RIRS (p>0.05). No differences were found in complication rates or the need for additional interventions. In patients with stones less or equal 1 cm, micro-PCNL provided a shorter hospital stay than mini-PCNL - 3.4+/-0.5 versus 5.1+/-0.4 days (p=0.04). For lower calyceal stones, micro-PCNL demonstrated better efficacy than RIRS, 94.4% versus 70.4% (p=0.04). Analysis of the renal collecting system anatomy showed that the best outcomes of micro-PCNL were achieved in patients with a narrow (A1) and standard (A2) single pelvis, whereas in patients with a wide pelvis (A3) its efficacy decreased to 71.4% versus 94.7% and 95.2% for mini-PCNL and RIRS, respectively (p<0.05). CONCLUSIONS:Micro-PCNL is an effective and safe method for the treatment of kidney stones up to 2 cm, comparable to mini-PCNL and RIRS. Optimal outcomes of micro-percutaneous interventions are achieved in patients with stones less or equal 1 cm, stones located in the lower calyx, as well as in patients with a narrow or standard single renal pelvis.
Changes in kidney function parameters in men receiving testosterone replacement therapy (TRT) may influence the clinical assessment of treatment safety. However, the physiological meaning of these changes remains uncertain. In most cases, kidney function during TRT is evaluated using surrogate laboratory markers rather than glomerular filtration rate (GFR) measured with exogenous filtration markers. This creates a risk of misinterpretation, as the observed changes may reflect not only true alterations in glomerular filtration, but also therapy-related effects and patient phenotype-related characteristics. Existing studies do not allow a reliable distinction to be made between true changes in filtration function, changes in the characteristics of the marker used, or a combination of both, since most of them rely on surrogate indicators without comparison with measured GFR. Therefore, the question of what changes in kidney function parameters during TRT actually mean, and how they should be interpreted, remains unresolved.
INTRODUCTION:Cytokine-mediated mechanisms play a substantial role in the pathogenesis of chronic bacterial cystitis. However, the design of the vast majority of previous studies has not taken into account the systemic nutritional and metabolic status of the subjects, which may independently affect cytokine metabolism and the parameters under investigation, irrespective of infection. Vitamin D has well-documented immunomodulatory and anti-inflammatory properties, and its deficiency is reliably associated with an increased risk of both the first episode of urinary tract infection (UTI) and recurrent UTIs. Nevertheless, the effect of vitamin D status on cytokine metabolism in the bladder during UTIs remains largely unexplored. AIM:To investigate the features of bladder cytokine status in experimental models of vitamin D deficiency and chronic bacterial cystitis. MATERIALS AND METHODS:The study was carried out in 20 sexually mature female albino rats. Following experimental induction of vitamin D deficiency, the animals were divided into two groups: a control group without vitamin D deficiency (n=10) and a main group with vitamin D deficiency (n=10). A model of recurrent chronic bacterial cystitis was subsequently induced in both groups. Cytokine status was assessed at both stages of the experiment by measuring tissue concentrations of secretory immunoglobulin A (sIgA), interleukin-8 (IL-8), and interleukin-10 (IL-10) in bladder homogenates using a solid-phase chromogenic enzyme-linked immunosorbent assay (sandwich ELISA). Statistical analysis was performed using Microsoft Excel spreadsheets and Statistica V10 (StatSoft Inc., USA) and SPSS Statistics V17 (USA) software packages. RESULTS:The mean baseline tissue concentration of sIgA in the intact bladder of animals with vitamin D deficiency was significantly 1.4-fold lower than in the control group (p<0.001), whereas baseline IL-8 and IL-10 concentrations did not differ significantly between the groups (p>0.05). In the chronic bacterial cystitis model, the mean induced tissue concentrations of sIgA, IL-8, and IL-10 in the bladder of animals with vitamin D deficiency were significantly lower than in the control group by 2.5-fold, 1.7-fold, and 2.8-fold, respectively (p<0.001). DISCUSSION:Vitamin D deficiency in the experimental model of chronic bacterial cystitis was associated with a substantial and significant reduction in local anti-infectious immunity and bladder immune reactivity. This was manifested by the development of a decompensated hypoergic infectious-inflammatory process in the bladder, which may represent one of the mechanisms underlying the increased risk of UTIs and their recurrence reported in the literature in the setting of vitamin D deficiency. CONCLUSION:Vitamin D deficiency may independently suppress local anti-infectious immunity and immune reactivity of the bladder both under normal conditions and following exposure to uropathogens. These findings support considering vitamin D as an important systemic regulator of the immunological mechanisms involved in chronic bacterial cystitis.
INTRODUCTION:The early postoperative period after surgical intervention for extramedullary spinal cord tumors is critical for the recovery of neurological function, including voiding function. Inadequate diagnosis and treatment lead to secondary complications associated with delayed recovery and increased treatment costs. At this stage, the supportive role of a urologist familiar with the basic principles of neurosurgery and neurourology is important for choosing an individualized strategy for treatment and rehabilitation of voiding function, taking into account tumor size, histology, and location, as well as other risk factors. MATERIALS AND METHODS:The data of 221 patients (155 women and 66 men; age range, 19 to 84 years) who underwent surgery for extramedullary spinal cord tumors at the N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of Russia, from January 2019 to December 2022 were analyzed. Of these, 178 patients were included in the prospective analysis and 43 patients in the retrospective analysis based on medical record data. In the prospective group, urinary symptoms were assessed by a urologist of the Center before and after neurosurgical intervention. Neurological syndrome and voiding function were evaluated by a neurologist and a urologist of the department using the modified mJOA scale. RESULTS:The significant differences in changes in voiding function, according to mJOA scores, after neurosurgical interventions in patients with and without urological follow-up were observed. Urological supervision allowed to assess baseline voiding function and the functional outcomes of surgical treatment of extramedullary spinal cord tumors more objectively. CONCLUSION:Urological support of patients with extramedullary spinal cord tumors in the perioperative period allows objective and detailed monitoring of the clinical course, both neurological and urological, which is important for a clearer understanding of the functional outcomes of neurosurgical treatment.
INTRODUCTION:Male stress urinary incontinence (SUI) following prostate surgery significantly impairs quality of life. The main surgical treatment options for SUI are male sling (MS) implantation and artificial urinary sphincter (AUS) implantation. The optimal choice of procedure depends on the severity of incontinence. The 24-hour pad test and pad count do not reliably reflect the functional status of the external urethral sphincter (EUS). The Male Stress Incontinence Grading Scale (MSIGS) has been proposed to improve patient stratification. OBJECTIVE:To evaluate the effectiveness of preoperative assessment of SUI severity based on a combination of MSIGS and the 24-hour pad test in guiding surgical decision-making in men with post-prostatectomy SUI. MATERIALS AND METHODS:From 2016 to 2022, SUI severity in our clinic was determined using only the 24-hour pad test. From 2022 to 2025, the MSIGS was incorporated into preoperative evaluation. Patients with urine loss less or equal 200 g/day and MSIGS less or equal 2 underwent sling implantation, whereas those with urine loss >200 g/day and MSIGS more or equal 3 received AUS implantation. RESULTS:Between 2016 and 2025, a total of 39 patients underwent surgery: 13 with slings and 26 with AUS. A history of pelvic radiotherapy (RT) was present in 15.4% (2/13) of sling patients and 30.8% (8/26) of AUS patients. After the introduction of combined assessment (pad test + MSIGS), the proportion of AUS implantations increased from 27% (n=3) to 82% (n=23) (OR=12.27; 95% CI 2.53-50.45; p=0.002). Furthermore, sling efficacy improved from 25% to 80% when patient selection was based on the combined approach (OR=12.00; 95% CI 0.67-165.6; p=0.103). Importantly, the higher rate of AUS implantation was not associated with reduced efficacy (p>0.05). CONCLUSION:The choice of surgical treatment for SUI depends on incontinence severity and prior RT. Male sling implantation is effective in mild cases but its efficacy is markedly reduced in severe SUI and in patients with prior RT. The AUS remains the gold standard for severe SUI. The combination of MSIGS and the 24-hour pad test improves diagnostic accuracy and optimises implant selection, which is particularly valuable in patients with moderate SUI.
Varicocele is a common condition characterized by dilation of the veins of the pampiniform plexus of the left testicle, affecting 15-20% of adolescents and adult men. Clinical manifestations include pain, decreased left testicular volume, infertility, and the presence of a mass in the form of dilated veins in the scrotum. In adolescents, one of the main indications for surgery today is the prevention of future infertility, but no proven efficacy of any conservative treatment has been described. Various surgical techniques for varicocele treatment have been proposed in the literature, including retroperitoneal, laparoscopic, inguinal, subinguinal, and X-ray surgical (embolization). Each technique has its own advantages and disadvantages. In this case report, we describe a relatively rare complication that arose after intravascular occlusion of the internal spermatic vein with a coil.
INTRODUCTION:The increasing number of performed cystectomies (CE) has significantly heightened the demand for effective urinary diversion methods. The declining use of continent cutaneous urinary diversion (CCUD) leads to an impoverishment of the modern reconstructive urology arsenal and a reduced quality of life for post-cystectomy patients when orthotopic neocystoplasty is not feasible. AIM:To conduct a comparative analysis of the clinical and functional outcomes of the classic and modified Kock pouch continent cutaneous urinary diversion. MATERIALS AND METHODS:The results of a consecutive series of 56 patients were analyzed. The patients underwent: open CE with classic Kock CCUD (13 patients, 23.2%), open CE with modified Kock CCUD (27 patients, 48.2%), and laparoscopic CE with modified Kock CCUD (16 patients, 28.6%). RESULTS:The incidence of resecting a prolapsed valve nipple decreased by 6.2 times with the modified technique. Valve revision was required in 30.8% of patients after the classic procedure compared to 7.0% after the modified procedure, resulting in a 4.4-fold reduction in revision frequency. Reservoir calculi formation was 1.4 times lower in the modified surgery group. Difficult catheterization decreased by 23.9% (a 4.5-fold reduction) in the modified group. Continence rates were 76.9% and 93.1% in the compared groups, respectively, showing a 16.2% improvement (a 1.2-fold increase) with the modified Kock reservoir. The advantages of surgical approaches (open vs. laparoscopic) and diversion modification (modified vs. classic Kock procedure) become apparent only when considering long-term postoperative outcomes ( more or equal 90 days). CONCLUSION:Despite the waning popularity of the traditional heterotopic Kock continent urinary diversion, which undoubtedly depletes the arsenal of modern reconstructive urology, its modified version represents a promising tool in the hands of a contemporary urologist.
RELEVANCE:Growing evidence highlights the significant role of the human microbiota and microbiome in the pathogenesis of malignant tumors, including renal cell carcinoma (RCC). This systematic review evaluates studies addressing the associations between the microbiota/microbiome and the development and progression of RCC, as well as the influence of the microbiota on therapeutic efficacy in this malignancy. MATERIALS AND METHODS:The review was conducted in accordance with PRISMA guidelines. A systematic search of bibliographic databases (PubMed, Scopus, etc.) using the keywords ("renal cell carcinoma"/"kidney cancer"/"renal cancer" and "microbiota"/"microbiome") identified 12,547 publications. After removal of duplicates and screening for eligibility, 33 studies directly examining the relationship between the microbiota and RCC were included in the analysis. Studies not relevant to the topic or focusing on tumor growth without specific reference to kidney cancer were excluded. RESULTS:The review summarizes the composition and alterations of the microbiota in RCC: (1) the intratumoral microbiota of renal tumors differs from that of adjacent healthy kidney tissue, showing reduced diversity and distinct bacterial profiles; (2) the gut microbiota of RCC patients is dysbiotic compared with healthy controls, characterized by enrichment of potentially pro-carcinogenic taxa and depletion of protective bacteria; (3) the urinary microbiome also undergoes changes in RCC, though data remain limited. Potential mechanisms have been proposed: microbiota-derived metabolites (e.g., tryptophan-kynurenine pathway intermediates, short-chain fatty acids, trimethylamine N-oxide [TMAO]) may influence the tumor microenvironment, immune response, and metastatic potential. Importantly, gut microbiota composition has been shown to modulate response to immunotherapy in RCC: higher microbial diversity and the presence of specific taxa (e.g., Akkermansia muciniphila) are associated with improved response to immune checkpoint inhibitors, whereas dysbiosis and antibiotic exposure correlate with diminished efficacy. Several studies have demonstrated that modulation of the microbiome (via probiotics, prebiotics, or fecal microbiota transplantation) can enhance antitumor immunity and improve treatment outcomes in RCC, although clinical data specifically addressing RCC onset and progression remain limited. CONCLUSIONS:The microbiota and microbiome are increasingly recognized as key factors in the development and progression of renal cell carcinoma, also influencing the effectiveness of contemporary therapeutic strategies. Further research is required to establish causal relationships and to develop microbiome-oriented approaches for the prevention and treatment of RCC.
AIM:To compare outcome of muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard frequency and severity of postvoid dribbling. MATERIALS AND METHODS:Our study included 32 patients with bulbar urethral stricture underwent buccal mucosa graft urethroplasty. 18 patients were operated by dorsal onlay urethroplasty (Barbagi technique), 9 patients underwent ventral onlay urethroplasty, 3 patients were operated by Asopa technique and 2 patients underwent urethroplasty by Kulkarni technique. 19 patients were operated by muscle and nerve-sparing bulbar urethroplasty, 13 patients underwent standard bulbar urethroplasty. Follow-up examination of frequency and severity of urinary disorders were matched by questionnaire at 4 mo, 8 mo and 12 mo after surgery. RESULTS:Postvoid dribbling was demonstrated in 12 patients (37,5%) at 4 mo after surgery. No statistically significant difference of postvoid dribbling was found between the groups of muscle and nerve-sparing and standard bulbar urethroplasty at 4 mo after surgery (=0,4104). Postvoid dribbling was demonstrated in 6 patients (18,8%) at 8 mo after surgery: in 2 patients who underwent muscle and nerve-sparing bulbar urethroplasty and in 4 patients who underwent standard bulbar urethroplasty. Postvoid dribbling was demonstrated in 4 patients (12,5%) at 12 mo after surgery: in 1 patients (3,1%) who underwent muscle and nerve-sparing bulbar urethroplasty and in 3 patients (9,4%) who underwent standard bulbar urethroplasty. DISCUSSION:The frequency of postvoid dribbling is lower in patients with muscle and nerve-sparing bulbar urethroplasty compare to standard bulbar urethroplasty, but no statistically significant difference was found between the groups. Sparing the bulbospongiosus muscle during urethroplasty impact on complete emptying of the urethra. The same time the compensatory capabilities of bulbospongiosus musle in patients who underwent non sparing bulbar urethroplasty impact also on complete emptying of the urethra. CONCLUSION:Sparing the bulbospongiosus muscle, the central tendon of the perineum, and the perineal nerves during bulbar urethroplasty seem to have a significant impact on improving outcomes. In our experience the muscle and nerve sparing technique seems to be a safe and effective alternative for standard bulbar urethroplasty on follow-up up to 12 mo.
BACKGROUND:Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are widely used organ-sparing treatment methods for T1 renal cell carcinoma (RCC). Numerous international meta-analyses on this topic have shown that RAPN provides perioperative outcomes comparable to those of LPN, while offering additional advantages such as significantly lower blood loss and a shorter warm ischemia time. However, no superiority of either technique over the other has yet been demonstrated with regard to oncological outcomes and preservation of renal function. AIM:To compare functional and oncological outcomes of laparoscopic and robot-assisted partial nephrectomy for RCC at A.S. Loginov Moscow Clinical Scientific Center with data from international studies. MATERIALS AND METHODS:A search of current literature on outcomes of RAPN and LPN was performed using PubMed. The most relevant publications were analyzed and served as the basis for this study. In addition, we retrospectively analyzed the surgical outcomes of 277 patients who underwent surgery for RCC using the Da Vinci robotic surgical system (n=175, group 1) or a laparoscopic technique (n=102, group 2) at A.S. Loginov Moscow Clinical Scientific Center between 2019 and 2024. Functional and oncological outcomes were collected and compared between the two groups. RESULTS:The postoperative decline in creatinine clearance was significantly greater in patients in group 2. Positive surgical margins and recurrence of RCC were also significantly more common in group 2. CONCLUSION:The use of a robotic system for partial nephrectomy is an alternative to the laparoscopic technique, providing reliable functional and oncological outcomes. This is supported both by studies from a number of international centers and by the results obtained at A.S. Loginov Moscow Clinical Scientific Center.
OBJECTIVE:providing objective data on the shortterm and longterm efficacy and safety of the drug based on bovine testicular polypeptides in realworld clinical practice. MATERIALS AND METHODS:A prospective, multicenter, noninterventional observational study enrolled 668 patients with impaired spermatogenesis (oligoasthenozoospermia) and diagnosed male infertility. The patients received Testivell 5 mg once a week for 10 weeks. During the subsequent three visits at 3month intervals and the follow-up period of up to 9 months, the parameters listed below were analyzed: semen analysis parameters, DNA fragmentation index, and clinical outcomes (pregnancy achievement and live birth). RESULTS:Treatment with Testivell demonstrated improvements in semen parameters in all study populations and subpopulations: sperm concentration increased from 21 [7; 46] to 34 [12; 62] mln/mL (p<0,001); the number of progressively motile sperm cells rose from 12.6 [2.3; 41.3] to 31.2 [6.6; 74.7] mln (p<0,001); and the proportion of morphologically normal sperm increased from 2 [1; 3] to 3 [1; 4]% (p<0,001). In patients with initially elevated DNA fragmentation, the index decreased from 27 [21; 37] to 11 [2; 17.5]% (p<0,001). 184 participants who completed the therapy course underwent a full followup cycle with monitoring of conceptions and births. A total of 85 pregnancies were recorded, corresponding to a clinical efficacy rate of 48,9% [37.7%; 52.4%]. Data on 70 pregnancy outcomes were collected, and in all cases, the pregnancies resulted in the birth of a healthy live infant. Testivell demonstrated good tolerability when used in combination with other drugs. No clinically significant adverse reactions were observed. CONCLUSION:Real-orld clinical practice has provided evidence of both shortterm efficacy (regarding basic ejaculate parameters and DNA fragmentation) and longterm efficacy (as reflected by pregnancy and live birth rates in couples), along with the safety of a course of therapy using a testicular polypeptidebased drug. Testivell is suitable for use in the management of idiopathic infertility, as an adjunctive therapy in cases with established causes of infertility, and as part of preparation for assisted reproductive technologies (ART) for couples when male infertility is associated with spermatogenesis disorders (oligoasthenozoospermia).
