Introduction. Postcoital cystitis, or urinary tract infection associated with sexual intercourse (UTI), is a pathological process characterized by inflammation and infection of the bladder occurring after sexual activity. Case Description: In this article, we present the results of surgical treatment for a complication after distal urethra transposition. Discussion. This article discusses the key surgical techniques for the treatment of postcoital cystitis. There is no single correct approach with regard to efficacy. Studies suggest that a transposition of the distal urethra is highly effective in reducing symptoms and recurrence rates. Conclusion. Surgical treatment for postcoital cystitis should be considered as a last resort, only in cases of ineffective conservative therapy and the presence of strict indications.
BACKGROUND : Worldwide, a high prevalence of benign diseases in women is registered, which in some cases can lead to the development of malignant neoplasms. The role of estrogens in the onset of neoplastic processes is well known. Long-term pathogenetically oriented prevention can contribute to disease regression and a reduced risk of malignant transformation. AIM : To compare the efficacy and safety of a complex product containing resveratrol and indole-3-carbinol (dietary supplement Imaston) administered in a once- and twice-daily regimen. METHODS : The article presents brief data on the molecular mechanisms and pathogenesis of estrogen-associated diseases, as well as the interim results of the open-label, multicenter clinical study PRIMA-024. RESULTS : The therapy demonstrates a pronounced initial clinical response in both groups of patients with benign mammary dysplasia. CONCLUSION : Plant-derived components (resveratrol and indole-3-carbinol) show high efficacy and safety in both the treatment and long-term prevention of benign neoplasms in women.
Introduction. Intermittent priapism is characterized by recurrent painful episodes of prolonged erection, predominantly at night (NPP), waking the patient and disturbing his sleep. NPP resolves spontaneously and alternates with periods of detumescence. It occurs from once a week to several episodes of erection per night. The pathophys-iology of NPP is not fully understood. In vivo and in vitro studies suggest that the underlying mechanisms of the disease include an imbalance between vasorelaxant and vasoconstrictive processes responsible for erection and detumescence. In foreign literature, NPP is designated as sleeprelated painful erection (SRPE). In Russian and foreign literature, there are no convincing randomized clinical trials on the treatment of this rare condition. The aim of the study. To evaluate the effectiveness and safety of complex X-ray endovascular technologies in the treatment of nocturnal intermittent priapism. Material and methods. Patient B., 73 years old, came in February 2024 with complaints of debilitating, prolonged, painful nocturnal erections not associated with sexual activity up to several times a week, sometimes relieved by positioning on the side with the knees brought to the stomach. Similar complaints for 12 years, the patient also com-plained of nocturia up to 2-3 times, pollakiuria, weight loss. During clinical and urological examination, including a study of monitoring nocturnal penile tumes-cence, the diagnosis of NPP was confirmed. Clinically significant benign prostatic hyperplasia was detected as a concomitant disease. Stage 2. Attempts at multiple outpatient treatment with antiandrogens, nootropics, hypnotics, antidepressants, vascular, neurotropic and anticonvulsant drugs were unsuccessful. At the end of March, X-ray endovascular embolization of the tributaries of the internal iliac vein system on the left was performed. Bilateral superselective embolization of prostatic arteries, bilateral embolization with autologous blood clots of the distal branch-es of the pudendal arteries. Results. In the postoperative period, after 7, 14, 30, 90 days of dynamic observation, the patient noted a subjective improvement in the quality of life, the absence of painful night tumescence, an improvement in the quality of urination, and normalization of vascular penile blood flow according to the data of triplex ultrasound examination of the penis. Conclusion. A successful case of complex X-ray endovascular treatment of NPP based on modern neurourological examination is presented. Abbreviations: Nocturnal intermittent priapism (NIP), Erectile dysfunction (ED), Penile Doppler ultrasound (PDИ).
Introduction. Prostate cancer ranks as the second most prevalent malignancy among men worldwide, with radical prostatectomy (RP) remaining the gold standard treatment for localized disease. However, postoperative complications including erectile dysfunction (ED) and urinary incontinence significantly impair patients’ quality of life. While penile prosthesis implantation is well-established for ED management, its potential role in addressing concomitant urinary incontinence requires further investigation. Aim. To evaluate the effect of implantation of a semi-rigid penile prosthesis on urinary incontinence after RP. Objective. The prospective study included 26 patients who underwent RP without nerve-sparing, with ED (> 1 year) and mild-moderate stress urinary incontinence (urine loss 33–98 g/day according to 24-hour pad test). Exclusion criteria: severe incontinence, cancer recurrence, inflammatory diseases. All patients underwent penoscrotal implantation of a semirigid penile prosthesis. The main efficacy assessment included the pad test, ICIQ-SF, I-QoL, IIEF-5 questionnaires Results: In the group of patients with mild incontinence (< 50 g/day, n = 17), full continence was achieved (0 g according to the pad test) with an improvement in I-QoL indices from 76.9% to 90.2%. In the group with moderate incontinence (50–200 g/day, n = 9), a decrease in urine loss to 74.8 g/day was noted with an increase in I-QoL from 57.5 to 67.8%. Despite the restoration of erectile function in all patients, a decrease in sexual desire associated with residual urine leakage persisted in the second group. No postoperative complications were observed. Conclusion: Penile prosthesis implantation effectively manages mild post-RP incontinence, enabling complete sexual rehabilitation and significant quality-of-life improvement (I-QoL >90%). For moderate incontinence, combined approaches with anti-incontinence procedures (artificial urinary sphincter/sling) are recommended.
Introduction: the relevance of the problem of infertility is indisputable fact in the medical community. The prevalence of male infertility, according to some data, reaches 50 %. Various treatment options for pathozoospermia have been studied for a long time, including conservative methods and surgical interventions, but assisted reproductive technologies still most effective. The high prevalence of infertility globally and in Russia in particular, along with the lack of regional data on providing medical assistance to the population with male factor infertility, has defined the relevance of this study. Research aim: to estimate the efficiency of treating male infertility using different options of conservative therapy, surgical interventions, and ART programs in the Krasnoyarsk region. Materials and methods: 540 clinical records of patients planning pregnancy were analyzed. Patients were divided into 5 groups: normozoospermia, moderate pathozoospermia, severe pathozoospermia, immunological factor of male infertility, and azoospermia. Changes in sperm parameters during conservative therapy, surgical treatments, and the outcomes of ART programs were evaluated in the study groups. Results: empirical antioxidant therapy is most effective for couples with moderate pathozoospermia. Prolonged courses of therapy with boggyaluronidase azoximer and inosine (over 3 months) show a significant reduction in the MAR test in the long term. Hormonal stimulation combined with antioxidants is an effective and relatively safe treatment method for patients with severe spermatogenesis disorders. Varicocelectomy had limited efficiency in the study groups. The success rate of ART is higher in the group with obstructive azoospermia, as is the probability of obtaining sperm compared to non-obstructive cases. Conclusion: the treatment methods’ data obtained in the study correlate with global statistics, and further data collection is necessary to uncover regional specificities.
Acute scrotal hematoma developing due to spontaneous rupture of the spermatic cord caused by varicocele is a relatively rare complication. Its clinical presentation is similar to testicular torsion, appendix testis torsion and malignant tumor which significantly complicates differential diagnosis. Sudden pain, scrotum enlargement, sometimes cyanosis after intraperitoneal pressure increase or intense physical activity and hematoma on the left should alarm a doctor because they can be signs of vein rupture due to varicocele. Anamnesis of varicocele, character of the injury, color Doppler ultrasound can help in differential diagnosis and to avoid unnecessary orchidectomy. The article presents a review of international literature on a rare complication of varicocele – rupture of the testicular veins.
The article presents the results of a study of relapse-free survival in patients with localized prostate cancer in the Samara region, focusing on comparing the effectiveness of radical treatment and active surveillance, depending on the cancer progression risk group. The data analysis showed statistically significant differences in relapse-free survival rates. The treatment results highlight the critical importance of risk group stratification for making informed clinical decisions in the treatment of patients with localized prostate cancer.
This analytical review, synthesizing data from 172 Russian and international studies, explores targeted therapy for chronic prostatitis and chronic pelvic pain syndrome using Querceprost – a multifunctional bioactive complex containing quercetin, lycopene, naringin, selenium, and zinc. The findings highlight multiple effects of Querceprost, including its antimutagenic, anti-inflammatory, cardioprotective, and neuroprotective properties. Querceprost mitigates oxidative stress, preserves nitric oxide and endothelial integrity, and modulates neurohormonal signaling. Furthermore, it promotes pro-survival cellular pathways while simultaneously inhibiting apoptosis, autophagy, and ferroptosis.
Despite conflicting views on the relationship between varicocele and patho-spermia, numerous studies have proven the negative impact of varicocele on spermato-genesis parameters and ultrastructural characteristics of spermatozoa. Studies conducted in the last decades have somewhat changed the general view on the pathophysiology of pathospermia development in varicocele and revealed the role of interrelated processes: heat stress, oxidative stress (OS), apoptosis, genetic, inflammatory and other factors that contribute to the induction of pathophysiological manifestations.
Introduction: rectourethral fistula (RUF) is a rare but severe complication after radical prostatectomy (RP), which significantly reduces the quality of life of patients. There are several treatment methods, including transposition of the gracilis muscle ( m. gracilis ) of the thigh, which shows positive results due to excellent vascularization and ease of mobilization. Aim: to evaluate the effectiveness of staged surgical treatment of RUF in patients after RP using a transperineal approach and a m. gracilis flap. Materials and methods: the study included 5 patients with RUF: 3 patients after RP; 2 patients after cryoablation for prostate cancer (PCa) treatment. All patients underwent staged surgical treatment: stage 1 — supravesical urine diversion with installation of nephrostomy tubes; stage 2 — transperineal excision of the fistula and transposition of the m. gracilis flap. The results were assessed on post-operative day 14–16: proctography, pericatheter or micturition cystourethrography were performed. The next day, the urethral catheter was removed, followed by removal of the cystostomy drainage and closure of the colostomy. Results: the average age of patients was 62 years (from 58 to 67 years). Successful healing of the rectourethral fistula was observed in all patients which was confirmed by control proctography and micturition cystourethrography. In one patient a urethroperineal fistula developed after surgery, that required additional surgery, which was combined with a one-stage closure of the colostomy. Conclusion: transperineal approach using the gracilis flap demonstrates high efficiency rate in the treatment of RUF in patients after surgical treatment of prostate cancer.
Multiple evidence suggests that inflammation and oxidative stress negatively affect sperm parameters, spermatogenesis, and testicular and epididymal function, although the etiology of infertility caused by varicocele may be multifactorial. In this regard, the anti-inflammatory effect of various drugs in patients with varicocele is being studied and in the future, it may be possible to develop new treatment methods and conduct an appropriate selection of patients for whom these drugs can help. The article presents a review of the world literature on the influence of the inflammatory process on spermatogenesis in varicocele.
Introduction. Varicocele is recognized as the most prevalent and treatable factor contributing to both primary (PI) and secondary (SI) male infertility. This condition has been widely studied due to its impact on fertility, and varicocelectomy is a commonly employed surgical intervention aimed at improving reproductive outcomes. Objectives. The purpose of this study was to evaluate and compare the effectiveness of varicocelectomy in men with primary and secondary infertility, focusing on changes in semen parameters post-surgery. Materials and Methods. This prospective single center study included men diagnosed with PI ( n = 22) and SI ( n = 28), who underwent varicocelectomy at the Republican Specialized Scientific-Practical Medical Center of Urology between January 2021 and December 2022. Semen parameters before and after varicocelectomy were assessed in accordance with the WHO 5th (2010) and 6th (2021) manuals. Results. Our analysis demonstrated that patients in group I were significantly younger ( p < 0.001) and experienced a shorter infertility duration ( p < 0.01) compared to those in group II. Key semen parameters showed notable improvement in group I; for instance, sperm concentration rose by 50 %, from 62.2 ± 8.7 to 93.5 ± 10.0 M/ml, while total motile sperm count increased by 113 %, from 76.7 ± 17.1 to 163.4 ± 27.8 M ( p < 0.05). In contrast, group II showed a significant increase only in the percentage of progressive motile sperm (up by 107 %, from 13.5 ± 2.6 to 28.0 ± 5.2 %, p < 0.05). A notable distinction was observed in the improvement of total motile sperm count between groups I and II (113 % vs. 74 %, respectively, p < 0.01). Additionally, a difference was identified between the groups in the correlation coefficient (r) for the initial and post-surgery percentages of progressive motile sperm. Conclusions. Patients with SI presented with a higher mean age and longer infertility duration than those with PI. Varicocelectomy led to significant improvements in key semen parameters in patients with PI, whereas for patients with SI, the procedure primarily enhanced only the percentage of progressive motile sperm. These findings indicate that the type of infertility may influence the effectiveness of varicocelectomy, but only in the context of differences in age and duration of infertility between these groups.
Erectile dysfunction and genital response insufficiency in men with infertility most often have a multifactorial nature, in which organic and psychogenic mechanisms mutually reinforce each other. Current international guidelines on male infertility emphasize the importance of a comprehensive assessment of men, including mental health evaluation; however, in routine clinical practice the psychological component often remains underestimated. Psychogenic factors such as sexual performance anxiety, insecure attachment styles, negative sexual experiences, and delayed help-seeking behavior are associated with greater severity of erectile dysfunction and reduced sexual quality of life. The aim of this review is to analyze current evidence on the role of psychogenic factors in the development of genital response insufficiency in men with infertility and to evaluate the potential of a psychogenic component rating scale for erectile dysfunction as a tool for optimizing clinical management strategies. Psychodiagnostic methods can help differentiate psychogenic and organic forms of erectile dysfunction and improve treatment outcomes through targeted psychotherapeutic interventions. In the Russian Federation, a psychogenic component rating scale for erectile dysfunction has been developed to identify key psychological phenomena including anticipatory anxiety, avoidance of sexual intimacy, and hyperfocus on erectile performance. The scale enables stratification of patients according to the severity of psychogenic involvement, ranging from the absence of clinically significant anxiety to a predominantly psychogenic form of dysfunction. This review compares this instrument with internationally used psychometric tools for erectile dysfunction and infertility, including SIEDY Scale 3, psychological distress scales, and questionnaires focused on sexual cognitions and expectations. The potential integration of this scale into diagnostic and therapeutic algorithms for male infertility is discussed, along with its role in reducing diagnostic and pharmacological burden and its prospects for further psychometric validation. The systematic use of the scale may serve as a functional marker of the psychogenic contribution to genital response insufficiency and may facilitate the personalization of reproductive care.
Urethral stricture in men remains an important problem of reconstructive urology. Incidence of this pathology is 229–627 cases per 100,000 men. Urethral stricture significantly affects patients’ quality of life. Despite high efficacy of autologous buccal mucosa transplants (85–93 % of surgeries are successful), their use is limited by donor zone morbidity and tissue deficit, especially in cases of repeat surgical interventions. In recent decades, tissue engineering approaches have been actively developed, including cell-free matrices, hybrid composite constructions, 3D bioprinting, cell therapy. The review summarizes modern data on the types of matrices, clinical experience of their use and future of this approach to reconstructive surgery of the urethra.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains a relevant medical issue in the modern world due to the lack of effective treatment options. The condition significantly impairs quality of life by negatively affecting sexual, reproductive, and psycho-emotional health. In recent years, increasing attention has been paid to the role of prostatic fibrosis in disrupting glandular function, contributing to urinary disorders, and reducing male fertility. Efforts are underway to identify optimal therapeutic strategies. This article presents a clinical case of a patient with pronounced prostatic fibrosis associated with CP/CPPS category IIIB. The treatment included a combination of extracorporeal shock wave therapy and the enzyme-based drug bovhyaluronidase azoximer. Following the treatment course, improvements were observed in clinical and laboratory parameters, as well as in the findings of instrumental diagnostic methods.
BACKGROUND : Varicoceles are highly prevalent among men of reproductive age and significantly affect of male infertility. Statistics show that the incidence of varicoceles is 15–20 % in men, while among patients with fertility disorders, this figure rises to 35–40 %. This underscores the importance of further understanding of this condition and its impact on spermatogenesis. AIM : To evaluate the role of varicocele in male infertility and to assess the effectiveness of varicocelectomy in patients with primary and secondary infertility. METHODS : The study included 300 men divided into three groups: 100 patients with primary infertility after varicocelectomy, 100 patients with secondary infertility after varicocelectomy, and 100 conditionally healthy men. Varicocele was diagnosed using physical examination and Doppler ultrasound. Varicocele grading was performed according to the WHO classification (2000). Semen parameters were evaluated before and after surgery in accordance with WHO guidelines (2010). Statistical analysis was performed using parametric methods; differences were considered significant at p <0.05. RESULTS : Before surgery, patients with varicocele demonstrated significantly impaired semen parameters compared to the control group. After varicocelectomy, a statistically significant improvement in sperm concentration, motility, and total motile sperm count was observed in both infertility groups. The most pronounced improvement was noted in patients with primary infertility. CONCLUSION : The results of the study confirm the significant role of varicoceles in the development of spermatogen- esis disorders and male infertility. Varicocelectomy is an effective treatment for varicocele-associated male infertility and helps improve the reproductive potential of patients.
Introduction. Thulium vaporesection of the prostate (ThuVaRP) is a relatively safe and effective surgical procedure for benign prostatic hyperplasia (BPH). It does not require a long training period or additional expensive equipment. The limited number of studies evaluating the results of ThuVaRP makes this study relevant. Materials and Methods. The prospective study included 405 men with BPH who underwent ThuVaRP between 2018 and 2024 using a thulium fiber laser (Urolaz 1st generation, NTO IRE-Polus, Fryazino, Russia). During the operation, both resection and evaporation of prostate tissue occurred simultaneously to isolate its capsule. Results. The patients’ age ranged from 49 to 93 years (median 69 years), prostate volume from 35 to 198 cm3 (median 76 cm3), maximum urination rate from 0 to 11.2 ml/s (median 7.3 ml/s), residual urine volume from 35 to 220 ml (median 110 ml). 85 (21.0%) patients had suprapubic cystostomy drainage. The duration of the operation ranged from 49 to 93 minutes (median – 69 min), estimated mass of removed tissue – from 24 to 173 g (median – 55 g), decrease in hemoglobin after surgery – from 3 to 15 g/l (median – 6 g/l), duration of catheterization – from 3 to 8 days (median – 5 days), hospital stay after surgery – from 4 to 15 days (median – 6 days). The following complications were noted in the early postoperative period: bleeding – in 6 patients (1.5%), urinary tract infection – in 58 (14.3%), acute urinary retention – in 19 (4.7%), transitory urgent urinary incontinence – in 43 (10.6%). The following complications were observed in the late stages: bladder neck stenosis in 7 patients (1.7%), urethral stricture in 2 patients (0.5%), stress urinary incontinence in 15 patients (3.7%), and recurrent BPH in 13 patients (3.2%). The postoperative follow-up period varied from 3 to 70 months (median 32 months). During the entire follow-up period, a significant improvement in key urination parameters was observed after surgery compared to preoperative data. Conclusion. ThuVARP can be successfully used to treat BPH regardless of the size of the prostate gland, including in patients receiving anticoagulant and/or antiplatelet therapy. Due to its properties, it can be considered as an alternative to transurethral resection and laser enucleation of the prostate.
BACKGROUND : The acute (active) phase of Peyronie’s disease is characterized by penile pain, progressive curvature, and significant psychosexual distress. Conservative management during this stage aims to suppress inflammation, stabilize deformity, and preserve erectile function; however, an optimal multimodal therapeutic protocol has not yet been standardized. AIM : To evaluate the clinical efficacy of a novel comprehensive conservative approach for penile deformity correction in patients with Peyronie’s disease in the active phase. METHODS : An observational case-series study included 58 male patients treated between February 1, 2025 and July 27, 2025. The therapeutic protocol consisted of a nonsteroidal anti-inflammatory drug, daily administration of a phosphodiesterase type 5 inhibitor, ultrasound-guided manual traction therapy, and targeted psychotherapeutic intervention using eye movement desensitization and reprocessing (EMDR). Patients were assessed monthly for penile curvature angle, plaque size according to ultrasound examination, erectile function using the International Index of Erectile Function–5 (IIEF-5), and psychoemotional status. RESULTS : After 3 months of treatment, the mean relative reduction in penile curvature was 24.1 ± 8.7 % (p <0.05), while plaque length decreased by 16.3 ± 6.9 % (p <0.05). The IIEF-5 score increased from 10.2 ± 1.8 to 19.4 ± 2.6 points (p <0.05). No cases of deformity progression, plaque calcification, or serious adverse events were recorded during follow-up. CONCLUSION : The proposed multimodal conservative protocol in the active phase of Peyronie’s disease was associated with statistically and clinically significant reduction of penile deformity and improvement in erectile function. These findings support the need for further randomized controlled trials to confirm the efficacy and long-term sustainability of the therapeutic effect.
A growing body of evidence suggests a significant role of the human microbiome, particularly of the gut and urogenital tract, in the development and progression of various cancers, including prostate cancer. Dysbiosis of the microbiota can modulate local and systemic inflammation, hormone metabolism, and carcinogenesis. The aim is to summarize current knowledge on the relationship between microbiome dysbiosis and the risk of developing prostate cancer. A review of the literature demonstrates that specific changes in the composition of the intestinal and urinary tract microbiota are associated with the risk of developing prostate cancer. Key mechanisms include: induction of chronic inflammation, production of microbial metabolites affecting cell proliferation and signaling pathways, modulation of the host immune response, and potential impact on the metabolism of androgens and estrogens.
Introduction: the problem of treating chronic prostatitis (CP), due to its negative impact on quality of life, requires the search for effective methods of treatment. The study objective: to evaluate the efficacy and safety of the combined use of extracorporeal shock wave therapy (ESWT) and the drug bovhyaluronidase azoximer in the treatment of patients with CP. Materials and methods: the research included 70 men (mean age 44.8 ± 7.3 years) with CP, fibrotic changes and/ or calcinates in the prostate according to transrectal ultrasound (TRUS). According to the NIDDK/NIH classification, рatients with category II CP were divided into group 1 ( n = 20) — ESWT, 3-As-therapy, while patients with category IIIA and IIIB CP were randomized into group 2 ( n = 20) — ESWT monotherapy, and group 3 ( n = 30) — ESWT, the drug bovhyaluronidase azoximer. All participants underwent ESWT sessions targeting the perineum twice a week for 6 weeks. Assessments were conducted at baseline, weeks 7, 10, and 18, and included NIH-CPSI, IPSS, IIEF-5, VAS, uroflowmetry, TRUS, prostate secretion microscopy/sperm analysis, culture of prostate secretion/sperm, total PSA levels for men over 50 years. Results: by week 18, the intragroup results showed improvement in laboratory parameters, erectile function, relief from pain and dysuria, reduction in prostate volume, calcinates and fibrosis size ( p < 0.05). Analysis of variance between groups showed significant differences in NIH-CPSI, IPSS, VAS, Qmax, Qave, prostate volume, calcinates and fibrosis size ( p < 0.05). At weeks 7, 10, and 18, group 3 demonstrated significant ( p < 0.05) regression of symptoms for the parameters studied compared to groups 1 and 2. Conclusion: the presented treatment methods effectively alleviate CP symptoms and improve patients’ quality of life. The combination of ESWT and bovhyaluronidase azoximer shows significantly greater efficacy compared to ESWT monotherapy and the combination of ESWT with 3-As-therapy.
