Overactive bladder (OAB) is a syndrome consisting of urgency, usually accompanied by urinary frequency and nocturia, with or without urgent incontinence, in absence of a causative infection or pathological conditions. The prevalence of OAB is approximately 11-19% in both men and women, and leads to a significant negative effect on health-related quality of life. The prevalence of OAB increases with age. The elderly population is unique, with increased medical comorbidities and the possibility for cognitive and functional deficits. Anticholinergics should be avoided in older adults as this class of drugs is associated with an increased risk of cognitive decline. Unfortunately, there is little data on the possibility of using intradetrusor injections of botulinum toxin, as well as tibial and sacral neuromodulation in elderly patients with OAB.

The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to a higher risk of postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a set of expert recommendations to assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is a common condition in older man. Uroselective a1a-adrenoceptor (AR) antagonists tamsulosin and tamsulosin modified release (OCAS) are the most frequently prescribed medications for the men with LUTS due to BPH. Both tamsulosin and tamsulosin OCAS improve the patients disease-specific quality of life, reduce IPSS by approximately 30–40% and increase Qmax by approximately 20– 25%. The high selectivity of tamsulosin to α1А-adrenoceptor and slow release system OCAS provide a minimal vasodilating effect and correspondingly low risks of falls. These benefits are important in the treatment of LUTS in older men.

The article describes an example of successful surgical treatment of an elderly patient with an arterio-ureteral fistula in the presence of an infected vascular graft after numerous arterial reconstructions on the aortoiliac segment with the multidisciplinary team support. Restoration of the magistral blood flow in the aortoiliac region using bypass surgery or graft implantation relates to a technically sophisticated surgeries, especially in patients with severe concomitant diseases and previously implanted graft infection. This is associated with the high incidence of complications, which varies from 19.2 to 45% according to different sources. In such cases, extra-anatomic reconstructive interventions that are low-traumatic may be the method of choice for relieving critical ischemia. This approach in most cases becomes the only opportunity to save a limb in such clinical situation. A pronounced cicatrical adhesion process in the abdomen and retroperitoneum caused by numerous reconstructive surgeries on the infrarenal aorta in some cases can be the cause of ureteral strictures, which requires the involvement of a urologist in the treatment of such patients. Arterio-ureteral fistula (AUF) is an uncommon but potentially lethal complication. Despite increased number of reported cases and clinical awareness, AUF is not always detected in a timely manner. The prognosis in such cases can vary depending on the time interval from onset of clinical symptoms to the start of treatment. In the vast majority of cases, the AUF is located at the site where the ureter crosses over the bifurcation of the common iliac artery. Angiography is deemed the most effective procedure to diagnose AUF, although its sensitivity is only 62%. According to most authors, implantation of an endovascular stent graft for AUF is preferred over open surgery (mortality rate is 4 and 11%, respectively). However, an individual treatment strategy is developed in each specific case

INTRODUCTION:Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem, which may have a large impact of quality of life. AIM:To assess the prevalence of UI in people over the age of 65. MATERIALS AND METHODS:Participants were 4308 elderly individuals (1292 men and 3016 women) with an average age of 78+/-8 years. RESULTS:UI was detected in 1953 patients (45,3%), including urgent UI in 25,8%, stress UI in 12,3% and mixed UI in 8,3% cases. There was a clear tendency to higher incidence of all types of UI with age. Our data show the need for mandatory consultation with a urologist for all person over the age of 65.

Primary leiomyosarcoma is an extremely rare entity constituting only 0.5–1% of all invasive renal tumors. It is frequently diagnosed after histological examination because it does not have any specific diagnostic features clinically and radiologically. At times, it is difficult to differentiate leiomyosarcoma from the sarcomatoid renal cell carcinoma even during histological examination as both tumors have spindle-shaped atypical cells. Moreover, some epithelial markers can be present in pure smooth muscle sarcomas, while some smooth muscle markers are positive in carcinomas. An extremely uncommon condition is leiomyosarcoma that develops in the renal pelvis. A patient with an obstructive stone-related left renal colic was admitted to hospital with a filling defect in the renal pelvis, which was initially misdiagnosed as a blood clot. After visual examination of the renal pelvis and a biopsy of the exophytic lesion, leiomyosarcoma was determined to be the cause. Laparoscopic radical nephrectomy was performed, histological and immunohistochemical examination confirmed the lesion to be a leiomyosarcoma with mixomatoid component. No adjuvant treatment was performed, and the patient remains healthy 6 years after surgery without recurrence. Herein we provide literature review, discussion of the diagnosis and treatment scenario of the patient with renal pelvis leiomyosarcoma with mixomatoid component.

Overactive bladder (OAB) — is a clinical syndrome which includes urge urination with or without urge urinary incontinence which is usually accompanied by frequent urination and nocturia. In most cases, OAB does not pose a threat to the life of patients, but significantly worsens the quality of all spheres of human life. Urge urinary incontinence is one of the main causes of falls in older patients, which often leads to fractures of the proximal femur and is accompanied by severe complications. Drug therapy with M-cholinoblockers (cholinolytics) is the leading direction in the treatment of patients with OAB. However, this type of therapy remains poorly understood in older men and women. The choice of an effective and safe cholinolytic for older and senile patients is the subject of discussion and scientific research. The results obtained show trospium chloride as an effective drug for the treatment of urgent and frequent urination due to idiopathic OAB, as well as the lack of influence on cognitive function in older patients.

Leiomyosarcoma arising from renal pelvis is a very rare disease. A patient was admitted to hospital with left renal colic due to nephrolithiasis, with a filling defect in renal pelvis that was considered to be a blood clot. Diagnosis of leiomyosarcoma was made after visual inspection and biopsy of the exophytic lesion. Laparoscopic radical nephrectomy was performed, histological and immunohistochemical investigation confirmed leiomyosarcoma with mixomatoid component. No adjuvant treatment was performed, the patient remains healthy 5 years after surgery without recurrence. Herein we provide literature review, discussion of the diagnosis and treatment scenario of the patient with renal pelvis leiomyosarcoma.

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

The purpose of the first multidisciplinary Consensus: to comprehensively analyze the pathophysiological, clinical, and pharmacotherapeutic aspects of the syndrome of increased epithelial permeability (SPEP) as one of the basic mechanisms of the development of human pathology. The Consensus presents the structure of the three main levels of cytoprotection: preepithelial, epithelial and subepithelial, and the structure of intercellular tight contacts in epithelial tissues and endothelium is considered in detail. The clinical sections of the Consensus are devoted to the role of SPEP in diseases of the digestive system, cardio-cardio-vascular and other visceral systems. A separate section summarizes the materials illustrating the significant role of SPEP in mental disorders and diseases of the nervous system. A separate chapter of the Consensus is devoted to cytoprotective therapy in SPEP. Cytoprotective effects of such proton pump inhibitor as rabeprazole, bismuth preparations and probiotics have been shown. Special attention is paid to the clinical and pharmacological specialties of the cytoprotector of rebamipide. Clinical the effectiveness of re-bamipide shown as in functional, so in organic lesions of the digestive system. Its anti-cancer preventive effects are of practical importance.

World studies have shown that the mean prevalence of overactive bladder (OAB) ranges today from 11 to 16% of the global population and is common in both men and women. In addition, OAB is a diagnosis by exclusion. The article discusses two large groups of the causes of pathology: neurological and non-neurological. The former includes various diseases and conditions that lead to a complex abnormality in the urinary mechanism, namely, involuntary detrusor contractions and increased intravesical pressure. Spinal trauma, brain strokes and spinal strokes, multiple sclerosis, Parkinson’s disease, etc. are the most common of them. Unidentified factors constitute the second group of causes resulting in urgent frequent urination, and what is meant here is idiopathic detrusor hyperactivity (IDH). In this case, a patient may have these symptoms amidst full health without any neurological history. According to the available current guidelines, the treatment of OAB includes a three-step algorithm and suggests lifestyle changes, drug therapy and, finally, minimally invasive methods of treatment. Historically, M-anticholinergics are the main drugs for the treatment of OAD symptoms. However, administration of drugs from this group may often be impossible due to prominent side effects, which are more commonly reported among elderly patients. Unlike M-anticholinergics, Mirabegron is the only β3-adrenergic receptor agonist today that has shown a high efficacy and safety profile based on the results of large-scale placebo-controlled clinical trials.

Currently, one of the most common issues in medicine is antibiotics resistance. This relates to nosocomial and to communityacquired infections. This problem is common for economically developed countries of the whole world and in its significance must be placed side by side with issues of the threat to national security. In Russia annual mortality from nosocomial infection remains high and, unfortunately, this indicator doesn’t reduce from year to year [1].

Antagonists of α1-adrenergic receptors (α-blockers) are among the most effective drugs for the treatment of patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH; LUTS/BPH). Based on the results of treatment outcome analysis, the American Urological Association acknowledged these drugs as drugs of choice for the treatment of BPH [1].

: The retrospective evaluation of efficacy and safety of tamsulosin omnik (0.4 mg once a day) for 8 years in 17 patients with BPH and LUTS was performed. At the time of appointment of tamsulosin, mean age of patients was 61.9 years (range, 51 to 69 years). Efficacy of tamsulosin was evaluated based on the change of obstructive and irritative symptoms according to items of I-PSS scale, maximum urinary flow rate, residual urine volume and prostate volume. The study found that factors for favorable prognosis against the background of use of tamsulosin include moderate LUTS, small- or medium-sized BPH, maximum urinary flow rate of not less than 9 ml/s, and residual urine volume not more than 100 ml.

The first mentioning of plant extracts for the treatment of urination disorders in men with prostate disease dates back to the ancient Egypt, namely XV century BC. Currently we know of about 30 kinds of plant extracts which are used in the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) or chronic prostate inflammation. More than 40 clinical studies have been published which demonstrate the efficacy of herbal medicines for male LUTS.

Lower urinary tract symptoms (LUTS), which are quite common especially in elderly men, may be caused by a number of diseases. A sharp decline in the quality of life forces patients to see an urologist who has to apply a differentiated approach in order to identify the cause of LUTS and choose the correct method of treatment.