Introduction. Reconstructive interventions on the male urethra present a complex surgical challenge. It is crucial not only to restore the anatomical patency of the urethra but also patients’ quality of life. The onset of sexual dysfunction after the operation significantly reduces the patients' quality of life and their perception of treatment outcomes. Objective. To conduct a review of the current literature on sexual and reproductive disorders following reconstructive interventions on the male urethra. Material and methods. Literature search was conducted using the PubMed, Google Scholar, and eLibrary databases up to August 2023. The search was performed using keywords in both Russian and English, including urethroplasty, urethral stricture, sexual dysfunction, ejaculatory dysfunction, penile shortening, penile curvature, and cold glans. Results. The development of sexual dysfunction after reconstructive interventions on the urethra depends on anatomical factors, surgical technique, and the extent of urethral involvement. Erectile dysfunction is present within the first 6 months after the surgery, followed by gradual recovery. The development of ejaculatory dysfunction, penile shortening or curvature, as well as impaired sensitivity, depends on the chosen surgical approach. Conclusion. The literature on sexual dysfunction is characterized by heterogeneous studies, making their analysis challenging. Data on reproductive disorders following urethroplasty are presented only in a few studies. To further assess surgical und functional outcomes it is necessary to conduct multicenter studies using validated questionnaires.

Background . Circumcision is one of the most commonly performed surgical procedures in men. Approximately 20 % of men in the world have undergone circumcision. It helps to prevent infections and inflammatory diseases of the lower urinary tract and reduces the risk of sexually transmitted diseases, helps to reduce the risk of developing glans cancer in men and cervical dysplasia in women. Being aware of complications that may occur after circumcision allows to conduct the surgery in a way that minimizes the risk of complications. Aim . To analyze both the circumcisio complications and their surgical management. Materials and methods . A retrospective analysis of a case series of 53 patients with complications after circumcision was performed: 30 patients underwent circumcision in childhood (average age 3.2 ± 1.8 years), 23 patients have been circumcised as adults (average age 34.9 ± 7.8 years). Complications that occurred in different age groups were analyzed, as well as their surgical management. Results . In this study, complications such as insufficient foreskin excision, severe scarring of the penile skin, phimosis recurrence, excessive foreskin excision, residual synechiae on the glans, amputation of the glans or the shaft, bleeding or hematoma formation, purulent inflammatory disease of the penile skin and glans, complications caused by local anesthetics, urethral injury with subsequent fistula formation or ischemia, meatostenosis have been observed in patients. All patients underwent surgical correction to achieve high functional and cosmetic results. Conclusion . Understanding the causes of circumcision complications and surgical management is a high priority task for the andrology community.

INTRODUCTION Flexible ureterorenoscopy (fURS) has become one of the most frequent procedures in urology in recent years. The main problem on the way of the spread of flexible ureterorenoscopy in everyday urological practice all over the world is the fragility of endoscopes. MAIN AIM To evaluate the potential use of reusable and single-use ureterorenoscopes for kidney stones. MATERIALS AND METHODS The analysis included 30 patients who underwent of retrograde intrarenal surgery (RIRS) for kidney stones. The patients were divided into two groups. I gr. - RIRS was performed with a reusable flexible ureterorenoscope Flex XC "Karl Storz" (Germany) (n=20), II gr. - a single-use flexible ureterorenoscope PU3022 "Pusen" (China) (n=10) was used. Lithotripsy was performed with a Lumenis Pulse 100H holmium laser (Israel, USA). RESULTS The age of patients, size and density of stones in I gr. and II gr. were comparable (42.5+/-16.9 vs 50+/-10.07 (years); 8.5+/-2.9 vs 10+/-2.5 (mm); 1248+/-315.3 vs 1376+/-223.3(HU+). Intraoperative complications were noted: in the I gr. - migration of stone fragments and bleeding; in the II gr. - migration of a fragment of stone. The time and efficiency of the operation of I gr. and II gr. were 75+/-39.9 vs 82.5+/-45.7 (min); 18 (90%) vs 9 (90%), respectively. Additional shock wave lithotripsy was required in 2 cases in the I gr., and more frequent usage stent was noted in the II gr. 10 (100%). In I gr. 5 (25%) patients had signs of inflammatory complication and 1 (5%) patient needed a change of antibiotics, after operation. The acute pyelonephritis was indicating in 2 (20%) patients of II gr. in the same period. DISCUSSION The use of access sheath was in all patients of II gr. and in 14 (70%) cases of I gr. In 1 case of the II gr. it was not possible extract of a stone fragment from the lower calyx due to the thickness of the intrument. The possibility of bending was higher for the "Karl Storz" ureterorenoscope due to smaller diameter of the instrument. One of the disadvantages of reusable flexible ureterorenoscope is the fragility of the instrument. In our research, the repair of the instrument was required after 12 manipulations. CONCLUSION The use of smaller instruments, the use of new digital imaging, the mobility of devices, allows performing interventions simultaneously by two surgeons, achieving the greatest fragmentation or evacuation of fragments of stones with good visualization, as well as using methods of drainage-free lithotripsy ("tubless").

INTRODUCTION:Surgical treatment of benign prostatic hyperplasia (BPH) is influenced by a rapidly growing number of technologies. AIM:To determine the surgical potential of holmium laser enucleation of the prostate (HoLEP) and the rate of postoperative complications during the learning curve. MATERIALS AND METHODS:A total of 98 patients undergoing HoLEP in the surgical department of the Clinical Hospital "Mother & Child" during the period from January 2018 to May 2020 were included in the study. HoLEP was performed by a single surgeon with previous experience in transurethral procedures. The criteria for inclusion in the study group were as follows: moderate-to-severe lower urinary tract symptoms, prostate volume > 40 cm3, maximum flow <15 ml/sec, the volume of residual urine > 50 ml. The exclusion criteria were the following: inflammatory process in the lower urinary tract, genitourinary malignancy, previous urinary tract interventions. The evaluated criteria included age, prostate size, International Prostate Symptoms Score (IPSS and QoL), bladder diary, PSA, uroflowmetry, total operative time, length of catheterization, complications according to the Clavien-Dindo Classification, and length of stay. RESULTS:During pathologic study, two cases of incidental prostate cancer (2.1%) were detected. The relationships between the prostate size and operative time (p<0.05), operative time and length of stay (p<0.05) were found. The total rate of complications was 16.3%. There were no complications more or equal IIIb according to the Clavien-Dindo Classification. The most dangerous complications were injuries of the bladder wall and ureteral orifice (31.25% and 18.75% among all complications, respectively). DISCUSSION:It should be considered that a large "middle lobe" is associated with a high risk of injury of the ureteral orifices. In our series, there were 5 cases of bladder tamponade, while bladder injuries during the morcellation developed in the first 10 patients. CONCLUSION:HoLEP is a reasonable alternative to TURP for surgical treatment of BPH and is considered a safe procedure for patients taking anticoagulant and antiplatelet drugs. Past experience of TURP allows to learn the technique faster and to reduce the number of complications.

Differential diagnosis between obstructive and non-obstructive azoospermia is an important task in clinical management of infertile patients. Chances of extracting sperm in obstructive azoospermia are high enough to inform the couple about favorable outcome of assisted reproductive technologies without resorting to donor sperm. Some forms of seminal tract obstruction can be corrected by microsurgical interventions or endoscopic resection of the ejaculatory ducts. Therefore, one of the objectives standing before imaging methods in reproductive andrology is the detection of these cases. In this literature review we present a detailed analysis of how to suspect and diagnose this form of azoospermia using imaging.

Introduction. Inflammation and fibrosis may have a significant role in pathogenesis of benign prostatic hyperplasia and associated lower urinary tract symptoms. Moreover, those factors may compromise the outcomes of surgical interventions for bladder outlet obstructions, such as transurethral resection of the prostate (TURP). Additional measures, such as administration of anti-fibrotic agents, may decrease the incidence of certain complications (e.g. bladder neck stenosis, urethral stricture) and improve overall outcomes of TURP. Bovhyaluronidase azoximer is an enzyme combined with high molecular mass copolymer which may inhibit surgery-related tissue remodeling and prevent excessive fibrosis. Materials and methods. Sixty-five patients undergoing monopolar TURP were enrolled in this prospective randomized open-label study. Patients in Group 1 ( n = 34) received 5 intramuscular injections of bovhyaluronidase azoximer (3000 IU) on days 3, 6, 9, 12 and 15 after TURP in addition to standard therapy. Patients in Group 2 ( n = 31) received conventional peri-operative therapy. All patients routinely underwent uroflowmetry and post-void residual volume measurement on follow-up 3 months after TURP. Incidence of fibrosis-associated complications was compared using Fisher’s exact test. Uroflowmetric parameters were compared using Mann-Whitney U-test. Results. One patient in Group 1 was excluded from the study due to mild allergic reaction after second injection of bovhyaluronidase azoximer. There were three cases of clinically significant fibrosis-associated complications in Group 2 which were confirmed on imaging (9.7 %). One case of stricture in bulbar urethra was later successfully managed with anastomotic urethroplasty, and two cases of bladder neck stenosis were managed with transurethral incision. No such complications were observed in Group 1 (0 %). However, the difference was not statistically significant ( p = 0.1079). Otherwise, there were no adverse events in both groups. Median Q max in Groups 1 and 2 was 24 ml/s and 22 ml/s, respectively ( p = 0.08). Median Q ave in Groups 1 and 2 was 15 ml/s and 9 ml/s, respectively ( p <0.00001). Median of post-void residual volume in Groups 1 and 2 was 25 ml and 40 ml, respectively ( p = 0.00438). Conclusion. This study was underpowered to demonstrate significant difference in incidence of fibrosis-related complications of TURP, though there was a trend towards lower risk in patients treated with bovhyaluronidase azoximer. There was also a statistically significant difference in Q ave and post-void residual volume in favor of Group 1, which may demonstrate lower rates of subclinical fibrosis. Overall, treatment with bovhyaluronidase azoximer was safe. Robust studies with longer follow-up are required to confirm efficacy of bovhyaluronidase preparations in post-TURP setting.

Background. Not all pathological mechanisms of fertility disorders in men are currently the correct diagnostic tests, this significantly reduces the prognostic value of the spermogram and makes the question of assessing spermogram character disorders and its impact on the effectiveness of assisted reproductive technologies (ART) procedures extremely relevant. In our study, we retrospectively evaluated the parameters of ejaculate and their effect on ART outcomes.Aim. To assess the effect of sperm agglutination and ejaculate liquefaction time on in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) results.Materials and methods. The selection of married couples was carried out on the basis of the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia. The study included 6,416 married couples who sought IVF-ICSI in the period from December 2012 to December 2016. Ages of men varied between 23 and 74 years, ages of women between 17 and 53 years. Examination data of the patients were extracted from the BABE software. In the study, sperm analysis parameters were evaluated during preparation to the IVF program, IVF-ICSI, and on the day of transvaginal ovarian puncture. Using univariant and regression analysis, prognostic factors of clinical pregnancy and childbirth after IVF-ICSI were determined.Results. Sperm agglutination rates adversely affect the incidence of clinical pregnancy (probability ratio (PR) 0.701; 95 % confidence interval (CI) 0.589–0.834; p <0.001) and childbirth (PR 1.719; 95 % CI 1.220–2.422; p = 0.002) in IVF-ICSI assisted reproductive technologies. Ejaculate liquefaction has a negative effect on the incidence of clinical IVF-ICSI pregnancy (PR 0.967; 95 % CI 0.949–0.986; p = 0.001).Conclusion. Andrologists should seek to improve the above ejaculate parameters with various treatments to improve the effectiveness of ART programs.

OBJECTIVE:to compare the efficacy of dapoxetine in treatment of primary and secondary premature ejaculation.MATERIALS AND METHODS:The study included 60 patients with premature ejaculation (PE). Depending on the form of premature ejaculation they were divided into two groups: 27 patients with primary PE (group 1) and 33 patients with secondary PE (group 2). Patients were recommended to take dapoxetine 30 mg 1 hour before intercourse. A follow-up visit was scheduled on day 30 after receiving the drug. The intravaginal ejaculation latency time (IELT) and the Premature ejaculation diagnostic tool (PEDT) score were evaluated before dapoxetine was given and after 30 days from the start of the study. The significance of differences between baseline and follow-up values were compared using Wilcoxons test. In both groups, the proportion of patients with an incomplete response (IELT less than 2 minutes, PEDT more than 10) to symptomatic therapy with dapoxetine was evaluated. The proportion of patients with incomplete response to therapy was compared using the chi-square test.RESULTS:The median IELT among all patients before starting therapy was 63 seconds (interquartile interval [IQR]: 28.75-94). After one month of therapy median IELT increased to 119 seconds (IQR: 58.75-321.75). Median PEDT score was 16 (IQR: 13-19) at baseline and 7 (IQR: 4-12) at follow-up. In group 1, the median IELT increased from 57 to 83 seconds (p = 0.02088), and in group 2, the median IELT increased from 70 to 173 seconds (p<0.00001). The mean PEDT score decreased to 7 in both groups (p<0.00001). Incomplete response to therapy was observed in 66.7% of patients in group 1 and in 39.4% of patients in group 2. The difference between two groups was statistically significant (p=0.035456).CONCLUSION:Symptomatic therapy with dapoxetine has a positive effect on the intravaginal ejaculation latency time and patient satisfaction in both primary and secondary premature ejaculation. However, the incidence of incomplete response to therapy is higher in patients with primary premature ejaculation, which may be due to characteristic differences in the pathogenesis of primary and secondary premature ejaculation.

Introduction. Varicocele is detected in 15% of healthy men, in 35% of men with primary infertility and in 80% of men with secondary infertility. The main non-invasive method to identify this pathology is ultrasound (US) with Doppler. Мaterials and methods. In this article, we reviewed and discussed the technical aspects of performing US diagnostics of varicocele, based on the clinical guidelines of the European Society for Urogenital Radiology. Results. The algorithm of US examination for the diagnosis of varicocele was analysed. It consists of 24 recommendations, which allows to increase the diagnostic value of US examination, as well as to reduce the frequency of diagnostic mistakes. Conclusions. US examination remains the most widely used imaging method of varicocele diagnostics. The described algorithm of this study may be useful for US diagnostics specialists.

AIMTo determine the possibility of performing minimally invasive percutaneous nephrolithotomy (PCNL) under ultrasound guidance with the use of X-ray during the access tract formation.MATERIALS AND METHODSThe results of 102 mini-PNL procedures, performed by a single surgeon during the period 2018-2019, were analyzed retrospectively. In the beginning, ureteral catheter Ch5 was put into an ipsilateral ureter. Further, a puncture of the collecting system was performed with an advancement of the guidewire. At the next stage, a dilation of tract was done using X-ray guidance for the safe formation of the working channel, followed by holmium lithotripsy. At the end a nephrostomy or JJ-stent was left.RESULTSThe mean age of the patients was 53.13+/-12.9, while average BMI was 29.3+/-6.5. In total, there were 44.1% of women. The average stone size was 20.7+/-10.9 mm; 45.1% of stones were left-sided. Staghorn stones accounted for 15.7% of cases and hydronephrosis was found in 18.6% of patients. The time for creating renal access, dilation of the nephrostomy tract, total operative time and fluoroscopy time were: 19.6+/-13.1, 7.7+/-4.2, 107.7+/-49.9, 57.1+/-41.2 minutes, respectively. In the Group I there were 32 (31.4%) patients undergoing to PCNL under X-ray guidance, while in Group II (n=70, 68.6%) combined US+/-X-ray control was used. The patients age (52.2+/-12.6 vs 53.6+/-13.2, p<0.05) and the stone size (20.6+/-8.9 vs 20.7+/-10.4, p=0.30) were comparable in both groups. There were slightly shorter access time and the total operative time in group II compared with group I (20.6+/-12.3 vs 19.2+/-13.5, p=0.27; 108.1+/-43.3 vs 106.9+/-53.2, p=0.25 respectively). In total, hematocrit level decreased by 4.5% and blood transfusions was done in 3 patients. Postoperative complications developed in 9 cases in both groups (according to the Clavien-Dindo classification, all complications were grade I-II). The stone-free rate (SFR) was 87.2%, and a second-stage was required in 2 cases.DISCUSSIONThe use of ultrasound guidance improves visualization of the collecting system and contributes to the creation of an optimal renal access. It significantly reduces the radiation exposure to the patient and the operating team. We were able to puncture the collecting system in all cases. SFR after PCNL under ultrasound guidance was 88.6%, which is comparable to the results of conventional PCNL with X-ray navigation.CONCLUSIONPCNL can be performed effectively and safely under ultrasound guidance, which reduces the number of renal punctures and lowers the complication rate. However, this technique also has disadvantages, including longer puncture time in morbidly obese patients without hydronephrosis. With growing experience, the number of unsuccessful kidney punctures decreases, as well as operative time. The use of fluoroscopy during dilatation of the nephrostomy tract allows for preventing additional injuries of the collecting system.

The article presents the results of frequency analysis in the nucleotide sequence of genes of the signal path Notch (DLL4 (rs35748882), HEY2 (rs61737181), JAG1 (rs1801140, rs1801139, rs45575136), NOTCH1 (rs61751542), NOTCH2 (rs3795666), NOTCH4 (rs8192576, rs8192579, rs8192585)) at patients with clear cell kidney cancer and healthy individuals from the population control. It was found that the frequency of detected changes in patients was on average higher than the general population values. The results of this study may indicate the contribution of the studied changes in the nucleotide sequence of genes of Notch signaling pathway to the pathogenesis of clear cell kidney cancer, as well as the possibility of their use while creating a panel of molecular markers for diagnosis and prognosis of the course of the disease.

The implementation of robotic surgery, in particular the da Vinci surgical system, is one of the biggest breakthroughs in surgery since the invention of anesthesia, and represents the most significant achievement in minimally invasive surgery of this decade. If the use of the da Vinchi robotic system in pelvic surgery has long been the gold standard, the use of this system in surgery of the base of the skull and sinuses is quite rare and is currently more experimental. Due to the lack of description in the domestic and foreign literature, it seems interesting to us to demonstrate the clinical observation of a patient with an orbital tumor.

Renal cell carcinoma (RCC) is a common renal neoplasia of various morphological types, among which clear cell RCC is the most common. About 70% of sporadic cases of clear cell renal cell carcinoma are accompanied by inactivation of the von Hippel–Lindau gene ( VHL ). It is known that VHL is a target for several miRNAs—small noncoding RNAs that carry out post-transcriptional regulation of genes. The purpose of this study was to analyze the expression levels of miRNAs which target the VHL gene and also to analyze the association of genotypes and alleles of the rs1642742 polymorphic locus of the VHL gene located at the miRNA binding site with the risk of developing clear cell renal cell carcinoma (ccRCC). As a result of the analysis, no statistically significant changes in the expression level were found, although miR-21 and miR-224 showed a tendency to increase expression in the tumor compared with normal kidney tissue ( p = 0.0597 and p = 0.0846, respectively). Also, in a comparative analysis of the frequencies of genotypes and alleles of the polymorphic locus rs1642742 of the VHL gene, an association of the rs1642742*GG genotype was found with the risk of developing ccRCC in a group of people over 55 years old ( p = 0.0381; OR = 1.84; 95% CI (1.03–3.31)). Undoubtedly, further study of miRNAs on large groups of samples is necessary, which will make it possible both to identify new molecular markers of the risk of developing the disease and to form panels of prognostic markers.

INTRODUCTION:Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis.OBJECTIVE:to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches.MATERIALS AND METHODS:In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months.RESULTS:Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period.CONCLUSION:Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.

Disturbances of urinary flow result in an increase in intrapelvis pressure and a decrease in the kidneys ability to filter urine. The impairment of the blood flow in renal parenchyma represents one of the causative factors. Compensatory mechanisms in case of prolonged occlusion include collecting system dilation as well as pyelorenalis reflux. These changes lead to urine circulation via glomerular and tubular apparatuses, the interstitial tissue and lymphatic vessels and lead to the pyelovenous reflux. The results of studies dedicated to impairment of blood flow in the kidney parenchyma during the ureteral occlusion and in different types of the surgical treatment of urolithiasis are presented in the article.

AIM To determine whether fosfomycin can be used in treatment of women with acute uncomplicated cystitis in the postpartum period. MATERIALS AND METHODS The results of treatment of acute uncomplicated cystitis in 51 patients in the postpartum period were retrospectively evaluated. All patients received a single dose 3 g of fosfomycin. RESULTS In order to determine clinical efficiency, in all cases laboratory tests were performed prior to and 3 days after treatment. A degree of pain syndrome, the number of voids and urgent episodes were also evaluated. Urine culture was studied before and 7 days after taking fosfomycin. There was a decrease in the number of leukocytes and erythrocytes in urine, number of voids, including urgent episodes. A normalization of urine flora after a single dose of the fosfomycin was noted. DISCUSSION In our research in the repeated analysis of urine culture, the number of bacteria was lower than 104 in all cases, and there was also decrease in the number of voids and intensity of pain syndrome. CONCLUSION The treatment of acute uncomplicated cystitis in women in the early postpartum period has its own characteristics. A single dose of fosfomycin allows to avoid long-term use of the antibiotic and to continue breastfeeding, which is required for the treatment of this disease in lactating women. One of the medicine used in AAC is Fosfomycin Esparma, which has a high safety profile. The use of high-quality antibacterial therapy in these patients to give possibility to avoid complications.

Introduction . Our first experience in embolization of prostatic arteries at patients with benign prostatic hyperplasia had comprised patients with the symptoms of chronic urinary retention. Material and methods . The average age of patients (n=3) was 61.0±4 years. Among medical indications to embolization there were dysuria significantly degrading the patients’ life quality and their unwillingness to proceed to transurethral resection. Before the embolization of the prostatic artery, it is necessary to identify the place of its departure and its anastomosis by computed tomography. Successful operation was effectuated without microcatheter guides in 3 cases and with the application of microcatheter guides in 3 cases. For the purposes of embolization there were used spherical embolus HydroPearl sized 400 nm. No complications were reported neither in the operational nor in the post-operational periods. Results . All patients admitted a decrease in dysuria as well as the improvement in life quality already in 7–15 days after the endovascular invasion. Control ultrasound dopplerography was performed 3 months after intervention. Two patients with embolization showed decrease of prostate volume by 26%, and one patient — by 35%. Conclusions . Embolization of the prostatic arteries is a promising low-traumatic and safe method for treating patients with benign prostatic hyperplasia. It is necessary to further study its long-term results, to develop an optimized methodology — fast, simple and cheap, but not at the expense of efficiency and safety.