Introduction. A new paradigm in the diagnosis, treatment, and prevention of urinary tract infections (UTIs) is currently emerging in medical science, based on the understanding that urine is not sterile and the urinary tract is inhabited by a diverse microbiome. Recurrent UTIs remain one of the leadingproblems in the management of patients with neurogenic lower urinary tract dysfunction (NLUTD), but the dependence of UTI recurrence rate on the composition of the urinary microbiome has not been studied. The purpose of the study was to assess the changes in the urinary microbiome in patients with neurogenic bladder and the relationship between these changes and the frequency of recurrent urinary tract infections. Materials and methods. The urinary microbiome was studied in 118 patients with neurogenic bladder without UTI recurrence and 15 healthy volunteers as a control group. Urine cultures were performed using the modified enhanced quantitative urine culture (EQUC) method, with determination of antimicrobial susceptibility of the microorganisms, and real-time PCR analysis of urine samples using the Androflor kit (DNA-Technology, Russia). Results. Bacterial growth was obtained in 72% of urine cultures from NLUTD patients and 80% in the control group. A total of 175 isolates were obtained: from 1 to 6 (on average 1.76±1.22) per patient. PCR analysis of urine samples revealed the presence of microbial DNA in all urine samples, including those that did not show growth on culture media. The most common microorganisms in the microbiome of NLUTD patients were: Escherichia coli (20%), Enterococcus faecalis (19%), Staphylococcus spp. (15%), Streptococcus spp. (12%), and Klebsiella pneumoniae (9%). The microbiome of patients with preserved spontaneous urination was closest to the control group, but differed in an increased proportion of Enterobacteriaceae and Enterococcus spp. The presence of a significant number of representatives of the normal microflora, such as Lactobacillus spp., Streptococcus spp., Staphylococcus spp., and a more diverse composition in general, distinguished the urinary microbiome of patients using intermittent catheterization from those with a permanent drainage. Urine cultures of patients with recurrent UTIs yielded fewer isolates than those without frequent infection exacerbations (1±0.58 and 2.25±1.29, respectively, p=0.001). Conclusions. The urinary microbiome of NLUTD patients is dominated by Enterobacteriaceae. The presence of a significant number of representatives of the normal microflora, such as Lactobacillus spp., Streptococcus spp., Staphylococcus spp., and a more diverse composition in general, distinguish the urinary microbiome of patients with intermittent catheterization from those with cystostomy or a permanent urethral catheter. Species diversity of the microbiome is associated with a lower frequency of recurrent urinary tract infections.

Introduction. Reorganization of the urinary microbiome in patients with neurogenic low urinary tract dysfunction (NLUTD) plays an important role in the pathogenesis of urinary tract infections (UTIs). However, we still do not know how the different types of NULTD therapy affect the microbiome.Purpose of the study. Was to assess the influence of botulinum toxin (BoNT) injections on the urinary microbiome.Materials and methods. Urine samples were obtained from 6 persons (4 females and 2 males) with NLUTD before BoNT therapy (200 UI) and 6 weeks after. Standard urine analysis, urine culture and 16S rRNA gene sequencing were performed. a total of 144,562 quality-filtered 16S rDNA sequence reads were processed through an Illumina MiSeq platform.Results. The results of the urine culture correlated with 16S rRNA sequencing results, but the greater number of bacterial taxa were detected. Analysis of the bacterial community in urine samples revealed between 2 and 21 species-level reads per individual. All patients before BoNT demonstrated abnormal urinary microbiome with a predominance of Enterobacteriales. In three cases in females, clinical and urodynamic improvement after botulinum therapy was associated with changing of the microbiome from Enterobacteriaceae to Lactobacillales. In one female and two males, no principal changes had happened.Conclusions. This is the first report comparing in pilot study the urinary microbiome before and after BoNT injections into the bladder wall. The results are restricted by the small number of participants. However, the promising observation about the influence of botulinum toxin therapy on urinary microbiome was obtained.

The main indicators of organization of urological care in Sverdlovsk region were analyzed. The structure of urological and oncourological morbidity in dynamic from 2000 to 2018 was presented. The data of the personnel structure and bed stock of urological service was shown. The effective methods of men treatment with prostate cancer in the year of 45-80 by the modern methods of SOKB №1: brachytherapy, robot-assisted operations, ultrasound ablation HiFU, radical prostatectomy, laser ablation, hormonotherapy - allow us to prove for the soon improvement and use in regions of Sverdlovsk region (Governor’s program “Urological men’s health» in Sverdlovsk region)

A major focus of this paper is on the organization of specialized urological treatment, by taking into account the Governor's program “Male urological health” in the Sverdlovsk Region. It also shows the great importance of financial support for early diagnosis, timely effective treatment, clinical examination, and better quality of life in the male population of the Sverdlovsk Region.