Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

A stricture is a type of narrowing of the urethra, which can be caused by a variety of reasons. In addition, urethral strictures are associated with a wide range of symptoms and require special diagnostic examination before proceeding with any treatment. The treatment of urethral strictures has remained a challenge for many years. Stricture recurrence is still a serious problem in reconstructive urology. During the second half of the 20th century, urologists tried to find solutions for treating both simple and complex urethral strictures. Within the last few decades research has mainly focused on improving existing procedures to mitigate the negative postoperative effects. Despite considerable scientific achievements in this area, numerous studies have revealed a lack of knowledge about urethral stricture surgery among urologists and have shown that patients with urethral strictures are generally offered inadequate treatment options. Currently, many surgical interventions are available to treat this condition. However, the variety of treatment methods reflects a lack of optimal technique. This bibliographical review presents data on the effectiveness of minimally invasive (endoscopic) and various urethroplasty options in urological practice.

The purpose of the study is to study the efficacy and safety of the prostate extract (GEROFARM LLC, Russia) in the postoperative period in patients after transurethral bipolar resection of the prostate.MATERIALS AND METHODS:The clinical study included 127 men aged 50 to 78 years with grade II benign prostatic hyperplasia (adenoma) who underwent a typical bipolar transurethral resection of the prostate. Patients of the main (n=60) group received tamsulosin 0.4 mg/day for 30 days in the postoperative period in combination with prostate extract 10 mg rectally for 21 days. In the control group (n=67) - tamsulosin 0.4 mg/day for 30 days as monotherapy. To assess the results of treatment, the questionnaire of the international system of total assessment of symptoms in prostate diseases (IPSS) with the definition of quality of life (QoL), the international index of erectile function (IIEF-5) and uroflowmetry were used. The control was carried out in terms of 1 and 3 months after the operation.RESULTS:In the main group, in the observation period of 1 and 3 months after the operation, a decrease in the average IPSS score by 40.2% and 52.9% was revealed, and an improvement in the quality of life by 45% and 64.7%, respectively, was noted. In the control group, at the same time of observation, a decrease in the average IPSS score by 34% and 44.7%, respectively, was revealed, and the quality of life improved by 25.5% and 37.3%, respectively. The increase in the average rate of urination in the main group by the end of 1 and 3 months of treatment was 59.2% and 85.7%, respectively, and in the control group, these figures were 40.5% and 50%. The positive effect of the proposed combination therapy on erectile function in the main group by the end of 1 and 3 months of treatment was 5.2% and 9.2%, respectively, and in the control group, these figures were 2.9% and 5.2%.DISCUSSION:There is a significant decrease in the symptoms of the lower urinary tract in the group of patients who received the drug Prostateks (GEROFARM LLC, Russia).CONCLUSIONS:The efficacy results of Prostatex (GEROFARM LLC, Russia) (reduced symptom severity on IPSS (11.7 1.2 ) and QoL (2.3 0.3)) scales are comparable to those of Vitprost Plus which allows you to evaluate the effectiveness of two drugs equally.

Stromal vascular fraction (SVF) is a heterogeneous cell extract obtained with enzymatic dissociation of adipose tissue followed by centrifugation. This population includes many different cell types, i.a. adipose tissue stem cells (ATSCs), vascular endothelial and smooth muscle cells and their precursors, pericytes, fibroblasts, macrophages, T-lymphocytes, etc., excluding mature adipocytes. The main SVF component is ATSCs capable of self-renewal and multipotent differentiation. Since early research on SVF, an extensive effort has been aimed at understanding its clinical applications promoting a significant progress in the SVF use for treatment of various diseases and injuries. The past decade has witnessed an upward publication trend in basic and clinical research into the SVF therapeutic value. Manifold methods and devices for the SVF isolation from human liposuction lipoaspirate have been developed, continuously contributing to preclinical and clinical trials of its safety and efficacy. This review discusses the main properties and functions of the SVF cell population, its efficacy and safety for human therapy.

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.

The lack of consistent standardized approach and variety of suggested methods for strictures treatment are still complicated problems for the modern urology. In this article, we investigate surgical treatment methods of urethra strictures, taking into account the aetiology, localization, extension and intensity of spongiofibrosis. The method for estimation of optimal resection zone in anastomotic urethroplasty, fixation zones of buccal graft and flap, using optical coherence tomography, is proposed. This will give the opportunity to improve the surgical treatment results for this category of patients

Introduction. Standard methods used for the diagnosis of strictures in the penile and bulbar urethra (urethrography, multislice computedtomography) do not always provide reliable information on the length of spongiofibrosis, which may sometimes require the adjustment of treatment strategy and the volume of surgery.Objective. We aimed to assess the effectiveness of coherence tomography in preoperative evaluation of the length of spongiofibrosis.Materials and methods. The study included 24 patients diagnosed with strictures of the anterior urethra and treated at the Departmentof Urology of the Bashkir State Medical University between 2015 and 2017. All patients underwent preoperative optical coherence tomography (OCT) of the urethra and surrounding tissues performed using Ilumien ARTRU100126317 (St. Jude Medical, Australia). The method allows evaluating histological characteristics of the urethra and the length of spongiofibrosis, therefore, helps to choose an optimal tactics of surgical treatment. In all patients, the length of spongiofibrosis, estimated by OCT, correlated with that measured intraoperatively.Results. We compared the lengths of spongiofibrosis assessed by three methods (urethrography, OCT, and intraoperative measurement) and found that the intraoperative results had good correlation with OCT findings and poor correlation with urethrography findings. Mean length of urethral strictures was 6.32 ± 0.6 cm upon urethrography, 8.15 ± 0.3 cm upon OCT, and 7.8 ± 0.5 cm upon intraoperative measurement.Conclusion. Accurate estimation of the length of urethral strictures using coherence tomography will improve treatment results in these patients.

The paper is devoted to the techniques of treatment of spontaneous kidney rupture (SKR) and spontaneous retroperitoneal hemorrhages (SRH) in patients with hemorrhagic fever with renal syndrome (HFRS). The paper describes endemic character of the disease, its incidence rate, frequency, peculiarities the course, of the disease, tactics of conservative and surgical treatment of patients with SKR and SRH. The paper proves the efficacy of satratorium and resort factors in the treatment of patients who had SKR and SRH. It confirms the efficacy of optimal combination of therapeutic, climatic, balneal factors and medicinal effect of the mineral water obtained from spring № 12 and mineral baths. The combination of all these factors results in the improvement of the function of the kidneys, increase in glomerular filtration, decrease in tubular reabsorption of sodium and water and amelioration of rheological blood properties and by a number of other effects. This combined approach can be recommended as an indispensable part in the treatment of patients who underwent surgical treatment due to SKR and SRH caused by HFRS because it allows to achieve considerable results in rehabilitation of such patients.

Morphometry issues of lower urinary tract microcirculatory components in pathology-free participants and in cases of various urologic disorders have been considered in the article. General patterns in microcirculatory and morphological changes of the bladder and urethra in cases of diverse lower urinary tract disorders have been experimentally revealed. In order to create an experimental model of lower urinary tract disorders, 50 animals were employed. In the present analog study, the results of the bladder and urethra microcirculatory investigations have been shown to directly correlate to the morphological examination findings of histologic specimens made within the appropriate time period.

The article presents post-examination and post-treatment outcome of 357patients with lower urinary tract disease consistent with the assessment of microvasculature compensatory-adaptive reaction mechanisms and microcirculation disorders correction.

The use of afala in patients with benign prostatic hyperplasia and moderate urination disturbances reduced the symptoms of the disease, improved urodynamic parameters, and increased quality of life. Clinical efficiency of afala was comparable with the efficiency of Serenoa repens extract (reference preparation).

The effects of indol-3-carbinol and epigallocatexin-3-gallate on alteration and reparation in the urethra were studied in 30 male Shinshilla rabbits. From the observation day 2 the rabbits were fed with indol-3-carbinol and epigallocatexin-3-gallate in addition to standard diet. Microcirculation was assessed with a laser analyzer of capillary circulation LAKK-01 which detected earlier recovery of microcirculation in the group of the animals fed with indol-3-carbinol and epigallocatexin-3-gallate. Thus, antioxidant and antiproliferative properties of indol-3-carbinol and epigallocatexin-3-gallate improve alteration and reparation in affected urethra due to development of soft elastic connective tissue with better capillary circulation.

To study changes in microcirculation of the lower urinary tract in different diseases we used laser analyzer of capillary circulation LAKK-01. The control group consisted of 25 volunteers, the study group--of 65 patients with different vesico-urethral diseases. Normal values of microcirculation in the wall of the urinary bladder, prostatic gland and urethra were determined. These values were significantly reduced in patients with vesico-urethral disorders. Thus, alterations in microcirculation in different pathological conditions of the vesicourethral segment confirm the hypothesis of a direct involvement of microcirculation disorders in pathogenesis of many urological diseases.