In half of the cases, a decrease in the quantity and/or quality of spermatozoa is the cause of infertility. The pathogenesis of such disorders is multifactorial, often unknown, and data on the treatment efficiency are still contradictory. Based on the recent high-level evidences (randomized studies and meta-analyses), the real clinical efficiency of various surgical and conservative treatment methods for the main clinical forms of male reproductive dysfunction, including hypo- and hypergonadotropic hypogonadism, secretory and obstructive azoospermia, retrograde ejaculation and anejaculation, pathospermia associated with varicocele, and idiopathic forms, is analyzed. An algorithm for managing patients with these disorders is proposed, which can be convenient in the routine practice of a urologists regardless of the level of equipment of a healthcare facility.

A review of controversial issues about the terminology on male infertility and reproductive function, which is currently used, as well as proposals for updating clinical guidelines for the diagnosis and treatment of male infertility and men in infertile couples are presented in the article. An algorithm is described, the elements of which ensure referral of patients based on the possibility and timing of restoration of reproductive function, taking into account the reproductive health of a woman, as well as increasing the likelihood of successful treatment aimed at the birth of a healthy child.

С 7 по 10 сентября 2022 г. город Казань (Российская Федерация) стал центром притяжения для всех врачей, работа которых направлена на сохранение репродуктивного здоровья мужчин и женщин, а также на лечение бесплодия. Репродуктологи, акушеры-гинекологи, андрологи, урологи, генетики, эмбриологи, врачи ультразвуковой и клинической лабораторной диагностики, врачи общей практики провели 4 дня в междисциплинарном диалоге, результатом которого стало обогащение каждого участника новыми знаниями и навыками.

INTRODUCTION:In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed.MATERIALS AND METHODS:a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups.RESULTS:Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers.CONCLUSION:the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

Testosterone replacement therapy (TRT) allows to combat the symptoms of age-related androgen deficiency (AAD); however, it may have side effects, including the reduction in sperm count and even complete cessation of spermatogenesis and development of azoospermia. The fertility may not be restored even within 18 month after treatment completion. Russian researcher explored the impact of TRT with gel on the ejaculate parameters in men with hypogonadism and observed no negative effects on spermatogenesis within 3 months after treatment initiation. We describe a clinical case of reversible azoospermia induced by a relatively short course of TRT with gel. Fertilizing capacity of sperm was finally restored, which was confirmed by a clinical pregnancy obtained by in vitro fertilization. Physicians prescribing TRT should inform their patients that such treatment is contraindicated to those men who would like to preserve their fertility and explain that the restoration of fertility will take some time after treatment completion.

The article reviews the domestic studies showing the efficacy and safety of suppositories containing prostate extract (Samprost substance) Vitaprost Forte in treating men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The data obtained by Russian specialists confirm the effectiveness of Vitaprost Forte suppositories in managing patients with moderate LUTS and infravesical obstruction caused by BPH to reduce dysuria, improve the quality of life and normalize urodynamic parameters.

Злокачественные опухоли яичка составляют около 1–2 % всех новообразований у мужчин и 5 % опухолей мочевыделительной системы и мужских гениталий. На ранних стадиях злокачественные новообразования яичка не проявляются клинически. Постепенно увеличиваясь в размерах, они меняют форму и плотность яичка. Мужчинам, обратившимся за консультацией по поводу бесплодия в браке, рекомендуется проводить ультразвуковое исследование органов мошонки. В результате выявляется больше больных, у которых при нормальном уровне онкомаркеров и отсутствии симптомов выявлены небольшие (<1 смв диаметре) новообразования яичка (инциденталомы яичка) и тестикулярный микролитиаз. В последнее время появляется все больше публикаций, свидетельствующих о возможности расширения показаний к проведению органосохраняющего лечения, в частности при инциденталомах яичка. Представляем обзор данных литературы на эту тему и собственные наблюдения.

Malignant tumors of the testicle comprise about 1–2 % of all neoplasms in males and 5 % of tumors of the urinary system and male genitals. At early stages, malignant tumors of the testicle have no clinical manifestations. Gradually increasing in size, they change the shape and density of the testicle. Men seeking medical consultation on infertility are recommended to undergo ultrasound examination of the scrotum. As a result, in patients with normal tumor marker levels and lack of symptoms small (less than1 cmin diameter) testicular tumors (incidentalomas of the testicle) and testicular microlithiasis are diagnosed. Lately, a number of studies has shown a possible need to expand indications for organ-preserving treatment, in particular, for incidentalomas of the testicle. Here we present a literature review on this subject and our clinical observations.

AIM:To compare the results of population studies conducted in the Russian Federation to identify the prevalence, severity and risk factors for urinary disorders in men.MATERIALS AND METHODS:Data of a survey of 1083 men were analyzed for the age, weight, height, comorbidities with their signs and symptoms, history of surgery on pelvic organs, copulative disorders, and IPSS and quality of life scores. The findings were compared with the results of a survey of 482 Russian men under the protocol of the International Society of Continence (ICS) aimed to identify patients with overactive bladder (OAB), in whom pollakiuria, nocturia, urgency, urinary incontinence, stress-incontinence, poor flow and terminal dribbling were registered.RESULTS:According to findings on IPSS scores voiding disorders were diagnosed in 649 (59.9%) of respondents, with mild, moderate and severe lower urinary tract symptoms (LUTS) in 370 (34.2%), 216 (19.9 %) and 63 (5.8%) men, respectively; mean IPSS score was 5,0+/-7,0. Among men with LUTS 34.6% were not satisfied with their quality of life. The severity of LUTS was greater among older respondents (B = 0,441; p<0,001), having a high body mass index (B = 0,119; p<0.001), ischemic heart disease (B = 0,231; p<0,001), hypertension (B = 0,240; p<0,001), diabetes mellitus (B = 0,158; p<0,001), obesity (B = 0,151; p<0,001), history of surgery on pelvic organs (B = 0,259; p<0,001), suffering from erectile dysfunction (B = 0,126; p<0,001). 116 (24.1%) men surveyed under ICS protocol had LUTS consistent with OAB criteria. Symptoms of urine storage, emptying and post-micturition symptoms were found in 299 (62%), 164 (34%) and 106 (22%) patients, respectively and were more common in older men. 236 (48.9%) of respondents experienced discomfort or pain, in 72 (15%) - LUTS resulted in decreased sexual activity, but only 149 (30.9%) of men sought treatment.CONCLUSIONS:LUTS in Russia are common among men of any age. They reduce the quality of life, closely associated with erectile dysfunction, metabolic disorders and diseases. Men with urinary disorders need a comprehensive examination and treatment based on an interdisciplinary approach.

The high prevalence of erectile dysfunction (ED) in men of all age groups with different psychogenic and organic disorders requires a personalized approach to the choice of treatment. Widely prescribed as first-line treatment for ED, sildenafil can be used in various dosages that are selected depending on comorbidities, tolerability and efficacy of the drug. Currently there is a wealth of accumulated experience of sildenafil dose adjustment depending on the severity of ED, its etiology and duration, as well as matched to the individual characteristics of copulatory activity. Divisible tablets Tornetis® ("Sandoz") give the opportunity to choose an effective and safe dose of sildenafil for of all patients with ED.

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

The arsenal of professionals providing assistance to men with erectile dysfunction includes a new, mouth dissolving dosage form of the vardenafil--levitra ODT. This form is effective, safe, and has a higher bioavailability as compared to vardenafil in the form of coated tablets. POTENT I and POTENT II studies revealed that levitra ODT equally successfully corrects erectile dysfunction in men younger and older than 65 years regardless of concomitant diseases and metabolic disorders: hypertension, diabetes, dyslipidemia. In addition, it was found that this drug helped to successfully carry out sexual intercourse in the first 15 minutes after dosing in 62.5% of patients. This allows to widely recommend levitra ODT for the treatment of erectile dysfunction in young men and older men.