The article details the examination plan and recommendations for the endovascular treatment of patients with prostate adenoma with concomitant diabetes mellitus. The results of the work of the Department of Andrology and Urology at the Endocrinological Research Center for prostate artery embolization are also displayed. A clinical case of care for a patient with prostate adenoma and severe diabetes mellitus is presented.

Introduction. The urogenital form of autonomic diabetic polyneuropathy is a specific lesion of the autonomic nervous system in diabetic patients. It is main pathogenetic cause of sexual disorders in this category of patients. The most common violation of sexual function in patients with diabetes is erectile dysfunction (ED).Objective. Diagnosis of peripheral neuropathy with ED caused by type I diabetes and assessment of the effectiveness phosphodiesterase type 5 inhibitor (PDE5-I) in its treatment.Materials and methods. The study included 40 patients with ED due to type 1 diabetes at the age of 25.7 ± 6.1. The duration of type 1 diabetes was 18 ± 9.7 years. All 40 patients, initially and after the course of therapy with the PDE5-Is, underwent a neuromyographic study with the determination of the excitation propagation rate for nervus peroneus and nervus pudendus, endothelial function evaluation on the EndoPat ™ device, and the questionnaire on the international index of erectile function (IIEF-5) scale.Results. In 30 (75.0%) men, endothelial dysfunction was determined according to EndoPat ™. In the range of the gray zone of reactive hyperemia index (RHI) was detected in 7 men (16.6%). Normal function of the endothelium was revealed in 3 cases (8.4%). In the control study, the following data were found: endothelial dysfunction was detected in 6 patients (16.6%) according to Endo Pat ™, in 14 patients (33.4%) in the range of gray zone of RHI, endothelial function was normalized in 20 patients (50.0%). According to the neuromyographic study, initially all patients had diabetic neuropathy in both the distal and urogenital forms. After therapy, significant positive dynamics were shown. Based on the results of the questionnaire on the scale of IIEF-5, initially all patients showed ED of varying severity. With the control questionnaire after therapy, there was an improvement in erectile function.Conclusions. Given the high incidence of endothelial dysfunction and its generalized nature in patients with ED due to diabetes, it is advisable for all patients with diabetes to study the state of the endothelium in conjunction with a neuromyographic study. Medicine from the PDE5-I group with individual taking course are highly effective in restoring vascular endothelial function, and also have a neuroprotective effect, which is especially important for patients with type 1 diabetes.

The incidence of urethral strictures and their recurrences is high. The effectiveness of optical urethrotomy in men is insufficient. Reconstructive urethroplasty is the "gold standard", but it is traumatic and accompanied by a prolonged period of rehabilitation. The results of using metal endourethral stents were unsatisfactory because of their incrustation and migration. This paper presents the results treating urethral strictures of various etiologies in 22 patients, who underwent optical urethrotomy with temporary placement of a new generation polyurethane-covered nitinol stents. After removing the stents from 3 to 8 months after implantation, there was a stable effect of preserving the urethral lumen. The recurrence of the stricture occurred in 1 case 1 month following the stent removal. In other cases, there were no recurrences over 1-3 year follow-up. We consider placing an internal stent as an alternative adjunctive treatment of patients with urethral strictures.

The paper presents the unique clinical experience of successful sexual rehabilitation of a patient who has undergone penile amputation for cancer. Complex reconstruction of all parts of the lost organ, by using known methods and those proposed for the first time in global practice (balanus repair with transposition of the testis), was performed in the patient.

Background. Retrograde ejaculation in patients with type 1 diabetes mellitus is a complication of autonomic neuropathy that causes excretory infertility. It can be partial (reduction of ejaculate) or total (absence of ejaculate) and occurs in 10%–20% of men with type 1 diabetes mellitus.Aim. The aim of the study was to assess the effectiveness of a new endoscopic method for retrograde ejaculation correction and antegrade ejaculation restoration.Materials and methods. We included 30 patients with type 1 diabetes mellitus who had spermatozoa present in their post-orgasmic urine and ultrasonographic evidence of impaired or absent bladder neck closure. The mean age of participants was 32 (30–35) years, mean duration of diabetes was 17 (12–22) years and mean preoperative glycated haemoglobin level was 7.4% (6.9%–8.0%). All participants had total retrograde ejaculation. We used conventional irrigated urethrocystoscopy under local anaesthesia. During urethroscopy, bladder neck gaping was observed in all cases. Biocompatible material was injected at three points under the mucous layer of the posterior urethra, reaching the closing of the opposite edges of the urethra. A spermiogram was examined 1 week after the operation.Results. Restoration of antegrade ejaculation was achieved for 22 patients (73%), and the effects persisted for a mean of 7 (2–12) months. The spouses of four men became pregnant after surgery. In one case, the pregnancy resulted in a spontaneous abortion at gestational week 8, but the other three cases continued normally.Conclusion.This new method provides a highly effective means of restoring the physiological passage of the ejaculate. The operation is a low-invasive endoscopic procedure that does not disrupt urination, and it is possible to receive ejaculate of sufficient.

Urogenital form of autonomous diabetic polyneuropathy is a specific lesion of the autonomic nervous system in patients with diabetes mellitus (DM) and is the main pathogenetic cause of sexual dysfunction in these patients. The most common form of the sexual dysfunction in patients with DM is an erectile dysfunction, the risk of which is at 3 times higher for patients with DM compared to the population without it. Considering that patients with DM are a special group because of the presence of specific complications, preferences in therapy is given to inhibitors of PDE-5 type inhibitors. Aim - optimization of diagnosis and treatment of neurogenic erectile dysfunction caused by urogenital autonomic diabetic neuropathy in patients with type 1 diabetes. Material and methods. The study included 40 patients with DM type 1 at the age of 25.7±6.1 years. The duration of the DM type 1 18±9.7 years. The average level of glycated hemoglobin at the time of inclusion of patients in the study 7.1±1.3%. All patients in addition to general clinical examination performed neuromyography of peroneal nerve and pudendal nerve (at baseline and after a course of therapy with sildenafil) and the analysis of endothelial function on the EndoPat ™ (baseline and after a course of therapy with sildenafil). Results. At baseline, all 40 men s complained on the quality of erection of varying severity. In 30 (75.0%) of men according to a survey on the unit EndoPat ™ determined endothelial dysfunction (RHI 1.45±0.16). In the range of the gray zone (RHI 1.79±0.13) IRG was detected in 7 (16.6%) men. RHI values, indicating normal functioning of the endothelium, were obtained in 3 (8.4%) cases. After 6 weeks, analisys of endothelial function after the course of treatment with sildenafil was repeated: endothelial dysfunction was found in 6 (16.6%) patients, in the range of the gray zone RHI was registered in 14 (33.4%). Evidence about normalized endothelial function were obtained from 20 (50.0%) patients. The results of neuromyomyographic test of n. peroneus and n. pudendus confirmed the presence of distal diabetic neuropathy and urogenital form of autonomic diabetic neuropathy baseline in all patients. Retest after treatment showed a significant positive trend in our patients. Conclusion. Our study showed the advisability of using inhibitiors PDE-5, in particular sildenafil, not only to improve erectile function in patients with DM type 1, but also to improve endothelial function and condition of the peripheral nerves. We are convinced that the examination of such patients should include both of these methods, because diabetic neuropathy in patients with DM directly linked with endothelial dysfunction

The article presents a unique clinical case of social, psychological and sexual rehabilitation of a patient who had undergone amputation of the penis due to penile cancer, without recurrence. The patient was submitted to comprehensive reconstruction of the lost parts of the sexual organ (corpora cavernosa, urethra, glans penis) using both conventional techniques and the ones performed for the first time in reconstructive plastic surgery.

Venogenic erectile dysfunction (ED) is 20 to 60 % of all causes of erection problems. In most cases, the choice of surgical treatments depends on the degree and pattern of vascular disorders in the genesis of ED. The authors use the alternative treatment procedure X-ray endovascular occlusion of veins in the prostatic plexus. There is a significant improvement in the quality of erection in the first 3 months after surgery. The application of this innovative technology permits safe, mini-invasive and pathogenetically sound treatment for ED caused by abnormal venous drainage from the cavernous bodies.

Analyzed the sources of foreign and Russian literature. Discussed existing today conservative and surgical methods of treatment of retrograde ejaculation, their efficacy and safety in patients with diabetes. A new method of antegrade ejaculation restoration which has been developed in Endocrinology Research Center described.

Sexual dysfunction characterized by a significant decline in the quality of life of patients and leading to infertility and problems in social life is diagnosed in more than 40% of patients with diabetes mellitus (DM).Erectile dysfunction is the most common sexual disorder in DM patients. The article describes epidemiology, classification, pathophysiology, diagnostic and treatment of erectile dysfunction in T1DM patients.

In this review of the literature shows the epidemiology, classification, pathophysiology, diagnosis and treatments for erectile dysfunction in patients with type 1 diabetes. Erectile dysfunction in young patients with diabetes mellitus is a serious problem because of fairly widespread, and the impact on the psychological state of patients and quality of life in general. Emphasized that timely diagnosis with the correct definition of a form of erectile dysfunction can reasonably and adequately pick therapy for each individual patient.

Analyzed the sources of foreign and Russian literature. Discussed existing today conservative and surgical methods of treatment of retrograde ejaculation, their efficacy and safety in patients with diabetes. A new method of antegrade ejaculation restoration which has been developed in Endocrinology Research Center described.

Venogenic erectile dysfunction (ED) is 20 to 60 % of all causes of erection problems. In most cases, the choice of surgical treatments depends on the degree and pattern of vascular disorders in the genesis of ED. The authors use the alternative treatment procedure X-ray endovascular occlusion of veins in the prostatic plexus. There is a significant improvement in the quality of erection in the first 3 months after surgery. The application of this innovative technology permits safe, mini-invasive and pathogenetically sound treatment for ED caused by abnormal venous drainage from the cavernous bodies.

This article describes a new technique of correction of the retrograde ejaculation in patients with type 1 diabetes mellitus. Currently, treated 12 patients with type 1 diabetes mellitus and retrograde ejaculation as a manifestation of urogenital form of autonomic diabetic neuropathy. The positive effect of the operation was achieved in 11 of 12 treated patients. Registered 2 cases of physiological pregnancy.

The article presents the results of the use of alternative method of treatment--endovascular occlusion of the prostatic plexus--in patients with isolated venogenic erectile dysfunction. The IIEF-5 and AMS questionnaires were used for the evaluation of results of the operation. Improvement of quality of erection in the first 3 months after surgery was achieved in the majority of patients. The use of this innovative technology provides secure, minimally invasive and pathogenetically justified treatment of ED caused by abnormal venous drainage from the cavernous bodies.