Introduction. Over the past 30 years in reconstructive urology there has been a tendency to reduce the frequency of use of minimally invasive methods of surgical treatment of urethral strictures of various localizations and the predominant use of reconstructive plastic interventions with the expansion of the narrowed area of the urethra using inserts from various tissues. Buccal dilation urethroplasty is currently recognized as the optimal treatment option for urethral strictures of various locations and of varying length. Thus, the issue of choosing the most appropriate method of surgical intervention for recurrent urethral strictures, in the context of a possible increase in the risk of complications, requires additional research. Purpose. To analyze and evaluate the results and complications after plastic surgery of recurrent urethral strictures using a free autograft of the buccal mucosa. Materials and methods. The analysis included data on 51 patients operated on at the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina–branch of the Federal State Budgetary Institution National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation for the period from 2014 to 2021 regarding recurrent urethral stricture. The average age of the patients was 36.2±1.6 years (from 18 to 58 years). The diagnosis of recurrent urethral stricture was confirmed by anamnesis, clinical and laboratory examination according to a standard protocol, and special examination methods (uroflowmetry, ultrasound examination of the bladder, retrograde or antegrade cystourethrography, voiding urethrography). According to indications, fibrourethrocystoscopy was performed. According to radiological research methods, the localization and extent of urethral stricture were determined. The functional state of the bladder and the severity of bladder outlet obstruction were determined by the volume of residual urine determined by ultrasound of the bladder, as well as by uroflowmetry data. Results. An analysis of the results and complications after plastic surgery of recurrent urethral strictures using a buccal flap was carried out after repeated operations. As the length of the stricture increases, the risk of its recurrence increases significantly. The most significant factors are the location of the stricture in the penile region and its extent. No other long-term complications (newly developed urinary incontinence/erectile dysfunction) were observed in any case in the analyzed group of patients. Conclusion. Repeated operations for recurrent urethral strictures can eliminate urinary disorders with an effectiveness close to (or equal to) that of primary operations. When choosing a method of surgical treatment of recurrent strictures, both the extent of the stricture and its location should be taken into account. The presence of an extended stricture of the penile urethra may be a risk factor for its recurrence. Complications that develop after repeated operations in the vast majority of cases are not life-threatening. The question of the effectiveness of different types of surgery requires additional research with the accumulation of clinical material.

In the era of antibiotic resistance, strict control of foci of infection (for example, a long-term stent) and adherence to the timing of drainage removal are necessary. The spread of pan-resistant pathogens requires the development of effective alternative antimicrobial measures, in particular, bacteriophage therapy. A clinical case of a 42-year-old patient with a closed spinal cord injury, lower paraplegia, pelvic organs dysfunction, post-traumatic right ureteral stricture, and right kidney stones is presented in the article. The patient developed stent-associated urosepsis due to pan-resistant Klebsiella pneumonia after endoscopic removal of a long-term right ureteral stent (over 3 months) with endotoxic shock, disseminated intravascular coagulation syndrome and wound sepsis, which was treated using personalized local bacteriophage therapy.

Introduction. Chronic kidney disease (CKD) is a global medical problem. The long-term latent course of the disease leads to a progressive increase in its incidence. Along with laboratory methods of research in the arsenal of the diagnostic service, there are tools that allow you to detect a violation of the kidneys functional ability. Purpose. To analyze modern instrumental methods for diagnosing the functional ability of the kidneys. Materials and methods. The review was conducted based on data published in PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed /) and еLibrary.ru (https://elibrary.ru) and was limited only to articles in scientific peer-reviewed journals. It was carried out until January 2023, by keywords: kidney ultrasound, computed tomography, positron emission tomography, magnetic resonance imaging, kidney function. Results. We found 189 sources not older than 10 years (published after 2012) that were relevant to the topic of the review. Conference abstracts, short messages, duplicate publications were excluded from them. After that, based on the relevance of the data, reliability of sources, impact factors of journals and the sequence of presentation of the material in the manuscript, 46 articles were selected directly for citation in the review. Also, when writing the review, original articles published before 2012 were used. Conclusion. The available modern instrumental methods for assessing renal function open up broad prospects for their clinical application and require further research.

Introduction. Growth of urological infection caused by antibiotic-resistant pathogens require the search for alternative antimicrobial treatments. Bacteriophage (phage) preparations are currently the only viable alternative to antibiotics. The therapeutic effect of bacteriophages is significantly different from antibiotics, making them active against multidrug-resistant bacteria. Bacteriophage therapy - creation of viral infection in bacteria. However, the effectiveness of treatment depends primarily on the quality of commercial bacteriophage preparations. The collections of bacteriophages is constantly updated in industrial production but in order to increase the lytic activity of bacteriophage preparations to the uropathogens of our clinic, it is necessary to constantly determine the sensitivity of the main pathogens of infection to commercial bacteriophage preparations and regularly update (adapting) commercial phage preparations. Purpose. Improve the lytic activity of commercial bacteriophage preparations; adapt them to the pathogens of a particular hospital. Materials and methods. From 2017 to the present, at the Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin, a branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia (hereinafter referred to as the Research Institute of Urology), regular work has been carried out to update (adapt) commercial bacteriophage preparations to the uropathogens. The most problematic multidrug-resistant microorganisms -pathogens of urological infection- were send for phage production. Wastewater from the clinical building of the Institute of Urology was also send to phage production. Results. Analysis of data on antibiotic- and phage resistance of uropathogens for 2022 indicates multi-resistance of microorganisms in our clinic. Antibiotic resistance phenotypes of pathogens in the urine of outpatients and inpatients have been defined as a whole: extended-spectrum beta-lactamases (ESBLs): 5.3-1.6%, respectively (E.coli-38%; Klebsiella spp. 62%; Proteus mir. 38,5%; P. aeruginosa -61%) methicillin-resistant Staphylococcus aureus (MRSA) 9.9-8.4%; carbapenem-resistant enterobacteria (CRE) 1.7-4.5% (E.coli-1.9%; Klebsiella spp. 29%); Proteus mir. 5%; P. aeruginosa -47.7%) and bacteriophage resistance of uropathogens 4-16.3% . After adaptation of bacteriophage preparations, an increase in their lytic activity to specific microorganisms was obtained by an average of 14% (from 78% to 92%), and an increase in the lytic activity of Sextafag, a polyvalent piobacteriophage containing phagolysate filtrates of Staphylococcus spp., Streptococcus spp., Proteus (P. vulgaris, P. mirabilis), Pseudomonas aeruginosa, Klebsiella pneumonia, E. coli by 16% (48% to 64%) Conclusions. To improve the lytic activity of bacteriophage preparations and improve the effectiveness of urological infection treatment, it is necessary to constantly update the composition of the cocktail of commercial bacteriophage preparations with phages from hospital wastewater and adapt them to freshly isolated microorganisms from urological patients.

Introduction. Recently, there has been a tendency to perform reconstructive-plastic interventions for the treatment of both primary and recurrent urethral strictures. Buccal urethroplasty is currently recognized as the «gold standard» for the urethral strictures treatment. However, despite a large number of works on operative correction of urethral strictures using the cheek mucosa, the issues of prevention and correction of intra- and postoperative complications of buccal urethroplasty have not been finally resolved. The purpose. Using the world literature, to stydy complications, methods of their prevention and correction for improving the efficiency of primary and repeated recοnstructive-plastic οperations on the urethra using free autograft of mucous membranes οth cheeks. Materials and methods. The literature review was made using bibliographic databases: Pubmed, Web of Sience, Science Direct, Scopus, Cyberleninka, eLibrary.ru and others for the period from 1990–2022. The following keywords were used: urethral stricture, buccal graft, complications of buccal urethroplasty, buccal urethroplasty, diagnosis of complications of buccal urethroplasty, treatment of complications of buccal urethroplasty, anastomotic urethroplasty, urethroplasty replacement. In total, 150 original publications were identified and analyzed, and 104 articles of them were selected for a literary review. Results. The analysis of complications of primary and repeated buccal urethroplasty was carried out, possible options for diagnosis and correction of complications of reconstructive plastic surgery on the urethra of men using the cheek mucosa were studied and the quality of life of patients after surgical treatment was analyzed. Conclusion. The analysis of the scientific literature on the results of the surgical treatment of primary and recurrent urethral strictures using buccal mucosa graft shows that at present there is no single clinical position that would clearly classify the emerging complications of this method of uretroplastics and contributed to the development of measures for their prevention.

Introduction. Over the past decade, there has been a progressive increase in the number of patients with chronic kidney disease (CKD). Early diagnosis of renal insufficiency allows to prevent irreversible consequences leading to disability and significant medical and economic costs. Purpose: to analyze modern markers for determining the functional ability of the kidneys. Materials and methods. A search was carried out in PubMed and Library, according to the keywords creatinine, urea, glomerular filtration rate (GFR), clearance, formulas for calculating creatinine clearance, cystatin C, β2-microglobulin, β-bound protein, NGAL, KIM-1, chronic kidney disease, chronic renal failure, urolithiasis. We found 389 sources no older than 10 years (published after 2012) that were relevant to the topic of the review. 80 articles were selected directly for citation in the review. Results. GFR assessment and detection of albuminuria are the most effective methods, but biomarkers used to calculate GFR are subject to a number of factors and do not allow assessing kidney function in real time. For early prediction of acute renal injury, the most suitable biomarkers are considered to be: NGAL and KIM-1 and IL-18. Equations combining cystatin C and creatinine r work better than equations using only cystatin C or creatinine, especially in situations where it is necessary to confirm chronic kidney disease. The combination of creatinine, cystatin C and the ratio of urine albumin to creatinine improves the stratification of the risk of progression of kidney disease and mortality. The latest developments in biomarkers allow us to hope that in the near future the assessment of the functional ability of the kidneys will be carried out in real time and will become a general clinical practice of a modern doctor. Conclusion. Modern biomarkers of the functional ability of the kidneys allow not only to evaluate the function, but also to screen for diseases, conduct differential diagnosis, and evaluate the effectiveness of the treatment. The modern approach to the diagnosis of renal dysfunction should be based not only on its diagnosis, but also on determining the topic of nephron damage.

INTRODUCTION:In order to improve clinical efficiency and reduce the risk of postoperative complications in patients with staghorn stones, we compared the results of original technique of biportal percutaneous nephrolithotomy (PCNL) with the standard PCNL.MATERIALS AND METHODS:The total of 221 patients with staghorn stones of K3-K4 was included in the study. The biportal PCNL was used in 109 patients, while the control group consisted of 112 patients. Inclusion criteria were stone size more or equal 2 cm, age over 18 years, absence of coagulopathy and width of the renal parenchyma more or equal 1 cm. On 1st postoperative day, ultrasound or plain urography was performed, while in patient with radiolucent stones, multi-slice computed tomography was used. In addition, complete blood count and biochemical profile were done. The main difference from the standard PCNL with sequential renal tracts is the simultaneous creation of the main and additional accesses when performing biportal PCNL. This method allowed two surgeons to simultaneously and synergistically perform lithotripsy and stone extraction from two accesses using a standard nephroscope in the main tract of 24 Ch and a miniaturized nephroscope in the additional tract of 16.5 Ch.RESULTS:The stone-free rate in the group of biportal PCNL was 80.7% (n=88), compared to 72.3% in the control group (n=81). Secondary interventions and additional procedures were required in 29 (26.6%) and 40 (39.2%) cases, respectively. The total number of infectious and hemorrhagic complications was higher in the control group.DISCUSSION:According to our data, significant advantages are observed in the group of biportal PCNL compared to the standard technique.CONCLUSION:Biportal PCNL can be recommended as a promising advancement of the technique traditionally used in the clinical practice.

Introduction: Nephrolithiasis is one of the health concerns worldwide with the increasing prevalence and recurrence rates and the prevalence is ranging from 7% to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Urinary stones are affecting approximately 12% of the world population of all ages, sex, and race. In this study, we evaluate of efficacy of retrograde intrarenal surgery (RIRS) combined with percutaneous nephrolithotomy (PCNL) in the treatment of kidney stones and compare its results with RIRS and PCNL monotherapy. Methods: We analyzed 144 patients who underwent combined method (12.5%), RIRS (53.4%), and PCNL (36.1%) treatments between 2017 and 2018. The stone-free rates after one session at different treatments were following combined method (94.44%), RIRS (83.78%), and PCNL (78.85%). The mean duration of operation was 58.88±13.12 min in combined method, 55.94±26.50 min in the RIRS, and 67.01±29.39 min in the PCNL group (p<0.0277). Duration of hospitalization, intraoperative blood loss, blood transfusion hematuria and complication in the postoperative period were also evaluated. Results: We found that the combined method had a higher stone-free rate, shorter length of stay. This could partially be explained by the minimal invasiveness, less trauma and high stone-free, which result in the complete evacuation of stones and fast recovery. Notably, most of the large, rigid, and complex stones were treated with the combined method. Although the combined treatment is a safe and effective method, the complication rate was slightly higher.

In connection with growing problem of antimicrobial resistance, the search for alternative treatments for infection is popular topic nowadays. This article represents an overview of published data on the therapeutic use of bacteriophages, specifically in urinary tract infections. The history of phage therapy of infectious diseases from the beginning of the 20th century to the present days is presented. The paper also discuss the mechanism of bacteriophages activity, differences between lytic and lysogenic phages, mechanisms of bacterial tolerance to phages and ways of its overcoming are. Authors present their own data on 30 years of clinical use of “bacteriophage cocktails” in the treatment and prevention of urological infection.

Introduction. The urethroplasty of the urethral stricture disease is still a severe problem for surgeons. The aim of this study is to evaluate own results of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture. Aim. Evaluation of own results of urethroplasty with a graft of the oral mucosa in the treatment of urethral strictures. Materials and methods. Between 01.08.2014 and 01.06.2020 we treated 136 patients with urethral stricture at our Medical Centers, where we provided buccal mucosa graft urethroplasty for bulbar and penile urethra. Results. The bulbar stricture was found among 105 patients of 136 (77,1 % cases), in which 64 had stricture in proximal part and 41 – in distal part of the urethra, 19 patients – in penile urethra and the other part had panurethral lesion. The median length of the stricture was measured as 3,8 ± 0,6 sm in the first three groups, and in the last group it was 10,4 ± 1,5 sm. At a median follow-up of 16,3 months 87,5% of patients in the first group, 90,2 % in the second, 84,2 % in the third and 83,3 % in the fourth group had no stricture recurrence and were satisfied with BMGU. Conclusion. For patients with urethral stricture disease, BMGU offers excellent success, morbidity with different techniques and methods, which statistically are equal to each other.

A literature review dedicated to the problem of bacteriophage therapy for infectious and inflammatory diseases, including urological infections, is presented. Considering the growth of antibiotic resistance, the search for alternative treatments is relevant. Current data about bacteriophages and mechanism of their action, difference of virulent and temperate phages is given, as well as mechanisms of bacteria resistance to phages and ways of its overcoming. The history of phage therapy for infectious diseases from the beginning of the 20th century to the present days is presented. Pharmacokinetic studies of phages after oral administration are given. Moreover, we described our 30 years experience on of clinical use of bacteriophage cocktails in the treatment and prevention of urological infection. In addition, problems of phage therapy are discussed, including immunological issues and the advantages of bacteriophages over antibiotics.

Background. The highest rate of incontinence after radical prostatectomy (RP) is observed in the first 2–6 months after surgery. In order to decrease the period of incontinence, virous surgical methods aimed at preservation and reconstruction of structures participating in the mechanism of urine retention has been developed and improved.The study objective is to evaluate effectiveness of an original method of formation of an urethral anastomosis in the early continence recovery.Materials and methods. Data on 126 patients who underwent retropubic RP were analyzed. Depending on the method of urethral anastomosis formation, patients were divided into 2 groups: in the 1st group (n = 52) the patients underwent PR with urethra suspension m. levator ani, in the 2nd (n = 74) – standard RP. In the 1st group, 6 ligatures were applied to the anterior and posterior urethra walls: at the 12 and 6 hour projections through the mucosa, submucosa, and smooth muscle; at the 10, 2, 4, and 8 hour projections – more laterally with capture of the m. levator ani medial margins. Continence recovery was evaluated on days 1, 7, and 14 after urinary catheter removal and then at days 30, 90, 180, and 365 after RP. The criteria of continence were absence of urine leakage at rest and during physical activity and a necessity of using a safety liner.Results. There weren’t any significant differences at day 1 after urinary catheter removal between the two groups (р > 0.05). In the 1st group, continence values at days 30, 90, and 180 after RP were significantly higher (57.7, 69.2, and 71.1 %, respectively) compared to the 2nd group (35.1, 41.9, and 51.3 %, respectively) (р <0.05).Conclusion. Results of this work show significant benefits of RP with urethra suspension m. levator ani compared to standard RP per continence recovery criteria at days 7, 14, 30, 90, and 180 after the surgery. The technique of urethra suspension m. levator ani is easy to perform and ensures early continence recovery after RP.

Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation.Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney.Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture.Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony.Conclusion. Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.

The present review describes the mechanisms of benign prostatic hyperplasia (BPH) development in patients with metabolic syndrome (MS) and its association with androgen deficiency, which is frequently observed in these patients. We cover the data indicating that despite a reduced serum level of testosterone in patients with MS, they are more likely to be diagnosed with BPH, have more significant prostate enlargement, more rapid BPH progression, as well as deterioration of urination problems compared to patients of similar age without MS. The following factors are considered to trigger BPH in patients with MS: changes in the tissue metabolism of sex hormones with increased androgens and estrogens concentrations in the prostate gland despite the reduced serum androgen levels, relative prevalence of the estrogenic effects, chronic pelvic ischemia, stimulation of prostate cells proliferation due to the elevated insulin level and the increased secretion of growth factors, and developing chronic low-intensity inflammation. Specific features of BPH pathogenesis in individuals with MS suggest a correction of therapeutic approaches to BPH in such cases, because conventional therapy in patients with BPH and MS is less effective than in patients with BPH only.