Aim. To evaluate immediate and long-term oncological results ofsurgical treatment of recurrent rectal cancer involving the urinary tractsystem to show the need for a multidisciplinary treatment approach for locally advanced recurrent rectal cancer. Material and methods. Retrospective cohort analysis with prospective supported database. Analyzed 14 cases: all patients with locally advanced rectal cancer recurrence involving urinary tract system were operated at the Clinic of Coloproctology and Minimally Invasive Surgery in 2013-2022. Results. The age of the patients was 51.6 ± 13.0 years, 6 men, 8 women. The greatest recurrence number was (88%) finded in group of primary colorectal cancer of the lower and middle parts of the rectum. In 57.2% observations patients received preoperative chemotherapy or combination with radiotherapy. Approximately 64% of primary operations were performed using an open approach. Recurrence of CRC with pT3-T4 invasion was diagnosed in 72% of cases. Metastatic damage of lymphatic nodes after primary surgery were identified in 57.2% of cases. In 2 observations primary surgery was performed with R2 resection margin, relapse in that cases was detected after 11 and 13 months. One histopathological report indicated R1 resection, relapse noted after 6 months. Adjuvant chemotherapy was performed in 10 cases (71.4%), in two cases (14.3%) – postoperative radiation therapy. Average time for recurrence detecting after primary operation was 16.5 [12-28] months. Advanced combined interventions including recurrence removal with colon resection, gynecological and urological stages (RR+CR+GR+UR) amounted to 36%, recurrence removal with resection colon and urological stage (RR+CR+UR) was performed in 43% of cases, recurrence removal without the colonic stage (RR+GR+UR and RR+UR) - 3 (21%) patients. Reconstructive surgery to restore urine derivation were performed in 12 (85.7%) cases. The average duration of the procedures was 412.5[205-490] minutes, intraoperative blood loss - 275 [150-400] ml. Early postoperative complications are classified as Clavien-Dindo III. One patient with SIRS was classified as a complication Clavien-Dindo IV. The duration of the postoperative period was 25.5 [14-30] days. Postoperative mortality was 0%. According pathohistological examination R1 resection was detected in 3 (21.4%) cases. Adjuvant chemotherapy was performed 8 (57.1%) patients, in 1 case (7.1%) combination with a course of radiotherapy. During the period 24 months after surgery the mortality rate was 14.3%, repeated relapses diagnosed in 3 (21.4%) patients, one was reoperated. Distant metastases was noted in 4 (28.6%) patients, of which in 1 case with repeated recurrence. Discussion. Our urogenital bacterial diversity analysisshowed that human testicular tissue is not a microbiologically sterile environment and also presented new data associated with testicular tissue and its possible relations with male infertility. Conclusion. The main treatment method for locally advanced rectal cancer recurrence involving the urinary tract system is surgical. Multidisciplinary approach with the involvement in the surgical team urologist oncologist made it possible to perform a one-stage radical intervention for locally advanced recurrence of rectal cancer with restoration of derivation urine without the need for subsequent reconstructive procedures on the urinary system. Keywords: rectal cancer, urinary tract, multidisciplinary approach, surgical treatment, recurrence.

Prostate cancer is one of the most common cancers and ranks second in frequency among men in the Russian Federation. In this regard, timely and accurate diagnosis of prostate cancer seems relevant. This review is devoted to the relevance of using magnetic resonance imaging with diffusion-weighted images in the diagnosis of prostate cancer. The review represents modern diagnostic methods used in the primary diagnosis of prostate cancer, disease staging, assessment of response to therapy and detection of cancer recurrence. The authors discuss the advantages and disadvantages of the method, and further prospects for the use of diffusion-weighted images in the examination of patients with prostate cancer. The search for the preparation of this review was performed using electronic bibliographic databases PubMed, E-library, Medline, Google Scholar.

Background . According to the contemporary data available contrast-enhanced computed tomography can be used to assess total and split kidney function. The Urology Clinic of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University) utilizes mathematical processing of computed tomography data for the assessment of split kidney function. Aim . To evaluate the effect of main renal artery clamping (warm ischemia time) during partial nephrectomy for a unilateral tumor on the kidney function. Materials and methods . 33 patients of both sexes who underwent partial nephrectomy for unilateral kidney tumor were enrolled in the study. Prior to and 3–6 months after the surgery, 3D glomerular filtration rate (GFR), 3D perfusion, 3D volume of the renal parenchyma were evaluated by mathematical processing of computed tomography data with contrast enhancement. As well as that the dynamics of the total GFR (CKD-EPI equation) and total volume of the kidneys were assessed. Results . No significant changes were registered for both general functional renal parameters (creatinine level, total GFR, total volume of functioning renal parenchyma) and split 3D GFR. There were significant differences in 3D perfusion and kidney parenchyma volume prior and after partial nephrectomy. Conclusion . The results of the research highlight good reserve capacity the kidneys after partial nephrectomy with main renal artery clamping. The evidence that the non-operated kidney takes over the function of the resected kidney is based on the fact that there is an increase in its perfusion and volume of the kidney in the postoperative period. This state can also be regarded as a redistribution of functional loads between the kidneys, which is an adaptive mechanism in the postoperative period.

Kidney stones develop silently . Several markers revealing the activation of lithogenic process were proposed . Here we review the technologies behind these diagnostic tests and describe six groups of lithogenic activity markers : 1) indices and calculated supersaturations , based on concentration of stone forming and inhibiting ions in 24h-urine; 2) macromolecules or specific molecules in urine ; 3) urine physical properties , 4) blood markers ; 5) instrumental methods ; 6) induced urinary crystal formation tests . The induced urinary crystal formation group is the most promising and successful . These tests can be used for revealing the periods of high lithogenic activity and guiding prompt treatment intensification . Convenient and affordable markers of lithogenic activity , applied regularly and remotely , make effective personalized recurrence prevention programs feasible .

Physiotherapy is a treatment method for a wide range of diseases of various organs and systems. Its efficacy and practicability are of the great discussions during the past few decades. In urology, this method is used for treatment of erectile dysfunction (ED) caused by a violation of the trophism of genitalia due to radical prostatectomy, atherosclerosis, diabetes mellitus, Peyronie's disease. Shock wave therapy based on the remote action of a low-intensity focused acoustic wave is one of the widely used effective physiotherapeutic methods for the treatment of vasculogenic ED. The main effects of shock waves are neoangiogenesis, nerve fibers regeneration, deceleration of the cavernous fibrosis and reduction of the sympathetic outflow. Some technologies (e.g. radio waves) in addition to those effects also warm the tissues, what accelerates metabolism and improves regenerative processes. All shockwave and radiowave technologies have already demonstrated their efficacy compared with sham control. However, in the few comparative studies, no significant difference was found in efficacy between different technologies. Clinical guidelines consider physiotherapy only as an alternative treatment for patients with mild vasculogenic ED who are refractory or unresponsive to oral vasoactive therapy. Nevertheless, some studies make it possible to judge the efficacy of physiotherapy for treatment of patients with either etiology of the ED. The result of the ED treatment does not depend on the number of treatment courses, their duration, the number of pulses per course and the periodicity of therapy sessions. Also, the original studies have some major shortcomings (i.e. a large percentage of patients dropping out of follow-up). These factors cast doubt on the organotropism of physiotherapy. So, additional comparative studies are required to determine the optimal dosing regimen and to explore the influence of physiotherapy organotropic and psychological components on the results of the treatment. The study aimed to summarize the currently available data evaluating the efficacy of different physiotherapeutic technologies, to compare the efficacy of different technologies for ED treatment.

Objective. To assess functions of each kidney in dynamics using mathematical analysis of contrast-enhanced computed tomography findings in patients with unilateral kidney tumors. Patients and methods. We present preliminary results of a prospective study within the protocol "Assessment of the functioning renal parenchyma volume and functions of each kidney in patients with tumors before and after resection" conducted in the Institute of Urology and Human Reproductive Health, I.M.Sechenov First Moscow State Medical University. This study included 20 patients of both sexes who had undergone resection of unilateral kidney tumors with compression of the main renal artery. We performed mathematical analysis of contrast-enhanced computed tomography findings before surgery and 3–6 months postoperatively to evaluate functions of each kidney. In addition to that, we measured the dynamics of total glomerular filtration rate (GFR) using a special formula. Results. We observed no significant dynamics in any total functional renal parameters (creatinine level, total GFR, total functioning renal parenchymal volume) and in 3D-GFR of each kidney. However, there were significant differences in the dynamics of functional parameters measured for each kidney individually, including 3D renal perfusion and functioning parenchyma volume of each kidney. The volume of functioning renal parenchyma in the affected kidney decreased significantly (p = 0.006). In the subgroup with no lesions, we observed no significant dynamics (p = 0.236). Changes in perfusion affected both sides. Conclusion. We found no significant changes in the total kidney function after surgery, which suggests a sufficient reserve capacity of this paired organ. Increased postoperative perfusion in the intact kidney is likely to reflect redistribution of functional loads between the kidneys and can be considered as an adaptive mechanism. This hypothesis is also confirmed by redistribution of the functioning parenchyma volume 3–6 months postoperatively. The intact kidney probably compensates the loss of function in the affected kidney.

This article analyzes the reasons for refusal to use mesh implants in pelvic organ prolapse surgery (mesh technology), which has recently been widely discussed in the international community. Large-scale analytical reviews and results of randomized clinical trials comparing the effectiveness of standard surgical interventions (native tissue repair) and mesh technologies were described in detail, and the prospects for further development of the latter were outlined. The popularity of mesh technologies used to correct pelvic organ prolapse, which peaked in 2004–2010, led to the widespread and not always justified use of transvaginal mesh implants. The subsequent drastic decline in the use of mesh technology in urogynecology was due to several reasons: postoperative complications, poor experience of physicians, and the frequent involvement of mesh implant manufacturers in litigation.

Introduction. Transvaginal mesh-reconstruction of urogenital prolapse remains a controversial trend in modern urogynecology. We have seen growth in transvaginal mesh surgery since 2004, followed by a sharp decline after 2011 due to FDA restrictions related to imperfections in previously available prostheses and implantation techniques. Improving the efficacy and minimizing complications of transvaginal mesh-surgery is at the forefront of research in the field of modern urogynecology.Purpose of the study. To optimize the indications for transvaginal mesh-reconstruction of anterior apical prolapse.Materials and methods. The study enrolled 375 patients with anterior apical prolapse. The grade of prolapse was assessed using POP-Q. In patients with endopelvic pelvic fascia insufficiency, severe cystocele (Aa ≥ +1) and hysteroptosis grade II – IV, the correction was carried out using the six-arm OPUR® («ABISS», Saint-Étienne, France). lightweight polypropylene monofilament implant (n = 290). When the cystocele was not prominent (Aa ≤ -1) and grade III – IV hysteroptosis, posterior sacrospinal hysteropexy was preferred with the CYRENE® («ABISS», Saint-Étienne, France) tape (n = 85). In 35 patients, the operation was combined with anterior colporrhaphy. In 5 patients, a simultaneous conization/amputation of the cervix was performed. The examination was performed 1 month after surgery and then annually. Prolapse ≥ grade II was as recurrent. The follow-up period of 67 patients was more than 4 years.Results. After OPUR® prosthesis implantation, recurrent hysteroptosis was detected in 6 women with cervical hypertrophy / elongation within a period of 1 mo to 3.5 yr and cystocele in 4 patients. The efficacy was 96%. In 9 patients, an postoperative ischuria was found associated with extensive dissection and hypotension of the bladder wall due to chronic urinary retention in severe cystocele. Urination improved in 88% of cases. In the remaining cases, long-term mediator and hormone replacement therapy were continued., One recurrent hysteroptosis was observed during the implantation of the CYRENE® prosthesis. No damage to the bladder was observed. Acute urinary retention was detected in 1 case, which resolved after intermittent catheterization. Conclusion. The availability of 2 types of transvaginal prostheses for various degrees and configurations of urogenital prolapses allows a differentiated approach to their choice. Both prostheses suggest reliable «reconstruction-imitation» of the sacroiliac ligament by sacrospinal hysteropexy. If necessary, the operation can be supplemented with anterior colporrhaphy. The prevalence of anterior prolapse with endopelvic fascia insufficiency requires more extensive reconstruction, which can be performed relatively safely and effectively by implantation of a 6-arm OPUR® prosthesis.

AIM:To evaluate the efficiency of radio wave electrotherapy (448 kHz) for the treatment of patients with organic erectile dysfunction (ED). MATERIALS AND METHODS:A prospective, randomized, blind, sham- controlled clinical trial was carried out. Inclusion criteria were as following: 1) patients with 5 to 20 points on the IIEF-5 score; 2) patients with proven organic erectile dysfunction lasting at least 6 months; 3) patients with penile arterial insufficiency and/or venous insufficiency, confirmed by doppler study of penile vessels with pharmacological stimulation (peak systolic velocity (PSV) <25 cm/s, end-diastolic blood flow velocity (DPV) >5 cm/s, resistance index (IR) < 0.8). The participants were randomized into two groups (experimental and control) in a 1:1 ratio. The full treatment course lasted 9 weeks. Patients underwent an assessment of erectile function based on questionnaires (IIEF-5, SEP, Schramek), as well as Doppler ultrasound of the cavernous arteries before inclusion in the study as well as a after treatment. RESULTS:The study included 61 men (experimental group [n=31], control group [n=30]. There was a significant difference in the IIEF-5 scores after treatment between the experimental group and the control group (19.5+/-3.2 vs. 15.1+/-5.4, p=0.017, respectively). Significant differences were also noted in mean total score of the SEP questionnaire: an increase to 3.6+/-1.0 in the treatment group compared to 2.4+/-1.1 in the control group (p=0.004). The results of the Schramek questionnaire also demonstrated a significant increase in the mean score in the experimental group compared to the control group: 4.2+/-0.6 vs. 3.2+/-1.0 (p=0.011). The response time to the drug and the detumescence time also significantly differed between the two groups: 11.9+/-4.0 min vs. 15.5+/-4.1 min, p=0.001 and 126.6+/-60.7 min vs. 66.2+/-40.9, p<0.001, respectively. Neither complications nor any adverse events were recorded during treatment or after its completion. CONCLUSIONS:Radio wave electrotherapy with a radiofrequency of 448 kHz can improve the IIEF-5, SEP and Schramek scores, as well as the indicators of ultrasound Doppler ultrasonography in patients with organic ED. To assess the feasibility of this method in patients with organic ED of different stages, further studies are needed.

The study objective is to study the role of multiparametric magnetic resonance imaging (mpMRI), to predict extracapsular extension, infiltration of the seminal vesicles, neurovascular bundles and status of positive surgical margin (PSM) in robot-assisted radical prostatectomy (RARP) with fascio- and nerve-sparing and anatomy-sparing techniques in patients with low and intermediate oncological risk; to evaluate safety of RARP with anatomy-sparing techniques in the context of oncological results in the studied patient cohort.Materials and methods. Fifty-four males underwent mpMRI in the device with magnetic field density 3 Tesla without endorectal coil. Results of mpMRI were analyzed using PI-RADS v.2. Prostate-specific antigen level, results of prostate biopsy, nomogram were analyzed. All patients were included into groups with low and intermediate oncological risk. The patients underwent RARP with anatomy-sparing techniques. Gross specimen removed during the surgery was stained with tissue stain DECOLA and subjected to stepwise pathomorphological analysis. Comparative analysis of tumor lesion localization was performed for mpMRI and pathomorphological examination. The study concentrated on the largest tumor lesion locations. The anterior surface of the prostate was examined in detail. Patients were classified per risk groups in accordance with the National Comprehensive Cancer Network (NCCN) and D'Amico criteria.Results. Full or partial overlap of the lesions per mpMRI and pathomorphological examination were observed in 48 (88.9 %) patients; locations of tumor lesions disagreed in 6 (11.1 %) patients. PSM was detected in 8 (14.8 %) patients; among them in 7 (12.9 %) the size was between 0.1 and 0.4 cm. On the anterior surface of the prostate 3 (5.5 %) PSM were observed, 2 of which were between 0.14 and 0.4 cm, 1 was multifocal, larger than 0.3 cm. Per mpMRI results and histological examination, the anterior surface (fibromuscular stroma) was affected in 14 (25.9 %) and 11 (20.4 %) cases, respectively. Among them, lesion locations overlapped in 11 observations. Results of anatomy-sparing RARP show increased PSM rate compared to traditional nerve-sparing based on the anterior surface of the prostate.Conclusion. Routine mpMRI for patients who are planned to undergo RARP allows to justify selection of anatomy-sparing RARP or rejection of modification in favor of more thorough dissection. mpMRI plays a significant role on planning of anatomy-sparing RARP, achievement of negative surgical margin in patients with low and intermediate risk of oncological progression. Evaluation of the location and size of cancer lesion in the prostate allows to plan for special aspects of anatomy- and/or nerve-sparing techniques, achieve lower PSM rate, optimize oncological and functional surgical results in localized prostate cancer.

Introduction. Currently, a large number of different surgical methods have been developed for the treatment of postcoital dysuria caused by hypospadias and urethral hypermobility. However, the literature does not reflect clear criteria and indications for a particular treatment method. Various modifications of the traditional urethral transposition can be accompanied by traumatic injury to the abundantly innervated paraclittoral and paraurethral zones, which provokes sexual disorders, up to anorgasmia. The search continues for new, effective, but less invasive techniques compared to traditional surgical transposition.Purpose of the study. To assess the efficacy and safety of a combined technique: removal of urethra-hymenal adhesions along with a paraurethral injection of gel filler.Materials and methods. 83 patients with hypospadias and urethral hypermobility complicated by postcoital dysuria were treated since 2015. The age ranged from 17 to 40 years. Examination revealed urethro-hymenal adhesions of varying severity and positive O’Donnell-Hirschhorn test in all women. One patient had previously undergone urethral transposition with a temporary effect. All women underwent surgical treatment, which consisted of the urethro-hymenal adhesions removal and suburethral injection of hyaluronic acid-based filler. The bulking gel (1-2 ml) was injected in a fan-shaped manner paraurethrally in from the point at 6 o'clock of the conventional dial. Thus, a «gel pad» was created, which lifts the meatus and the distal urethra, limiting their mobility and traumatization during intercourse. No complications were observed. The postoperative examination was performed after 1, 6, 12 months.Results. An improvement in the quality of life was noted in 74 patients (89%) (UDI 6 and PISQ-12 questionnaires). The external urethral orifice was not displaced inwards, the urethra projected above the vaginal entrance during the vaginal examination and the O’Donnell-Hirschhorn test. In 13 (15.5%) patients, the biodegradation of the gel was accompanied by the return of symptoms of various degrees in different terms after the operation (from 8 to 13 months). 8 women required repeat injections of the filler; four patients needed 2 injections and 1 patient needed three injections. The repeated manipulations were performed under local anaesthesia. In 8 cases (9.6%), continued urination disorders were noted despite the termination of the dominance of postcoital dysuria, which required additional complex treatment. Improvement of sexual life was observed in 89% of all operated women according to the described technique. Urethral transposition was not required in any of the patients.Conclusions. The combined technique improves the treatment's results of female hypospadias and urethral hypermobility complicated by postcoital dysuria with minimal development risk of complications. The disadvantage is the natural bulking gel biodegradation, which may necessitate its reimplantation.

We compared the cutting and coagulation efficiency of the blue laser, the Tm laser, and the combination of them during laparoscopic partial nephrectomy (LPN). The combination of the blue and Tm lasers provided the most promising results in terms of resection rate and hemostasis.

Introduction The SuperPulse Thulium (Tm) fiber laser (wavelength of 1.94 m) has been recently introduced as a directed-energy source for urology. Preclinical studies have shown a significant potential of the SuperPulse Tm fiber laser (SP TFL) for lithotripsy. However, clinical reports of using SP TFL to treat urolithiasis are still few and limited. Of special interest are challenging cases, e.g., lower pole stones, when extreme deflection of the instrument is required. Objective To evaluate the effectiveness of the SuperPulse Tm fiber laser in the management of lower pole small calyceal stones during flexible ureteroscopy (F-URS). Method s. The SuperPulse Tm fiber laser device (Urolase 2, IRE Polus, Fryazino, Russia) has been cleared for clinical use by the Ministry of Health of Russian Federation. Study protocol has been approved by the Ethical Review Committee. Between January 2018 and February 2019, 130 patients with kidney stones have undergone Thulium fiber laser lithotripsy during F-URS. We retrospectively analyzed 15 of this patients with a single radiopaque lower pole calculus that were included in the present study. Stone size, stone density, lithotripsy time (from the first to last footswitch press) and lasering (laser emission) time were measured. The SP TFL was used for stone disintegration with different settings in dusting and fragmentation modes (0.1 - 4J, 7-300Hz, 6-40W) via a fiber with a 200-m core diameter. Low dose CT scanning was performed on POD 90 to assess SFR. Results Stone size ranged from 4 to 17 mm and stone density varied from 350 to 1459 HU. The average lithotripsy time was 12 min (3-30 min). The average lasering time was 1.3 min (0.4-2.5 min) and the mean hospital stay was 1.1+/-0.3 days. In all cases we reached the lower pole stone containing calyx with a laser fiber. The complication rates were evaluated by using the Clavien-Dindo grading system and did not exceed GII (6.6%). SFR on POD 90 was achieved in 86.6% of cases. Conclusions F-URS with SuperPulse Tm fiber laser is safe and effective option in the management of lower pole small calyceal stones. The possibility of using small laser fibers gives better instrument deflection which make possible to reach lower pole calyceal stones even with acute lower pole infundibulopelvic angle (IPA).

The study objective is to evaluate the effectiveness and safety of the 6-arm mesh OPUR implant in treatment of anterior apical prolapse. Materials and methods. Three hundred patients with anterior apical prolapse (grade III–IV cystocele, grade II–IV hysteroptosis) underwent surgery. Prolapse repair was performed using the 6-arm mesh OPUR implant.Results. In 290 patients, the intended result was achieved (full prolapse elimination or stage I prolapse per the POP-Q (Pelvic Organ Prolapse Quantification System)). However, in 6 cases recurrences of hysteroptosis, in 4 cases recurrences of cystocele were diagnosed. The following postoperative complications were observed: hematoma of the anterior vaginal wall with spontaneous resorption in 12 patients; acute urinary retention resolved in 3–7 days after the surgery in 5.8 % cases; vaginal mucosa erosion in 4 cases (in 2 cases, fragment resection was necessary); intraoperative injury of the bladder in 3 patients (in 2 cases, prolapse repair after defect suturing was finished with transvaginal contralateral sacrospinous hysteropexy supplemented by anterior colporrhaphy; in 1 case, bladder defect was sutured prior to implantation). Conclusion. Transvaginal repair of anterior apical prolapse of the pelvic organs in women using the 6-arm implant is effective and relatively safe. Satisfactory anatomical results persisting for a long time (4–5 years) after implantation were achieved.

The aim of this literature review was to demonstrate the pluses and minuses of each kind of biopsy, which can be helpful for preparing an algorithm and determining the indications and contraindications for each prostate biopsy (PB). Prostate biopsy is the main method of diagnosing prostate cancer (PC), and it remains relevant even in spite of the appearance of a number of new diagnostic tests and methods. Transrectal 12-core biopsy without pre-biopsy mpMRI remains a routine sampling of prostate material. But with the appearance of a great variety of PB and their introduction into practice, there arises the need to compare these methods with each other. At present, all available studies dealing with the informativity of some biopsy method or another, were conducted in different time periods and cannot reliably reflect their informativity for making a comparison. In our opinion, further research into this problem is required and research works should study the informativity of various kinds of biopsy depending on visualization of a pathological site for suspected prostate cancer, in TRUS and its location coincidence in mpMRI, in Pi-RADSv2.1 classification. Key words: prostate biopsy, prostate cancer, transrectal ultrasound