Introduction. The gold standard of treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of the bladder (TURB) in combination with intravesical therapy. However, this procedure may cause serious complications. At the same time, studies of various lasers for the treatment of NMIBC have demonstrated their safety and efficacy. Despite this, the topic has not yet been fully explored and is not widely practiced in clinical oncology, making further research necessary.Objective. To compare thulium and holmium lasers with conventional TURB for management of non-muscle-invasive bladder cancer (NMIBC).Materials & methods. In our study, depending on the treatment approach, 84 NMIBC-patients were divided into three groups. Group 1 included 27 patients (34.14%), who underwent laser thulium bladder resection; group 2 included 25 patients (29.76%), who underwent laser holmium bladder resection, and group 3 included 32 patients (38.1%), who underwent standard TURB. Prior to surgery, all patients received a standard set of preoperative general clinical and instrumental examinations for bladder cancer, and the choice of surgical approach was based on informed patient consent, taking into account the benefits and risks of the three treatment options. All surgeries were performed in accordance with established protocols.Results. In the TURB group, the surgery time was the longest and totalled in 20.5 ± 7.4 min. Laser technologies reduce the surgery time to 16.3 ± 5.3 min for a holmium laser and to 14.7 ± 5.2 min for a thulium laser. Also, in groups 1 and 2, a shorter duration of postoperative bladder irrigation was noted (4.4 ± 1.8 and 4.7 ± 1.6 hours) and shorter periods of postoperative bladder catheterisation (1.5 ± 0.08 and 1.6 ± 0.08 days) compared to group 3, where these indicators were 16.4 ± 2.5 hours and 2.5 ± 0.13 days, respectively. Among patients undergoing either holmium or thulium surgery, a higher rate of disease-free survival has been noted. Independent prognostic factors that influence the prognosis of NMIBC in all groups include the type of surgery, history of bladder tumors, and pathological stage.Conclusion. The use of laser technology, such as thulium and holmium laser, in bladder wall resection for NMIBC shows promising results and provides a good clinical outcome that is comparable to (and in some cases, superior to) standard TURB.

AIM:To compare thulium and holmium lasers in the treatment of non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS:In our work, patients were divided into 3 groups, depending on the treatment method. In the group 1 (n=27, 32.14% of the cohort), thulium laser resection of the bladder was done, while in the group 2 (n=25, 29.76% of the cohort) and group 3 (n=32, 38.10 % of the cohort) holmium laser resection and standard transurethral resection (TUR) were performed, respectively. In the preoperative period, all patients underwent a standard clinical examinations and imaging studies (computed tomography of the thorax, abdomen and retroperitoneal space, magnetic resonance imaging of the pelvis, cystoscopy, cytological examination of urine sediment). RESULTS:The duration of the procedure was 14.7+/-5.2 minutes for a thulium laser and 16.3+/-5.3 minutes for a holmium laser, compared to 20.5+/-7.4 minutes for standard TUR. The duration of postoperative irrigation after laser resection was lower (4.4+/-1.8, 4.7+/-1.6 and 16.4+/-2.5 hours, respectively) (p<0.001). The period of postoperative catheterization in groups 1 and 2 was 1.5+/-0.08 and 1.6+/-0.08 days, respectively, compared to 2.5+/- 0.13 days in the group 3 (p=0.002). In the group of thulium and holmium laser resection, a higher disease-free survival was demonstrated compared with TUR throughout the entire follow-up period. CONCLUSION:When performing laser resection of the bladder wall for NMIBC, a significant lower number of complications and better survival were documented compared to patients who underwent TUR.

Единовременные эндовидеохирургические вмешательства при лечении урологических заболеваний, в случае достаточной отработки методики, являются эффективным методом лечения. При этом они выполняются только у 2,0 – 6,4% пациентов, нуждающихся в таких вмешательствах. Цель настоящего исследования: анализ периоперационных результатов симультанных вмешательств и соответствующих изолированных операций при урологических заболеваниях. Материал и методы проведен ретроспективный анализ периоперационных результатов хирургического лечения 5748 пациентов, прооперированных в период с 01.09.2018 по 30.12.2019. При этом анализировали следующие периоперационные показатели: продолжительность вмешательства, объем интраоперационной кровопотери, время дренирования мочевого пузыря уретральным катетером, частота встречаемости инфекционно-воспалительных осложнений со стороны органов мочеполовой системы в ближайшем послеоперационном периоде, количество койко-дней в стационаре в послеоперационном периоде, продолжительность анестезии. Результаты: выявлены преимущества единовременных эндовидеохирургических вмешательств перед двух- и более этапными вмешательствами урологического профиля по продолжительности, объему интраоперационной кровопотери, частоте развития инфекционно-воспалительных осложнений со стороны урологических органов в раннем послеоперационном периоде и другим изучаемым показателям. Заключение: результаты проведенного исследования полностью подтверждают целесообразность и необходимость более широкого использования единовременных эндовидеохирургических вмешательств при плановом хирургическом лечении сочетанных заболеваний урологического профиля.

Background . Among the drug methods of penile rehabilitation in patients after nerve-sparing prostatectomy, the use of phosphodiesterase-5 (PDE-5) inhibitors is proposed as the first line of therapy, which have shown high efficiency, ease of use, good tolerability and safety, improving the quality of life of patients. Aim. To evaluate the effectiveness of drug-induced penile rehabilitation after nerve-sparing prostatectomy in the restoration of erectile function (EF) with an analysis of the factors influencing it. Materials and methods . The study included 108 patients with localized prostate cancer who underwent nerve-sparing prostatectomy. All patients were randomized into two groups. In Group 1 patients did not receive drug therapy for the prevention and treatment of erectile dysfunction. In Group 2 patients in the postoperative period received daily PDE-5 inhibitors (tadalafil) at a minimum dosage of 5 mg for 12 months as a drug therapy. Initially and at the annual stage of the study, the state of EF, erectile rigidity, night penile test, and quality of life were assessed. An analysis was also made of the factors affecting the preservation of EF one year after nerve-sparing radical prostatectomy. Results. The best reliable results in terms of maintaining EF at the annual stage of the study were obtained in the group whose patients received postoperative drug therapy with PDE-5 inhibitors. It was possible to identify the most significant factors influencing the state of EF in the postoperative period after radical prostatectomy: the type of operation – bilateral nerve sparing, taking PDE-5 inhibitors, the patient’s age, the presence/absence of diabetes mellitus, the state of EF (International Index of Erectile Function-5 value) before the operation. Conclusion . Daily intake of PDE-5 inhibitors at a low dose of 5 mg is indicated for patients after nerve-sparing prostatectomy as an effective means of penile rehabilitation in order to preserve EF, as it provides better results compared to no drug therapy. Patients who meet criteria such as young age, no diabetes, high preoperative International Index of Erectile Function-5 levels may benefit most from nerve-sparing surgical techniques and early postoperative participation in a penile rehabilitation program for erectile dysfunction.

BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly. AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups. MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically. RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 18.0 min, and partial nephrectomy 135.5 25.0 min (p 0.0001), in patients of group II, 120.0 20.5 and 138.0 25.5 min (p 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 1.2 min in patients of group I and 18.2 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 20.0 ml when performing radical nephrectomy and 236.5 20.0 ml when performing partial nephrectomy (p 0.0001), and in group II 125.0 18.5 ml for radical nephrectomy and 246.0 22.0 ml for partial nephrectomy (p 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the ClavienDindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group. CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 5664 and 6575 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.

Worldwide, prostate cancer has remained one of the most common malignant neoplasms among men and it is accompanied by high mortality rates. Standard methods for diagnosing prostate cancer have limited sensitivity and specificity, unnecessary biopsies are often performed, and the risk of overdiagnosis of the disease and overtreatment of patients is high. The review considers diagnostic and prognostic biological markers of prostate cancer proposed in recent years. Theoretical foundations for the use of new biomarkers are analyzed. The characteristics and practical significance of biomarkers of various groups (immunohistochemical, molecular and genetic, prostate specific antigen-associated, volatile organic metabolites) are presented. The need for further large-scale scientific research in the field of biomarker application in prostate cancer, criteria for their selection and evaluation are described. The introduction of modern diagnostic and prognostic markers into real clinical practice opens up new opportunities for improvement of prostate cancer diagnosis, individual prognosis, and rationalization of treatment strategy.

Purpose of the study. To evaluate the levels of metabolic markers in patients with prostate cancer (PCa) in comparison with patients with benign prostatic hyperplasia (BPH).Patients and methods. 108 patients were included in the study. The majority of patients had comorbidities: coronary heart disease, hypertension, and almost one third of patients had type 2 diabetes mellitus. Median (Me) age was 67 (64–74), body mass index was 25.9–34.7. The main study group included 54 patients with histologically verified prostate cancer, the comparison group consisted of 54 patients with benign prostatic hyperplasia (BPH). The level of basic biochemical parameters, glomerular filtration rate, lipidogram, total prostate-specific antigen (PSA), total testosterone was determined in all patients.Results. When comparing anamnestic and biochemical parameters, the groups were not statistically significantly different. When comparing the groups by lipid status, it turned out that in the group with RPW, in contrast to the group of patients with BHP, statistically significantly higher levels of total cholesterol (5.13 (3.3–10,4) and 4.60 (2.5–6.3)) mmol/L, respectively, p = 0.023), low–density lipoproteins (2.93 (0.8–5.9) and 2.60 (0.9–4.2) mmol/L, respectively, p = 0.035), triglycerides (2.10 (1.0–8.0) and 1.70 (0.5–7.3) mmol/L, respectively, p = 0.048). In case of dyslipidemia, an increased risk of developing PCa was identified. Correlation analysis revealed a direct moderate relationship between total PSA levels and total cholesterol concentration (r = 0.51).Conclusion. Our study revealed that in the PCa group, there was a higher level of total cholesterol, low-density lipoproteins, and triglycerides, in contrast to the group of patients with BPH. Additionally, in the group of patients with BPH, dyslipidemia was a risk factor in the development of PCa, which should be taken into account in PCa prevention and diagnosis.

Background. Bladder cancer is the most common malignancy of the urinary tract and one of the most common neoplasias in this group. The incidence and mortality rates of the population from bladder cancer differ significantly in different geographical regions of Russia. Aim. To assess the main epidemiological indicators of malignant neoplasms of the bladder in residents of Saint Petersburg and the regions of Russia. Materials and methods. The main epidemiological indicators of malignant bladder neoplasms in Saint Petersburg, Russia and individual federal districts for the period 2012–2021 were studied: crude and standardized rates of morbidity, mortality, prevalence, age structure of patients, the number of cases of diagnosis of the disease at various stages, indicators of one-year mortality and 5-year survival, data on completed cases of treatment of bladder neoplasms. Sources of information: Form No. 7 “Information on cases of malignant diseases” and the database of the Medical Information and Analytical Center (Saint Petersburg). Results. During the period 2012–2021 in Russia, there was an increase in the incidence and prevalence of malignant neoplasms of the bladder. At the same time, mortality rates decreased, and 5-year survival rates increased. This fact indicates the effectiveness of the treatment of patients in this category. In more than 50 % of cases, the disease was detected at stage I of the pathological process, which is due to the proper level of diagnosis. The main medical and statistical indicators in patients with malignant bladder neoplasms in Saint Petersburg are comparable to the average Russian data, and in a number of parameters they exceed them. Conclusion. Oncourological assistance to the population with malignant neoplasms of the bladder in Saint Petersburg is provided properly. The study of medical and statistical indicators in dynamics can be used to improve the algorithms of medical and diagnostic care for cancer patients.

Introduction. Warm renal ischemia (WRI) is used during the organ-preserving surgery of localized renal cell carcinoma to reduce blood loss, improve the imaging quality, facilitate both accessing the cavitary system and suturing the parenchyma. However, WRI can lead to the ischemic reperfusion injury of the preserved nephrons. Superselective embolization (SSE) of the tumor-feeding branch of renal artery is currently being considered as the alternative method of intraoperative hemostasis. Aim. To evaluate the results of organ-preserving surgery of localized kidney cancer in the conditions of SSE. Materials and methods. Three patients who had undergone laparoscopic kidney resection (LKR) with SSE were included in the study. Parameters for assessment were as follows: surgery duration, surgery workflow, intraoperative blood loss volume, the degree of radical surgery according to the histological data, the presence of postoperative complications, and the duration of hospitalization. Results. Compared with the LKR with WRI (n=78, data from a previous own study), the features of the LRK with SSE (n=3) were as follows: 1) the same surgery duration; 2) three times less intraoperative blood loss; 3) the absence of infectious and inflammatory complications; 4) comparable duration of hospitalization. Also, additional advantages of the LKR with SSE were described: 1) the radicality of surgery; 2) the absence of the risk of renal pedicle injury; 3) the absence of the risk of ischemic reperfusion alteration of the preserved renal tissue. Conclusion. Preliminary SSE of the tumor-feeding branch of renal artery may improve functional results of the organ-preserving surgery of localized kidney cancer via reducing the intraoperative blood loss, exclusion the possibility of renal pedicle injury, and provision of the functional activity of the preserved nephrons.

Introduction. In recent years, the clinical and practical interest in malignant neoplasms and diseases of the cardiovascular system has been extremely high. These nosologies are the leading causes of hospitalisations and deaths worldwide.Objective. To assess the prevalence of coronary heart disease and risk factors among patients with newly diagnosed prostate cancer, as well as to identify their relationship with the severity of prostate cancer.Materials & methods. The study included 140 newly diagnosed prostate cancer (PCa) patients with a median age of 65 [62; 70] years. All patients had the level of prostate-specific antigen, pelvic MRI, prostate biopsy with determination of Gleason score, all patients filled out the questionnaire of the International Index of Erectile Function (IIEF-5). Depending on the presence of coronary heart disease (CHD), all patients were divided into two groups: Group 1 — 94 (67%) PCa patients without CHD; Group 2 — 46 (33%) PCa patients with CHDResults. In a comparative analysis, the groups did not differ in indicators such as age, BMI, prostate volume, incidence of diabetes mellitus type 2, and lipid status level. However, in PCa patients with CHD, erectile dysfunction was statistically significantly more pronounced than in patients without CHD (10 vs 18 IIEF5 points, p = 0.03), respectively. In terms of PSA levels, it turned out that in Group 2, this indicator was significantly higher than in Group 1 (15.8 ng/ml vs 10.1 ng/ml, p = 0.03), respectively, which indicates possibly more high malignancy of the process. Furthermore, in Group 2, patients with a high grade PCa according to the classification of The International Society of Urological Pathology (ISUP) 4 / 5 were statistically significantly more common compared to patients of Group 1 (12 (26%) vs. 10 (11%), p = 0.01), respectively. In a comparative analysis of patients depending on the risk of a possible PCa recurrence of , which was taken into account by such parameters as PSA level, Gleason index + ISUP grade, it turned out that in Group 2 there were statistically significantly more patients with a higher risk of PCa progression compared to Group 1 (20 (44%) vs 26 (28%), p = 0.02), respectively.Conclusion. PCa patients with concomitant CHD are characterized by a higher waist circumference, they had lower indicators of erectile function, a more pronounced comorbid background, and more often had a history of stroke. In addition, PCa patients with CHD had a high grade PCa and a higher risk of PCa progression.

Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р<0,05); 2) the IBLV was reduced by 47–51% (р<0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р<0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.

Background. In recent years, approaches to performing radical prostatectomy have undergone many modifications to reduce postoperative complications. However, controversy over the technique of radical prostatectomy persists from the moment of its appearance to the present day. Objective: to assess the state of erectile function, the quality of life of patients with localized prostate cancer before surgery and after performing various types of radical prostatectomy, taking into account the safety of cancer progression. Materials and methods. We examined 127 patients with localized prostate cancer in low and medium risk groups. Depending on the type of radical prostatectomy, patients were divided into three groups: patients with radical retroperitoneoscopic prostatectomy without preserving the neurovascular bundles, patients with unilateral, and patients with bilateral nerve-sparing prostatectomy. Initially and at the annual stage of the study, the state of erectile function, erection rigidity, quality of life was assessed, and oncological outcomes were analyzed. Results. One year later, the best results in terms of preserving erectile function were obtained in the group of patients who underwent bilateral nerve-sparing prostatectomy, and in the group without nerve-sparing, the most serious decrease in the level of erection was noted; prostatectomy with unilateral nerve-sparing took an intermediate value. Indicators such as overall satisfaction and quality of life were higher in patients of the nerve-sparing group compared with patients without nerve-sparing. All three types of radical prostatectomy, when strictly indicated, provide similar short-term oncological results. Conclusion. Intrafascial unilateral nerve-sparing method is indicated for men with a low/intermediate risk of disease progression, both with and without preoperative erectile dysfunction, as it provides similar short-term oncological results and contributes to the restoration of a higher quality of life compared to traditional laparoscopic prostatectomy. The technique with bilateral preservation of intrafascial nerves promotes more effective preservation of erectile function in the postoperative period and can be recommended for young people with a high expectation of preservation of erectile function in the postoperative period.

Introduction. The problem of the pandemic caused by the COVID-19 virus is extremely relevant. It has been proven that SARS-CoV-2, which causes respiratory distress syndrome, is not only aggressive towards lung tissue, as was originally assumed. A promising direction in the study of the pathogenic properties of the pathogen is the effect on the male reproductive system. Materials and methods. The review authors searched the Pubmed and eLibrary databases for the keywords «COVID-19», 2 SARS-CoV-2», «male fertility», «reproductive health», «sperm», «erectile function», «erection». A total of 122 publications were found, of which 34 were selected for this review. Results. According to a review of scientific publications, coronavirus infection can negatively affect the reproductive system of men through a combination of ACE-2 receptors and cellular transmembrane serine protease 2 (TMPRSS2), due to the development of oxidative stress in testicular tissue, hyperthermia, secondary cytokine storm syndrome, side effects of medications taken, which leads to damage to the testicular tissue, a decrease in the quantity and quality of spermatozoa, and the development of various forms of pathospermia. The cascade of pathological processes in the body of a man, developing under the influence of the COVID-19 virus, leads to damage to the endothelium of the penile vessels, a decrease in nitric oxide level in the cavernous bodies, which is manifested by a decrease in erectile function. Conclusions. Due to the short duration of the studies performed, the heterogeneity of the observed groups of patients, and a limited sample, it is impossible to make final predictions of the severity of reproductive and sexual disorders after a new coronavirus infection, their relationship with the characteristics of the course of the disease and the degree of reversibility of pathological processes. Accumulated data during the pandemic period indicate the potential impact of SARS-CoV-2 on male fertility and erectile function, which requires further large-scale homogeneous observations.

Aim. To assess the impact of homeostasis parameters on risk of prostate cancer.Materials and Methods. The study included 108 patients with urologic diseases and with (n = 54) or without (n = 54) prostate cancer. Median age in both groups was 67 (interquartile range 64-73) years. Clinicopathological data and blood test results have been collected from outpatient and inpatient records. In particular, we measured serum levels of total testosterone and prostate-specific antigen.Results. Risk factors for prostate cancer include increased total cholesterol (p = 0.023), low-density lipoprotein cholesterol (p = 0.035), total triglycerides (p = 0.048), and total testosterone (p = 0.002). High levels of total testosterone directly correlated with the tumor stage (r = 0.56). The concentration of prostate-specific antigen correlated with the lipid parameters and remained a reliable diagnostic criterion (p = 0.002).Conclusion. The association of hyper/dyslipidemia with prostate cancer provides an opportunity to improve its prevention by routine lipid screening in high-risk groups.

Prostate cancer (PCa) remains a relevant public health concern and one of the main causes of morbidity and mortality worldwide. Coronary artery disease (CAD) with the underlying coronary artery atherosclerosis is the leading cause of global death. The interaction between modifiable and non-modifiable risk factors for these pathological conditions is discussed in the review. Elevated serum cholesterol, a known risk factor for CAD, can be associated with both development and progression of PCa. From this perspective, patients with atherosclerosis may represent a potential target group for PCa screening. Alternatively, patients with PCa should undergo examination for concomitant cardiovascular diseases as well as their risk factors. Statins are supposed to be potentially beneficial in treating atherosclerosis in men and reducing the risk of PCa development and progression.

AIM:to estimate the effects of exercise training on erectile function after coronary artery bypass grafting.MATERIALS AND METHODS:114 men with stable coronary artery disease undergoing on - pump coronary artery bypass grafting were examined. Patients with ED were randomized into two groups comparable in the main demographic, clinical and baseline parameters: a group of patients undergoing supervised exercise trainings at the outpatient rehabilitation center (n=53) and a group of patients without any exercise trainings at the outpatient hospital (n=61). Patients were assessed 1, 6 and 12 months after CABG. All patients underwent echocardiography (ECHO-CG), bicycle ergometer test without discontinuation of the drug therapy, measurement of nocturnal penile tumescence (NPT), ultrasound assessment of the cavernous arteries with the further estimation of their endothelial function.RESULTS:In addition to the expected improvements in exercise tolerance, regular cycling exercises led to a significant recovery of erectile function (number and duration of NTP, increased penile blood flow volume, estimated during NTP measurement), improved endothelial function of the cavernous arteries, compared to patients without exercise trainings. However, the obtained effects in the group with exercise trainings were short - term. One year after CABG, the number of NTP and penile blood flow volume were superior in patients undergoing exercise trainings. Differences in other parameters became less reliable between the groups.CONCLUSION:Aerobic exercise trainings appeared to be effective for optimizing exercise tolerance, erectile and endothelial function, and allow improving the prognosis of these patients and, therefore, are needed to be included in the rehabilitation programs for patients undergoing CABG.

Цель. Оценить влияние наличия эректильной дисфункции (ЭД) на выраженность системного воспаления у пациентов после коронарного шунтирования (КШ). Материал и методы. Методом случай-контроль в исследование вошли 117 мужчин в возрасте 55,8±5,3 года, планирующихся на КШ, которые по результатам опроса, регистрации ночных пенильных тумесценций, дуплексному сканированию пенильных артерий были разделены на 2 группы - с наличием ЭД (60 человек) и сохраненной эректильной функцией (57 человек). Оценивали состояние больных за 7 дней до КШ, через 1, 6 мес и через 1 год после КШ. Методом иммуноферментного анализа оценивали концентрацию С-реактивного белка (СРБ), фибриногена, фактора некроза опухоли a (ФНО-a). Использовалось компьютерное программное обеспечение Statistica 6.0. Результаты. При анализе периоперационной динамики концентраций маркеров воспаления в крови пациентов c ишемической болезнью сердца оказалось, что у пациентов с ЭД концентрация СРБ достоверно не менялась в течение 1 года после КШ. В группе пациентов без ЭД через 1 мес после КШ анализируемый показатель достоверно не изменился, а через 6 мес и через 1 год отмечено снижение уровня СРБ в сравнении с предоперационными данными: с 3,7 (2,6; 11,9) до 2,5 (1,9; 10,5) мг/л, p=0,04, и с 3,7 (2,6; 11,9) до 3,0 (2,1; 10,7) мг/л, p=0,04 соответственно. И если в предоперационном периоде и через 1 мес после КШ в сравниваемых группах различий концентрации СРБ не было, то через полгода и 1 год после КШ в группе пациентов с ЭД были более высокие показатели СРБ в сравнении с пациентами без ЭД: 6,2 (3,5; 13,4) и 2,5 (1,9; 10,5) мг/л, p=0,04, и 5,9 (3,1; 13,8) и 3,0 (2,1; 10,7) мг/л, p=0,04 соответственно. Уровень фибриногена в течение 1 года после КШ в сравниваемых группах достоверно не менялся. Однако у пациентов с ЭД концентрация фибриногена исходно, через полгода и через 1 год после КШ была достоверно выше, чем у пациентов без ЭД: 3,7 (2,9; 4,6) и 2,8 (1,9; 3,9) мг/л, p=0,03; 3,7 (2,9; 4,6) и 3,0 (1,9; 3,7) мг/л, p=0,04, и 3,5 (3,0; 4,8) и 2,8 (2,0; 3,5) мг/л, p=0,04 соответственно. При анализе динамики концентрации в крови ФНО-a оказалось, что перед КШ, через 1 и 6 мес достоверной динамики в сравниваемых группах не было. Однако через 6 мес у пациентов без ЭД отмечалась уже тенденция к снижению данного показателя по сравнению с исходными значениями: с 36,8 (22,4; 46,3) до 29,4 (20,6; 39,7) мг/л). А через 1 год после КШ в этой группе пациентов были достоверно более низкими показатели ФНО-a в сравнении с исходными данными: с 36,8 (22,4; 46,3) до 27,6 (19,6; 38,1) мг/л, p=0,04. Кроме того, у пациентов без ЭД исходно, через полгода и через 1 год после КШ отмечались более низкие показатели ФНО-a, чем у пациентов с ЭД: 36,8 (22,4; 46,3) и 44,7 (31,4; 55,1) мг/л, p=0,03; 29,4 (20,6; 39,7) и 40,1 (29,6; 51,4) мг/л, p=0,01, и 27,6 (19,6; 38,1) и 37,5 (23,7; 42,3) мг/л, p=0,04 соответственно. Заключение. Наличие у пациентов c ишемической болезнью сердца ЭД усугубляет выраженность системного воспаления у пациентов, подвергшихся КШ.

This article presents a review of literature on the history of the study of theerection phenomenon and erectile dysfunction (ED). In the article the evolution of ED studiesis reviewed in a chronological order. Erectile dysfunction has been a major concern at all times. In the process of human development the knowledge of anatomy, physiology of the penis, the erection phenomenon and causes of erectile dysfunction as well asthe methods of treatment of this disease have been improved. The parallel development of different concepts, organic, hormonal and psychological theories has led to a common understanding that there is no a single mechanism of erection and there is no one factor influencing the occurrence of erectile dysfunction. Thus, there is no any single treatment for this disease. Currently clinical practice and research require an integrated approach to the problem of ED, multidisciplinary approach to diagnosis and treatment of erectile dysfunction with close cooperation of doctors of different specialties.

Aim. To evaluate coronary bypass grafting under artificial circulation conditions on endothelial and erectile dysfunction in patients with ischemic heart disease (CHD). Material and methods. Totally 117 patients participated in the study, with stable CHD at the mean age 55,8±5,3 y. o., planned to CBG. In all patients we used questionnaire “International Index of Erectile dysfunction” (IIED), registration of nocturnal penile tumescenses (NPT), post compression tests on brachial and cavernous arteries. All patients were divided into two groups, those with and without erectile dysfunction (ED) (n=60, n=57, resp.). Results. By the results of the investigation in patients with ED after CBG there was significant worsening of erectile function. It was found, that the existence of ED before operation is an important prognostic factor for its progression after the operation. Others, with non-affected erectile function, after the operation had higher chances to save it. Even more, it was found that in patients without preoperational ED by 6 months after CBG there was tendency to improvement of EZVD comparing with baseline values, but in group with ED this tendency was not found. Also in patients without ED in all stages of study there was significantly better vasoregulating function of endothelium on brachial artery comparing to ED patients. The same tendency was found and on cavernous arteries. While analyzing the prevalence of cardiovascular events after CBG it was found that in ED group 4 patients (7%) cardiovascular events developed, but without ED — did not. Conclusion. So the presence of ED might be a significant marker of worse outcome in CHD patients, underwent CBG.