Urologiia

Introduction. The problem of rational antimicrobial therapy for urinary tract infections (UTIs) remains highly relevant for physicians of various specialties. Knowledge of the level of antibiotic resistance among UTI pathogens is critically important for the choice of empirical therapy, prevention of recurrence, chronic infection, and complications such as urosepsis and stone formation.

Aim. To analyze antibacterial resistance data for the main pathogens causing community-acquired UTIs, namely Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, in the Russian Federation in 2024.

Materials and methods. A retrospective analysis was performed on 185,480 urine samples collected in outpatient settings throughout Russia. Microorganism identification was carried out using an automated analyzer and identification systems (VITEK2, MALDI Biotyper). Antimicrobial susceptibility was determined in accordance with the Russian guidelines “Determination of susceptibility to antimicrobial agents” 2024 [14].

Results. Pathogens at a diagnostic titer (≥10⁴ CFU/mL) were isolated in 23.5% (n=43,550) of the analyzed samples. The distribution of pathogens was as follows: E. coli – 64.1%, K. pneumoniae – 13.1%, P. mirabilis – 3.6%. The resistance profile of E. coli varied substantially depending on the demographic group. The most unfavorable situation was observed in adult men, with resistance to fluoroquinolones exceeding 57% and resistance to third-generation cephalosporins approximately 48%, whereas the most favorable situation was observed in pregnant women. Fosfomycin and nitrofurantoin retained the highest activity against E. coli in women, with more than 96% of strains remaining susceptible. K. pneumoniae was characterized by a markedly higher level of resistance to all major classes of antibacterial agents, including critically low susceptibility to meropenem (70.7%). P. mirabilis retained high susceptibility to carbapenems (98.4%) and third-generation cephalosporins (83.9%).

Conclusions. The obtained data highlight the need to take into account the patient’s sex, age, and physiological status when selecting empirical therapy for UTIs. Fosfomycin and nitrofurantoin confirmed their status as first-line agents for uncomplicated UTIs in women. The high resistance of uropathogens to fluoroquinolones and co-trimoxazole necessitates restricting their use. The identified increase in resistance of K. pneumoniae to amikacin requires special attention in the treatment of complicated UTIs.

Introduction. Chronic recurrent cystitis (CRC) in women is characterized by frequent exacerbations and the difficulty of achieving stable remission. Local inflammation and impaired urothelial barrier function play a key role in its pathogenesis. The search for objective markers of therapy effectiveness, such as urinary cytokines, is an urgent task.

Objective. To analyze the clinical efficacy and urinary cytokine profile in the treatment of CRC in women with the polypeptide drug Vesusten and intravesical hyaluronic acid instillations.

Materials and Methods. This prospective, open-label, comparative study included 45 patients with CRC, divided into two groups: Group I (n=25) received Vesusten 5 mg IM, 10 injections; Group II (n=20) received intravesical instillations of sodium hyaluronate 40 mg, 4 procedures. Clinical efficacy was assessed using VAS, PPIUS, TUFS scales, and urinary frequency. Urinary cytokine levels (MCP-1, calprotectin, RANTES, MIF, TNF-α, IL-6) were measured by ELISA before and after treatment.

Results. Both groups achieved significant improvement in all clinical parameters (p< 0.05). Group I showed a more pronounced reduction in TUFS score (3.9-fold). Cytokine analysis revealed a significant decrease in MCP-1, calprotectin, and IL-6 in both groups. The key difference was the dynamics of RANTES: Group I showed a trend towards an increase (+8.6%, p=0.412), while Group II showed a significant decrease (p=0.02). The median relapse-free period in Group I was 42.5 weeks, significantly higher than in Group II (38.0 weeks; p< 0.05).

Conclusions. The conducted study demonstrated the effectiveness of Vesusten and intravesical hyaluronic acid instillations in achieving prolonged remission in patients with chronic recurrent cystitis (CRC). Vesusten provides a longer relapse-free period (42.5 vs 38.0 weeks, p< 0.05).

Aim. To improve the diagnosis and treatment of urolithiasis in the conditions of the Far North.

Materials and methods. The study included 136 patients in whom stone analysis after surgical treatment was done. The patients underwent examination and treatment at Salekhard District Clinical Hospital and Outpatient Department No. 4 of University Clinical Hospital No. 2, Sechenov University. The mean age of the patients was 47.6±11 years. There were 89 men (65.4%) and 47 women (34.6%). Before surgical intervention, stones were located in a calyx in 31 patients (22.8%), in the renal pelvis in 28 (20.6%), in the upper third of the ureter in 17 (12.5%), in the middle third in 9 (6.6%), and in the lower third of the ureter in 51 patients (37.5%). Indications for surgery included frequent episodes of renal colic, hematuria, and chronic calculous pyelonephritis. Preoperatively, 29 patients (21.3%) had recurrent stone formation, whereas in 107 patients (78.7%) the stone was detected for the first time. Extracorporeal shock wave lithotripsy (ESWL) was performed in 24 patients (17.6%), ureteroscopy with lithotripsy in 74 (54.4%), and percutaneous nephrolithotomy in 38 (27.9%). The mineral composition of the stones was characterized by diversity and variability in frequency. In 28 patients (20.6%), the stone consisted of two types of minerals, whereas in 108 (79.4%) it consisted of three types of minerals in different proportions. During the 24-month follow-up period after surgery, no recurrence of stone formation was observed in 45 patients (33.1%), whereas recurrence was diagnosed in 91 patients (66.9%).

Results. Cluster analysis identified four groups of observations that differed in sample size. Cluster 0 was characterized by a high whewellite content (65.612±12.456) with moderate variability of this parameter. The weddellite level in this group was intermediate (31.729±13.551), also with variable values. The key feature of this cluster was the complete absence of postoperative recurrence of urolithiasis: the recurrence rate was 0.000±0.000. Cluster 1 showed the highest whewellite content among all groups (68.798±11.669). At the same time, the weddellite level in this cluster was lower than in cluster 0 and amounted to 24.218±10.583. The most concerning characteristic of this group was the 100% rate of postoperative urolithiasis recurrence (1.000±0.000). Cluster 2 demonstrated the lowest whewellite content among the first three clusters (42.177±16.461), but at the same time had the highest weddellite level (47.983±21.185). In addition, this group showed an increased uric acid content (40.078), exceeding the corresponding values in the other clusters. The risk of urolithiasis recurrence in this group was extremely high: the mean value was 0.971±0.171, corresponding to a recurrence probability of 97.1%. Cluster 3 represented a distinct subgroup, the smallest one, with only 4 observations, and was characterized by a zero standard deviation. Its distinguishing feature was a markedly elevated level of uric acid dihydrate (30.000), which was 2-2.5 times higher than in the other groups. At the same time, the ammonium urate content (20.000) in this subgroup was lower than in the remaining patients.

Conclusion. The course of urolithiasis is determined by the mineral composition of stones. The four-cluster model clearly demonstrated that the probability of recurrence after surgical treatment is associated with the ratio of mineral components within the calculi. Adaptation of these strategies to the harsh conditions of the Far North is of particular importance. Limited sunlight exposure, extreme temperatures, restricted access to fresh foods, and the remoteness of populated areas require careful control of hydration status, correction of vitamin D deficiency, implementation of telemedicine support, and consideration of local dietary traditions when developing dietary recommendations.

Background. Dietary supplements play an important role in the treatment and prevention of urinary tract infections (UTIs). However, their mechanism of action often remains unclear.

Aim. To study the anti-adhesive, antibiofilm, and direct antibacterial activity of the dietary supplement Ciurol N against uropathogenic bacteria causing UTIs.

Materials and methods. The study material consisted of uropathogenic microorganisms (127 strains) isolated from urine samples of 120 women with recurrent UTIs. Five cultures each of the most commonly detected uropathogens were selected: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis (20 samples in total). The anti-adhesive activity of Ciurol N was assessed by changes in the adhesion index (AI), antibiofilm activity by changes in the optical density of biofilms, and the direct antibacterial effect by the number of viable bacteria after interaction with the tested product, with calculation of the minimum inhibitory concentration (MIC). Control samples consisted of bacterial suspensions in meat-peptone broth at a concentration of 1×10² CFU/mL, whereas experimental samples consisted of the same bacterial concentration supplemented with Ciurol N.

Results. In the experimental samples, 24 hours after the start of the study, AI values compared with the control were lower by 2.4-fold for E. coli, 2.4-fold for K. pneumoniae, 2.2-fold for P. mirabilis, and 2.8-fold for E. faecalis. At the same time point after the addition of Ciurol N, the optical density values of biofilms were 2.2-2.8 times lower than in the control for all studied uropathogens. A direct antibacterial effect of Ciurol N was also demonstrated, as evidenced by suppression of colony growth of the studied microorganisms. Overall, for all uropathogens, a stable antibacterial effect persisted for 9 hours of observation. After 12 hours, an increase in the number of viable colonies was observed; however, their number remained substantially lower than in the control.

Conclusions. The results of this study indicate that the dietary supplement Ciurol N has anti-adhesive, antibiofilm, and direct antibacterial activity in vitro against the main uropathogens. These findings may be useful for planning studies of the clinical efficacy of Ciurol N in patients with UTIs.

Introduction. Standard diagnostic testing for male infertility includes a spermogram in accordance with current World Health Organization (WHO) recommendations. However, a basic ejaculate examination is insufficient to identify the causes of unsuccessful conceiving attempts, early pregnancy terminations, and ineffective ART protocols. Modern methods include transmission electron microscopy (TEM) of sperm, which allows visualization of their ultrastructural elements, and the HBA (Hyaluronan Binding Assay) test, which assesses the functional maturity of sperm. The clinical significance of these methods lies in their ability to detect hidden disorders of spermatogenesis, assess sperm DNA quality, and determine the functional readiness of gametes for fertilization.

Objective. To establish a relationship between the level of functional maturity of spermatozoa, determined using the HBA test, and the presence of ultrastructural changes detected using electron microscopic examination of spermatozoa.

Materials and methods. The retrospective study included 98 men who sought medical help due to marital infertility. The average age was 33.5±4.2 years; the duration of infertility was 2.4±1.9 years. All men underwent ultrasound examination of the scrotum, determination of testosterone, LH, FSH, prolactin, and estradiol levels in the blood serum, spermogram, HBA test, and EMIS. Sperm analysis for both tests was performed from one portion of ejaculate. The men were stratified into two groups: group 1 – patients with HBA test < 65% (n=21) and group 2 – with HBA test > 65% (n=77). The study groups did not differ in age, anthropometric data, hormonal profile indicators, incidence of varicocele, and bad habits.

Results. Semen analysis revealed a significant reduction (p< 0.01) in the main ejaculate parameters in the group with impaired functional sperm maturity compared with the control group: sperm concentration (38.8±10.3 million/ml vs. 64±5.8 million/ml, respectively), total sperm count per ejaculate (125±32,5 million vs 229±23,1 million), progressive motility (44,8±5,4% vs 60±2,5%), and normal morphology (1,9±0,7% vs 3,6±0,42%). According to TEM data, the presence of an acrosome on the sperm head (R=0,343, p=0,002) and an intact postacrosomal sheath (R=0,248, p=0,024) showed a weak positive correlation with the HBA test, whereas reduced acrosomal size (R=−0,227, p=0,039) and reacted acrosomes (R=−0,295, p=0,007) demonstrated a weak negative correlation with the HBA test. Chromatin decondensation (R=−0,353, p=0,001) and the presence of a cytoplasmic droplet on the sperm head or neck (R=−0,427, p=0,001) were negatively correlated with the HBA test. In patients with an HBA test value < 65%, there was a positive correlation with the presence of an acrosome (R=0,759, p=0,0001), its normal position (R=0,557, p=0,009), and normal axonemal structure (R=0,449, p=0,041), and a negative correlation with reduced acrosomal size (R=−0,541, p=0,011), reacted acrosomes (R=−0,683, p=0,001), and abnormal chromatin structure (R=−0,467, p=0,033) on TEM.

Conclusion. Reduced sperm binding capacity to hyaluronic acid is associated with ultrastructural sperm abnormalities. Assessment of functional sperm maturity using the HBA test serves as a predictor of ultrastructural defects in spermatozoa and is of considerable clinical relevance.

Disturbances of microcirculation and congestive processes in prostatic tissue play a key role in the development of chronic prostatitis. High-frequency Doppler ultrasonography of the penile vessels is used for objective assessment of erectile function (EF) in patients with chronic prostatitis (CP). A pathogenetically oriented treatment option for chronic abacterial prostatitis is the use of peptide bioregulators, including Prostatilen, which has been used for more than 30 years.

Aim. To evaluate the effect of a complex prostate-derived peptide preparation on erectile function and penile arteriolar blood flow in patients with chronic abacterial prostatitis.

Materials and methods. A total of 50 patients aged 25 to 64 years with CP and concomitant erectile dysfunction (ED), who received Prostatilen-AC rectal suppositories (30+180 mg) once daily at bedtime for 10 days, are included in the study. Before and after treatment, the following parameters were assessed: EF using the IIEF-5 questionnaire, as well as peak systolic velocity (Vas) and mean linear velocity (Vam) of arterial blood flow in the vessels of the non-erect penis using high-frequency Doppler ultrasonography.

Results. Before treatment, mild ED was identified in 8/50 (16%) patients, moderate ED in 24 (48%), and severe ED in 18 (36%) patients. The mean IIEF-5 score was 12.8±5.1. According to Doppler assessment, marked microcirculatory disturbances were detected in 26/50 (52%) patients. After treatment with Prostatilen-AC, the mean IIEF-5 score increased significantly compared with baseline, from 12.8±5.1 to 17.8±4.3 (p< 0.05), respectively. After therapy, all patients demonstrated a reduction in the severity of clinical manifestations of ED: in 6 (12%) patients symptoms were absent, 20 (40%) patients had mild ED, 14 (28%) had moderate ED, and only 7 (14%) patients retained severe ED. Therapy was also associated with a statistically significant improvement in penile arteriolar blood flow parameters in the observed patients: mean Vas increased from 2.78±0.26 cm/s before treatment to 3.41±0.31 cm/s after treatment (p< 0.05); mean Vam increased from 0.56±0.11 cm/s to 0.88±0.12 cm/s, respectively (p< 0.05).

Conclusion. Treatment of patients with CP and concomitant ED with a complex prostate-derived peptide preparation contributed to a reduction in the severity of clinical manifestations of ED. An objective criterion of treatment efficacy, reflecting improvement of microcirculation in the penile vessels, is provided by the results of high-frequency Doppler ultrasonography of the penile vessels. Improvement in penile arteriolar blood flow following treatment in patients with manifestations of ED was indicated by increases in its main Doppler parameters, Vas and Vam.

Restoration of urinary tract continuity using isolated segments of the small intestine is required in cases of extensive ureteral defects of various origins. In recent years, several publications have reported the use of laparoscopic techniques for performing ileoureteroplasty. The aim of the research is to present the outcomes of laparoscopic intestinal ureteral reconstruction.

Materials and methods. From 2001 to 2026, small bowel ureteral reconstruction was performed in 249 patients. Laparoscopic ileoureteroplasty has been carried out by our team since 2013, and during this period we have accumulated experience with 101 such operations (50.2%), involving a total of 109 ureters. Among these patients, there were 44 men (43.6%) and 57 women (56.4%), with a mean age of 48.8±1.6 years. Unilateral ileoureteroplasty was performed in 93 patients (92.1%), and bilateral procedures in 8 patients (7.9%).

Results. Early postoperative complications occurred in 6 patients (5.9%). There were no fatal outcomes. Late complications were followed up in 89 patients over a period ranging from 3 to 254 months (mean 66±2 months) after surgery and developed in 5 patients (5.6%). Urinary tract urodynamics on the operated side improved in all patients. According to nephroscintigraphy, kidney function after ileoureteroplasty improved in 98 patients (97.0%), remained at the same level in 1 (1.0%) and worsened in 2 (2.0%) patients.

Discussion. An isolated segment of the ileum is the best and most versatile substitute for the reconstruction of extensive ureteral defects. In most patients, ileoureteroplasty can be successfully performed using a laparoscopic approach.

Conclusion. Laparoscopic ileoureteroplasty reduces surgical trauma and shortens the duration of hospital stay.

Objective. To assess time to urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and to describe early perioperative and oncological outcomes.

Materials and methods. A retrospective analysis was performed of patients who underwent RS-RARP in 2022–2024. The primary endpoint was time to complete urinary continence (0 pads/day). Time-to-event analysis (continence recovery) was carried out using the Kaplan–Meier method, with cumulative event probability visualized as (1−S(t)) and 95% confidence intervals calculated.

Results. A total of 344 patients were included. On day 1 after urethral catheter removal, complete continence was observed in 90,1% of patients (0–1 pad/day in 97,3%). Complete continence rates were 92,1% at 1 month and 97,2% at 12 months. Mean time to continence recovery was 0,7 months (95% CI 0,428–0,973). Positive surgical margins were detected in 9% of cases; no biochemical recurrence was recorded during follow-up. Mean operative time was 113 min and mean blood loss was 121 mL.

Conclusions. RS-RARP provides rapid recovery of urinary continence with high early complete continence rates and acceptable perioperative and short-term oncological outcomes. Comparative studies versus standard RARP and comprehensive analyses of oncological and functional outcomes are needed to further clarify the advantages and limitations of this technique.

Foreign bodies in the upper urinary tract are relatively rare. Publications on this topic primarily consist of clinical case reports describing the removal of foreign bodies discovered after surgical interventions. However, in modern combat trauma care, the relevance of this issue has increased. In cases of penetrating abdominal or lumbar injuries involving the kidney, the penetrating projectile may remain in the renal parenchyma and subsequently migrate or initially lodge in the pelvicalyceal system. In the vast majority of cases, patients present with multiple (18.6%) or combined (71.2%) injuries, making minimally invasive surgical approaches the preferred method for foreign body removal. Modern technologies allow for the use of percutaneous and/or transurethral techniques in such situations. In this context, we present a clinical case of endoscopic removal of a fragment from the pelvicalyceal system of the right kidney.

Abstract. Urogenital tuberculosis is difficult to diagnose in the general healthcare network because it has no pathognomonic symptoms, and there is no screening for urogenital tuberculosis, which complicates its timely diagnosis.

This article presents a clinical case of generalized tuberculosis that first manifested as a lesion of the external genital organs. A high level of clinical suspicion for tuberculosis prompted special investigations using widely available methods. Real-time PCR diagnostics allowed to identify tuberculosis of the male genital organs as the first manifestation of generalized tuberculosis. We present a rare case of urogenital tuberculosis diagnosed by ejaculate analysis, as well as a successful treatment outcome.

The key factor in timely diagnosis of tuberculosis is physician awareness, which is based on a certain minimum level of knowledge about the infection.

Giant condyloma of Buschke–Loewenstein is a rare benign tumor characterized by viral etiology, slow growth, the ability to cause disfigurement of the affected areas and a certain potential for malignancy. The main treatment option for this disease is surgery. Our clinical case is dedicated to the successful surgical treatment of a 57-year-old patient, in whom giant condyloma of Buschke–Loewenstein of the penis developed over 10 years without malignant transformation.

On February 14, 2026, the expert forum «Interdisciplinary Aspects of the Management of Patients with Urinary Tract Infection and Chronic Pelvic Pain» was held within the framework of the activities of Committee on Infection of the Russian Society of Urologists. The meeting addressed current issues in the diagnosis and comprehensive treatment of patients with urinary tract infection and chronic pelvic pain. The specialists focused on the pathogenetic mechanisms underlying pain syndrome in this category of patients, the relationship between functional disorders of the lower urinary tract and urinary tract infection, as well as current data reflecting changes in the understanding of the etiological structure of these conditions. Following the meeting, the experts concluded that mandatory interdisciplinary collaboration among urologists, obstetricians, gynecologists, neurologists, and other specialists is necessary, as is expansion of the diagnostic work-up through the mandatory inclusion of cytological and morphological methods in the diagnostic work-up for patients with recurrent infectious diseases of the urinary tract. In specifying the issues of antibacterial therapy for urinary tract infection in the context of the global problem of antibiotic resistance, the feasibility of using soluble nitrofuran formulations was substantiated in order to provide reliable etiological control and prevention of infectious complications. The experts also emphasized the importance of pathogenetic therapy aimed at stimulating neuroregeneration processes and correcting psychological and emotional disorders for effective pain relief and achievement of stable remission.