Urologiia

Aim. To analyze the structure of pathogens responsible for community-acquired urinary tract infections (UTIs) in the Russian Federation during 2022–2024.

Materials and Methods. A total of 566,122 microbiological urine samples from residents of 834 cities across 83 regions of the Russian Federation were analyzed between 2022 and 2024. The study was carried out using real-world data (RWD) analysis, based on relevant segments of the Invitro Laboratory database. Separate analyses were performed for specific types of UTIs in pregnant women, children, men, and women across various age groups.

Results. The most common UTI pathogen in Russia was Escherichia coli, detected in 40.7% of men, 69.5% of women, and 61.2% of children with community-acquired UTIs. The prevalence of E. coli was highest among women aged 38–55 years and men aged 20–50 years. The second most frequent pathogen was Klebsiella pneumoniae (12.8%), with an increasing detection rate beginning from the 38–40-year age group. Among other Enterobacterales, Proteus mirabilis was identified in 3.4% of cases. Among Gram-positive bacteria, the leading pathogens were Enterococcus faecalis (5.7%), Staphylococcus saprophyticus (1.5%), and Streptococcus agalactiae (1.8%). A significant increase in Streptococcus agalactiae detection was observed in pregnant women (6–19%) compared with non-pregnant women (2–5%) of the same age group.

Conclusions. RWD analysis represents a simple and cost-effective tool for studying the pathogen structure of community-acquired UTIs. It complements traditional microbiological surveillance methods and provides unique insights into infection etiology, including detection rates of less common uropathogens and detailed age-related variations in pathogen distribution.

Introduction. In women, urinary tract infections (UTIs) rank second in morbidity after acute respiratory viral infections. Therefore, issues of non-antibacterial prevention and treatment of UTIs are of great relevance. Particular interest is focused on evaluating the efficacy of the herbal medicinal product Canephron® N in UTI prevention under conditions of rapidly increasing antibiotic resistance among uropathogenic bacterial strains, as well as the growing frequency of microbial associations and multidrug-resistant pathogens.

Aim. To assess and update data on the efficacy and safety of Canephron® N for the prevention of recurrent UTIs in outpatient practice.

Materials and methods. A total of 72 female patients with a clinical diagnosis of acute cystitis or exacerbation of chronic cystitis, for whom empirical antibiotic therapy (ABT) was indicated according to the Russian clinical guidelines, were enrolled in a multicenter, open, prospective, randomized study. Thirty-six patients were assigned to the main group, receiving ABT in combination with Canephron^® N (2 tablets three times daily) followed by prophylactic monotherapy with the herbal product for 1 month. Thirty-one patients, receiving ABT only (contact was lost with 5 patients after randomization, and they were excluded from further analysis), were included in the control group. Treatment efficiency and recurrence rates were evaluated for 12 months after completion of therapy.

Results. The mean age of the patients was 37,4 years: 35,1 years in the main group and 39,7 years in the control group. Acute cystitis was diagnosed in 36 (53,7%) patients, and recurrent cystitis in 31 (46,2%). When Canephron^® N was administered at the onset of the disease together with antibiotic therapy and subsequently for one month, recurrences of uncomplicated lower urinary tract infections (LUTIs) within one year were observed in 13,9% of patients, compared with 38,7% in the control group.

Among patients with acute cystitis, a recurrent episode during the year occurred in 5% of those treated with ABT and Canephron^® N, compared with 31,2% in the group without phytotherapy. In patients with recurrent cystitis, the recurrence rate within one year was 25% in the Canephron^® N group versus 46,7% in the control group.

Discussion. Currently, Canephron^® N is one of the herbal medicinal products with the most convincing evidence base, a high safety profile, and a broad range of therapeutic effects. The components of this phytomedicine are included in the 2024 Russian Ministry of Health Clinical Guidelines «Cystitis in Women» as an agent for both the prevention and treatment of recurrent cystitis. Our study demonstrated that the combination of antibiotic therapy with Canephron^® N reduced the recurrence rate by almost threefold (from 38.7% in the control group to 13.9% in the main group) and prolonged the recurrence-free period in both acute and chronic cystitis in outpatient practice.

Conclusion. Evidence has been obtained supporting the therapeutic efficiency of Canephron^® N in the combination treatment and prevention of recurrent UTIs. A positive trend was observed toward improved treatment outcomes and reduced recurrence rates in real clinical practice among patients with uncomplicated cystitis receiving the herbal product in combination with antibiotic therapy.

Background: To decrease the high morbidity and mortality of patients with end-stage renal disease kidney transplantation is the most effective management.

This study aimed to investigate changes in clinical, biochemical, inflammation, rejection, and its association with the renal arterial resistive index after kidney transplantation.

Methods: In this study, we assessed changes in clinical, biochemical, and renal arterial resistive (RRI) index measured by doppler ultrasound and its association with graft rejection after kidney transplantation in 60 adult recipients. Data included; gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, donor (living or cadaver), preference of vessel anastomosis (first artery- second vein; FASV or FVSA), preference of arterial anastomosis (as end-to-end to hypogastric artery or end-to-side to common or external iliac artery), evidence for acute tubular necrosis (ATN), in addition to biochemical variables were noted analyzed by SPSS.

Results: With a minimum of 16 and a maximum of 68, the mean±SD was 42,3±13,7 years old. Of the total population studied 52% received kidneys from cadaver donors. Although acute tubular necrosis versus acute rejection was reported at 32% versus 60%, the value of RRI in the total population was 0,76±0,11. There was a significant difference in rejected versus non-rejected (p=0,001) and living versus cadaver donors regarding the values of reported RRI (р=0,018).

Conclusion: In this study, the recorded RRI suggested respected information regarding changes within intraparanchymal vascularization linked to rejection after kidney transplantation. Further evidence-based studies regarding RRI with more sample size are recommended.

Introduction. The symptoms of novel coronavirus infection (SARS-CoV-2), observed in the long-term period after COVID-19 and collectively referred to as post-COVID syndrome, include not only pulmonary complications but also damage to other target organs, particularly the male reproductive system. Most published studies are based on data obtained during the acute phase of the disease, while reports on long-term reproductive complications are scarce. Therefore, assessment of post-COVID effects on male reproductive function remains a relevant clinical issue.

Aim. To evaluate hormonal status and semen parameters in men of reproductive age after recovery from COVID-19 in the long-term period.

Materials and methods. A prospective study included 120 men aged 21–44 years. Group 1 comprised 60 patients who had COVID-19 complicated by viral pneumonia, and Group 2 included 60 patients with COVID-19 presenting as an acute respiratory viral infection (ARVI). Peripheral blood and semen samples were collected on the 15th and 90th days after disease onset. The following blood parameters were analyzed: total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, and sex hormone-binding globulin (SHBG).

Results. Analysis of hormonal profiles showed a decrease in total testosterone relative to the diagnostic threshold on day 15 from disease onset by 46% in patients with COVID-19 complicated by pneumonia and by 17% in patients with ARVI-like COVID-19. A significant positive trend in TT level was observed in both groups by day 90: an increase of 20% in Group 1 (p ≤ 0.05) and 33% in Group 2 (p ≤ 0.05). Compared with reference values, SHBG levels exceeded the upper limit by 24% and 25% in Groups 1 and 2, respectively, on day 15, and remained elevated on day 90 (by 16% and 11%, respectively), despite a significant decline over time (p ≤ 0.05 in both groups). Level of pituitary hormones and estradiol remained within the reference range at all time points. A decrease in total sperm motility relative to reference values was recorded in both groups due to a reduction in progressively motile sperm. However, a significant improvement in progressive motility was noted by day 90, resulting in higher total sperm motility in Group 1 (p ≤ 0.05) and a 14% increase in the proportion of morphologically normal sperm in Group 2 (p ≤ 0.05).

Conclusion. Men recovering from COVID-19, both with and without pneumonia, showed significant alterations in total testosterone and SHBG levels on day 15 and by the end of the third month of observation. Microscopic semen analysis revealed reduced total sperm motility relative to reference values on days 15 and 90 after disease onset, primarily due to a decrease in progressive motility. Nevertheless, a significant improvement was observed by the third month in both total sperm motility and the proportion of morphologically normal spermatozoa.

Introduction. The authors consider gestational pyelonephritis as a relevant clinical problem requiring timely diagnosis and a well-grounded choice of treatment strategy.

Aim. To develop and validate a scale for stratifying the risk of acute pyelonephritis in pregnant women, allowing determination of the optimal management strategy (conservative therapy or upper urinary tract drainage) at various gestational stages.

Materials and methods. A retrospective analysis was performed on 161 cases of urinary tract infection in pregnant women: 73 patients observed in 2024 using the proposed scale and 88 patients from 2023, who formed the control group.

Results. Implementation of the scale in 2024 increased the frequency of ureteral stenting (32.8% vs. 17% in 2023) and reduced the number of cases with kidney decapsulation (2.9% vs. 3.5%). A statistically significant increase was observed in the proportion of hospitalizations during the third trimester (20.6% vs. 6.8% in the first trimester), indicating more accurate risk stratification and timely selection of treatment tactics.

Conclusion. The developed scale facilitates objectification of clinical decisions in managing pregnant women with gestational pyelonephritis, ensures timely drainage in high-risk patients, and reduces the frequency of unnecessary invasive interventions.

Introduction. Accurate assessment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is one of the key tasks of a urologist for selecting adequate therapy, monitoring treatment, and determining indications for surgical treatment. The International Prostate Symptom Score (IPSS) questionnaire, developed in 1992, has become a simple and widely used method to grade the presence, type, and severity of LUTS in men with BPH. However, the IPSS has certain limitations: the poorer a patient’s cognitive abilities, the greater the likelihood of incorrect responses due to the complexity and abstract nature of the questions and the difficulty in translating subjective sensations into a written numerical score.

In 2011, a new tool, namely the Visual Prostate Symptom Score (VPSS), was proposed as a visual analogue of the IPSS, in which the questions are presented in pictorial form, thereby reducing the dependence on literacy and cognitive function. Despite these advances, the search for the most rational and cognitively accessible questionnaire for assessing LUTS remains relevant.

Aim. To compare the IPSS, modified IPSS (mIPSS), and VPSS questionnaires in men with BPH, with reference to uroflowmetry and cognitive function, and to improve the diagnostic accuracy of IPSS through its modification.

Materials and Methods. A total of 72 men with symptomatic BPH presenting for initial outpatient evaluation were included in the prospective study. The median age was 68 [64–72] years. All patients underwent standard assessments according to the Russian Society of Urology clinical guidelines: urinalysis, complete blood count, prostate-specific antigen (PSA) testing, transrectal ultrasound (TRUS) with measurement of prostate volume and post-void residual urine, renal ultrasonography, and uroflowmetry. Inclusion criteria were: prostate volume 40–180 cc, residual urine ≤150 mL, and PSA < 4 ng/mL. Exclusion criteria were suspicion of prostate cancer or other causes of voiding dysfunction unrelated to BPH.

All patients provided written informed consent, and the study was approved by the local ethics committee. Each participant completed four questionnaires, including the newly developed modified IPSS (mIPSS). In this version, the IPSS items were divided into two groups: voiding (obstructive) symptoms: questions 1, 3, 5, 6; storage (irritative) symptoms: questions 2, 4, 7.

Results. For most questions, the proportion of identical responses between questionnaires exceeded 50%, and all correlation coefficients were r > 0.6, indicating a strong association between the results and suggesting that the tools measure similar constructs and are largely interchangeable. Uroflowmetry parameters correlated significantly only with the total mIPSS score. Both Qmax and Qave showed a significant inverse correlation with mIPSS total score, while voided volume showed no correlation with any questionnaire scores. The urinary stream strength item correlated significantly with Qmax and Qave, and nocturia correlated with all three parameters (Qmax, Qave, and voided volume). This indicates that the mIPSS questionnaire can be used as a rational and sufficiently quick tool for assessing lower urinary tract symptoms (LUTS).

The mIPSS and IPSS questionnaires are interchangeable in terms of the evaluated characteristics of urination; however, mIPSS shows a stronger correlation with objective uroflowmetry parameters and is therefore considered a more reliable assessment method.

Conclusion. The results demonstrate the advantages of the modified IPSS (mIPSS) compared with the standard IPSS, owing to its stronger correlation with objective urodynamic findings and greater ease of use. The mIPSS and VPSS questionnaires may be effectively applied to identify voiding disorders, particularly in patients with cognitive impairment. At the same time, the interchangeability of the questionnaire items and the rationale for dividing the questions into obstructive and irritative categories by splitting them into two columns have been demonstrated.

Aim. To improve surgical outcomes in patients with benign prostatic hyperplasia (BPH) by assessing the efficacy and safety of bipolar transurethral resection of the prostate (b-TURP) in comparison with thulium laser enucleation of the prostate (ThuLEP).

Materials and methods. A retrospective and prospective analysis of surgical outcomes was performed in 555 patients with BPH who were examined and operated on between 2018 and 2024. Among them, 301 patients underwent bipolar TURP, and 254 patients underwent transurethral thulium laser enucleation of the prostate (ThuLEP). The mean age of patients was 68.8±8.10 years in the b-TURP group and 68.3±8.10 years in the ThuLEP group (p>0.05).

Results. The intraoperative blood loss and volume of removed tissue were significantly higher in the ThuLEP group. The incidence of early and late postoperative complications was significantly higher in patients after b-TURP. The need for additional postoperative pharmacotherapy and its duration due to lower urinary tract symptoms (LUTS) were also significantly greater after b-TURP.

Conclusion. Although both techniques provide a comparable and high efficacy in the surgical removal of adenomatous prostatic tissue, their safety profiles differ. Despite effective relief of bladder outlet obstruction, bipolar TURP is inferior to ThuLEP in terms of patient safety and early postoperative recovery.

Introduction: Urinary incontinence in men after endoscopic enucleation of benign prostate hyperplasia (BPH) can reach 55% and significantly impairing the quality of life and social rehabilitation of patients. A large number of individual patient parameters and features of surgical treatment are considered as potential risk factors. At the same time, the influence of urodynamic factors, including the external urethral sphincter function at the preoperative stage, fades into the background, and research on this issue is extremely limited.

Objective: comprehensive assessment of urodynamic risk factors for urinary incontinence after endoscopic enucleation of BHP.

Materials and methods. This prospective study included 69 patients who underwent endoscopic enucleation of BPH (thulium fiber enucleation – 62 patients, bipolar enucleation – 7 patients) performed by single surgeon between October 2023 and August 2024. All patients underwent an invasive urodynamic study 1 day before the planned surgical treatment, including uroflowmetry, cystometry, flow/pressure study and profilometry performed by single urologist. In the postoperative period, the presence and duration of urinary incontinence were recorded in accordance with the definition of the International Continence Society. Statistical data processing was carried out using RStudio software in the R programming language.

Results. Transient urinary incontinence after endoscopic enucleation was detected in 36.2% patients. In 100% cases, the duration of incontinence did not exceed a 3-month period. The independent urodynamic predictors of urinary incontinence were the bladder outlet obstruction index (BOOI), the bladder contractility index (BCI) and maximum intraurethral pressure (Pura max). Thus, with an increase in BOOI for 1 unit, the chance of urinary incontinence increased by 1,027 times or 2.7% (OR=1,027; 95%CI=1,003–1,052; p=0,027). With an increase in BCI for every 1, the chance of urinary incontinence increased by 1,020 times or 2.0% (OR=1,020; 95%CI=1,001–1,039; p=0,043). Large values of Pura max, on the contrary, led to a decrease in the chance of urinary incontinence, thereby acting as a protective factor. With an increase in Pura max for every 1 cm of H2O, the chance of urinary incontinence decreased by 1,087 times or by 8% (OR=0,920; 95%CI=0,876–0,966). The overall accuracy of the proposed model was 88,1% with sensitivity and specificity of 90,5 and 86,8% (ROC–AUC=0,897). The only independent intraoperative factor associated with urinary incontinence was the operation time: with an increase in the operation time for every 1 minute, the chance of urinary incontinence increased by 1,022 times or by 2,2%, regardless of the type of energy used and the early sphincter release (OR=1,022; 95%CI=1,005–1.040; p=0,011; ROC–AUC=0,721).

Conclusion. The chance of urinary incontinence at longer endoscopic enucleation, higher BOOI and BCI and low Pura max increases, which, thereby, can be used in predicting the functional results of endoscopic enucleation, taking into account individual urodynamic risk factors.

Corresponding author: M.E. Efremov – Сand.Sc.(Med), Assist. of the urology Dept. of the Kuban State Medical University of the Ministry of Health of the Russian Federation; urologist of the Research Institute – Regional Clinical Hospital № 1 Prof. S.V. Ochapovsky, Krasnodar, Russia; e-mail: efremov.uro@yandex.ru

Introduction. In recent decades, cardiovascular diseases (coronary heart disease, arterial hypertension, arrhythmias, dyslipidemia, etc.) and prostate cancer remain quite frequent causes of incidence and mortality. Previously, the results have been obtained, according to which the development of PCa mainly takes place in men, who are characterized by low sexual activity throughout life, in connection with which there is a need to clarify the relationship between the CVD and PCa.

The purpose of the study. Determine the frequency of the diagnosis of CVD in hyposexual men undergoing brachytherapy.

Materials and methods. The study includes 148 men (group I) aged 68 [64; 72] with the first diagnosis of prostate cancer (PCa) T1C-2CN0M0, subject to brachytherapy, and 99 men (II group) at the age of 67 years [62; 72] The diagnosis of prostate hyperplasia (PH).Diagnostics of PCa and PH was carried out in accordance with the current clinical recommendations of RUA and ROUA. All patients independently filled the Rostov questionnaire at an integral assessment of male sexuality [15]. The diagnosis of related cardiovascular diseases and conditions was carried out according to the clinical recommendations of the RCS. The level of general testosterone in the blood serum was determined on the automatic immunochemistiluminated analyzer «Advia CentAur XP» (Siemens).

Results. Almost half of men (50.7%) from the group had a reduced (≤12.0 nmol/l) level of general blood testosterone and low sexuality. In patients with RPGs, angina pectoris, dyslipidemia, extrasystole and bradyarrhythmia (p <0.05) are reliably more common. And patients with PH significantly more often suffer from common atherosclerosis, atherosclerosis of aorta and coronary arteries, chronic heart failure, tachyarrhythmias, obesity, have acute cerebrovascular accident, stenting of coronary arteries/ aorto-coronary noise (p <0.05). As it turned out, there are no differences in the frequency of coronary heart disease, myocardial infarction, diabetes mellitus, hypertension, atherosclerosis of brachiocephalic arteries for PCa and PH. With angina pectoris, the chances of the availability of PCa than the PH, 2.7 times higher compared to the absence of angina pectoris. With dyslipidemia, the chances of the presence of a diagnosis of prource are higher than 3.8 times. With bradyarrhythms and extrasystoles, the chances of the presence of PCa, not PH, are also significantly increased, but the growth intensity is difficult to accurately assess, since there are no data from the CVD in the group of patients with PCa. In chronic heart failure, the chances that the patient has a PH, not PCa, is 2.8 times higher than the lack of chronic heart failure. The presence of the rest of the CVD (percutaneous stenting of coronary arteries/aorto-coronary bypassing and a history of cerebral circulation in the history of cerebral circulation, atherosclerosis, including aorta and coronary arteries, tachyarrhythms) and obesity increases the chances that the patient will have a diagnosis of PH, and not PCa. As for the level of general testosterone of blood, hyposexual men with PCa do not have its reliable effect on the frequency of SVD.

Conclusion. Identification of the frequency of a wide range of CVD for PCa showed a strong relationship for some and low communication for other CVD. Moreover, the comparison of the connection of the CVD with PCa and PH confirms more differences in these connections than similarities. The study of the mechanisms of the communication of CVD with PCa promising in terms of influence on individual factors of a young man in order to reduce the risks of the development of PCa.

This article describes a clinical case of the successful use of high doses of vitamin C and Suby G solution to reduce urine acidity in a patient with encrusted cystitis. The previously used combination of oral methionine intake and intravesical instillations of a 3% aqueous boric acid solution was ineffective. As part of comprehensive therapy, transurethral resections of bladder wall encrustations were performed, along with antibacterial therapy with vancomycin. The obtained results indicate the potential effectiveness of this combination; however, further clinical studies are needed to verify them.

The management of overactive bladder (OAB) involves drugs from several pharmacological classes, among which anticholinergic agents occupy an important place. The choice of therapy should be strictly individualized, taking into account not only the expected efficacy but also potential drug interactions, age-related pharmacokinetic and pharmacodynamic changes, comorbidities, the overall anticholinergic burden, and the risk of adverse effects.

Trospium chloride (Spasmex) is considered the drug of choice for patients with OAB. Its pharmacological properties ensure both clinical efficacy and good tolerability, along with proven cognitive safety. Trospium chloride does not cross the blood–brain barrier and therefore does not cause central nervous system adverse effects. Another advantage of trospium chloride is the flexible dosing regimen, which allows for individualized dose titration according to patient response and tolerability.

It has been established that women who undergo hysterectomy, even in cases where the ovaries are preserved, frequently experience premature ovarian insufficiency syndrome, which can lead to various endocrine and metabolic disorders. A comparable inquiry emerges in the context of radical prostatectomy (RP) in males: whether the extraction of the prostate gland itself influences testicular function and the emergence of polymetabolic disorders in the absence of androgen deprivation therapy (ADT).

Radical prostatectomy has been recognized as an effective treatment for localized prostate cancer (PCa), providing high survival rates for patients diagnosed with this disease. The primary focus of specialists in this field has historically centered on the surgical consequences of RP, such as erectile dysfunction and stress urinary incontinence. However, mounting evidence suggests that prostate removal itself can also result in a transient decrease in testosterone levels, manifesting as biochemical or manifest hypogonadism, along with moderate metabolic disturbances, though not to the same extent as observed with adjuvant hormone therapy. In some cases, patients already in the preoperative period may have risk factors for metabolic syndrome, osteopenia, and other perioperative complications, which makes it difficult to objectively assess the direct effect of RP. A more profound comprehension of the pathophysiologic mechanisms underlying these changes appears to be a pivotal element in facilitating timely diagnosis, prevention, and treatment of potential endocrine-metabolic complications associated with RP.

Introduction. The first part of a systematic review and meta-analysis addressing the problem of purulent pyelonephritis is presented in the article.

Aim. To analyze the epidemiology, predisposing factors, diagnostic approaches, and microbiological characteristics of purulent pyelonephritis, which is a complicated form of acute pyelonephritis characterized by renal parenchymal suppuration, sepsis, or localized abscess.

Materials and methods. A systematic review of 46 studies (1981–2024) on complicated pyelonephritis was performed. The review included clinical series (observational and one randomized trial) with ≥10 patients reporting on prevalence, risk factors, clinical course, diagnostic approaches, microbiology, treatment, and outcomes of severe pyelonephritis. Data were synthesized qualitatively, and a meta-analysis of key outcomes (mortality and need for surgical intervention) was carried out using a random-effects model.

Results. Acute pyelonephritis is one of the most common serious urinary tract infections, with an annual incidence of 15–17 per 10,000 women and 3–5 per 10,000 men. In most cases, the disease responds well to antibiotic therapy; however, in 20–30% of patients complicated pyelonephritis develops.

Predisposing factors include diabetes mellitus, urinary tract obstruction, advanced age, male sex, immunodeficiency, and pregnancy. Diabetes mellitus is present in 30–35% of hospitalized patients with pyelonephritis (vs. 10–15% in uncomplicated cases) and in 75–95% of patients with emphysematous pyelonephritis. Urolithiasis accounts for approximately 20% of cases with complicated pyelonephritis. Elderly (>65 years) and male patients are affected less frequently but experience more severe disease: men constitute only about 25% of acute pyelonephritis cases but have higher rates of abscess and sepsis.

Purulent pyelonephritis is typically associated with pronounced systemic symptoms: high fever (>39 °C in 70% of cases), chills (50–60%), and septic shock (25–30% upon admission). In 15–20% of severe cases, local urinary symptoms (flank pain, dysuria) are absent.

Laboratory findings usually demonstrate leukocytosis >15×109/L (80%) or, conversely, leukopenia <4×109/L (20–30%) in cases with disseminated intravascular coagulation, along with markedly elevated C-reactive protein levels (>100 mg/L).

Imaging plays a decisive role: ultrasound can detect hydronephrosis and pyonephrosis, whereas contrast-enhanced computed tomography is the gold standard for detecting abscesses and gas formation.

The main pathogens of complicated pyelonephritis are Gram-negative enteric bacteria, primarily Escherichia coli (60–75%), Klebsiella pneumoniae (10–15%), and Proteus mirabilis (5–10%). In 10–30% of cases, isolates exhibit multidrug resistance (e.g., ESBL-producing strains). Polymicrobial infection occurs in approximately 5–10% of severe cases.

Conclusions. Purulent pyelonephritis is a relatively uncommon but potentially life-threatening complication of renal infection, strongly associated with risk factors such as diabetes and urinary obstruction. Improved patient outcomes depend on early identification of high-risk individuals, timely imaging to detect purulent complications, and empirical antibiotic therapy that accounts for likely antimicrobial resistance (treatment strategies and outcomes will be discussed in Part 2 of this review).

Introduction. Chronic bacterial prostatitis (CBP) is a disease with a multifaceted pathophysiological basis, including infectious, immunological, neurological, vascular, endocrinological, biochemical, and psychological factors, making it a multidisciplinary problem. One current treatment strategy is the use of the original drug Longidaza^®, which has demonstrated efficacy in this disease, primarily due to its anti-inflammatory effect. A large number of original studies necessitate systematization of the results.

Objective. To conduct a comprehensive assessment of the clinical efficacy of Longidaza^® (bovhyaluronidase azoximer) when included in the treatment plan for chronic prostatitis, based on data from controlled clinical trials.

Materials and Methods. A systematic review and meta-analysis were conducted according to the PRISMA protocol. Elibrary, PubMed, and Cyberleninka databases were used to search for articles. The search was conducted using a combination of keywords: chronic prostatitis and «Longidaza,» «Bovhyaluronidase azoximer,» among studies published no later than August 31, 2025.

Results. A search of scientific databases using the algorithms illustrated in Figure 1 yielded a total of 210 publications, of which 10 studies were then selected based on inclusion/exclusion criteria.

Conclusions. The results of the analysis suggest that adding Longidaza^® to standard therapy for chronic prostatitis (antimicrobial and anti-inflammatory agents) significantly reduces clinical manifestations of the disease. Furthermore, the inclusion of Longidaza^® in the treatment plan reduces inflammation in the prostate gland and improves maximum urinary flow rate, resulting in a significant reduction in the severity of chronic prostatitis.