Urologiia

Aim. To assess the resistance to the mechanical compression of single and tandem stents.

Materials and methods. An in vitro model of the ureter using a silicone tube connecting the proximal and distal reservoirs was assembled. The proximal reservoir was sealed and connected to a pressure gauge. Stents were placed sequentially in the lumen of the tube. A part of the model of ureter was passed through a compression platform which had a length of 4 cm, a bending angle of 35–40° and the ability to apply variable pressure. Five different 7 Ch polymer ureteral stents were tested in single and tandem manner. The compression force was applied and measured at the level of the compression platform. A criterion of stent failure was an increase of the pressure in proximal reservoir over 20 cm H2O with irrigation of saline at a rate of 30 ml/hour.

Results. Measurements were performed in 11 variants, including without a stent, with single stent (5) and with tandem stents (5). Polyurethane stents showed the least resistance to mechanical compression. In case of tandem stenting, all stents demonstrated an increase in resistance to compression compared to a single stent.

Conclusions. Polymer stents are more resistant to mechanical compression compared to polyurethane ones. Tandem stenting can be an effective tool to counteract the compression by the tumor.

Introduction. Sexual dysfunction is extremely common in the world. The frequency of erectile dysfunction can approach 50%, while ejaculation disorders more than 30%. The patient’s sexual well-being is an integral part of general health and can correlate with the risk of developing diseases of organs and systems. Currently, the most common assessment of individual aspects of sexuality at the time of the inspection by clinical interview is, however, the issue of determining all the components of the sexual function throughout the life of the patient is acutely. To solve this problem, M.I. Kogan was developed and published in 2009 an Integral assessment of male sexuality (IAMS).

Aim. To determine the validity and reliability of the questionnaire of sexual functioning of men.

Materials and methods. The study consists of 209 men. Of these, 43 healthy people aged 31.0 [26; 36] years; 57 people aged 63.0 years [59.0; 67.0] with benign prostatic hyperplasia (BPH); and 109 people aged 64.0 years [61.0; 68.0] with verified prostate cancer (PCa).

Age in healthy men ranged from 18 to 52 years, while men with BPH it was 49–71 and in those with PCa 47-70 years. In the whole cohort, 78.0% were married, 13.9% were divorced, but had sexual relations out of marriage, and 8.1% were lonely. 136 men (65.0%) had children. All men filled in IAMS.

Results. The Alpha Kronbach coefficient exceeded 0.6 for all three versions of the questionnaire and groups of men, while for all examined, as well as patients, exceeded 0.9. The highest values were obtained for a group of patients, as well as for all examined, which confirms the reliability of the questionnaire. Lower values for healthy persons can be explained by a small number. All correlation coefficients were positive and significant at a high level (p<0.001), which indicates that the increase in the sum of points for each component means an increase in the level of male sexuality and confirms the validity of the questionnaire. The level of sexuality of patients was much lower compared to healthy men (p<0.001). Among healthy people, the majority had a normal level of sexuality (62.8%), while 23.3% were hyposexual and 14% were hypersexual. In the group of patients, hyposexuality was prevalent (74.1%), while normal sexuality was seen only in 18.7%, and hypersexuality in 7.2%. Thus, the results of all calculations confirm the validity and reliability of this questionnaire. IAMS not only gives an integral assessment of a man’s sexuality at the time of contacting a urologist, but also quantitatively determines the type of sexuality, which is a reflection of the innate qualities of the male body throughout his sexual life.

Conclusions. IAMS is valid and reproducible questionnaire for an integral assessment of male sexuality, which is possible to use in epidemiological and clinical studies in the future.

Introduction. Prostate extract has pronounced anti-inflammatory and anti-androgenic properties, which contribute to a reduction in the volume of the prostate and an improvement in urination. Alpha-adrenoblockers, in turn, exert a relaxing effect on the smooth muscles of the bladder and prostate, thereby facilitating the urination. The combined use of these two drugs may provide a synergistic effect, leading to a pronounced improvement in quality of urination and accelerates recovery in patients after transurethral resection of the prostate. This approach may be more effective than using only one of these drugs.

Aim. To investigate the efficiency and safety profile of the prostate extract in combination with tamsulosin in patients after transurethral bipolar resection of the prostate.

Materials and methods. A total of 147 patients with benign prostatic hyperplasia (BPH) of stage II without severe concomitant diseases were included in the clinical study. The age of the men ranged from 48 to 81 years (61.7±1.4). All patients underwent transurethral bipolar resection of the prostate. Patients were randomized into two groups. In the main group, men received from the first postoperative day a combination of prostate extract with an alpha-adrenoblocker (prostate extract in powder 50 mg in terms of water-soluble peptides 10 mg and tamsulosin hydrochloride 0.4 mg) in the form of suppository after spontaneous bowel evacuation or enema daily for 30 days (n=70). In the control group, only alpha-adrenoblocker (tamsulosin 0.4 mg once a day for 30 days) in the postoperative period was given (n=77).

Results. In the main group, there was a reduction in the mean total IPSS score by 34.5% (p <0.05), and improvement in quality of life by 52% (p <0.05). The maximum urine flow rate increased by 69% (p <0.05), and the average urine flow rate increased by 94.6% (p<0.05). The positive effect on erectile function was 17.8% (p <0.05).

Conclusions. Our data allow to recommend this drug in the combined treatment of patients with benign prostatic hyperplasia (BPH) after transurethral resection of the prostate to restore urination function and improve quality of life.

Introduction. Oncological diseases of the anogenital zone in men have become increasingly relevant in recent years. It is associated with the increasing incidence, subtle clinical manifestations, and difficulties in establishing a diagnosis, requiring, in most cases, histological examination, since the diagnostic capabilities of non-invasive methods, unfortunately, are limited. Precancerous conditions, both associated with the human papillomavirus (HPV) and HPV-negative, occupy a special place among penile oncological disorders, timely diagnosis of which is extremely important.

Aim. To determine the frequency of precancerous and malignant diseases of the penis in the general structure of anogenital dermatoses in men, as well as to describe their main clinical features.

Materials and methods. The results of a survey of 160 men aged 18 to 86 years with various dermatoses of the anogenital zone who seek medical help in dermatological or urological departments are presented in the article.

Results. Various forms of penile squamous cell carcinoma were detected in 17 (10.6%), and precancerous conditions were detected in 21 (13.1%) cases. Among the latter, HPV-associated subtype of penile intraepithelial neoplasia (bowenoid papulosis, Bowen's disease, erythroplasia of Queyrat) was diagnosed in 19 (11.8%) patients. Objective symptoms were characterized by a variety of morphological and clinical manifestations. The list of incorrect clinical diagnoses which patients are followed with included banal balanoposthitis, lichen sclerosis, psoriasis, lichen planus, leukoplakia, and papillomatous nevus, which are characterized by a recurrent course and low efficiency of therapy. Histological examination was required to confirm the diagnosis of squamous cell carcinoma and precancerous diseases.

Conclusions. The oncological alertness of urologists and dermatologists in patients with chronic recurrent processes of the external genitalia is justified. If there is any doubt, tissue biopsy for morphological diagnostics should be done.

Introduction: Disturbances due to the novel coronavirus infection (COVID-19) caused economic, physical and psychological damage to the population of the whole world. The number of people who have suffered SOVID-19 is growing, and there is a number of negative consequences are documented for many organs and systems of the body, including reproductive.

Aim. To study the pathomorphological changes in ejaculate revealed by transmission electron microscopy in patients who have had COVID-19.

Materials and methods. The results of the electronic transmission microscopy of ejaculate 157 men were analyzed. They were divided into four groups. In group 1, there were 49 patients with idiopathic infertility who suffered COVID-19, group II included 42 patients with idiopathic infertility without prior of history of COVID-19, group III consisted of 39 fertile men who have had COVID-19, while in group IV there were 27 fertile men without prior of history of COVID -19.

Results. In most cases, pathological changes detected during morphological examination of patients before and after inclusion in the study were detected in the head of the sperm, which were resulted in a small specific gravity, but 12 months after infection with SARS-CoV-2, the percentage of acrosome changes increased in groups I and III. Moreover, combined pathological changes in the acrosome were recorded.

Conclusions. Thus, transmission electron microscopy revealed morphometric sperm disorders that were associated with energy processes in the cell, which naturally should be taken into account when rehabilitation of reproductive men who have had SARS-COV-2.

In addition, in patients of SARS-COV-2, a severe cell pathology was noted, due to the residualization of the cytoplasm and the pathology of mitochondria.

Introduction. Penile rehabilitation strategies have been developed to accelerate and improve the recovery of erectile function after radical prostatectomy. However, the differential efficacy and the best penile rehabilitation strategy are still unclear. Therefore, the search for factors influencing the prognosis of erectile dysfunction (ED) one year after radical prostatectomy and the formulation of algorithms for patient management is highly relevant.

Aim. To analyze pre- and postoperative factors that affect erectile function after radical prostatectomy with the development of an algorithm for calculating the risk of developing ED.

Materials and methods. A total of 104 patients with localized prostate cancer who underwent nerve-sparing prostatectomy were retrospectively examined. A year after surgery, regardless of whether medicinal penile rehabilitation was used or not, patients were divided into two groups depending on the possibility of having sexual intercourse.

Results. The following indicators were identified as predictors of an unfavorable prognosis using multiple regression analysis with a stepwise inclusion method: age, erectile function assessed using the International Index of Erectile Dysfunction-5 (IIEF-5) before surgery, the presence of type 2 diabetes mellitus, use of phosphodiesterase type 5 (PDE-5) inhibitors in the postoperative period, type of radical prostatectomy (unilateral or bilateral nerve sparing). It was found that the presence of factors such as the older age, type 2 diabetes mellitus and a lower preoperative IIEF-5 score were associated with lower IIEF-5 score after a year. Taking PDE-5 inhibitors for a year and bilateral nerve-sparing RP increased IIEF-5 score.

Of the five factors presented in the model, four (patient’s age, presence/absence of diabetes mellitus, IIEF-5 level before surgery) were not controlling factors, since they could not influence the choice of rehabilitation method. The indicator reflecting the fact of taking PDE-5 inhibitors during the year was a controlling factor, since its inclusion in the model allowed to choose the appropriate method of rehabilitation for the patient. The multiple correlation coefficient is 0.898, which characterizes the high predictive level of this model.

The data obtained were converted into an algorithm that allowed to calculate the risk of developing ED, taking into account modern methods of treatment and rehabilitation, and make the right decision in choosing the optimal strategy for further rehabilitation interventions.

Conclusions. From the presented data we can conclude that the prognosis for the development of ED after radical prostatectomy can be determined with high reliability based on the following risk factors: the type of surgical treatment, namely bilateral nerve sparing, affects the preservation of innervation, which affects the postoperative restoration of erectile function. The use of PDE-5 inhibitors helps restore erectile function only in a certain category of patients. The older age, type 2 diabetes mellitus and erectile dysfunction at baseline (IIEF-5 value) aggravate ED in the postoperative period.

Thus, taking into account these risk factors, it is possible to determine an individual management strategy for the patient and provide optimal and timely treatment, which will preserve the quality of life and effectively use medical resources.

Aim. To study the features of the clinical manifestations, diagnosis and treatment of children with bladder hernias.

Materials and methods. A total of 8 children with bladder hernias were observed, including five patients with inguinal hernias of the bladder and two with femoral hernias. One girl had a perineal bladder hernia. To verify the diagnosis, clinical and laboratory examinations, ultrasound and Doppler examination of the scrotum, bladder catheterization, cystoscopy and cystography, intravenous urography, CT, and morphological studies of the surgical specimen were used. In this article, we presented four clinical cases.

Results. Difficulties in diagnosing bladder hernias in children, especially when they are incarcerated, are associated with atypical clinical manifestations, which mimic an incarcerated inguinal hernia. In 5 children with inguinal and two children with femoral hernia of the bladder, the diagnosis was not correctly made before the surgical procedure. In two cases, there was bladder damage during intervention. Combined surgical procedure with abdominal and herniotomy approaches allowed to perform radical procedures for both inguinal and femoral hernias of the bladder. A girl with a perineal hernia of the bladder complicated by urolithiasis was undergone to anterior colporrhaphy and posterior colpoperineorraphy with a removal of bladder stones.

Conclusions. Bladder hernias in children are always sliding and are rare. Clinically, bladder hernias in children mimic an incarcerated inguinal hernia. Correct diagnosis of bladder hernias is difficult. No child with inguinal and femoral bladder hernias was correctly diagnosed before surgical intervention. Abdominal and herniotomy approaches can be the method of choice for femoral hernias of the bladder. With perineal hernia of the bladder, anterior colporrhaphy and posterior colpoperineorraphy are indicated.

Schwannoma is a benign tumor arising from the peripheral nerve sheaths and consisting of highly differentiated Schwann cells, which under physiological conditions produce the essential component of nerve fibers myelin. Frequent localization of neoplasms are areas with developed and abundant nerve supply – the head, neck, limbs, less often its occur in the chest, mediastinum, retroperitoneum, adrenal glands, organs of the gastrointestinal tract, cases of schwannoma of the penis and vulva are also described. In clinical practice, extratesticular schwannoma of the scrotum is extremely rare, when analyzing literary sources, descriptions of only isolated observations were found. Scrotal schwannoma is often associated with systemic pathology – neurofibromatosis type 2 or schwannomatosis, isolated development of the tumor is rather considered an exceptional event. In this article, we present a description of a clinical case of multiple large scrotal schwannoma in a 45-year-old man who underwent surgical treatment with excision of the tumor in 2011. During the period 2011–2024, the patient had no relapse of the disease, the quality of life was high and the prognosis was favorable.

The main changes and additions to the clinical guidelines "Urinary Incontinence" (2024) are presented in the review. Certain changes to the guidelines "Urinary Incontinence" developed by the Russian Society of Urologists (RSU) and approved by the Ministry of Health of the Russia became possible thanks to the work of the expert Councils, which include the national leading specialists dealing with the problem of urination disorders. The inclusion of the Russian drug in the clinical guidelines will allow regulating the prescription of bladder polypeptides (Vesusten) in the routine clinical practice of a urologist and will help a wider range of patients receive pathogenetic therapy for OAB/urgent urinary incontinence.

Male infertility may be a consequence of various diseases, many of which can be detected during examination. Modern methods of treating male infertility are diverse and include drug and non-drug therapy, diet therapy, and also a combination therapy that combines them, and therefore choosing the optimal approach to each patient is an absolutely important task. We have analyzed the literature on approaches to treating patients with different hormonal status, which allows us to conclude that hormonal therapy in certain cases has a positive effect on spermatogenesis parameters and increases the chance of pregnancy, but at the same time, it is necessary to systematize the available data to identify typical patient models for conservative therapy of male infertility.

Introduction. Progression of metastatic prostate cancer after castration resistance is one of the main challenges in prostate cancer therapy. ¹⁷⁷Lu-PSMA-617 has been recently investigated in castration resistant metastatic prostate cancer.

Objectives. To systematically evaluate the efficacy and safety profile of ¹⁷⁷Lu-PSMA- 617.

Patients and methods. A systematic review and meta-analysis was conducted according PRISMA principles. From initial 261 results, 3 randomized controlled trials met our inclusion criteria. The primary outcome of this study was oncological response and side effects. RevMan 5,4 software was applied in this systematic review and meta- analysis.

Results. A total of 1071 patients were included in the pooled analysis. 670 (62,6%) patients received ¹⁷⁷Lu-PSMA-617. Progression-free survival was significantly better with a hazard ratio of 0,72 (p= 0,00001). 50%>PSA reduction reported in 75 (63%) vs. 45/121 patients (37,2%) (p=0,0001). Total adverse events recorded in 572 / 627 (91,2%) developed AEs, vs. 204 / 290 (70,3%) (p = 0,00001). Fatigue was reported in 306/647 (47,3%) patients vs 88/310 (28,4%) (p=0,00001). And constipation in 110/549 (20%) vs 24/225 (10,7%) (p=0,003). Both thrombocytopenia and leucopoenia were marginally significantly higher in 114 / 647 (17,6%) vs 19 / 310 (6,1%) (p=0,08) and 81 / 647 (12,5%) vs 13 / 310 (4,2%) (p=0,10), respectively.

Conclusion. ¹⁷⁷Lu-PSMA-617 results in significant reduction in PSA and improves the progression-free survival. It can cause tolerable side effects, mainly fatigue, constipation, thrombocytopenia and leucopoenia.

Objective: to assess the needs and attitudes of urologists regarding the use of technologies related to artificial intelligence, particularly the web platform «Sechenov.AI_nephro», in the surgical treatment of patients with renal parenchymal neoplasms.

Materials and methods: a qualitative study was conducted through in-depth interviews. A questionnaire was developed for the interviews, including 14 categories of questions covering various aspects of the use of artificial intelligence (AI) aimed at optimizing preoperative planning for patients with renal parenchymal neoplasms. The study involved 8 urologists with extensive experience in the surgical treatment of patients with renal parenchymal neoplasms.

Results: the survey results highlight the growing interest in the implementation of AI technologies in medical practice.

Conclusion: in-depth interviews among urologists in Russia showed that there is a high interest in AI developments in urological practice. At the same time, successful integration of technologies requires overcoming several obstacles, including training specialists and ensuring data security. The «Sechenov.AI_nephro» platform has the potential to become an important tool in optimizing preoperative planning, but its success will depend on the readiness of physicians for new technologies and support from the medical community.

Aim. To present a view on the problem of postcoital cystitis, the technique and results of extravaginal urethral transposition using the method we developed.

Materials and methods. From 2005 to 2025, extravaginal urethral transposition was performed in 602 patients aged 18 to 61 years (average 26.7±1.3 years) at the Urology Clinic of the I.I. Mechnikov North-Western State Medical University. In all cases, the method developed at the clinic (patent No. 2408296 dated 10.01.2011) was used. It involves complete mobilization of the urethra and its placement in the submucosal tunnel into the clitoris area, where it is brought out through a separate incision and fixed with interrupted sutures. The posterior wall of the urethra is captured in the suture when closing the vaginal incision, which makes the urethra more securely fixed in a new place. Urethro-hymenal adhesions are necessarily excised.

Results. Early postoperative complications occurred in 17 (2.8%) patients. In the late period from 6 to 192 months (mean 38 ± 2 months), 435 (72.3%) women were examined. Complete recovery occurred in 339 (77.9%), while significant improvement was noted in 66 (15.2%) cases. In 30 (6.9%) patients, urethral transposition was ineffective, and reintervention was successful in 10 patients. A positive result was achieved in 415 (95.4%) women.

Discussion. In all patients, the meatus was in the same place above the introitus and was never located inside it. There was no ectopia/dystopia in relation to the vagina. The abnormality was that in patients with postcoital cystitis, both tubes, urethral and vaginal, were located low, but at the same level. The external opening of the urethra and the introitus, without changing their position in relation to each other, were located under the pubis or even behind it. Obviously, the transformation of the urogenital sinus into the vestibule of the vagina occurred, and the urethra and vagina did not completely emerge from under the pubis behind it. This can be called sub-symphyseal or retro-symphyseal urethro-vaginal dystopia.

Conclusions. Retro-symphyseal urethro-vaginal dystopia should be considered as a mild urogenital malformation, but sufficient to become the anatomical basis for the development of postcoital cystitis. This anomaly and frequent episodes of cystitis after sexual intercourse are indications for surgical intervention. The best results are achieved with proper selection of patients and compliance with all technical features of the extravaginal transposition of the urethra developed in our clinic.

Urolithiasis (kidney stone disease) remains a significant healthcare challenge worldwide due to its increasing prevalence and high recurrence rates. The rising incidence of urolithiasis can be attributed to the widespread use of advanced imaging techniques, such as computed tomography, as well as the growing prevalence of metabolic syndrome and shifts in lifestyle and dietary habits. Consequently, there has been an increase in endourological procedures for the management of kidney and ureteral stones. The primary clinical goal in treating patients with urolithiasis – achieving a stone-free status – equires the integration of highly skilled techniques and innovative technologies. This literature review, conducted within the framework of the RSF grant, aims to analyze the latest advancements in the diagnostics and surgical treatment of urolithiasis, focusing on improving treatment efficacy and long-term outcomes.