Urologiia

Objective. To evaluate the effectiveness and safety of extracorporeal electromagnetic stimulation (EMS) of pelvic floor muscles in patients with urinary incontinence after radical prostatectomy (RP).

Materials and methods. A prospective randomized controlled clinical study was conducted involving 101 patients with urinary incontinence 3 months after RP. Patients were divided into experimental (n=51) and control (n=50) groups. In the experimental group, patients received a course of EMS at the Moscow Multidisciplinary Clinical Center «Kommunarka» using the Neuro-MSX device (8 sessions with frequency of 2–4 times per week, amplitude 30%, pulse frequency 50 Hz) in addition to Kegel exercises. The control group performed only Kegel exercises. Evaluation of the outcomes was conducted at 6 and 9 months after surgery using pad test, International Conference on Incontinence Short Form (ICIQ-SF), The Overactive Bladder Questionnaire (OAB-q), Quality of Life (QoL) from International Prostate Symptom Score (IPSS) questionnaires, and prostate specific antigen (PSA) level measurement.

Results. Both groups were comparable in baseline clinical and demographic characteristics 3 months after surgery. Both groups showed significant improvements in all evaluated parameters. Statistically significant differences in treatment outcomes between groups were demonstrated at 6 months for the number of pads used per day (1 pad/day (1–1) vs. 1.5 pads/day (1–2), p<0.001) and for the amount of urine lost (14 g/day (4–50) vs. 32.5 g/day (15.25–55), p=0.034) with better results in the experimental group. By 9 months, these differences were leveled. Nocturia indicators (sum of scores for questions 4 and 5 of OAB-q) were significantly better in the experimental group both at 6 months (4 (3–4) vs. 4 (4–5), p=0.014) and at 9 months after surgery (3 (3–4) vs. 4 (2.25–5), p=0.016). No significant differences in PSA level and biochemical recurrence rate were found between groups, confirming the oncological safety of the method.

Conclusion. Extracorporeal electromagnetic stimulation of pelvic floor muscles accelerates the recovery of urinary continence after radical prostatectomy, demonstrates sustained efficacy in reducing nocturia, and is oncologically safe. It is recommended to include EMS course in rehabilitation program of patients after RP for faster continence recovery and quality of life improvement.

Introduction. Infectious and inflammatory diseases of the genitourinary tract account for approximately 42% of all outpatient urology cases, and disorders such as cystitis, pyelonephritis, and prostatitis are often characterized by a chronic, recurrent course. One of the key contributors to recurrent urinary tract infections is inappropriate therapy that does not take into account the local microbial spectrum and pathogen resistance profiles.

Aim. To determine the spectrum of uropathogens and their antimicrobial resistance patterns in patients with cystitis, pyelonephritis, and prostatitis.

Materials and methods. We analyzed the results of microbiological urine cultures from outpatient urology patients processed by the Invitro Laboratory between 2022 and 2024. In total, 4031 bacterial isolates were included: 2903 (72.0%) from patients with cystitis, 1017 (25.2%) from patients with pyelonephritis, and 111 (2.8%) from patients with chronic prostatitis.

Results. The structure of the microbial landscape differed by diagnosis. E. coli was the predominant pathogen in all groups, with a detection rate of 73.8–75.3% in cystitis and pyelonephritis, while in chronic prostatitis the rate was markedly lower at 53.1%. Klebsiella pneumoniae and Enterococcus faecalis were more frequently isolated in prostatitis (19.0% and 15.3%, respectively) compared with urinary infections, where their combined frequency ranged from 6.9% to 11.9%. Other pathogens (Proteus mirabilis, Streptococcus agalactiae, Enterobacter cloacae, Pseudomonas aeruginosa) accounted for 6.4% of isolates in cystitis, 7.6% in pyelonephritis, and 12.6% in prostatitis.

Antimicrobial resistance was assessed for E.coli isolates. Resistance to amoxicillin/clavulanate was 24.9% in cystitis, 31.0% in pyelonephritis, and 38.9% in prostatitis. Levofloxacin resistance was observed in approximately one third of isolates from cystitis and in about half of isolates from pyelonephritis, whereas all E.coli isolates from prostatitis cases were susceptible. Resistance to trimethoprim-sulfamethoxazole in prostatitis was approximately twice as high as in cystitis and pyelonephritis.

Conclusion. Urinary tract infections are predominantly caused by E.coli, while chronic prostatitis is associated with a more diverse spectrum of pathogens, with E.coli detected in only 53.1% of cases. Antimicrobial resistance profiles differ substantially between urinary infections and prostatitis, underscoring the importance of tailoring empirical therapy to local pathogen distribution and resistance patterns.

Objective. To evaluate the diagnostic value of computer cavernosography (CT cavernosography) in erectile dysfunction (ED) with a description of the technical aspects of the method.

Materials and Methods. The study included 350 patients with ED who underwent CT cavernosography between 2018 and 2025. Age, form of pathological venous drainage, concomitant changes in cavernous tissue, and complications were assessed.

Results. The average age of patients was 32±6.9 years. Signs of pathological venous drainage were detected in 88.57% of patients. The most frequently diagnosed types were mixed venous leakage (38.29%), proximal (31.14%), and distal (19.14%). Cavernous fibrosis was detected in 4.57% of patients. The frequency of complications was 3.4%.

Discussion. CT cavernosography demonstrated high sensitivity in detecting venous leakage, especially in complex forms. The method allows assessing not only vascular but also structural changes in cavernous tissue, including fibrosis and post-traumatic changes, which is critically important when planning surgical intervention.

Conclusions. CT cavernosography is a safe and highly informative method for diagnosing venogenic ED, allowing for accurate determination of the form of venous leakage, the degree of fibrosis, and the parameters of the cavernous bodies. The method can be recommended as a key diagnostic tool when planning surgical treatment for ED.

Introduction. The thulium fiber laser (TFL) is a relatively new certified system with unique physical properties that make it a potentially ideal energy source for endoscopic enucleation of the prostate (EEP). A specially designed modulated pulse has recently been introduced to enhance mechanical tissue dissection, similar to what is clearly observed during holmium laser enucleation. Evaluating the efficiency of this new pulse mode was designated as the primary endpoint of our study. Secondary endpoints included the quality of mechanical dissection, degree of carbonization, and hemostasis.

The study was approved by the Local Ethics Committee of Sechenov University (Protocol No. URO-LEP3-1940, 05.06.2022).

Materials and methods. The study was carried out from September 2023 to September 2024. A total of 80 patients scheduled for laser enucleation of the prostate were enrolled and randomized in blocks into two groups (40 patients each): a DP group (Dissect Pulse), in which enucleation was performed using a modulated pulse mode, and an SP group (Standard Pulse), in which enucleation was performed using the standard pulse mode. All procedures were carried out at the Urology Clinic of Sechenov University. Statistical analysis was performed using IBM SPSS Statistics (version 27.0.1.0)

Results. The median duration of the procedure was 55 minutes in the DP group and 60 minutes in the SP group (p=0.495). In all patients, the urethral catheter was removed on postoperative day 2. Both groups demonstrated a significant increase in maximum urinary flow rate, as well as a reduction in IPSS and QoL scores at 3 months. No significant differences were observed between the groups in functional outcomes of surgical treatment or in complication rates. The degree of mechanical tissue dissection was significantly higher in the DP group (p<0.001). A trend toward reduced tissue carbonization was noted (p=0.18).

Conclusion. The technological advancement of TFL, a modulated pulse shape, demonstrates improved mechanical tissue dissection and reduced carbonization effect. As clinical experience with this technology grows, it may emerge as the preferred choice for surgeons, offering an optimal balance between a cut precision, enucleation speed, and hemostasis to enhance treatment outcomes for patients with benign prostatic hyperplasia.

Despite technological advances in the treatment of urolithiasis, the problem of residual fragments (RF) larger than 2–4 mm remains relevant, and their effective metaphylactic treatment, along with fundamental metabolic correction, is a critically important unresolved task. The aim of the study: to evaluate the clinical efficacy, litholytic and lithokinetic potential of the biologically active food supplement (DS) «Astracit – Asfarma» (potassium citrate + magnesium citrate) as part of complex therapy for RF after endoscopic (RIRS) and remote (SWL) lithotripsy. Materials and methods. A prospective, randomised, comparative, open-label study was conducted involving 100 patients with nephro-ureterolithiasis who underwent planned lithotripsy using SWL or RIRS. Patients were randomised into three equal groups: group 1 – SWL + standard therapy + dietary supplement «Astracit – Asfarma»; group 2 – RIRS + standard therapy + dietary supplement ‘Astracit-Asfarma’; group 3 (control): subgroup 3A SWL + standard therapy only; subgroup 3B RIRS + standard therapy only. The following were evaluated: total volume and density of fragments (by CT), proportion of patients without visualisable RF concretions ≤ 2 and ≤ 4 mm (stone-free rate, SFR) after 60 days, as well as the dynamics of biochemical urine parameters (pH, citraturia, oxaluria, magnesiuria, calciuria, uraturia, relative salt supersaturation indices) and blood. Results: The addition of the dietary supplement ‘Astracit - Asfarma’ to standard therapy accelerated the elimination and litholysis of RF: the total volume of residual stones after 30 and 60 days decreased by ~30% from the initial postoperative level and more than twice compared to the control group, the density of fragments decreased by 10–12% (maximum in group 2). Analysis of the frequency of achieving stone-free status (SFR) on the 60th day of observation showed that in the groups with adjuvant therapy, there was a numerical increase in the proportion of patients without visualisable RF. For the SFR ≤2 mm threshold, the proportion of such patients was 60% in group 1,72% in group 2, and 52% in the control group. For the SFR ≤4 mm threshold, the corresponding figures reached 80, 92, and 76%. Against the background of taking the dietary supplement «Astracit-Asfarma» in combination with standard therapy, a sustained correction of key biochemical urine parameters was identified: an increase in the average urine pH to 6,2 (compared to 5,9 in the control group; p<0,001), a 60% increase in citrate excretion to normal values (>2,0 mmol/day; p<0,001), a 1,3-fold increase in magnesium excretion (p<0,001) and a 20–25% decrease in oxaluria (p<0,001). No significant changes in these indicators were observed in the control group. These positive changes were achieved with a favourable safety profile: no clinically significant adverse events or serious adverse events were reported during the 60-day course, kidney and liver function indicators remained stable, and adherence to therapy exceeded 96%. Conclusion: A 60-day course of adjuvant therapy with the dietary supplement Astracit-Asfarma dietary supplement demonstrates a high safety and clinical efficacy profile in the treatment of residual fragments after lithotripsy, as confirmed by the realization of litholytic and lithokinetic potential, ensuring their accelerated litholysis and elimination.

Introduction. Obesity is a significant risk factor for urinary incontinence. Research suggests that weight loss, including bariatric surgery, helps reduce urinary incontinence.

Study Objective: To evaluate the effect of weight loss following bariatric surgery on urinary incontinence in patients with morbid obesity.

Materials and Methods: Fifty-eight patients were included in the study. All patients underwent bariatric surgery for weight loss. The examination included the UDI-6, ICIQ-SF, and I-QoL questionnaires, a vaginal examination with a cough stress test, bladder ultrasound with residual urine determination, and uroflowmetry. Results were assessed at 3, 6, and 12 months postoperatively.

Results. The most significant reduction in body mass index and urinary incontinence symptoms was observed in the first 6 months after surgery. Urodynamic studies revealed no statistically significant changes. One year after surgery, urinary incontinence persisted in 15.5% of patients.

Conclusion: Weight loss after bariatric surgery significantly reduces urinary incontinence symptoms. Most patients noted objective improvement one year after surgery. Risk factors for symptom persistence include menopause, multiple pregnancies, and a history of pelvic surgery.

Introduction. Benign prostatic hyperplasia (BPH) is a disease characterized by the growth of the periurethral glandular zone of the prostate gland, leading to lower urinary tract obstruction and lower urinary tract symptoms (LUTS).

Objective. To conduct a comparative analysis of the results of an immunohistochemical study of androgen receptor expression in prostate epithelial tissue in patients with BPH with testosterone deficiency and normal testosterone levels.

Materials and methods. We analyzed the results of a morphological examination of resected prostate tissue from 188 men with BPH, divided into two groups: Group I – 71 patients with testosterone deficiency; Group II (control) – 117 patients with testosterone levels above 12.1 nmol/L.

Results. Immunohistochemical examination of prostate tissue samples from patients with Tc levels above reference values revealed a positive reaction for androgen receptors, detected both in the nuclei of glandular secretory cells and in their cytoplasm. In patients with testosterone deficiency, a weak positive reaction for androgen receptors was detected only in the nuclei of glandular secretory cells.

Conclusion. In patients with testosterone deficiency, androgen receptor expression in prostate epithelial tissue samples is reduced compared to patients with Tc levels within the reference range.

Aim. To identify immunohistochemical (IHC) markers of tumor-associated fibroblasts (TAFs) in bladder cancer and to assess their association with clinical and morphological tumor characteristics.

Materials and methods. Surgical specimens from 44 patients diagnosed with bladder cancer and treated at the Medical Scientific and Educational Center of Lomonosov Moscow State University between March 2017 and December 2023 were included. Clinical and morphological characteristics were evaluated, and their associations with CAF markers were analyzed.

Results. When tumor stage and grade were compared with TAFs expression levels, significant differences were observed (p<0.001). The association between this marker and tumor stage and grade was strong (V=0.656 and V=0.674, respectively). Tumor diameter also differed significantly depending on the level of FAP expression (p=0.033).

Discussion. Despite favorable overall survival outcomes in non-muscle-invasive bladder cancer, the risk of recurrence remains high. Currently used risk stratification tools, including the CUETO and EORTC models, do not reliably predict recurrence or response to intravesical BCG therapy. Immunohistochemical assessment using antibodies to TAFs markers may serve as an important tool for prognostic evaluation and treatment strategy selection.

Conclusion. IHC assessment of TAFs demonstrated associations with clinical and morphological tumor characteristics. Further studies are required to evaluate the relationship between these markers and disease prognosis, as well as response to therapy.

Acute respiratory diseases (ARDs) are among the most common illnesses of the 21st century and serve a leading cause of temporary disability. They are also a frequent trigger for the development of acute kidney injury (AKI), which, when progressing to acute kidney failure (AKF), requires costly treatment, including hemodialysis. The risk of AKF increases with age, especially in the presence of comorbidities. The proportion of AKF patients in intensive care units reaches 10–15%.

This article presents clinical observations of two female patients of middle and advanced age who developed AKF following ARI. In biochemical blood tests, both Patient A (58 years old) and Patient D (85 years old) exhibited significantly elevated levels of C-reactive protein (CRP: 384 mg/L and 285.4 mg/L, respectively), interleukin-6 (IL-6: 197.0 pg/mL and 143 pg/mL, respectively), and D-dimer (3.88 mg FEU/L and 8.11 mg FEU/L, respectively). These changes were accompanied by an increase in serum creatinine (Scr: 339 µmol/L and 160 µmol/L, respectively) and a marked decrease in glomerular filtration rate (GFR: 12 mL/min and 25 mL/min, respectively).

With conservative therapy, the general condition of the patients improved, and there was a significant reduction in CRP levels (17.7 mg/L and 104 mg/L, respectively), IL-6 (48.2 pg/mL and 67.7 pg/mL, respectively), and Scr (64 µmol/L and 84.7 µmol/L, respectively), as well as an increase in GFR (92 mL/min and 57 mL/min, respectively). However, serum cystatin C and D-dimer levels remained above threshold values throughout dynamic monitoring.

Conclusion. In patients with severe ARI, the development of AKF is associated with elevated CRP, IL-6, and D-dimer levels. Increased serum cystatin C levels may serve as a predictor of chronic kidney disease in the future.

Renal cancer (RC) is a common oncological disease in adults. About 5% of RC are caused by germline mutations and are manifestation of hereditary cancer syndromes: von Hippel-Lindau syndrome, Burt-Hogg-Dube syndrome and other monogenic forms of hereditary RC. A few studies were reported about a rare form of hereditary RC with a balanced chromosome 3 translocation, as well as other congenital chromosomal rearrangements associated with an increased risk of RC. We have described for the first time a case of complex chromosomal pathology in the patient with Klinefelter syndrome and balanced translocation involving chromosome 3: karyotype 47,XXY, t(3;8)(q23;p21). The patient developed clear cell RC at a young age, and had RC family history in the paternal line of pedigree. Using this example, we have discussed the features of medical genetic counseling and active surveillance in patients with chromosomal aberrations predisposing to RC.

The treatment of urethral strictures in men remains one of the most widely discussed issues in clinical urology. Minimally invasive approaches have limited applicability in urethral strictures of different locations and lengths, particularly in strictures of the anterior urethra. Therefore, a more detailed and individualized approach is required, taking into account the characteristics of each clinical case. This literature review summarizes data on minimally invasive methods for the management of anterior urethral strictures, including urethral dilatation, balloon dilation, Otis internal urethrotomy, direct visual internal urethrotomy, laser urethrotomy, antifibrotic (local) therapy, and urethral stenting.

Stress urinary incontinence (SUI) is a common problem in women, significantly reducing the quality of life. The main surgical method for SUI correction is the installation of a midurethral sling using a transobturator approach. The main techniques for performing this operation are outside-in (TOT) and inside-out (TVT-O). This paper presents a literature review devoted to a comparative assessment of the effectiveness and safety of these surgical approaches, with the aim of identifying possible differences in clinical outcomes and complication rates.

Androgen deficiency following radical prostatectomy (RP) is a clinically uncharacterised and conceptually undefined phenomenon. Meanwhile, millions of men undergo RP annually, and if persistent hypogonadism truly developed in at least a subset of them, series of observations, cohort studies, and clinical guidelines would already exist. The absence of such evidence may reflect either a real problem, concealed at the intersection of urology and endocrinology, or the inherent untenability of the idea itself. To clarify this issue, a critical reappraisal of the hypothesis of persistent androgen deficiency as a potential consequence of RP is required. The focus of analysis is not on isolated findings but on the logic of their interpretation – ranging from alterations in endocrine profiles to proposed pathophysiological mechanisms, from diagnostic criteria to the rationale for replacement therapy and follow-up strategies. In each section, the emphasis shifts from simple fact-gathering to reconstruction of argumentation. The question is not merely what data exist, but whether they allow one to speak of a distinct clinical category. The objective of this article is not to refute the hypothesis, but to assess its validity as a scientific model aspiring to diagnostic and therapeutic significance.

Prostatitis is an inflammatory disease of the prostate gland that can present with lower abdominal pain, urinary incontinence, and sexual dysfunction. The diagnosis of prostatitis encompasses two main conditions: acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). Urinary dysfunction is a key factor in the pathogenesis of chronic prostatitis. Overactive contraction of the urinary sphincter can cause bladder outlet obstruction and residual urine, which can lead to urinary reflux into the prostate. Alpha-1-adrenergic receptor antagonists (alpha blockers) are a class of drugs that inhibit smooth muscle contraction in the prostate and bladder neck. Tamsulosin is the first selective α1-adrenergic receptor antagonist, primarily the α1A and α1D subtypes, which are found in the smooth muscle of the prostate, bladder neck, and prostatic urethra. Blockade of these receptors reduces smooth muscle tone in these structures, which, in turn, improves urine flow from the bladder.

We carried out a systematic review of the literature to evaluate the efficacy of tamsulosin in the treatment of acute and chronic bacterial and abacterial prostatitis, as well as chronic pelvic pain syndrome (CPPS). A search for clinical trials was carried out in the PubMed database, the clinical trials registry clinicaltrials.gov, and the Russian electronic library elibrary.ru by two independent researchers using keywords describing treatments that potentially included tamsulosin.

The search yielded information on 21 publications, 20 of which were included in the systematic review. Five studies were non-comparative, meaning they analyzed only patients receiving tamsulosin in addition to background therapy. The remaining studies had different comparison groups and could include active strategies such as antibacterial, analgesic, anti-inflammatory, herbal (urological) medications, and others. Treatment duration ranged from 4 to 52 weeks. The prescribed dose of tamsulosin was 0.4 mg orally once daily. Most studies used the NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) scores to evaluate outcomes. The average age of the participants ranged from 28.9 to 59.1 years. The quality of the included studies was highly variable.

Of the 20 studies included in this review, 19 examined the use of tamsulosin in patients with CP/CPPS. Positive treatment outcomes were observed in all studies using tamsulosin. Increases in maximum urinary flow rate, significant symptom regression, as measured by standardized scales, and improvements in quality of life were observed. The greatest differences in symptom regression were observed early in treatment, up to 45 days. This is likely due to the fact that urinary dysfunction, pain, and decreased quality of life become more prominent early in the disease course.

The safety of the treatment was assessed in 15 of the 20 studies. No standardized scales were used to assess safety. The safety of tamsulosin was assessed based on the reporting of adverse reactions. The development of serious adverse reactions (defined in Roszdravnadzor Order No. 1071 of February 15, 2017) was reported in two studies, but it was not possible to reliably link them to tamsulosin use.

Conclusion. The results of this systematic review confirm that tamsulosin is an effective drug for inclusion in combination treatment regimens for various forms of prostatitis, including CBP, chronic abacterial prostatitis, and CPPS. Its use significantly reduces symptoms such as pain and dysuria, which in turn improves patients' quality of life.

The latest 2025 guidelines of the European Association of Urology (EAU), the American Urological Association, the Canadian Urological Association, and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/CUA/SUFU) introduce a new classification system for urinary tract infections (UTIs) and update sections on cystitis and asymptomatic bacteriuria (ABU). Current approaches to the management of patients with UTIs, ABU, and even symptomatic bacteriuria are being reconsidered. In the era of increasing antimicrobial resistance among uropathogens, advances in researching of human microbiome and urobiome have changed the long-standing assumption that any bacteriuria necessarily requires antimicrobial treatment. At present, even in patients with a confirmed diagnosis of acute bacterial cystitis, international recommendations consider symptomatic treatment and a watchful waiting strategy as acceptable options for selected patient groups.

The new UTI classification, diagnostic features and symptoms of UTIs and ABU, non-antibiotic treatment options for cystitis, and age-related characteristics of UTI presentation are discussed in this review. Key aspects of the pathogenesis of recurrent UTIs are briefly addressed. Various urine sampling approaches are discussed, along with a differentiated strategy for prescribing antimicrobial therapy to women with acute and recurrent cystitis and non-antibiotic measures for recurrence prevention.

The diagnostic value of urinalysis has also expanded to include new indicators of microbial load and assessment of urine contamination. The role of modern molecular diagnostic methods, beyond standard urine culture, in the diagnosis and treatment of UTIs is analyzed. The need to adhere to principles of rational antibiotic use to avoid collateral damage associated with antimicrobial therapy for UTIs is emphasized.

Urolithiasis is one of the most common diseases of the urinary system, which occurs in 12% of the world’s population and is characterized by an extremely high recurrence rate, reaching 75-80%. The rapid development of endourological lithotripsy techniques today makes it possible to completely remove stones from the urinary tract. Nevertheless, surgical interventions, despite their minimal invasiveness, are associated with a number of intra- and postoperative complications, as well as associated with high economic costs of the healthcare system. Thus, the high frequency of recurrence of the disease requires the search for new effective ways to remove stones from the urinary tract and prevent recurrence, both by affecting the mechanisms of stone formation and formed stones in order to dissolve them. To date, attempts are being made to litholysis stones of various compositions, but successful dissolution is possible only for urates that require urine alkalinization, primarily through the use of citrate and bicarbonate mixtures. In this regard, the purpose of this review is to assess the available possibilities of litholytic therapy of stones of various compositions and highlight the prospects for the development of this area. As part of the litholysis of calcium oxalate stones, the possibility of using oxalate-degrading microorganisms Oxalobacter formigenes, the use of substances with chelating ability, complexones, in particular ethylenediaminetetraacetic acid and its disodium salt, Trilon B. is being considered. The latter is also being studied in the aspect of calcium phosphate urolithiasis, along with renacidin and its analogues, which have the ability to acidify urine. Despite the variety of available techniques and a large number of studies of potential solvents in vitro and in vivo, litholysis of urinary stones, mainly calcium-based, still remains an elusive goal.

This article is dedicated to a milestone in the history of Russian andrology, namely the 130th anniversary of the birth of an outstanding physician and scientist, Illarion Andronovich Ivanov (1895–1965). The paper reviews the key stages of his professional career and his contribution to the development of medical science, highlighting the relevance of his work to modern andrology. Based on the literature reviewed, the evolution of I.A. Ivanov’s professional path is traced from his early surgical practice to his establishment as a researcher. An analysis of available sources made it possible to identify the main stages of his development as a surgeon and his progress in academic activity. Owing to his professionalism, dedication to science, and humanity, he remains a role model for those who have chosen medicine as their life’s work.