Urologiia

Introduction. The early postoperative period after surgical intervention for extramedullary spinal cord tumors is critical for the recovery of neurological function, including voiding function. Inadequate diagnosis and treatment lead to secondary complications associated with delayed recovery and increased treatment costs. At this stage, the supportive role of a urologist familiar with the basic principles of neurosurgery and neurourology is important for choosing an individualized strategy for treatment and rehabilitation of voiding function, taking into account tumor size, histology, and location, as well as other risk factors.

Materials and methods. The data of 221 patients (155 women and 66 men; age range, 19 to 84 years) who underwent surgery for extramedullary spinal cord tumors at the N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of Russia, from January 2019 to December 2022 were analyzed. Of these, 178 patients were included in the prospective analysis and 43 patients in the retrospective analysis based on medical record data. In the prospective group, urinary symptoms were assessed by a urologist of the Center before and after neurosurgical intervention. Neurological syndrome and voiding function were evaluated by a neurologist and a urologist of the department using the modified mJOA scale.

Results. The significant differences in changes in voiding function, according to mJOA scores, after neurosurgical interventions in patients with and without urological follow-up were observed. Urological supervision allowed to assess baseline voiding function and the functional outcomes of surgical treatment of extramedullary spinal cord tumors more objectively.

Conclusion. Urological support of patients with extramedullary spinal cord tumors in the perioperative period allows objective and detailed monitoring of the clinical course, both neurological and urological, which is important for a clearer understanding of the functional outcomes of neurosurgical treatment.

Background. Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are widely used organ-sparing treatment methods for T1 renal cell carcinoma (RCC). Numerous international meta-analyses on this topic have shown that RAPN provides perioperative outcomes comparable to those of LPN, while offering additional advantages such as significantly lower blood loss and a shorter warm ischemia time. However, no superiority of either technique over the other has yet been demonstrated with regard to oncological outcomes and preservation of renal function.

Aim. To compare functional and oncological outcomes of laparoscopic and robot-assisted partial nephrectomy for RCC at A.S. Loginov Moscow Clinical Scientific Center with data from international studies.

Materials and methods. A search of current literature on outcomes of RAPN and LPN was performed using PubMed. The most relevant publications were analyzed and served as the basis for this study. In addition, we retrospectively analyzed the surgical outcomes of 277 patients who underwent surgery for RCC using the Da Vinci robotic surgical system (n=175, group 1) or a laparoscopic technique (n=102, group 2) at A.S. Loginov Moscow Clinical Scientific Center between 2019 and 2024. Functional and oncological outcomes were collected and compared between the two groups.

Results. The postoperative decline in creatinine clearance was significantly greater in patients in group 2. Positive surgical margins and recurrence of RCC were also significantly more common in group 2.

Conclusion. The use of a robotic system for partial nephrectomy is an alternative to the laparoscopic technique, providing reliable functional and oncological outcomes. This is supported both by studies from a number of international centers and by the results obtained at A.S. Loginov Moscow Clinical Scientific Center.

Introduction. Varicocele (VC) is one of the main causes of male infertility; however, it is not always associated with infertility. In addition to surgical correction of pathospermia in VC, adjuvant antioxidant therapy has been proposed. It is known from experience that not all patients are immediately treated with surgery, and, similar to cancer, neoadjuvant therapy may be beneficial. The optimal method for assessing the effectiveness of this hypothesis is to conduct a study using a varicocele model in a chronic experimental setting.

The purpose of the study: to study the effect of the timing of initiation of antioxidant therapy on spermogram parameters and testicular structure in a varicocele model.

Materials and methods. The chronic experiment involved 20 mature male rabbits randomized into 4 groups: Group I (N) – intact animals to provide normal anatomy of the testis and spermogram indicators (n=5). Group II – control group (GC) – VC model without drug exposure, withdrawal 2 months after VC formation (n=5). Group III – main group 1 (MG1) – VC model and drug exposure during the first month from the formation of VC and seven-day daily administration of progesterone (n=5). Group IV – main group 2 (OG2) – VC model and delayed drug exposure during the second month from the moment of VC formation and seven-day daily administration of progesterone (n=5). The drug was administered intragastrically at a dose of L-carnitine 26.15 mg/day, taking into account the species characteristics of the rabbit. Seminal fluid was examined using light microscopy to assess the quantity and quality of sperm. The removed testes were subjected to morphological examination using Mallory staining and hematoxylin and eosin. A semi-quantitative count of fibroblasts in a microslide was carried out.

Results and discussion. After 14 days from the creation of the model, dilated spermatic veins were visualized in all animals of experimental groups II–IV (on average up to 1.8 mm, without differences between groups) and hemodynamic reflux was recorded in them. The average diameter of the spermatic veins (up to 2.1 mm) was 2.1 mm on the 30th day; 2.0 mm on the 60th day. A progressive decrease in the volume of the left testicle was noted over 60 days by an average of 1.1 cm3 (p>0.05 between all groups). In group I (N), the initial characteristics of the general spermogram parameters were significantly higher than in experimental groups II–IV (p< 0.05–0.01). The total number of spermatozoa was 310.2 million (in group N) versus 199.3 million (in GC), 247.6 million (in OG1) and 221.3 million (in OG2). In group N: 94.3% of live sperm, total sperm motility (PR+NP) – 91.4%, progressive sperm motility (PR) – 87.2%, sperm velocity – 13 μ/sec. Between groups OG1 and OG2, there was a difference in spermogram results with a predominance for the better in group OG1: the total sperm count was 247.6 million (in OG1) / 221.3 million (in OG2); live sperm - 80.6% / 74.4%, respectively; PR+NP – 73.4% / 67.1%, respectively; PR – 65.4% / 56.7%, respectively, and sperm velocity of 8 / 6 μ/sec, respectively) (p< 0.05 vs N). The spermogram parameters in the GC group were significantly worse than in OG 1 and OG2: total sperm count - 199.3 million (in GC) / 247.6 million (in OG1) and 221.3 million (in OG2); live forms – 68.3% (in GC) / 80.6% (in OG1) / 74.4% (in OG2); PR+NP – 61.5% / 73.4% / 67.1%, respectively, PR – 48.7% / 65.4% / 56.7%, respectively, sperm velocity – 4 / 8 / 6 μg/sec. respectively (p< 0.01). Evaluation of the morphology of the spermatogenic epithelium according to Johnsen S.G. (1970) as modified (2014): Group I (N) – 10 points; GK – heterogeneous histological picture with significant reduction of spermatogenesis, 6–7 points; OG1 – heterogeneous picture with slight reduction of spermatogenesis, 8–9 points; OG2 – heterogeneous picture with noticeable reduction of spermatogenesis, 7–8 points.

Conclusion: The varicocele formed in the experiment had a negative effect on testicular function and structure, confirming the effectiveness of the modeling method. L-Carnitine had a protective effect on gonadal tissue and ejaculate quality. This effect was greater with earlier administration of the drug after the model was formed. This effect may be useful in clinical practice and requires further study.

Introduction. Cytokine-mediated mechanisms play a substantial role in the pathogenesis of chronic bacterial cystitis. However, the design of the vast majority of previous studies has not taken into account the systemic nutritional and metabolic status of the subjects, which may independently affect cytokine metabolism and the parameters under investigation, irrespective of infection. Vitamin D has well-documented immunomodulatory and anti-inflammatory properties, and its deficiency is reliably associated with an increased risk of both the first episode of urinary tract infection (UTI) and recurrent UTIs. Nevertheless, the effect of vitamin D status on cytokine metabolism in the bladder during UTIs remains largely unexplored.

Aim. To investigate the features of bladder cytokine status in experimental models of vitamin D deficiency and chronic bacterial cystitis.

Materials and methods. The study was carried out in 20 sexually mature female albino rats. Following experimental induction of vitamin D deficiency, the animals were divided into two groups: a control group without vitamin D deficiency (n=10) and a main group with vitamin D deficiency (n=10). A model of recurrent chronic bacterial cystitis was subsequently induced in both groups. Cytokine status was assessed at both stages of the experiment by measuring tissue concentrations of secretory immunoglobulin A (sIgA), interleukin-8 (IL-8), and interleukin-10 (IL-10) in bladder homogenates using a solid-phase chromogenic enzyme-linked immunosorbent assay (sandwich ELISA). Statistical analysis was performed using Microsoft Excel spreadsheets and Statistica V10 (StatSoft Inc., USA) and SPSS Statistics V17 (USA) software packages.

Results. The mean baseline tissue concentration of sIgA in the intact bladder of animals with vitamin D deficiency was significantly 1.4-fold lower than in the control group (p< 0.001), whereas baseline IL-8 and IL-10 concentrations did not differ significantly between the groups (p>0.05). In the chronic bacterial cystitis model, the mean induced tissue concentrations of sIgA, IL-8, and IL-10 in the bladder of animals with vitamin D deficiency were significantly lower than in the control group by 2.5-fold, 1.7-fold, and 2.8-fold, respectively (p< 0.001).

Discussion. Vitamin D deficiency in the experimental model of chronic bacterial cystitis was associated with a substantial and significant reduction in local anti-infectious immunity and bladder immune reactivity. This was manifested by the development of a decompensated hypoergic infectious-inflammatory process in the bladder, which may represent one of the mechanisms underlying the increased risk of UTIs and their recurrence reported in the literature in the setting of vitamin D deficiency.

Conclusion. Vitamin D deficiency may independently suppress local anti-infectious immunity and immune reactivity of the bladder both under normal conditions and following exposure to uropathogens. These findings support considering vitamin D as an important systemic regulator of the immunological mechanisms involved in chronic bacterial cystitis.

Introduction. Acquired proximal seminal tract obstruction may develop as a result of infectious-inflammatory, post-traumatic, or iatrogenic lesions of the epididymis and proximal segments of the vas deferens. In bilateral disease, it leads to obstructive azoospermia. Surgical sperm retrieval and microsurgical reconstruction remain the principal approaches to infertility management; however, conservative treatment targeting the inflammatory and fibrotic component of obstruction is of practical interest.

Aim. To carry out a pilot assessment of the potential effect of different dosage forms of bovhyaluronidase azoximer on semen parameters in patients with acquired proximal seminal tract obstruction.

Material and methods. A total of 80 men with obstructive azoospermia caused by proximal seminal tract obstruction and associated infertility were examined. The patients were divided into two groups of 40 patients each. In the first group, bovhyaluronidase azoximer was administered as rectal suppositories at a dose of 3000 IU; in the second group, it was administered as a lyophilizate for intramuscular injection at a dose of 3000 IU. Follow-up examination and semen analysis were performed once, 95–105 days after the start of therapy. Statistical analysis was primarily descriptive; the proportions of patients with spermatozoa detected in the ejaculate were compared using Fisher’s exact test.

Results. Spermatozoa appeared in the ejaculate in 10 of 80 patients (12.5%). The median sperm concentration was 0.85 million/mL, the median total sperm count was 1.65 million, and the median total motile sperm count was 0.1815 million. In the suppository group, spermatozoa appeared in 6 of 40 patients (15.0%); in the intramuscular injection group, spermatozoa were detected in 4 of 40 patients (10.0%). The between-group difference was not statistically significant (p=0.737).

Discussion. The number of spermatozoa obtained was insufficient for natural conception; however, in selected cases it could be of practical value for cryopreservation and subsequent use in intracytoplasmic sperm injection programs. These results should be considered preliminary because of the pilot design, absence of a control group, and limited number of patients with a positive response.

Conclusion. The obtained data suggest that bovhyaluronidase azoximer may be considered a potentially pathogenetically substantiated component of complex therapy in patients with proximal seminal tract obstruction. Further studies of appropriate methodological quality are required to clarify the clinical significance of these findings.

Aim. To evaluate the efficacy and safety of the multicomponent complex in the treatment of male infertility.

Materials and methods. A total of 90 patients aged 18–45 years with a confirmed diagnosis of male infertility, defined as oligozoospermia and/or asthenozoospermia were included in the study. After application of the exclusion criteria, the patients were divided into three groups. Patients in group 1 received standard lifestyle modification recommendations and the complex dietary supplement, 1 sachet once daily for 3 months; patients in group 2 received 2 sachets daily; and patients in group 3 received standard lifestyle modification recommendations only. Semen analysis was performed before enrolment and on days 30, 60, and 90. Statistical analysis was performed using IBM SPSS Statistics version 26.0.00.

Results. After 90 days of therapy, significant differences between the study groups were identified in sperm motility parameters and reactive oxygen species (ROS) generation. Significant between-group differences were observed in the proportion of progressively motile spermatozoa (p=0.0037), total sperm motility (p=0.002), total progressively motile sperm count (p=0.029), total motile sperm count (p=0.0165), and ROS levels (p=0.0086). Ejaculate volume, sperm concentration, total sperm count, sperm morphology, DNA fragmentation index, and HBA test results did not differ significantly between the groups (p>0.05). Post hoc analysis showed significant differences in the proportion of motile and progressively motile spermatozoa, as well as in ROS levels, between groups 1 and 3 and between groups 2 and 3; no significant differences were observed between groups 1 and 2.

Conclusion. The use of the complex dietary supplement was associated with improved sperm motility parameters and reduced oxidative stress as early as during the first 1–2 months of administration, with the effect persisting through day 90.

Background. Urolithiasis is one of the most common diseases of the urinary system, accounting for up to 50% of the capacity of urology departments in the Russian Federation. Modern minimally invasive technologies, including micro-percutaneous nephrolithotomy (PCNL), offer opportunities to optimize surgical strategy; however, the indications for its use remain controversial.

Aim. To perform a comparative analysis of the outcomes of micro-percutaneous procedures versus other minimally invasive interventions in patients with kidney stones up to 2 cm in size.

Materials and methods. The study included 172 patients with kidney stones up to 2 cm, divided into three groups: micro-PCNL (n=51), mini-PCNL (n=58), and retrograde intrarenal surgery (RIRS, n=63). A comparative assessment was performed of treatment efficacy, complication rates, additional interventions, and postoperative length of stay. The analysis also took into account stone location and size, as well as the anatomy of the renal collecting system according to the R. Takazawa classification (2018).

Results. The overall treatment efficacy was 88.2% for micro-PCNL, 93.1% for mini-PCNL, and 87.3% for RIRS (p>0.05). No differences were found in complication rates or the need for additional interventions. In patients with stones ≤1 cm, micro-PCNL provided a shorter hospital stay than mini-PCNL – 3.4±0.5 versus 5.1±0.4 days (p=0.04). For lower calyceal stones, micro-PCNL demonstrated better efficacy than RIRS, 94.4% versus 70.4% (p=0.04). Analysis of the renal collecting system anatomy showed that the best outcomes of micro-PCNL were achieved in patients with a narrow (A1) and standard (A2) single pelvis, whereas in patients with a wide pelvis (A3) its efficacy decreased to 71.4% versus 94.7% and 95.2% for mini-PCNL and RIRS, respectively (p< 0.05).

Conclusions. Micro-PCNL is an effective and safe method for the treatment of kidney stones up to 2 cm, comparable to mini-PCNL and RIRS. Optimal outcomes of micro-percutaneous interventions are achieved in patients with stones ≤1 cm, stones located in the lower calyx, as well as in patients with a narrow or standard single renal pelvis.

Introduction. Issues of continuity of care in the treatment of patients with urological diseases are becoming increasingly relevant as the specialty itself advances and high-technology treatment methods are introduced.

Aim. To draw the attention of pediatric and adult urologists to the problems of continuity of care and to the need for establishing a system for transferring patients from pediatric to adult urologists.

Materials and methods. Five male patients were treated at I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, on the basis of Morozov Children’s City Clinical Hospital and the Institute of Urology and Reproductive Health. Group I included 3 patients with penoscrotal hypospadias, and Group II included 2 patients with bladder exstrophy. All patients had undergone staged surgical treatment in childhood; however, due to the development of complications in adulthood, reconstructive plastic surgery was required.

Results. The early treatment outcomes in patients from both groups were assessed as good because no complications were observed. The long-term treatment outcomes in all patients were evaluated at 3 and 6 months, and at 1 and 3 years.

Conclusion. The growing recognition of the need for an uninterrupted continuum of care in the treatment of patients with urological diseases in childhood and adulthood highlights the importance of this work for healthcare systems and, above all, for patients. Reconstructive surgery in any person, and especially in a child, requires long-term follow-up, often throughout life.

Varicocele is a common condition characterized by dilation of the veins of the pampiniform plexus of the left testicle, affecting 15–20% of adolescents and adult men. Clinical manifestations include pain, decreased left testicular volume, infertility, and the presence of a mass in the form of dilated veins in the scrotum. In adolescents, one of the main indications for surgery today is the prevention of future infertility, but no proven efficacy of any conservative treatment has been described. Various surgical techniques for varicocele treatment have been proposed in the literature, including retroperitoneal, laparoscopic, inguinal, subinguinal, and X-ray surgical (embolization). Each technique has its own advantages and disadvantages. In this case report, we describe a relatively rare complication that arose after intravascular occlusion of the internal spermatic vein with a coil.

Three clinical observations in patients with various manifestations of pyelonephritis are presented. Using 18F-FDG PET/CT and transmission electron microscopy of the renal parenchyma at 10,000x magnification, the ultrastructural and molecular-cellular features of acute purulent pyelonephritis, chronic pyelonephritis with neurogenic hypertension, and chronic pyelonephritis resulting in secondary contracted kidney are identified. The clinical significance of the identified changes, the reliability of the obtained results, and the prospects for their further application are discussed.

Introduction. Artificial intelligence (AI) is one of the most innovative and promising fields of modern technology, exerting a significant impact on various areas of medicine, including urology. AI is increasingly being used not only for the diagnosis of urological conditions, but also for their treatment and prognostic assessment. The literature search was performed in the electronic databases PubMed, Web of Science, Scopus, CyberLeninka, and eLibrary. The inclusion criteria were original studies on the application of AI methods in urology and literature reviews on the topic. The exclusion criteria were preliminary studies and conference abstracts. The broad potential of AI methods in various fields of urology has been demonstrated. Machine learning and deep learning algorithms show high accuracy in diagnosing urological diseases based on laboratory and imaging data. AI models can assist surgeons in operative planning and intraoperative navigation. AI has also shown potential in predicting recurrences and complications based on the analysis of clinical data. Successful examples of AI implementation have been reported in urooncology, nephrology, and andrology. Future directions for improving AI models and integrating them into clinical practice are discussed.

Conclusion. Artificial intelligence demonstrates high efficacy across various fields of urology from image analysis to surgical navigation. However, its implementation requires addressing issues of ethics and system validation. With the proper approach, the integration of AI and physicians’ expertise can significantly improve disease diagnosis and patient treatment. Further research in this area is promising and may lead to breakthroughs in urological practice.

Objective. To identify the main surgical treatment methods for female urethral strictures and evaluate their efficacy and safety.

Materials and Methods. A systematic literature review was conducted in accordance with PRISMA guidelines using databases such as PubMed, Embase, and others. The review included studies comparing ≥2 surgical treatments for female urethral strictures. Eligible studies comprised randomized controlled trials (RCTs), prospective and retrospective cohort observational studies (OS), and case series with ≥10 patients. Inclusion criteria were: confirmed female urethral stricture, comparison of at least two surgical approaches, and available data on primary outcomes (urethral patency or absence of recurrence) as well as secondary outcomes (recurrence, complications, functional outcomes, patient satisfaction, and quality of life). The quality of evidence was assessed using the GRADE system. A meta-analysis was performed with pooled success rates and heterogeneity analysis (I²).

Results. A total of 37 studies (including 1 RCT and 36 observational studies) involving 1,279 patients were included. The main surgical interventions were simple dilation, internal optical urethrotomy (IOU), and various urethroplasty techniques. Due to the frequent sequential or combined use of dilation and IOU within single studies, they were grouped under «dilation-based methods» (DM). Urethroplasty approaches included buccal mucosa graft (BMG) urethroplasty, vaginal or labial flaps (e.g., labia minora flap [LMF]), and various graft combinations. In the meta-analysis, urethroplasty demonstrated significantly higher pooled success rates (PSR) or absence of recurrence – 92% (95% CI: 89–95%) with mean follow-up >2 years – compared to dilation (47%; 95% CI: 39–55%). BMG urethroplasty achieved cure rates of 88–95% over 2–3 years of follow-up, with comparable outcomes for vaginal flaps (VF) and LMF (78–94%). Differences between urethroplasty techniques were minor. Combined techniques (e.g., BMG + VF for long strictures) also yielded good patency rates, though data were limited. Urethroplasty significantly improved urodynamic outcomes: mean maximum urinary flow rate (Qmax) increased from 6–8 mL/s to 20–25 mL/s, and lower urinary tract symptom scores (e.g., AUA-SS) decreased from 22 to 6 points. Quality of life also improved significantly. In contrast, dilation-based methods offered only temporary symptom relief, with over 50% of patients experiencing stricture recurrence and requiring repeat interventions within the first year. Meta-analysis showed that the risk of stricture recurrence (RS) after dilation was significantly higher than after urethroplasty (risk ratio 3:1, p< 0.001). The overall complication rates were low across all groups. The most common complication after urethroplasty was transient stress urinary incontinence (5–15%), typically resolving within ≤6 months. Donor site morbidity for grafts and flaps was minimal. Comparative analysis revealed no significant differences in complication rates between various urethroplasty techniques.

Conclusions.This systematic review indicates that two primary surgical strategies exist for treating female urethral strictures: dilation-based methods and reconstructive urethroplasty. Both approaches are safe, but only urethroplasty consistently demonstrated high efficacy regardless of the specific technique or tissue used. Further prospective randomized trials are urgently needed to provide more robust evidence on the effectiveness of surgical treatments and long-term outcomes, including direct comparisons between urethroplasty techniques and their impact on urinary function and overall quality of life in women.

Introduction. RIRS is one of the main treatment options for urolithiasis. However, its high resource utilization and increasing number of procedures raise concerns regarding the sufficiency of reimbursement within the obligatory medical insurance (OMI) system. From 2022 to 2025, OMI tariffs for RIRS have shown steady growth, driven by the transition of the procedure to higher-reimbursed disease-related group (DRG groups). Nevertheless, despite the increase in tariffs, the issue of their adequacy for covering the costs of high-complexity interventions persists.

Aim. To analyze the sufficiency of the DRG tariff to compensate for the actual costs of performing RIRS of varying complexity levels in a federal medical institution in St. Petersburg.

Materials and methods. A cost analysis of 157 RIRS cases performed in 2024 at the N.I. Pirogov High Medical Technologies Clinic, St. Petersburg State University, was conducted. Costs were categorized as direct and indirect. The actual expenses were compared with the disease-related group (DRG) tariff.

Results. The average costs per treated RIRS case ranged from 139,000 to 180,000 rubles, depending on the complexity category. Direct costs accounted for 88–91% of the total expenditures. The DRG tariff (147,000 rubles) covered only the expenses for low-complexity (Category I) procedures. In more complex cases, the actual costs exceeded the tariff by 11.5–22.4%. As a result, for 83% of patients treated with RIRS at the clinic, the established tariffs were insufficient to reimburse the actual expenses, leading to a deficit of 3.01 million rubles.

Conclusion. In order to increase the economic sustainability of clinics operating under the DRG-based payment system, the possibility of introducing new reimbursement mechanisms is being considered. In particular, it is proposed to use differentiated values of the coefficient of complexity of patient treatment in the provision of RIRS procedures, depending on the appropriate category of complexity. For regional medical organizations with their own payment system (Moscow and St. Petersburg), it is recommended to provide tariffs that cover costs for all categories of RIRS complexity.

Changes in kidney function parameters in men receiving testosterone replacement therapy (TRT) may influence the clinical assessment of treatment safety. However, the physiological meaning of these changes remains uncertain. In most cases, kidney function during TRT is evaluated using surrogate laboratory markers rather than glomerular filtration rate (GFR) measured with exogenous filtration markers. This creates a risk of misinterpretation, as the observed changes may reflect not only true alterations in glomerular filtration, but also therapy-related effects and patient phenotype-related characteristics.

Existing studies do not allow a reliable distinction to be made between true changes in filtration function, changes in the characteristics of the marker used, or a combination of both, since most of them rely on surrogate indicators without comparison with measured GFR. Therefore, the question of what changes in kidney function parameters during TRT actually mean, and how they should be interpreted, remains unresolved.