Urologiia

Introduction. Existing treatment methods for Peyronie's disease (PD) aim to restore the normal biomechanical functions of the tunica albuginea (TA); however, current data on biomechanical changes in PD, as well as on the biomechanical properties of native human TA, are extremely limited. The aim of our study was to evaluate the biomechanical properties of intact TA and the materials most commonly used for its replacement.

Materials and Methods. Samples of the TA were collected from 9 male cadavers aged 20 to 65 years. Rectangular sections of the TA were excised from the dorsal surface of the corpora cavernosa. Fixation of the specimens in formalin was not performed, as this could affect the biomechanical properties of the tissue. Prepared samples were divided into longitudinal and transverse fragments. Pericardial grafts (allograft from cadaveric pericardium; xenograft from bovine pericardium) were prepared similarly. The obtained tissue fragments were subjected to mechanical testing. All tensile tests were conducted using a single-column universal material testing machine, the TA.XTplus Texture Analyzer (Stable Micro Systems Ltd., UK). Interactive stress-strain curves were used for result analysis. The following parameters were determined: stress, strength, strain, sample thickness. The obtained data were subjected to statistical analysis.

Results. Analysis of the obtained data revealed that the stress and strength of longitudinal fragments of TA were statistically significantly higher (p = 0,0004 and p = 0,0008; Tukey’s test) than those for the transverse fragments. This indicates that human TA is anisotropic. Correlation analysis showed a negative correlation between the patient age and the strength (r = –0,49; p < 0,05; Spearman’s rank correlation). Additionally, a negative correlation was found between the patient’s age and the thickness of their tunica albuginea (r = –0,56; p < 0,05 according to Spearman’s test). When comparing human TA with grafts from bovine and human pericardium, it was found that the strength and thickness calculated for human tunica albuginea were statistically significantly higher (p = 0,0001; Tukey’s test) than those for the grafts.

Conclusions. Human and bovine pericardium grafts significantly differ from healthy TA in terms of stress, elastic modulus, strength, and thickness, which may impact the outcomes of surgical treatment for patients with PD.

Aim. To investigate the effects of solutions composed of molecules with both chelating and surfactant properties on kidney stones.

Materials and Methods. Kidney stones and their fragments were obtained during ureteroscopy and retrograde intrarenal surgery, percutaneous nephrolithotomy, and stone extraction from the kidney performed in patients with urolithiasis. For the experiment, a solution was prepared based on a composition of iminodiacetate derivatives of fatty acid glycerides and iminodiacetate derivatives of polysaccharides. Stones of known mass were processed with this solution, dried, and examined using X-ray diffraction analysis. Qualitative protein analysis (biuret test) was performed on the solution and washout fluid.

Results. Struvite stones (MgNH₄PO₄(H₂O)₆) swelled in the solution and disintegrated into small fragments. Proteins and phosphate ions were detected in the prepared solution. Stones composed of crystalline uric acid or its hydrate, as well as hydrated calcium oxalates (whewellite and weddellite), also swelled, with occasional changes in surface structure and color. X-ray diffraction analysis revealed a decrease in the amorphous, presumably protein, component and changes in the relative proportions of crystallohydrates. The presumed mechanism of stone destruction was leaching of the amorphous protein binder between crystalline grains, together with alterations in the crystalline phases.

Conclusion. Complexons with emulsifying properties from the prepared solution penetrate the protein matrix of kidney stones and, together with enhanced water diffusion, cause partial protein extraction, swelling of amorphous and some crystalline phases, and subsequent stone disintegration. These findings highlight the potential of such hybrid compounds for the development of novel methods of treating urolithiasis and warrant further investigation.

Aim. To evaluate the efficiency, safety, and tolerability of Urorek^® (silodosin, 8 mg) in empirical therapy of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) without prior diagnostic assessment.

Materials and Methods. An open, prospective, multicenter observational study (MERCURY) was carried out in five clinical centers in Russia with the participation of 123 men (114 completed per protocol), aged 50–83 years. Urorek was prescribed empirically to patients with moderate LUTS. Efficacy was assessed using IPSS, QoL, VPSS scores, uroflowmetry parameters (Qmax, Qave), International Index of Erectile Function (IIEF), and hemodynamic parameters. The treatment duration was 90 days.

Results. At day 15, a significant IPSS decrease of 3.77 points was observed; at 1 and 3 months the reduction was 5.63 and 6.86 points, respectively (p < 0.001). QoL, VPSS, Qmax, and Qave improved significantly at all stages. By day 15, Qmax increased by 2.49 ml/s, and by day 91 by 4.74 ml/s (35.5% increase). Adverse events occurred in 1.72% (retrograde ejaculation); no cases of orthostatic hypotension or arrhythmia were recorded. The drug had no significant effect on blood pressure or heart rate.

Discussion. Silodosin demonstrated a rapid and marked effect on both voiding and storage symptoms of BPH, improving quality of life. Efficiency was evident as early as 15 days. VPSS showed strong correlation with IPSS and can be used in elderly or cognitively impaired patients. The drug demonstrated a high safety profile, especially in comorbid patients, and can be prescribed under conditions of limited diagnostic resources.

Conclusion. Urorek^® (silodosin, 8 mg) is effective and safe for empirical treatment of LUTS in BPH patients, including elderly and comorbid individuals. Its high selectivity for α1A-adrenergic receptors, low risk of drug-drug interactions, and lack of cardiovascular effects make it a treatment of choice for patients with LUTS/BPH prior to completion of the full diagnostic work-up.

Introduction. As COVID-19-induced disorders wreak havoc on populations worldwide, attention to the rehabilitation of the consequences has focused mainly on vital organ systems (lungs, kidneys, and heart) that are vulnerable to the initial viral attack and contribute to the development of acute pathology associated with this disease. However, we should not lose sight of the fact that COVID-19 affects any cells in the body that express ACE2, including human sperm.

Materials and Methods. The results of transmission electron microscopy of the ejaculate of 157 men were analyzed. They were divided into four groups: Group I – 49 patients with idiopathic infertility who had COVID-19, Group II – 42 patients with idiopathic infertility who did not have COVID-19 during the study, Group III – 39 fertile men who had COVID-19, Group IV – 27 fertile men who did not have COVID-19. Objective: To study the role of sperm mitochondrial dysfunction in the development of male infertility associated with COVID-19.

Results. According to transmission microscopy of the ejaculate, men who brought COVID-19 have severe sperm disorders, such as mitochondrial dysfunction and the presence of residual cytoplasm, which were more often recorded in infertile patients, compared to fertile men.

Conclusions. COVID-19 impairs male reproductive potential and may impair male fertility.

Introduction. Despite the widespread use of bladder catheterization in both inpatient and outpatient practice, the procedure carries a risk of serious complications, including urethral trauma, strictures, and the development of false passages. According to published data, their incidence ranges from 10.2% to 17.7%. The most common causes of unsuccessful bladder catheterization are anatomical or pathological changes in the urethra, as well as insufficient experience of medical personnel. Repeated attempts at catheterization increase the risk of iatrogenic injuries. In military medicine and emergency care, the problem is aggravated by the high frequency of urethral trauma. Despite the availability of alternative imaging techniques (ultrasound, retrograde urethrography), the choice of the optimal drainage method remains unresolved, particularly in settings with limited access to advanced endoscopic equipment.

Aim. To evaluate the efficiency and safety of the Visus MG optical urethral catheter with a portable endoscopic system (PES) in various types of urethral injuries.

Materials and Methods. A prospective study was conducted at the Institute of Urology and Reproductive Health, Sechenov University, and at the S.M. Kirov Military Medical Academy. Eighty-five patients were included (60 and 25 from each institution, respectively). The efficacy and safety of bladder catheterization using the Visus MG optical urethral catheter with PES were assessed after unsuccessful attempts at standard catheterization, and in some cases without prior standard attempts. Indications included acute urinary retention, urethral trauma (combat or iatrogenic), preoperative drainage, and approximation of urethral edges before urethroplasty. The optical catheter provided visual control of urethral passage and enabled successful drainage in the presence of anatomical obstructions.

Results. Patient age ranged from 20 to 86 years (mean: 59.8). The mean prostate volume among non-prostatectomy patients was 33.7 cc, most often between 20–39 cc (42.1%). Bladder catheterization was performed primarily in the operating room (43.5%) or in procedure rooms (37.6%), most commonly under local anesthesia (61.2%). A history of prior urological procedures was documented in 70% of patients. The use of the Visus MG optical urethral catheter with PES achieved successful bladder drainage in 96.5% of cases (82/85) without complications. The main causes of failed standard catheterization were strictures, urethral trauma, and other obstructive conditions.

Conclusion. The Visus MG optical urethral catheter with a PES enabled safe and effective bladder drainage in 96.5% of patients after failed standard bladder catheterization. The method is minimally invasive, provides direct visual control, and reduces the risk of false passages and urethral injury. It may serve as an alternative to cystoscopy in settings with limited access to full endoscopic equipment.

Radical cystectomy is recognized as the gold standard in the management of muscle-invasive bladder cancer. However, despite its definitive nature, recurrences of urothelial carcinoma in the upper urinary tract remain an important cause of morbidity and mortality during long-term follow-up. The prognosis of such recurrences is generally poor, largely due to delayed diagnosis.

This article presents three clinical cases of upper urinary tract recurrence detected 16–24 months after radical cystectomy. Successful treatment was achieved with radical nephroureterectomy including excision of the adjacent intestinal segment. These cases highlight the effectiveness of this surgical approach for upper tract recurrences following radical cystectomy and emphasize the need to establish criteria to determine whether urothelial tumors in the upper urinary tract represent true recurrences of bladder cancer or previously undiagnosed primary lesions. Further studies are required to develop algorithms for the early detection and management of this relatively rare pattern of disease progression.

Issues of etiology, pathogenesis, and diagnostics of tuberculous bladder lesions were discussed in the first part of the review. The presence of a “small contracted” bladder, regardless of etiology, is an indication for surgical treatment, including tuberculous microcystis. The surgeon’s main task is to select the optimal surgical approach in each case. An ileal segment is considered the best material for urinary reservoir reconstruction. Supratrigonal cystectomy with augmentation and radical cystectomy with orthotopic reconstruction are the most common procedures for tuberculous microcystis. In the postoperative period, assessment of quality of life and urodynamic parameters are key factors for successful outcomes. To summarize current data on surgical treatment of tuberculous bladder microcystis and to evaluate quality of life and urodynamic parameters after surgery, the publications from Elibrary.ru, PubMed, and Google Scholar were reviewed. This second part of the review highlights surgical treatment options for tuberculous microcystis and presents available data on quality of life and urodynamic outcomes after surgery.

Urolithiasis is one of the most prevalent urological disorders and remains among the leading urinary tract diseases worldwide. The risk of developing urolithiasis is influenced by a wide range of factors, and its global prevalence continues to rise, particularly in both developed and developing countries. A deeper understanding of its etiology, including the contribution of bacteria, is of paramount importance, as microorganisms may contribute to recurrent stone formation. This review summarizes current evidence supporting bacterial involvement in urolithiasis. Particular attention is given to the potential role of microorganisms in the pathogenesis of so-called non-infectious stones, as well as to the complex interplay between stone formation and urinary tract infection. The aim of this article is to integrate available data on the association between bacteria and urinary stones, with a focus on the pathophysiology of stone formation and the urinary microbiome in calculi of different chemical compositions.

The goal of vaginal reconstructive surgery is to address pelvic issues. Surgical procedures can greatly enhance the lives of many women by alleviating symptoms and improving their overall well-being. However, there are instances where women experience pelvic dysfunction for the first time — new or worsening symptoms in the pelvic area that emerge following surgery. The purpose of the review is to summarize current knowledge, identify existing gaps and suggest future research directions aimed at minimizing iatrogenic morbidity and improving the quality of life of patients. A search was conducted using PubMed, Scopus, Web of Science, and Cochrane Library databases. The search queries included various combinations of the following keywords: «pelvic floor dysfunction», «urogynecology», «vaginal surgery», «pelvic organ prolapse», «stress urinary incontinence», «overactive bladder», «de novo», «postoperative complications», «urination dysfunction», «dyspareunia», «fecal incontinence», «quality of life», «synthetic mesh», «repair with native tissues» and «results of surgical intervention». The search was limited to English-language publications from January 1, 2014 to December 31, 2024 (including articles published in early 2025). Literature data convincingly indicate that a significant proportion of women who have undergone urogynecological vaginal surgery develop de novo pelvic dysfunctions. The etiology of de novo pelvic dysfunction is complex and multifactorial, including nerve injury, mesh-related complications, altered pelvic floor biomechanics, pre-existing subclinical dysfunction, and psychological factors. Identifying risk factors and implementing strategies to prevent and effectively treat new dysfunction are critical to optimizing surgical outcomes and patient well-being.

Despite the growing popularity and expanding indications for retrograde intrarenal surgery (RIRS) in the treatment of urolithiasis, percutaneous nephrolithotripsy (PCNL) remains the method of choice for removing large kidney stones due to its high efficiency and safety. Modern approaches, such as tubeless or totally tubeless PCNL, allow faster recovery and improve patients’ postoperative quality of life. However, successful implementation of these procedures requires strict patient selection. The primary criterion is atraumatic nature, an absence of urinary tract infection and residual fragments.

To analyze modern instrumental techniques and technologies potentially capable of reducing the incidence of intra- and postoperative complications during tubeless PCNL, we carried out a literature search in PubMed, Scopus, ResearchGate, and eLibrary. The review included articles in Russian and English published between 1973 and 2024.

According to the literature, the frequency of tubeless PCNL can be increased by precise, atraumatic transpapillary puncture through the avascular zone. These conditions can be achieved not only by the surgeon’s experience, but also through the use of new atraumatic instruments for puncturing the collecting system and creating percutaneous access, such as the MG puncture needle, as well as imaging technologies that significantly improve puncture accuracy. To obtain more reliable evidence, prospective randomized studies including patients undergoing tubeless and totally tubeless PCNL are required.

Conclusion. The use of additional imaging technologies and atraumatic instruments for percutaneous access may reduce the complication rate after tubeless and totally tubeless PCNL. However, further prospective randomized studies are necessary in this field.

In accordance with the PRISMA protocol, a comprehensive literature search was conducted, and based on a systematic review and meta-analysis, the effectiveness of various surgical approaches for complete or partial urethral destruction in women was evaluated. A total of 36 studies were included, encompassing more than 500 female patients with severe urethral injury. The analysis incorporated retrospective case series, cohort and comparative studies, as well as one systematic review. The primary outcomes assessed were urethral patency restoration, urinary continence, recurrence rate, complications, and the need for re-interventions. Statistical analysis included a meta-analysis of success proportions using a random-effects model; the level of evidence was evaluated according to the GRADE system.

The best outcomes were observed with urethroplasty using autologous tissues (buccal mucosa, vaginal and labial flaps), which provided long-term urethral patency (88.2%; 95% CI, 82–93%) and preservation of continence. Other urinary diversion techniques (urethroclesis, suprapubic fistula, Monti procedure) achieved continence in the majority of patients with severe comorbidities (success rate 78%), but were associated with a high incidence of complications, including infections, stone formation, and progressive renal failure.

Tissue urethroplasty remains the most effective and safest method of urethral reconstruction in women. Minimally invasive procedures should be regarded as temporary measures, while diversion operations should be reserved for the most severe cases.

Antimicrobial resistance (AMR) poses a global public health threat and may result in serious economic consequences. Although the treatment regimens for uncomplicated urinary tract infections (UTIs) have remained largely unchanged, they require continuous monitoring due to increasing antimicrobial resistance. The most recent updates of clinical guidelines for the management of uncomplicated UTIs did not revise the list of first-line antibiotics, since no new oral agents are currently available. Single-dose fosfomycin administration has been shown to be as safe and effective as other antibiotics in the treatment of uncomplicated UTIs in women. Fosfomycin therefore remains an adequate empirical treatment option. However, ongoing surveillance of regional antimicrobial resistance is essential to ensure the rational selection of antibiotics for empirical therapy.