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Introduction. The influence of the length of the number of CAG repeats in the androgen receptor gene (nCAG AR) on endothelial dysfunction (EnD) is currently understudied.Objective. The study aimed to evaluate the relationship between the nCAG AR and the dynamics of biochemical and ultrasound markers of EnD in men with functional hypogonadism and type 2 diabetes mellitus (T2DM) receiving testosterone replacement therapy (TRT).Materials & methods. This study included 45 hypogonadal men with T2DM, receiving TRT for 1 year. Patients were assessed for carbohydrate and lipid metabolism parameters; total and free T; sex hormone-binding globulin; biochemical markers of EnD (NO, eNOS3, endothelin) and the nCAG AR; brachial artery (BA) vasoreactivity. Patients were divided into 3 groups: group I — 9 men with nCAG AR < 19; group II — 27 men with nCAG AR > 19 – 24; and group III — 9 men with nCAG AR >24.Results. Patients with nCAG AR < 19 exhibited a 2-fold greater and faster increase in BA vasoreactivity on TRT compared to patients with nCAG AR 19-24 and 3-fold greater than men with nCAG AR >24 (p < 0.05). Patients with nCAG AR < 19 also demonstrated the most pronounced rise in NO and eNOS3 on TRT compared to men with nCAG AR > 24. Patients with nCAG AR < 19 experienced the most pronounced decreases in weight, waist circumference, and HbA1c on TRT compared to other patients (p < 0.05).Conclusion. The nCAG AR length significantly affects the response to TRT in men with hypogonadism and T2DM. The most significant improvements are seen in patients with short nCAG AR.

Introduction. Urinary incontinence is a common complication of radical prostatectomy. The development of surgical techniques when performing radical prostatectomy that improve the function of urinary continence after surgery is actual.Objective. To compare urinary continence functions in long-term follow-up after open and laparoscopic radical prostatectomy when only posterior or combined (anterior + posterior) reconstruction of the pelvic fascial spaces is performed.Materials & methods. The study included 130 patients aged 63.0 [59.0; 68.0] years with local prostate cancer (сT1a-2сN0-xM0; 1 – 4 ISUP groups), subjected to non-nerve-sparing retropubic radical prostatectomy with posterior reconstruction and non-nerve-sparing extraperitoneal laparoscopic radical prostatectomy with isolated posterior or combined (anterior + posterior) fascial reconstruction of the pelvic fascial spaces. Postoperative continence function was studied at 1, 3, 6, and 12 months following surgery using a standard pad test.Results. The incidence of urinary continence was higher at all follow-up periods during laparoscopic surgery. From the 6-months follow-up, these patients did not have severe urinary incontinence. At the same time, the rate of growth of some patients who began to retain urine did not depend on the method of reconstruction of the pelvic fascial spaces. The use of combined reconstruction of the pelvic fascial spaces at 12-months follow-up showed an advantage in urinary continence over performing only posterior reconstruction. Such patients achieved urinary continence in 90% of cases compared to 80.0% of cases. At the same time, the restoration of urinary continence at all periods of observation had a relatively uniform linear rate of increase in the indicator.Conclusion. Reconstruction of the pelvic fascial spaces during open and laparoscopic radical prostatectomy allows one to achieve satisfactory continuation in the postoperative period. However, higher efficiency is achieved when using a combined reconstruction technique.

Introduction. Currently, various methods and modifications of radical prostatectomy (RP) have been developed and tested, aimed at preventing and minimizing the development of urinary incontinence (UI). However, UI remains an urgent problem in patients who undergo RP, especially at the early follow-up stages.Objective. To evaluate and compare the effectiveness of modified reconstructive techniques for vesicourethral anastomosis in radical prostatectomy for the prevention of urinary incontinence with respect to the standard technique at different follow-up periods.Materials and methods. Design: single-centre, clinical, simple, comparative, parallel-group study with retrospective and prospective material evaluation, conducted in 2017 – 2022. Patients: men with verified prostate cancer cT1a – 2cN0 – xM0 without decompensated comorbidities. Age: 45 – 78 years. Retrospective part — group (G) 1: 90 patients who underwent non-nerve-sparing open retropubic RP with a "classic" vesicourethral anastomosis (VUA). Prospective part — G2: 46 patients who underwent similar surgery with modified VUA in two variations: without and with prostatic urethra-sparing — G2a (n = 25) and G2b (n = 21), respectively. Initial examination: standard preoperative laboratory and instrumental examination, assessment of lower urinary tract symptoms (LUTS) using the IPSS-QoL questionnaire. Follow-up examination: objective evaluation of UI according to established criteria and subjective assessment using the ICIQ-SF questionnaire, tracking the dynamics of LUTS using IPSS-QoL. Follow-up periods: 0-point (after catheter removal), 1, 3, 6, and 12 months (exit-point); the dynamics of recovery of urinary continence (UC) was determined monthly. Statistical analysis: Statistica ver.10.0 (StatSoft Inc., Tulsa, OK, USA) using non-parametric methods (CL p < 0.05 at a = 0.05)Results. Preoperative demographic, questionnaire and instrumental statistics did not differ (p > 0.05) between the groups, confirming the homogeneity of the samples. After RP, the urethral catheter was removed in a period of 7 to 21 days. There was no difference (p > 0.05) in the duration of drainage between the groups. Total urinary continence (TUC) immediately after catheter removal was detected in G1, G2a and G2b in 20.0%, 44.0% and 57.1% of cases, respectively. Subsequent objective monitoring of UC recovery from 1 month showed differences (p < 0.001) between the groups in the dynamics of rehabilitation during the year. The improvement in UC over the one-year follow-up period was cumulatively achieved in G1, G2a and G2b in 48.9%, 44.0% and 33.3% of cases, respectively. Total UI persisted in G1 and G2a by month 12 in 22.2% and 8.0% of patients, respectively, and was not detected in G2b. The severity of UI by the end of the follow-up according to the ICIQ-SF data was the most pronounced (p < 0.001) in patients from G1. TUC-patients in all groups from 1 month showed a marked decrease in the severity of obstructive and irritative LUTS and improved quality of life, with no differences (0.157 < p < 0.390) in IPSS-QoL values between groups.Conclusions. The use of modified VUA reconstruction techniques made it possible, compared with the standard one, to achieve high continence rates in patients both immediately after the removal of the urethral catheter and at subsequent follow-up periods, without the formation of severe iatrogenic obstruction. Prostatic urethra-sparing modification is the most effective technique that provided the rehabilitation of UI to a complete and/or social level in all patients within a year after surgery.

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied.

Introduction. CThe basic symptoms in the non-inflammatory form of chronic prostatitis / chronic pelvic pain syndrome (CP / CPTB III B) are Pain, Symptoms of the Lower Urinary Tract (LUTS) and Erectile Dysfunction (ED). Pain is the main and leading symptom. Treatment of patients with this condition is extremely difficult and often ineffective. For the correction of present symptoms, it is considered reasonable to use alphai-Adrenergic Blockers (α1-AB), Antibacterial Drugs, Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Phytotherapy, since these drugs are approved and have a high level of evidence. However, their use in most cases does not allow to achieve the proper clinical effect.Objectives. Comparative analysis of the effectiveness of combination therapy of the «first-line» (α1-AB + NSAIDs) and combination therapy of the «first-line» (α1-AB + NSAIDs), supplemented by local physical effects on the prostate.Materials and methods. 73 patients with a previously confirmed diagnosis of CP / CPPS III B were included in the study. Study Design: A prospective randomized simple comparative study. The key evaluation criterion is the arterial intraprostatic blood flow rate. Clinical evaluation of patients was carried out by questioning (I-PSS, NIH-CPPS and ICEF-5 questionnaires) before and after taking medications. Drug therapy was performed for 30 days. Randomization: Group 1- first line therapy (α1-AB + NSAIDs). Group 2 - a massage of the prostate was added to the «first-line» therapy (α1-AB + NSAIDs). Statistical analysis was performed using non-parametric statistics.Results. Pain: decrease in pain intensity - by 7.7 and 26.9% for the Group 1 and 2, respectively. LUTS: decrease in severity / reduction - by 18.2 / 0% and 50 / 15.4% of cases for the Group i and 2, accordingly. Treatment satisfaction -3.8 and 26.9% of patients for the Group 1 and 2, respectively. A statistically significant improvement in erectile function was not observed in patients of both groups.Conclusions. In the case when CP / CPPS III B is accompanied by moderate arterial hemodynamic disorders of the prostate, it is possible to achieve an improvement in the results of standard «first-line» therapy recommended by the European Association of Urology. At the same time, it is possible to reduce the intensity of pain and the severity of LUTS. However, there is no improvement in erectile function in these patients.

Introduction. Currently, indications for intracorporeal lithotripsy of ureteral stones with sizes up to 10 mm inclusively of different localization are established. However, there is no consensus was reached on the preferences of this type of surgery over other existing one in the case of proximal ureteral obstruction by a stones greater than 10 mm in size. Endoscopic ureterolithotripsy is associated with existing studies on the effectiveness and safety of this method. Thus, it is important to continue conducting comparative studies in this direction.Materials and methods. 54 patients with proximal ureteral stones larger than 10 mm in size were investigated. All patients underwent Semi-Rigid Ureteroscopy and Laser Lithotripsy (SRULL) using a semi-rigid ureteroscope. Patients was stratified into several groups in accordance with the size of stones according to the actual AUA classification: group A (n - 46), the dimensions of ureteral stones from 11 to 20 mm inclusive and group B (n - 8), the size of stones over 20 mm. Criterion for the effectiveness of treatment was to achieve the "Stone Free" level after performing lithotripsy. Indicator of treatment failure was the impossibility of complete removal of ureteral stone within one surgical procedure without its expansion. Statistical data processing was performed using non-parametric data analysis methods applying the STATISTICA 10 (StatSoft Inc., USA) software package.Results. Larger stones compared to higher density. Obstruction symptoms such as hydronephrosis, nausea and vomiting, gross hematuria were more common with stones > 20 mm. Treatment duration in patient groups is similar despite differences in the number of complications and the incidence of postoperative ureteral stenting. At the same time, operation time depended on stone size and density. Surgery efficacy in patient groups was comparable and met 78.3% in group A versus 75.0% in group B.Conclusion. Inflammatory and destructive changes in the ureter wall are more common with stones greater than 20 mm, which affects the incidence of postoperative complications. Increasing the operation duration and frequency of proximal fragments' migration are determined by increasing of the stones' size and density. SRULL important feature is the lack of statistical difference in the effectiveness with the different sizes of stones. In addition, the achievement of "Stone Free" level for various size's stones does not exceed one day. Performing a SRULL of proximal ureter's large stones on the first day of a patient's hospitalization is accompanied by greater treatment efficacy. It statistically reliably determines the reduction in the frequency of postoperative complications.

Introduction. Today there is many highly effective surgical approaches in the treatment of benign prostatic hyperplasia (BPH). New technologies in the treatment of BPH continue to be implemented. Despite this in some patients the results of surgical treatment for short-term and long-term monitoring is unsatisfactory.Purpose of research. Тo improve the results of treatment of patients with benign prostatic hyperplasiaMaterials and methods. The functional state of the urethral sphincter was studied in 123 patients with symptomatic BPH. According to the treatment method, all patients were separated into groups. Group 1 - patients with established standard indications for surgical treatment. After surgery, patients with persistent obstructive urination received therapy with a central muscle relaxant for three months. Group 2 - patients with uncomplicated BPH, having hypertonic urethral sphincter and receiving drug therapy according to the established urodynamic patterns.Results. Our analysis of the efficacy of surgical treatment of patients with BPH demonstrates a significant correlation between negative outcomes of surgery for BPH with increased tone of the external urethral sphincter. So, in 70.1% of cases, symptomatic obstructive Low Urinary Tract Symptoms (LUTS) in BPH were accompanied by increased tone of the urethral sphincter from standard parameters. We believe that these changes were related to the anatomical characteristics of nodular hyperplasia.Conclusions. Exactly this fact, that these patients had urethral sphincter dysfunction in 14.5% of cases made for poor effect of surgical treatment of BPH. Use of muscle relaxants centrally acting drug therapy in these cases, significantly improves the urodynamics of lower urinary tract, which is accompanied by regression of LUTS.

After the Second World War 70 years have passed. Essentially already gone a generation of people for whom it was not a story, and the nationwide disaster and personal experience. And let time more and more we move away from the victory of 1945, the value and results of the war are enormous for the future of the modern world. Memory of the Great Victory presents to all of us now living, special requirements, the main of which consists in the fact that based on the analysis draw the necessary lessons from the past, draw the right conclusions for the safety of modern Russia. Over the years, the world has changed considerably. On the stage of world politics, a host of new independent states. There are new centers of economic development, and hence the new poles of power. Meanwhile, the events of recent months show that the main results of the Victory have not lost their importance today. This is best spoken of their incessant attempts to challenge by distorting the main points of the war and its lessons. And, obviously, it is no accident the day before and during the celebration of 70th anniversary of Victory wishing her to steal the peoples of Russia have been particularly active, as they claim - stiff and awkward. For domestic historiography it is not something unexpected. On the socio-political, military and economic results of the Second World War written many works, but probably in the light of the development of military-political processes in the world of individual instructive lesson it is important not to forget.

Morphological changes in the kidneys of patients with staghorn nephrolithiasis at the time of endoscopic surgery staghorn calculi. In all cases, the morphological study of biopsy specimens revealed varying degrees of renal parenchyma lesions that may be predictors of chronic renal failure in patients with staghorn nephrolithiasis. Assessment of the extent of damage of the renal parenchyma is necessary for the timely implementation of renoprotective therapy.

Nowadays late-onset hypogonadism in men is considered as one of the risk factors of cardiovascular diseases as well as obesity and type 2 diabetes. The pathogenetic mechanisms of testosterone metabolic effects on carbohydrate and lipid metabolism, the current data about the role of the imbalance of proinflammatory cytokines - interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), C-reactive protein (CRP) in the pathogenesis of metabolic disorders and late-onset hypogonadism in men considered in this review.

Extracorporeal shock wave lithotripsy (ESWL) in spite of the low invasiveness and high efficiency is accompanied by an infectious- inflammatory complications and renal parenchymal injury . Dynamics of microbial spectrum urine and the impact of postoperative antibiotic therapy currently remains unexplored. The study included 30 patients subjected to ESWL. Bacteriological study was midstream morning urine before ESWL, 1, 3 days after ESWL, and midstream urine in the first urination after ESWL. All patients were divided into 2 groups. Group I consisted of patients (46.7%) with antibiotic therapy . Group II patients (53.3 %) antibiotic therapy was performed. In most cases (97.8 %) were bacteriuria , while in 75% of cases highlighted in the various options bacterial associations representation aerobic- anaerobic mixed infection, among which was dominated by non-clostridial anaerobic bacteria in all samples. Revealed that after ESWL microbial spectrum urine does not change in any case within 3 days , except for Enterobacteriaceae, but the frequency of occurrence and level of bacteriuria vary for different periods after surgery and fees or absence of antibiotic therapy.

According to existing ideas erectile dysfunction is one of the symptoms of chronic pelvic pain syndrome (CPPS) associated with prostatic pathology . However, erectile dysfunction is not pathognomonic for this state. This paper presents the results of 249 patients CPPS obtained by filling out questionnaires NIH-CPSI; I-PSS; IIEF-5 . Shown separately symptomatology of inflammatory and non-inflammatory forms of CPPS . The frequency of an identified pain, symptoms of the lower urinary tract in detail the structure of erectile dysfunction and its relationship between the presence and severity of pain and urinary disorders.

This article presents the results of treatment of patients with ureterolithiasis, who had the transurethral ureterolithotripsy. The article demonstrated the advantages and disadvantages of various kinds of energy at endoscopic treatment of ureterolithiasis.

A study of staghorn nephrolithiasis pathogenesis with aim of stone prevention has particular importance. Knowledge of urine stones’ chemical structure is a basic in individual metaphylaxis. A complex biochemical analysis of blood and 24-hours urine for mineral disturbances detection in 136 patients with staghorn stones was performed. An x-ray analysis for detection a mineral structure of 130 stones was done. An analysis of chemical structure of stones and blood biochemical disturbances showed the typical changes of metabolism in specific stones only in 56,9% cases, which make an understanding of processes underlying stone formation more complicated.

Purpose: Determination of effectivity on the basis of estimation the activity KKS and NS in dynamics standard and biocontrol magneticlaser therapy patients with CAP/CPPS IIIA.Materials and Methods: 1st group - 42 patients with standard therapy and 2nd group – patients with biocontrol MLT.Results: In the blood of patients 2nd group the activity of α1-PI (рв

Objective: The purpose of this study was to evaluate the effectiveness of the drugs Solifenacin and Vesusten in relation to the treatment of neurogenic bladder overactivity in multiple sclerosis (MS)., Materials and Methods: A prospective, single-site, single-center, placebo-controlled, parallel-group, comparative clinical trial was conducted. The study included 41 MS patients of both sexes aged 18-50 years with urodynamically confirmed detrusor overactivity. Data were obtained by completing a voiding diary. Clinical data were assessed before taking the drugs, during a monthly course of therapy and after a month of observation after the end of treatment. The results were processed by nonparametric methods of statistical analysis., Results: Both drugs are effective in patients with MS to correct neurogenic bladder overactivity. At the same time, in comparison with Solifenacin, Vesusten showed better clinical efficacy in relation to clinical manifestations of overactive bladder (OAB). Pollakiuria and urgency also decreased significantly. The best profile of maintaining the therapeutic effect was observed with Vesusten in relation to the frequency of urinary incontinence and OAB syndrome. The results of the study established that Solifenacin and Vesusten can cause adverse events, the frequency and nature of which correspond to the data declared by the manufacturers., Discussion: Considering the clinical features of MS, the priority in treatment, in addition to effectiveness, is maximum conservative therapy. The currently recommended therapy for neurogenic bladder overactivity is limited to the use of M-anticholinergics and intradetrusor administration of botulinum toxin type A drugs. At the same time, multiple side effects of such treatment are observed with a high frequency. The emergence of a new effective therapeutic agent is a promising direction for the treatment of neurogenic bladder overactivity in patients with MS., Conclusions: Both Solifenacin and Vesusten are effective therapeutic options for the management of neurogenic bladder overactivity in MS. However, Vesusten has a more significant therapeutic profile, expressed in the correction of pollakiuria, urge incontinence and urgency. After completion of therapy, Vesusten, in comparison with Solifenacin, demonstrates the retention of a strong therapeutic effect. Based on the combination of various assessment parameters of a voiding diary, Vesusten is a priority therapeutic agent that determines the best quality of life profile for patients with MS.