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The study of the genital system' vessels in patients with erectile disfunction and chronic prostatitis was accomplished using ultrasound Dopplerography and pharmacological testing by phosphodiesterase inhibitors of 5th type (PDEI-5). The positive impact of PDEI-5 (such as Sildenafil, Vardenafil, Udenafil and Tadalafil) on organs' blood supply was revealed. The changes of USDG parameters were found comparable and, at the same time, individual. For patient-specific choosing the medicinal agent it is advisable to perform the pharmacological tests for each patient. The choice of the medicine for treating erectile disfunction and chronic prostatitis should be made on the basis of the results of ultrasound Dopplerography and pharmacological testing for each selected and tested medicine. For this purpose it is preferably to choose the medicine, which improves the blood flow in penis and, at the same time, in prostate gland and in testes.

Epidemiology and prophylaxis of prostate cancer (CaP) has remained a pressing and challenging issue for many decades. One of its aspects is the role of food additives and diet which diff er for people of various regions. Multiple dubious epidemiologic and clinical studies on this issue warrant further clinical and experimental research into the role of vitamins and microelements in different stages of prostate cancer initiation and development. The use of complex clinical and histological evaluation of urologic patients and blood sampling is viewed for vitamins as well as lipid peroxidation products and 21 microelements. The test subjects included 115 male patients of the Urology clinic – 95 patients with different kinds of prostate gland oncopathology and 20 males without prostate pathology. The results have shown a statistically significant deviation of the levels of certain substances in the blood. Patients with CaP had reduced levels of antioxidants (lycopene, vitamin Е, germanium, selenium) and increased levels of pro-oxidants (aluminum and conjugated dienes). We have demonstrated that patients with high-grade prostatic intraepithelial neoplasia (HGPIN) have decreased blood levels of vitamin C, total carotenoids, germanium, selenium and increased levels of aluminum and conjugated dienes. Malignant transformation of prostate gland cells is associated with a decreased blood level of antioxidants (lycopene, carotenoids, vitamin Е, vitamin C, germanium, sulfur, selenium) and a increased level of pro-oxidants (aluminum and conjugated dienes). The aforementioned changes associated with the mechanism of prostate carcinogenesis are already detected in patients with HGPIN (precancer) with no further progression in patients with developed CaP.

Radiofrequency ablation is a minimally invasive treatment for local destruction, widely used in the combined treatment of kidney cancer. Application of radiofrequency ablation allowed to expand the indications for more radical treatment of kidney tumors in patients who may not perform traditional nephrectomy or partial nephrectomy due to extremely burdened somatic status. Efficacy and safety of RFA greatly increased when it is combined with presuperselective occlusion of blood vessels that feed the tumor. We have experience in the use of superselective embolization in combination with RFA when a kidney tumor is in two patients. In both observations obtained good results of combined treatment. In some patients, this combination (CCE + RFA) may be an alternative to open surgery, thus expanding the range of modern minimally invasive treatments for kidney tumors.

The aim of the research. We have a detailed representation of the results of our analysis of 21 microelement’s concentration in blood of patients with different forms of pathology of the prostate. We haven’t succeeded in finding similar works on great amount of microelements in prostate cancer and prostate precancer. This work is made in the clinics of urology, on the chairs of urology and biochemistry and in heavy metals diagnosis laboratory of nephrology, medical and professional diseases clinics (of the I.M. Sechenov First Moscow State Medical University).

The content of vitamins and relative biologically active substances including the products of lipids peroxidation has been studied in the blood of 115 males -patients of Department of Urology of I.M.Sechenov First Moscow State Medical University. The patients have been divided to four groups: prostatic carcinoma (PC); high grade prostatic intraepithelial neoplasia (HG PIN) or precancer; mixed group of conditional control – low grade PIN, benign prostatic hyperplasia, chronic prostatitis or their combination; control group of healthy men without prostate pathology. Further statistically reliable differences have been found: patients with PC had lower level of antioxidants – lycopene, vitamin E and enhanced level of diene conjugates (products of lipid peroxidation); patients with HG PIN low level of vitamin C, total carotenoids and increased diene conjugates. The difference in vitamins-antioxidants levels in patients with PC and HG PIN has not been found out.

Aim. Assessment of functional status of muscles of pelvic floor and conductive ability of corticospinal tract in healthy men and patients with erectile dysfunction (ED) with compiling the database of electromyography parameters.Methods. 52 patients with ED (age 23-67 years) and 12 healthy volunteers, serve as controls, were included into the study. Acicular electromyography of muscles of pelvic floor and magnetic stimulation of cortical and spinal centers with registration of induced motor response were performed.Results. In healthy volunteers referent database of electromyography parameters was developed - latence of cortical and segmental period of motor response, period of central motor conduction, amplitude of action potential. Patients with ED were characterized with disturbances of conduction in corticospinal tract - increase of latency of period of cortical and segmental motor response >10%, prolongation of period of central motor conduction >15%, and decrease of motor unit potential amplitude. Among electromyography parameters spontaneous activity of muscle fibers and poliphasy of motor unit potential demonstrated ongoing process of denervation. In 80% patients with ED and chronic pelvic pain signs of ongoing denervation-renervation process were revealed. In patients with ED and inflammatory diseases of lower urinary tract signs of denervation- renervation are rare and, if present, are minimal.Conclusion. Denervation processes in pelvic floor muscles should be considered in clinical assessment of patients with ED.

The aim of this research is to investigate the effectiveness of m-holinolitics of those patients who have unsatisfactory results in transurethral resection of a TURP prostate. One of the most common diseases among older men, the benign prostate’s hyperplasia is a major medical and social problem nowadays.

This article deals with the problem of bone metabolism in the case of locally advanced prostate cancer.

Nowadays, the most notable negative effects of SARS-CoV-2 are the pulmonary manifestations as well as cardiovascular system damage. Evaluation of postvaccination changes in the male reproductive system and analysis of their mechanisms seem to be important because of their direct effect on fertility. Thus, it may play a significant role in perspective. Studies based on the application of fluorescence in situ hybridization showed that most acini epithelial cells, as well as some mesenchymal and endothelial cells were positive for SARS-CoV-2 RNA. As for co-expression of the ACE2 cell receptor and the serine protease TMPRSS2, which the virus uses to enter cells, it was also detected in most prostate epithelial and stromal cells. The mechanism of prostate damage in COVID-19 may also be related to dysregulation of the renin-angiotensin system. Increased levels of angiotensin-2 secretion in the prostate in patients with benign prostatic hyperplasia may increase the effect of the virus directly on the cells of the organ. These mechanisms may explain the elevated serum prostatic specific antigen levels in patients with benign prostatic hyperplasia during the active period of COVID-19. Non-specific mechanism of prostate damage is connected with coagulopathy development – thrombosis of venous plexus and hemodynamic disturbances, which can cause secondary damage of parenchyma. There is a definite relationship between the hormonal status of the patient and the severity of the infection – low levels of both testosterone and dihydrotestosterone contribute to the development of severe complications in patients infected with SARS-CoV-2. The possibility of using testosterone drugs in patients with hypogonadism and COVID-19 as an alternative treatment option – to suppress the cytokine storm phenomenon – is being considered. Patients with a history of prostate cancer, with localized prostate cancer in the absence of metastases participated in vaccine studies – among the side effects of vaccination in several cases only regional lymphadenopathy on the injection side of the drug was noted.

The article under consideration deals with the problems of personalized approach to the assessment of the androgenic status of men with ramex.

Introduction. An original research work was performed to assess split kidney function by glomerular filtration rate (GFR) with mathematical analysis of the kidneys computed tomography (CT) data in patients with kidney stone disease (KSD). Objective was to evaluate the GFR and the parenchyma structure of each kidney and identify the possible patterns of contrast medium intrarenal transport with mathematical analysis of the kidneys CT data in patients with KSD.Materials and methods. Data of 27 patients of both genders with KSD were retrospectively analyzed. To evaluate GFR separately for each kidney we analyzed the data of contrast-enhanced CT (GFR reference values are 0.55 % of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size ≤1,5-2,0 cm, no obstruction of the urine flow registered; 3) no kidney or upper urinary tract surgical history; 4) age - ≤45 years; 5) no severe chronic diseases. All of these allowed to minimize influence of any other disorders on split renal function except for SKD and conduct per se research.Results. The mathematic analysis of the contrast-enhanced CT data revealed GFR changes in 26 (96.3 %) out of 27 patients. Hyperfiltration was found in 12 (44.4 %) patients: right kidney GFR - 0.6-0.77 %, mean value - 0.65 %; left kidney GFR - 0.59-0.79 %, mean value - 0.67 %. Hypofiltration was found in 13 (48.1 %) patients: right kidney GFR - 0.2-0.54 %, mean value - 0.37 %; left kidney GFR - 0.2-0.53 %, mean value - 0.4 %. The GFR values significantly differed between the groups both for the right (p = 0.000014) and left (p = 0.000045) kidneys. We found no significant age-related difference between the groups (p = 0.895). As well as that no significant differences in Resistance Index both in magistral (right kidney: p = 0.221; left kidney: p = 0.850) and segmental (right kidney: p = 0.306; left kidney: p = 0.957) arteries between the groups with hyperfiltration and hypofiltration were observed. One patient demonstrated no changes in GFR, and the other one had hyperfiltration (0,62 %) in one kidney and hypofiltration (0,48 %) in another.Conclusion. Most of the patients (92.6 %) with SKD demonstrate GFR changes (either hyperfiltration or hypofiltration) that may indicate the disturbed intrarenal blood and urine flow through the kidney.

Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

Introduction. Urethral transposition remains the most popular operation for postcoital cystitis, however, traumatism and complications, especially such as pudendal neuropathies, dyspareunia and anorgasmia, make us continue to search for effective, but safer techniques.The study objective is to evaluate the efficacy and safety of the proposed treatment of postcoital cystitis, including removal of urethrogymenal adhesions and subsequent paraurethral filler implantation, in comparison with isolated hymenoplasty.Materials and methods. Since 2013, 75 patients with postcoital cystitis have been treated. Patients were divided into two groups: main group – hymenoplasty (removal of urethral adhesions) with paraurethral filler implantation (n = 45), control group – hymenoplasty (n = 30). The gel was injected paraurethrically, fan-shaped, in the volume of 1–2 ml, from a point on the 6-hour conditional dial, creating a gel cushion and thus raising the meautus and distal urethra. To assess the quality of treatment, profile questionnaires were used.Results. In the main group of patient, the quality of life improved in 35 (78 %); in 5 patients, due to the process of biodegradation of the gel during 1 year, the cystitis recidivated, which required the filler reimplantation. In 5 patients, the operation was not effective. In the control group the efficiency of isolated hymenoplasty was noted in 3 (10 %) patients, relapse of cystitis occurred in 27 (90 %) patients, which later required the implantation of a filler. No complications were observed.Conclusions. The suggested combined technique allows to improve the results of treatment of patients with postcoital cystitis. The operation does not carry the risk of damage to the sprigs of the genital nerve, can serve as an alternative to traditional urethral transposition. The main disadvantage is the natural biodegradation of the gel, which may create the need for its reintroduction.

Prostate cancer (PCa) is the most common oncological disease among men. It is important to note that over 50% of the first identified primary malignant neoplasms of prostate are low - risk PCa. Recently, radical prostatectomy and external beam radiation therapy have been the standard treatment options for PCa. According to recent data, patients with low - risk PCa have a favourable prognosis because of the slow progression of the disease. Some studies show no links between 10-year cancer - specific survival and treatment modalities and no progression even in the absence of therapy. Active surveillance (AS) allows avoiding unnecessary treatment in men who do not require immediate intervention but achieves the correct timing for curative treatment in those who eventually need it. According to the guidelines of the European Association of Urology, AS is one of the standard treatment options for low - risk PCa and should be consideredfor all patients in this category. The advantage of AS is to improve the quality of life in men with low - risk PCa and to delay surgical interventions as much as possible. However, despite widespread AS worldwide, there are only a few centres, which use it routinely in Russia. In this review, we would like to shed some light on the most important questions of AS strategy: what criteria should we use for selection of patients for AS strategy? How often should patient visit the urologist, control PSA level, and undergo prostate biopsy? When should a doctor change strategy and turn to active treatment? In this article, we considered indications for AS in men with PCa and showed the most recent data on the efficacy and relevance of this modality.

Introduction. Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical removal of prostate adenoma. It allows to quickly remove infravesical urinary tract obstruction, but at the same time it increases the risk of erectile dysfunction, one of the most important possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in urological practice.The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution of modern laser technologies and changes in approaches to preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of EF disorders after endoscopic surgeries for BPH removal, as well as to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction.Conclusion. According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its recovery is significantly quicker after ThuLEP; therefore, the last method is recommended for patients interested in quick EF recovery.

The article presents the study of the conditions and lifestyle of students in 37 medical schools. The comprehensive study of the factors shaping the health of the student in a manner involved the social, economic, and psychological characteristics of the study subjects. To obtain a general picture of the student health status, we studied the external factors of the student health in a holistic approach based on five main components: physical health (nutrition, sleepest, illness), spiritual health (selfrealization, plans for the future), social health, intellectual health (education, leisure), emotional health. The data analysis revealed correlation between individual indicators, assessed the contribution of individual components to the students life quality. Managed and conditionally managed priority risk factors were identified, their relationship with the student health was established, and the effect of their reproduction and impact on morbidity was determined. The paper presents modern approaches to the student health culture based on a systematic application of the latest health practice and science achievements. In detail, the main evolutionary factors of a healthy lifestyle are revealed, taking into the account the peculiarities of the student adaptation to the educational process.

The latest guideline of the European Association of Urology (2016) for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH).Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium) of the prostate according to the literature data and own observations.Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP), 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP). All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS), patients’ quality of life (QoL), peak flow rate (Qmax), and residual urine volume prior to surgery and 1 month after it.Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05)Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

The article presents data on the state of health of modern youth and organizational forms of rendering medical and preventive assistance for medical university students in Russia. The article provides an overview of student health status and health care activities, the sources of information on healthy lifestyles. The article discusses subjective factors of health and healthy lifestyle: diet, student and sports leisure time activities, bad habits. The article summarizes the long work results on both general theoretical-methodological approaches and practical mechanisms of health care activities organization and management in university students; the basic shortcomings of medical care for this cohort. The article puts forward options for disease prevention and rehabilitation optimization in university students. The problem requires a new approach to guarantee the quality health care for university students, innovative forms of organization, establishment of uniform model of student health management.

Holmium laser enucleation of the prostate (HoLEP) was first described by doctor P.J. Gilling et al. from New Zealand in 1996. The operation involves anatomical dissection of the prostatic tissue off the surgical capsule using a high-powered holmium laser followed by intravesical morsellation. The objective of this article is to explain the techniques for HoLEP.

The article describes a novel technique of performing transurethral cystolithotripsy in gas (carbon dioxide) medium, and the results of its first usage in 30 patients with bladder stones, compared to transurethral cystolithotripsy in conventional liquid medium in 30 patients. Data analysis shows that the rate of stone destruction in gas media was 1.47 times higher in small (less than 10 g) stones and 2.3 times higher in large (more than 10 g) stones as compared to surgeries conducted in liquid media. Also, we concluded that our proposed technique is safe and has advantages when compared to conventional surgery in liquid media. This is absence of increased stone mobility, better visualization during surgery and higher economic efficacy (5 times on average).

The paper gives the results of examination in 701 patients with suspected prostate cancer (PC) who have undergone histoscanning, followed by prostate biopsy and comparison of the results of histoscanning with those of other noninvasive diagnostic methods for PC and morphological conclusion after biopsy. The sensitivity and specificity of histoscanning procedures were determined in patients with different degrees of risk for PC progression.

Training of muscles of a pelvic bottom under control of biofeedback is applied at 87 patients with an urinary incontinence after a radical prostatectomy. Biofeedback increases management and control of a pelvic floor. At good ability of management of muscles of a pelvic floor the median of restoration was 4 months. Without opportunity of management of muscles of pelvic floor restoration was 9.4 months.

Aim: to examine androgenic status in men after surgical treatment of varicocele; to investigate genotype GSTT1 and GSTM1 in patients with pathozoospermia. Thirty men after surgical treatment of varicocele were recruited to this study. All subjects were evaluated by history, physical examination, semen analysis, serum FSH, LH, E2, PL, inhibin B and total testosterone determination. GSTT1, CSTM1 gene polymorphisms were determined by polymerase chain reaction. Total testosterone and inhibin B levels were significantly lower in patients with pathozoospermia. Patients with the GSTM1(-) genotype had lower sperm concentrations than those with the GSTM1(+) genotype.Our results suggest that the GSTM1(-) genotype is risk factor for androgen deficiency and pathozoospermia.

The paper discusses the specific features of the current course of acute glomerulonephritis, the spectrum of its etiological factors, and clinical manifestations. The factors influencing the course and outcomes of acute glomerulonephritis, including the risk of its progression to chronic kidney disease, are specially depicted.

The paper discusses current approaches to organizing a diagnostic process in health care facilities. It describes approaches to improving patient examinations in multidisciplinary hospitals.

The paper describes a case of Fabry disease in a patient in whom kidney biopsy enabled the renal lesion be characterized in detail. Fabry nephropathy-associated kidney tissue changes, including renal lesion, have been verified using electron microscopy of renal tissue.