Search

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.

Background. Bladder neck preservation during retropubic radical prostatectomy (rRP) promotes a protective effect on urinary continence compared to standard rRP.Aim. To assessment of possible predictors for positive surgical margin (PSM) recognition is an important step.Materials and methods. 136 patients with localized prostate cancer (PCa) were studied in the study. Group 1, 90 patients (retrospective assessment), underwent standard rRP, group 2, 46 patients (prospective assessment), underwent rRP modified by bladder neck preservation with a part of the proximal prostatic urethra. The clinical and pathological stages of PCa were assessed; the groups were compared to the parameter PSM. Statistical analysis was performed using nonparametric statistical methods.Results. Both groups were comparable in age and baseline total prostate specific antigen (PSA) but differed in prostate volume and Gleason score. Also, there were differences in clinical and pathological stages of PCa. PSM-patients had more aggressive PCa according to the International Society of Urological Pathology (ISUP) and TNM classifications and had higher progression risk prognosis stages. In PSM-patients, correlations were determined between prostate volume and baseline Gleason index (r = 0.338; p >0.05); baseline total PSA and Gleason score before (r = 0.529; p >0.05) and after (r = 0.310; p >0.05) rRP, respectively. Nevertheless, the incidence of PSM among all subjects was 6.6 % of cases, while in groups 1 and 2 was 7.8 and 4.3 % of cases, respectively. In this way, surgical techniques that maximize bladder neck preservation with a part of proximal prostatic urethra have no significant effect on PSM. Ranges of total PSA, clinical stage of PCa, Gleason score and progression risk stages (prognostic group for PCa) were determined as predictors of PSM. Their use will make it possible to establish patient selection criteria for bladder neck preservation with proximal prostatic urethra during rRP.Conclusion. The identified predictors will allow determining during clinical staging minimal risks of detecting PSM. The rRP modified by bladder neck preservation with part of the proximal prostatic urethra does not increase the incidence of PSM compared to the standard rRP. The feasibility of this technique should be related to total PSA, clinical stage of PCa, Gleason score, and the progression risk stage.

Introduction Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented. Materials and methods The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width. Results No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring. Conclusion The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.

Introduction Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis. Objective to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches. Materials and methods In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months. Results Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period. Conclusion Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.

Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented.The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width.No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring.The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.

Background To date, knowledge about the effects of testosterone (T) on the cardiovascular system of men remains controversial and requires additional research. Especially the putative impact of T replacement therapy (TRT) on lipid metabolism and endothelial dysfunction as a starting mechanism for the development of cardiovascular pathology in men with type 2 diabetes mellitus (T2DM) presenting with T deficiency has to be elucidated. The aim of this work was to evaluate the effect of T replacement therapy on lipid metabolism and function of endothelium in men with T2DM and hypogonadism. Methods The study included 95 men (mean age 55,3±2,4 years) with T2DM and late onset hypogonadism, established according to EAU 2015 criteria. Parameters of carbohydrate and lipid metabolism, as well as ultrasound assessment of flow-mediated dilatation of the brachial artery (FMD-BA) and intima-media thickness (IMT) of brachial arteries were performed at baseline and after 9 months. Patients were randomized into 2 groups: 1 - 45 men receiving TRT, using 1% transdermal T-gel and 2 (control group) - 50 men, who were not assigned to TRT. Statistical analysis was carried out using the Wilcoxon - test for repeated measurements (STATISTICA 10 software package). Results During the treatment period no serious adverse events were registered. The study revealed a significant decrease in HbA1c (p Conclusion TRT in men with T2DM and T deficiency leads to an improvement in carbohydrate and lipid metabolism together with a significant decrease in IMT and enhancement of endothelium vasomotor function, seems to facilitate a reduction in cardiovascular risk. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Russian Science Foundation

Postoperative stress urinary incontinence has a significant effect on reducing the quality of life of patients undergoing radical prostatectomy. This review discusses the existing methods for correcting this condition, described in the world literature and which to one degree or another improve the quality of life of patients in this category. Analysis of present data shows that currently there are 4 main basic techniques during radical prostatectomy, which allow to statistically significantly improve of functional results. In particular, usage of this methodic allows reducing the frequency and degree of postoperative incontinence: 1) preservation of neurovascular bundles, 2) anterior and/or posterior reconstruction of the fascial spaces of the pelvis, 3) preservation of the maximum length of the membranous urethra, 4) reconstruction of the bladder neck. Preservation of the neurovascular bundles, anterior and/or posterior reconstruction of the pelvic fascial spaces have already proven themselves as effective techniques currently used by many surgeons. In contrast, the clinical utility of reserve the maximum possible length of the membranous urethra and reconstructive surgery of the bladder neck are relatively new techniques. Their clinical usefulness, as well as safety, continues to be studied.

Effects of testosterone (T) on the cardiovascular system of men remain controversial. The impact of T-replacement therapy (TRT) in men with functional hypogonadism and type 2 diabetes mellitus (T2DM) has to be elucidated. This study included 80 men (mean age 51.5 ± 6.3 years) with newly diagnosed T2DM (according to ADA criteria) and functional hypogonadism (according to EAU criteria). Randomization: Group1 (

AIM To examine the structure of the prostate tissue in patients with III B chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS The study analyzed transrectal fine-needle biopsy specimens of 10 patients with the verified diagnosis of chronic pelvic pain syndrome/category III B chronic prostatitis (CPPS/IIIB CP) according to the National Institutes of Health classification. Tissues were examined using light and electron microscopy, and immunohistochemical study of the expression of CD31, CD34, NSE and S-100 markers. RESULTS All biopsy specimens of all patients showed fibroplastic changes of the prostate tissue most markedly pronounced in the stroma and muscle fibers in the form of total fibrosis, myofibril atrophy, and extracellular lipofuscin deposition. The examination revealed a significant reduction in the density of microcirculatory bed vessels and arteriolar luminal stenosis, a reduction in the number of nerve fibers, and compression of their fibrous tissue. No inflammatory changes were found in the prostate. DISCUSSION In patients with CPPS/IIIB CP, the changes in the prostate at the microscopic and ultrastructural levels are characteristic of severe chronic tissue hypoxia, which leads to the development of fibrosis resulting in stenosis of microcirculatory bed vessels and degenerative changes in nerve fibers and cells. No signs of an inflammatory reaction in the examined tissue were established. CONCLUSION Changes in the prostate tissue in CPPS/IIIB CP suggest the presence of chronic pelvic ischemia and exclude its association with inflammation as the main pathological process.

Background To date, the currently available data aboutthe effect of testosterone (T) on the cardiovascular system of men are highly controversial. The particular interest is its effect on the endothelium in men with type 2 diabetes mellitus (T2DM) having a high risk of vascular complications. The purpose of this work was to evaluate the effect of endogenous T on function of endothelium in men with T2DM. Methods The study included 204 men, aged 40–65 years, with T2DM. Patients underwent clinical examinations, analysis of carbohydrate metabolism, evaluation of biochemical parameters of endothelial function such as nitric oxide (NO), endothelial synthase type 3 (eNOS3), VCAM-1, ICAM-1, p- and e-selectins, endothelin. The ultrasound assessment of flow-mediated dilatation of the brachial artery (FMD-BA) and intima-media thickness (IMT) of brachial arteries were performed. Patients were divided into 2 groups: 1 – 93 men with late onset hypogonadism established according to EAU 2015 criteria and 2 – 111 men having normal level of endogenous T and absence of clinical symptoms of hypogonadism. Statistical analysis of the data was carried out using the Mann-Whitney U-test (STATISTICA 10 software package). Results The parameters of carbohydrate metabolism and the duration of T2DM were comparable in two groups. The concentrations of NO (85.0 [60.4; 210.4] vs 137.5 [87.8; 281.5] μmol/l, p=0.001) and eNOS3 (192.2 [109.6; 407.3] vs 293.3 [117.1; 686.2] pg/ml, p=0.03) were lower in the 1st group compared to the 2nd one. There was an increase in the levels of VCAM-1 by 32.6% and ICAM-1 by 43% (p Conclusion T deficiency in men with T2DM leads to endothelial dysfunction, decreasing secretory and vasomotor function of endothelium. This indicates the raise of cardiovascular risk and predicts progression of vascular complications in men with T2DM and late onset hypogonadism. Acknowledgement/Funding Supported by Russian Science Foundation, grant #14-25-00052.

Prostatitis is considered as heterogeneous group of the diseases attracting broad interest of researchers worldwide. The acute and chronic stages of the process, as particular categories of bacterial prostatitis, remain in the realities of modern practical and scientific urology with lively discussions. Despite a large number of domestic and international publications, consensus on many topical issues of bacterial prostatitis is currently not achieved. The true incidence and prevalence of bacterial prostatitis in various regions of the world has not been finally determined. The exhaustive data concerning the etiological structure, mechanisms of development and persistence of the inflammatory process in the prostate tissue are not presented. At the same time, new risk factors that can influence the development and progress of these diseases are identified and discussed. Researchers review algorithms for examining patients, obligate spectrum of diagnostic methods, as well as the desirability of using the newest investment means necessary for the successful verification of the diagnosis taking into account the development of modern medical technologies. This review describes in detail the various aspects of the epidemiology and etiology of bacterial prostatitis, based on an analysis of major literature sources in conjunction with its own scientific facts.

To examine the structure of the prostate tissue in patients with III B chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS).The study analyzed transrectal fine-needle biopsy specimens of 10 patients with the verified diagnosis of chronic pelvic pain syndrome/category III B chronic prostatitis (CPPS/IIIB CP) according to the National Institutes of Health classification. Tissues were examined using light and electron microscopy, and immunohistochemical study of the expression of CD31, CD34, NSE and S-100 markers.All biopsy specimens of all patients showed fibroplastic changes of the prostate tissue most markedly pronounced in the stroma and muscle fibers in the form of total fibrosis, myofibril atrophy, and extracellular lipofuscin deposition. The examination revealed a significant reduction in the density of microcirculatory bed vessels and arteriolar luminal stenosis, a reduction in the number of nerve fibers, and compression of their fibrous tissue. No inflammatory changes were found in the prostate.In patients with CPPS/IIIB CP, the changes in the prostate at the microscopic and ultrastructural levels are characteristic of severe chronic tissue hypoxia, which leads to the development of fibrosis resulting in stenosis of microcirculatory bed vessels and degenerative changes in nerve fibers and cells. No signs of an inflammatory reaction in the examined tissue were established.Changes in the prostate tissue in CPPS/IIIB CP suggest the presence of chronic pelvic ischemia and exclude its association with inflammation as the main pathological process.

Extracorporeal shock wave lithotripsy (ESWL) has proven efficacy in the treatment of proximal ureteral stones. The research to date has not been able to establish real time to spontaneous stone clearance after ESWL and the appropriateness and effectiveness of -blockers in stimulating residual stone clearance after ESWL. AIM To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance. MATERIALS AND METHODS ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. RESULTS Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. CONCLUSION Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

The current literature is lacking sufficient coverage of the relationship between erectile dysfunction (ED) and diabetes mellitus (DM), and age-related hypogonadism. At the same time, the mutual impact of cardiovascular and endocrine systems on men erectile function and the resulting damage of male sexual organs are being studied and debated. This prospective, randomized, simple comparative study examined the erectile function of 131 men with type 2 DM and age-related hypogonadism, tested the effects of DM on serum testosterone, formed an idea of possible relationship between DM, severity of ED and testosterone levels, degree of endothelial dysfunction and the involvement of the testicles. The study results showed the impact of testosterone level on the compensation of DM and frequency of ED. Correlations were observed between testosterone levels, peak systolic velocity of blood flow in the of capsular arteries of testes and testicular size. The interrelation between testicular size, reduction of testicular blood flow, and DM-related endothelial dysfunction and variability of serum testosterone levels was found. The findings suggest the need for revising existing reference ranges for serum testosterone upward to 15 nmol/L.

This article presents results of a study conducted to identify the causes of stenosis in the region of vesico-urethral anastomosis (VUA) after radical prostatectomy (RP). Tissue specimens from removed prostates were evaluated in 115 prostate cancer patients with a favorable postoperative period (group 1) and 5 patients who develop VUA stenosis between 6 months to1 year after RP. It was found that in the group 1 inflammatory infiltration did not basically affect tumor growth zones, was mild and did not spread beyond the prostate. Patients of the group 2 had maximum inflammation, with the inflammatory infiltration localized in the prostate regions, both affected and not affected by the tumor, and periprostatically. Taking into account more severe inflammatory response in the prostate with extracapsular extension of the process and the involvement of periprostatic structures in patients who developed VUA stenosis after RP, compared to those without VUA stenosis, we can consider this phenomenon as a risk factor for stenotic complications in the vesico-urethral segment after RP.

Expert panels of AUA and EAU defined highly effective approaches to surgical treatment of ureterolithiasis and recommended extracorporeal and contact lithotripsy as the main options. Therapeutic strategy for ureteral stones measuring less than 10 mm is clearly defined and supported by the Russian Society of Urology. At the same time, the views of researchers on the management of large ureteral stones vary. This literature review provides information on the results of extracorporeal shock-wave lithotripsy and contact ureterolithotripsy of large stones located in various parts of the ureter. Besides, the article outlines the results of treating ureterolithiasis using the second line surgical modalities.

Type 2 diabetes mellitus, as a chronic systemic metabolic disease, is widely spread in the population of middle- aged men. Previously it has been proven the link between the presence of type 2 diabetes and the development of lower urinary tract symptoms in men. At the same time, middle-aged men are characterized by the appearance and progression of benign prostatic hyperplasia.We performed a study of middle-aged men with type 2 diabetes to determine the interrelation of micturition disorders with deficiency of serum testosterone, in respect that the pathophysiology of prostatic hyperplasia is regarded as dysmetabolic dyshormonal state. The prospective study examined 112 men with type 2 diabetes randomized by the level of total testosterone. Lower urinary tract symptoms were assessed by I-PSS questionnaire. The study of serum total PSA, uroflowmetry, transrectal prostate ultrasonography were performed.As a result of the study the association between the severity of type 2 diabetes mellitus and the decrease in total testosterone levels was determined. The relationship of testosterone deficiency and the frequency of the presence and severity of lower urinary tract symptoms were demonstrated. The dependence of the prostate hyperplasia risks progression with the level of serum testosterone was found.The association of testosterone deficiency with frequency and severity of lower urinary tract symptoms, partially related with benign prostatic hyperplasia and clinically defined detrusor cistopathy, has been proven. Further clinical studies are needed to determine the pathophysiological and pathomorphological features of type 2 diabetes, which determines the development of detrusor cistopathy and late onset hypigonadism.

The current literature provides a wide range of publications on the anthropometry of the penis specifying the relationship between penile dimensions and sex hormones, weight, height and erectile function. But most of the studies involved healthy volunteers or young patients with erectile dysfunction. Our study was conducted in patients with type 2 diabetes. Penile measurements obtained in the present study were compared those of the average Russian man. The patients were divided into groups with preserved and impaired erectile function. Erectile function was also studied relative to the variability of penile dimensions. The effect of DM duration on erectile function was defined. Comparative analysis revealed the relationship between penile anatomical dimensions and erectile function. We studied the effect of type 2 diabetes on the anatomical dimensions and elasticity of the penis, established the relationship between penile dimensions and elasticity of the penis. The correlation between the severity of erectile dysfunction and serum testosterone levels on one side, and penile dimensions on the other was found. The effect of penile dimensions on erectile function in DM patients was also examined. Determining penile dimensions and their variability due to various pathological conditions or processes, may eventually lead to better result of ED management.

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.

In recent years, treatment of men with testosterone deficiency has become an important part of andrological and urological practice. Clinical manifestations of testosterone deficiency syndrome are usually diverse. Testosterone deficiency and erectile dysfunction often occur against the background of some systemic diseases, and sometimes are markers or predictors of these diseases. It is important that erectile dysfunction and testosterone deficiency syndrome are closely interrelated, and the correction of these conditions requires account of specific treatment of both diseases.

The evaluation of some indicators of blood proteolytic systems and their role in the development of endothelial dysfunction in noninflammatory form of chronic prostatitis abacterial (CAP III B) was performed. The association between the activity of blood proteolytic systems and endothelial damage in patients with CAP III B was examined. Indicators of blood kallikrein-kinin system and renin-angiotensin system (activity of kallikrein, alpha1-proteinase inhibitor, alpha2-macroglobulin, total argininesterase activity, activity of angiotensin converting enzyme, prekallikrein content) were evaluated in 32 patients with CAP III B before and after occlusive bronchial test. It was established that a violation of endothelium-dependent vasodilation is accompanied by an imbalance of pro- and antiproteolitic blood systems.

The widespread introduction of percutaneous nephrolithotomy has led to a significant narrowing of the traditional indications for surgery for staghorn calculi. We analyzed the efficacy and safety of percutaneous nephrolithotomy, depending on the stage ofstaghorn nephrolithiasis. In a period of 2008-2011, 120 patients with staghorn calculus underwent percutaneous nephrolithotomy. Data from spiral computed tomography were used in planning the surgical approach. In the preoperative period, staghorn calculi SN1-SN2 were diagnosed in 31.7% of patients (Group 1), and complex forms of stones corresponding SH3-SN4--in 68,3% (Group 2). The between-group analysis showed that the average time of surgery was significantly (p0,01) higher in patients in Group 2, the same group reported more frequent blood loss requiring to stop operation, as well as hyperthermia, hypotension during surgery, but the difference was not significant compared to Group 1 (p0,05). Conversion to open surgery was required in 2,6 and 2,7% of patients in Group 1 and Group 2, respectively. Application of PNL allowed to completely remove SN1-SN2 calculi in 94,7% of cases in Group 1, but similar result was achieved only in 63.4% of cases in most difficult group of patients with SN3-SN4.

From November 2010 to December 2011, 56 patients with coral nephrolithiasis underwent percutaneous nephrolithotomy. To assess the renal function before surgery and before discharge (6 to 7 days after surgery), glomerular filtration rate (GFR) by Cockcroft-Gault equation was defined. Preoperative renal functional reserve was evaluated by method using a single oral loading of protein drugs. 46.4% of patients have decreased GFR before surgery, and before discharge the proportion of such patients was 39.3%. In 80% of patients with reduced GFR, postoperative filtering function of the kidneys in response to a protein load was increased, but did not reach the pre-operative no-load values, and in 7.5% of cases corresponded to a load indicators. Filtering function of the kidneys before discharge below baseline and load levels was observed only in 8.9% of cases. The data obtained in most cases allowed to predict GFR decline in the postoperative period in patients with coral nephrolithiasis. 87.5% of patients before surgery were characterized by the absence of renal functional reserve, but in 28.6% of patients in the postoperative period there was an increase in GFR, indicating the positive impact of endoscopic percutaneous nephrolithotomy on the functional state of the kidneys in the immediate postoperative period.

The study examined symptomatology in 74 patients with chronic abacterial prostatitis. The features of blood lipid metabolism in inflammatory and noninflammatory forms of disease are redefined. Dynamic characteristics of arterial blood flow in the prostate gland of patients with chronic abacterial prostatitis are determined. Comparative analysis between groups revealed significant differences in some indices of blood lipid profile, and arterial flow velocity parameters of the prostate in patients studied; correlations between the intensity of pain, the type of dyslipoproteinemia and arterial ischemia of the prostate are shown. The feasibility of analysis of the blood lipoprotein spectrum in the differential diagnosis of inflammatory and noninflammatory forms of chronic abacterial prostatitis is demonstrated.

The article presents the results of neurophysiological examination of 32 patients with noninflammatory form of abacterial chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS III B). Intramuscular electromyography was performed, right and left bulbocavernous reflex and cortical somatosensory evoked potentials during stimulation of n. pudendus were evaluated. It is shown that there is a high frequency of abnormal neurophysiological patterns in the absence of clinical neurological disease in patients with CP/CPPS III B. In this case, the pain as the main symptom was not associated with prostate disease. It is suggested that some patients with a diagnosis of CP/CPPS III B have neurological pathology that not manifested at the time of the examination.

It is known that recurrent nephroliths form in about half of the operated patients within 5 years after operation while 60% of all recurrences occur 3 years after removal of the primary concrement. To prevent recurrent nephroliths, it is important not only to detect metabolic disturbances but also to investigate chemical composition of uroliths. Mineral composition of 112 stag-horn concrements from patients living in the south of Russia was studied with x-ray phase analysis which showed that 62.9% concrements had mixed composition. Compared to patients with primary stag-horn nephrolithiasis, patients with recurrent one more often had calcium-phosphate and calcium-oxalate concrements than urate concrements. Chemical composition of the concrements depended on features of the relief of the region where the patients live. Newly established mineral characteristics of stag-horn concrements in the citizens of south Russia should be taken into consideration both in surgical treatment and follow-up of such patients.

To assess efficacy of magnetolaser therapy (KAP-ELM-01 Andro-Gin unit) in the treatment of inflammatory chronic abacterial prostatitis (ICAP), 68 ICAP patients were divided into 2 groups. Group 1 patients (n = 33) received standard therapy. Group 2 patients received standard therapy plus magnetolaser (ML) therapy. The effect was assessed by the symptoms scale and indices of kallirrein-kinin system. After treatment pain relieved by 36,9%, on the average, in group 1 and by 63.1% in group 2. Lower urinary tract symptoms regressed insignificantly in both groups: by 4.8% and 7.1%, respectively. Quality of life improved by 27.6 and 65.5%, respectively. Kallikrein activity in prostatic secretion remained high in both groups. A 21.7% rise (p0.05) of prokallikrein level was seen after treatment only in group 2. Activity of KKS inhibitors (alpha2-MG and alphal-PI) in prostatic secretion normalized in group 2. Total activity of serin proteinases lowered in both groups (p0.05). High activity of alphal-PI (8.21 + 1.97 U/ml) persisted in group 1. Thus, standard treatment of ICAP does not result in biochemical normalization of prostatic secretion. ML therapy is more effective.

Charge transport and accumulation is investigated in SiO2 layers produced at 250 °C oxidation of monosilane and in SiO2 layers obtained in a high-vacuum system from SiO molecule flow in O2. It is found that the deposition of Al onto OH-containing SiO2 films an intermediate Al oxide layer influencing the charge transport is formed. SiO2 layers produced by two different techniques have the same characteristics of charge transport and accumulation. The charge transport is shown to be well described within the hopping mechanism of conduction among localized states near the middle of the forbidden zone of dielectric with a density of states of 1020 to 1021 cm−3 and a zone width of the localized states of ≈0.8 eV. The existence of localized states is proved by experiments on the accumulation of charge of both signs in the dielectric bulk. [Russian text Ignored.]