This comprehensive review article provides an in-depth analysis of the developmental trajectory of urology over the past five decades within the USSR, contemporary Russia, and the international medical community. The manuscript delineates the author’s scholarly observations regarding the progressive augmentation of the intellectual demands inherent to the urological specialty, while also presenting a prognostic framework for its future evolution and potential advancements within the medical field.

Introduction. Chronic uncomplicated recurrent cystitis denotes the presence of frequent disease exacerbations in the absence of complicating factors. The identification of inflammatory process markers within the bladder wall is of paramount importance, as these markers enable the detection of inflammation in cases of normal urine test results and facilitate the prediction of recurrence risk and the severity of cystitis progression.
Objective. To investigate the cytokine profile in blood and urine samples of female patients diagnosed with chronic recurrent cystitis.
Materials & methods. The prospective study enrolled 33 female participants with a confirmed diagnosis of chronic (recurrent) uncomplicated cystitis. At the time of blood and urine sample collection, all study participants presented with recurrent chronic pelvic pain and/or pressure, bladder discomfort, and lower urinary tract symptoms. All patients in the study group underwent cystoscopy within bladder wall biopsy. The control group comprised 27 healthy women of reproductive age. The investigation involved the analysis of calprotectin, interleukin-6 (IL-6), tumour necrosis factor, and vascular endothelial growth factor (VEGF) levels in urine and blood samples from both study groups.
Results. Statistically significant differences were identified in the levels of blood calprotectin, vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and urine calprotectin. The concentrations of these cytokines were elevated in the study group compared to the control group. Notably, while Student’s t-test for blood calprotectin approached the significance threshold (p ≈ 0.05), urine calprotectin demonstrated robust diagnostic significance (p = 0.0000). Elevated urinary VEGF levels were observed in the study group patients, suggesting an association with bladder wall hypoxia and inflammation. A direct moderate-strength correlation was established between chronic recurrent cystitis and both urinary calprotectin (R = 0.649, p = 0.0000) and leukocyturia (R = 0.519, p = 0.0000). Pathomorphological examination of the bladder wall in all study group patients revealed an inflammatory process, with 63.6% of cases exhibiting squamous cell metaplasia of the urothelium in the Lieto triangle. The potential key role of increased S100A8/ S100A9 expression on the bladder squamous cell epithelium surface in urinary disorders and chronic processes cannot be ruled out. Importantly, our data indicate that calprotectin can induce abacterial inflammatory processes in the bladder wall without concomitant leukocyte elevation in urine. Consequently, calprotectin exhibits particularly high diagnostic value as a bladder wall inflammation marker, especially in cases of normal urine test results.
Conclusion. The study demonstrates significantly elevated levels of urinary calprotectin, vascular endothelial growth factor (VEGF), and interleukin-6 (IL-6) in female patients diagnosed with chronic recurrent cystitis. Notably, the presence of leukocyturia does not influence urinary calprotectin and VEGF concentrations.Calprotectin emerges as a promising biomarker for detecting inflammation within the bladder wall. Its utility extends to both assessing the inflammatory process activity and evaluating therapeutic efficacy.

Introduction. Suburethral sling surgery has been successfully used for the treatment of female urinary incontinence (UI) for several decades. In addition to high efficacy, there are unresolved problems associated with the high recurrence rate of UI and re-emerging lower urinary tract symptoms associated with iatrogenic infravesical obstruction. Tension standardisation may be the key to further improving the outcomes of UI-patients.
Objective. To compare the results of surgical treatment of stress urinary incontinence (SUI) using a tension-controlled synthetic sling with standard suburethral sling surgery. 
Materials & methods. We conducted a randomised trial to evaluate the efficacy of surgery with tension-controlled synthetic loops (ClinicalTrials.gov no. NCT04101279). The middle portion of the loop has an absorbable damping layer that contacts the urethral mid-third, thereby providing standardised loop tension. Through block randomisation, patients were included in the study group and underwent surgery using a suburethral loop with a tension control device. The control group underwent surgery using a synthetic Urosling loop (Lintex®). All patients underwent standard examination before hospitalisation and after surgical treatment, including chairside examination. The stages of functional assessment of the patients' condition included assessment by the UDI-6 and IIQ-7 questionnaires, preoperatively and postoperatively at 1 and 3 months, as well as urodynamic examination before and after surgery.
Results. Overall, 280 patients were screened and signed informed consent to participate in the study. We enrolled 253 patients randomised into two groups: group 1 (study group) included 123 patients and group 2 (control group) included 130 patients. The mean age of the study participants in the study group was 55.2 ± 10.9 years, the mean BMI was 25.60 ± 2.55, and the mean length of urinary incontinence was 4.47 ± 3.79 years. According to the questionnaires (UDI-6, IIQ-7) after one month, the improvement of indicators was significant improvement in symptoms in both groups, while group to group comparison showed no difference. Based on urodynamic study three months after treatment, recurrence of SUI was noted in 6.6% of patients in the study group, while in the control group in 8.0%. Urge UI occurred de novo was noted in 4.9% of patients in the main group vs in 10.0% in the control group.
Conclusion. The tension-controlled synthetic suburethral loop has advantages over the traditional standard loop in the treatment of female SUI regarding the reduction of the incidence of infravesical obstruction, prosthesis protrusion, and the incidence of recurrent lower urinary tract symptoms. This is achieved by standardising the sling implantation step and preventing excessive or insufficient loop tensioning. This technique can be used in day-to-day urological practice.

Introduction. Percutaneous nephrolithotomy (PNL) is one of the recommended treatments for kidney stones exceeding 20 mm in size. A significant proportion of patients with recurrent nephrolithiasis require repeated surgical intervention on the ipsilateral side throughout their lifetime.
Objective. To compare the outcomes of primary and repeat mini-PNL procedures performed for recurrent urolithiasis on the ipsilateral side in patients with kidney stones.
Materials & methods. The study included two distinct patient groups. Group 1 comprised 124 patients with a primary episode of nephrolithiasis, while Group 2 consisted of 59 patients with a recurrent form of nephrolithiasis who had previously undergone PNL on the side of recurrence. All participants underwent mini-PNL. Preoperative patient characteristics and surgical treatment outcomes were evaluated. Complications were classified according to the Clavien-Dindo classification modifed for PNL. The achievement of stone free rate (SFR) was assessed using multispiral computed tomography (MSCT).
Results. The groups exhibited comparable preoperative characteristics. The SFR was 70.2% in Group 1 and 69.5% in Group 2 (p = 0.926). The median surgical duration was shorter in Group 2 at 90 (70.0 – 129.5) minutes compared to 100 (83.6 – 135.0) minutes in Group 1 (p = 0.082). The median postoperative hospital stay was 3 days for both groups (p = 0.246). The overall complication rate was 25.8% (32 patients) in Group 1 and 27.1% (16 patients) in Group 2 (p = 0.909). The median haemoglobin decreases on postoperative day 3 was 8.5 g/L in Group 1 and 8.0 g/L in Group 2 (p = 0.405).
Conclusion. Mini-PNL via a single access represents an effective treatment modality for both primary and recurrent forms of nephrolithiasis. The incidence of postoperative complications demonstrates a comparable safety profile for both primary and recurrent PNL procedures.

Introduction. The gold standard for assessment of urinary bladder function is a comprehensive urodynamic study. In clinical practice, there is a great need for inexpensive and minimally invasive diagnostic tool to provide information about bladder function in patients with suprapubic drainage.
Objective. To evaluate the diagnostic value of a functional bladder filling test to assess bladder contractile function in patients with suprapubic tube.
Materials & methods. The study included 70 men with suprapubic tube initially placed for urinary retention due to BPO/BPH. A month after cystostomy, patients were assessed for the functional state of the detrusor. It consisted of filling tests assessing the sensory functions of the bladder and urodynamic data obtained during cystometry at the attempt of urination. Finally, a comparison of the results of both tests was carried out.
Results. Assessment of sensory bladder function showed that 43 patients had normal sensitivity, 24 had reduced sensory function, and 3 patients had no sensitivity. In patients with normal sensitivity, the maximum detrusor pressure (Pdet) was 83.2 ± 46.4 cm H₂O. Among patients with reduced sensitivity, the maximum Pdet was 16.8 ± 3.1 cm H₂O, which placed them in the category of unsatisfactory contractile bladder function. In patients with no bladder sensitivity, there was no increase in Pdet during attempted urination, indicating the absence of contractile bladder function. Thus, bladder sensitivity correlated with indicators of its contractility (p < 0.05).
Conclusion. Our study demonstrates the correlation between the results of the clinical method for assessing bladder function and those of urodynamic testing. The functional test conducted proved its reliability in evaluating bladder sensitivity and contractility, particularly in situations where performing a standard urodynamic study is difficult.

Introduction. Robotic pyeloplasty represents the most frequently performed surgical intervention globally utilizing the da Vinci robotic platform in pediatric patients. The present study introduces the initial experience of executing robot-assisted laparoscopic pyeloplasty (RALP) employing the da Vinci Xi robotic system.
Objective. To conduct a comprehensive analysis of the experience in performing RALP in pediatric patients using the da Vinci Xi robotic platform. 
Materials & methods. Between July and October 2024, a total of 14 robot-assisted laparoscopic pyeloplasties (RALP) were successfully performed. The patient cohort consisted of an equal distribution of 7 boys (50%) and 7 girls (50%). The mean anthropometric parameters of the patients were as follows: height 131.2 ± 22.1 cm and body weight 29.7 ± 15.0 kg. The severity of hydronephrosis, assessed using the Society for Fetal Urology (SFU) grading system, revealed that 11 patients (78.5%) presented with SFU grade 3 hydronephrosis, while 3 patients (21.5%) exhibited SFU grade 4 hydronephrosis. The etiology of the ureteropelvic junction obstruction (UPJO) was determined as follows: an UPJO internal cause was identified in 6 patients (43%), whereas an external cause (‘conflict’ vessel) was detected in 8 patients (57%).
All patients underwent robot-assisted dissecting pyeloplasty without reduction resection of the renal pelvis. The surgical procedure was executed with the patient positioned on the side contralateral to the site of obstruction. The laparoscopic access was established using three 8 mm trocars for the insertion of optics and robotic instruments, complemented by a single 5 mm trocar for the assistant’s instrumentation.
Results. No conversions were observed throughout the case series. The operative time demonstrated a significant reduction over the study period: initially, the total operative time was 195 min, which decreased to 110 min by the study’s conclusion. The mean operative time across all cases was 146.7 ± 29.3 min. The docking time exhibited a notable learning curve, decreasing from 60 minutes during the initial stages to an average of 25.0 ± 10.8 min as proficiency improved. Similarly, the console time reduced from 150 min initially to 70 min by the study’s end. The mean console time varied based on the etiology of obstruction: for internal causes of OPUS, it was 82.0 ± 16.0 min, while for external causes, it was 93.0 ± 27.0 min. Postoperatively, only one patient experienced stent dysfunction, which was successfully managed without the need for stent replacement.
Conclusions. The initial experience with RALP reveals a significant advantage over conventional laparoscopic pyeloplasty (LP). Specifically, RALP allows for the preservation of the operator’s physical conditioning throughout the entire process of anastomosis formation. This preservation enables the formation of an anastomosis with maximum precision, thereby eliminating the compromise between the desired quality of intracorporeal suturing and the actual surgical outcome that often occurs due to operator fatigue with laparoscopic access. The current findings indicate that our accumulated two decades of experience in laparoscopic pyeloplasty substantially speeds up mastering the robotic platform. This prior expertise facilitates the optimization of console time duration and enables the rapid attainment of the performance plateau, achieving optimal surgical efficiency in the shortest possible timeframe.

The male genitalia are intrinsically linked to ancestral concepts of male fertility and sexual potency, serving as a fundamental component in the construction of masculine identity. A comprehensive study involving 25,594 healthy male participants revealed that 45% expressed dissatisfaction with their penile dimensions and desired penile augmentation. This negative body image perception often manifests as a somatoform disorder known as penile dysmorphic disorder. The present review provides an exhaustive analysis of contemporary global methodologies for penile lengthening procedures, encompassing both conservative management strategies and surgical interventions. Through the meticulous evaluation of over a hundred peer-reviewed scientific publications, this study elucidates the prevailing trends and prospective developments within the field of penile aesthetic surgery.

Reconstructive urology encompasses a diverse array of surgical modalities for the management of urethral strictures in the male population. Despite the extensive documentation of various surgical approaches and their purported benefits in the existing literature, there remains a notable paucity of comprehensive data regarding intraoperative and postoperative complications. These adverse events unequivocally exert a significant impact on patients’ quality of life and overall treatment satisfaction. The present manuscript provides a systematic review of the international literature pertaining to potential complications associated with diverse therapeutic interventions for urethral stricture disease.

The present review provides an in-depth analysis of palliative drainage modalities for the upper urinary tract (UUT) in patients diagnosed with cancer-associated obstructive uropathy. Although nephrostomy-based drainage is widely acknowledged as a valid approach, prolonged utilization of external urinary drainage systems is associated with specific complications and exerts a considerable impact on patients’ quality of life. Consequently, the quest for an optimal variant of prolonged internal urinary tract drainage in this patient population remains an ongoing endeavor. The primary parameters constraining the efficacy of conventional ureteral stenting include stent patency compromise due to tumor compression and stent lumen occlusion resulting from encrustation. Furthermore, the prevalence of stent-related symptomatology in most patients represents a significant clinical concern. This review synthesizes the findings of studies that both elucidate the factors limiting the utility of ureteral stenting in this patient cohort and propose strategies to overcome these limitations through targeted interventions addressing the physical, chemical, and biological determinants of internal ureteral drainage failure.

Radical prostatectomy (RPE) represents the gold standard for radical surgical management of non-metastatic prostate cancer (PCa). While robot-assisted and laparoscopic RPE modalities offer distinct advantages, they are also associated with various complications, notably sexual dysfunction. Sexual disorders following PCa treatment are highly prevalent and exert a profound impact on patients’ quality of life, self-esteem, and interpersonal relationships within both familial and professional spheres. The primary treatment modalities for prostate cancer frequently result in a spectrum of sexual disorders, encompassing erectile and orgasmic dysfunction, diminished libido, androgen deprivation symptoms, as well as alterations in penile morphology characterized by reductions in length and girth, along with penile curvature. The objective of this review was to critically evaluate the accumulated body of evidence pertaining to the diagnosis and management of sexual dysfunctions following RPE. The analysis incorporated peer-reviewed articles authored by both international and domestic researchers spanning the period from 2014 to 2024, in addition to foundational literature predating this period and comprehensive sources addressing sexual dysfunction in PCa patients post-RPE. The findings of our review underscore the multifaceted nature of sexual disorders encountered in patients following RPE, thereby corroborating the escalating necessity for the development and implementation of innovative interventions aimed at enhancing sexual health outcomes in patients undergoing radical prostate surgery.

Encrusting cystitis represents an exceptionally rare form of chronic bladder inflammation, characterized by bladder wall calcification. The predominant causative agent is Corynebacterium urealyticum, a gram-positive multidrugresistant bacillus. The pathogenic potential of C. urealyticum is attributed to its elevated urease activity, which initiates a cascade of urea decomposition into carbon dioxide and ammonia. This process results in hyperammoniuria and urine alkalization within the initial 24-hour period. The most significant predisposing factors for encrusting cystitis development include the presence of foreign bodies within the urinary system, such as urethral catheters, nephrostomy tubes, and internal ureteral stents, as well as a history of endoscopic urinary system interventions. Diagnostic suspicion of C. urealyticum presence in urine should be raised in cases of sterile urine according to standard microbiological examination results, elevated urine pH (typically up to 9.0 pH), crystalluria, and the detection of encrustations via imaging diagnostic modalities. Isolation of C. urealyticum necessitates cultivation for 48-72 hours at 370C on a medium enriched with blood or carbon dioxide; however, pathogen detection has been documented only after 90h of cultivation in certain instances. Therapeutic management of encrusting cystitis should encompass three primary components: antibacterial therapy, urinary acidification, and removal of encrustations harboring pathogen biofilms. The systematic review conducted within this study involved the analysis of documented clinical cases of encrusting cystitis, as well as an evaluation of treatment modalities employed by various specialists.

Introduction. The great majority of testis neoplasms are germ cell tumours. The most common site of metastasis is the retroperitoneal region. Metastasis to the bladder is very rare.
Clinical case. A 33-year-old male smoker had right radical orchiectomy two years ago for seminoma. The investigations then showed right retroperitoneal and iliac enlarged nodes and right renal hydronephrosis. Nephrostomy tube was inserted, chemotherapy was given with good response. Two years later the patient presented with right flank pain, hematuria and lower urinary tract symptoms. MRI showed a big bladder mass. Cystoscopy and transurethral resection were done and showed metastatic seminoma.
Discussion. Testicular tumours are the most common male malignant neoplasms between the ages of 15 and 35 years. The great majority of testicular neoplasms are germ cell tumours and seminomas are the most common type of this group. Urinary system metastasis is quite rare. 
Conclusion. Rare and late metastases to the bladder should always be considered, and careful medical history should be taken.

Bladder stones exhibit variability in size, morphology, and coloration, presenting either as solitary or multiple formations. The predominant configuration of bladder stones is spherical; however, in exceptional instances, they may manifest irregular radiating projections reminiscent of the components of the abroad children’s well-known game as Jacks. Consequently, such stones exhibiting an atypical stellate configuration have been designated as “Jack stones”. When formulating management strategies for patients presenting with large bladder stone and bladder outlet obstruction, it is imperative to consider the dimensions and composition of both the stone and the prostate, as well as the patients’ comorbidities, medical history, and structural anomalies of the lower urinary tract. The most employed surgical approaches for concurrent management include transurethral interventions on the prostate gland, transurethral or percutaneous cystolithotripsy, and open cystolithotomy. In the present study, we report our own clinical experience involving the removing of a large benign prostate hyperplasia [180 cc] and a giant bladder ‘’Jack stone’’ [50 mm in diameter], utilizing a combined endoscopic and open surgical approach.

Tuberculosis co-occurring with HIV infection frequently manifests as extrapulmonary localisations. The authors present a clinical case of a 53-year-old patient who initially presented with genital skin changes. The patient engaged in self-treatment, which ultimately resulted in the dissemination of the infectious process and significant alterations in the architectonics of the genital area. The patient exhibited socially withdrawn behaviour and refused medical consultation. Subsequent diagnostic evaluation revealed concomitant HIV infection. The patient succumbed to generalised tuberculosis with multiple organ involvement, including lesions in the brain, lungs, liver, spleen, large intestine, and skin. Histological examination confirmed cutaneous tuberculosis affecting the scrotum, penis, and inner surface of the thighs, characterised as the infiltrative-ulcerative form. This case highlights that timely medical intervention and overcoming psychological barriers, such as social stigma and personal embarrassment, could have saved the life of the 53-year-old patient.

Introduction. Venous malformation (VM) is a congenital anomaly of venous development that results from a somatic mutation during the embryonic period, leading to local haemodynamic disturbances.
Objective. The research aimed to present clinical cases of patients with penile venous malformations.
Materials & methods. Detailed data on the diagnosis and treatment of VM affecting the penis in four pediatric patients aged 2, 7, 10, and 15 years and four adult patients aged 18, 20, 28, and 42 years are presented, including comprehensive case reports for three individuals. For diagnostic purposes, the following methods were employed: ultrasonography with colour Doppler mapping, multiparametric magnetic resonance imaging, and computed tomography with intravenous contrast enhancement. The treatment of venous malformation was carried out using puncture sclerotherapy with the administration of bleomycin solution; in cases of generalised form, «Sirolimus» was additionally prescribed.
Results. In seven patients, a local form of VM was detected, limited to the spongy body of the urethra. In one patient, a generalised form of VM was observed, affecting the pelvis, gluteal region, right lower limb, and penis. After performing local bleomycin-based sclerotherapy of VM, a disappearance of its manifestations or a significant reduction in the size of VM was noted.
Conclusion. VM is a developmental disorder of venous vessels, representing a low-flow malformation that exhibits significant differences in pathogenesis compared to haemangioma and even more so compared to arterial-venous malformation. These differences must be considered during the diagnostic process and the selection of an appropriate management method.