Background. Urethral resection or urethroplasty are the exceptional radical methods of treating urethral stricture disease in men. But so far, standards for the rehabilitation of patients undergoing this operation have not been fully developed. Primarily, it refers to the restoration of erectile function and the relief of psychological and emotional disorders that always accompany this disease, especially in young men.

Objectives. Study the prevalence of anxiety and depression in the background of lower urinary tract symptoms (LUTS) and erectile disorders in urethral stricture disease before and after surgical treatment.

Materials and methods. A clinical and statistical analysis of the surgery of 70 men with different etiologies of urethral stricture disease, as well as their initial androgenic status was carried out. The dynamics of quality of life in patients were determined by the symptoms of LUTS, sexual dysfunction and erectile dysfunction (ED), in combination with the psychological and emotional status on the anxiety and depression scales (HADS 1, 2).

Results. The initial androgenic status of patients influences the risk of wound complications in the early postoperative period. Successful surgical treatment of urethral strictures (US) is characterized by rapid and reliable relief of LUTS and less relief of the severity of sexual disorders and erectile dysfunction.

Conclusion. A set of estimates of LUTS, ED, and anxiety / depression in the medium and long term after successful urethral surgery should be considered together.

Introduction. CThe basic symptoms in the non-inflammatory form of chronic prostatitis / chronic pelvic pain syndrome (CP / CPTB III B) are Pain, Symptoms of the Lower Urinary Tract (LUTS) and Erectile Dysfunction (ED). Pain is the main and leading symptom. Treatment of patients with this condition is extremely difficult and often ineffective. For the correction of present symptoms, it is considered reasonable to use alphai-Adrenergic Blockers (α1-AB), Antibacterial Drugs, Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Phytotherapy, since these drugs are approved and have a high level of evidence. However, their use in most cases does not allow to achieve the proper clinical effect.

Objectives. Comparative analysis of the effectiveness of combination therapy of the «first-line» (α1-AB + NSAIDs) and combination therapy of the «first-line» (α1-AB + NSAIDs), supplemented by local physical effects on the prostate.

Materials and methods. 73 patients with a previously confirmed diagnosis of CP / CPPS III B were included in the study. Study Design: A prospective randomized simple comparative study. The key evaluation criterion is the arterial intraprostatic blood flow rate. Clinical evaluation of patients was carried out by questioning (I-PSS, NIH-CPPS and ICEF-5 questionnaires) before and after taking medications. Drug therapy was performed for 30 days. Randomization: Group 1- first line therapy (α1-AB + NSAIDs). Group 2 - a massage of the prostate was added to the «first-line» therapy (α1-AB + NSAIDs). Statistical analysis was performed using non-parametric statistics.

Results. Pain: decrease in pain intensity - by 7.7 and 26.9% for the Group 1 and 2, respectively. LUTS: decrease in severity / reduction - by 18.2 / 0% and 50 / 15.4% of cases for the Group i and 2, accordingly. Treatment satisfaction -3.8 and 26.9% of patients for the Group 1 and 2, respectively. A statistically significant improvement in erectile function was not observed in patients of both groups.

Conclusions. In the case when CP / CPPS III B is accompanied by moderate arterial hemodynamic disorders of the prostate, it is possible to achieve an improvement in the results of standard «first-line» therapy recommended by the European Association of Urology. At the same time, it is possible to reduce the intensity of pain and the severity of LUTS. However, there is no improvement in erectile function in these patients.

Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world.

Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion.

Materials and methods. Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis.

Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%.

Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types.

Background. Infertility is the one of the complex and topical problem of the reproductology.

Objectives. The study of the involvement and etiological structure of Human Papillomavirus infection (PVI) in men with infertility combined with PVI.

Materials and methods. A survey of 71 patients aged from 22 to 44 years with the established infertility diagnosis combined with PVI and with the absence of other risk factors.

Results. When analyzing the ejaculate among the various variants of pathozoospermia, asthenozoospermia was detected most often - in 56% of cases, asthenoteratozoospermia was recorded less often - in 21% of cases and oligoasthenoterozoospermia was determined in 16% of cases, respectively. A small proportion was oligoastenozoospermia, namely in 6% of observations. Pathozoospermia was combined with PVI 16, 18, 33 types in most cases.

Conclusions. In the present study it was found that PVI can lead to various types of pathospermia. Infertility associated with PVI is characterized by impaired spermatozoa motility and deterioration in the morphological characteristics of the ejaculate. In the course of the analysis it was found that in patients with pathozoospermia have 16, 18, 33 HVP types in most cases.

Background. The prevalence of urinary tract infections (UTIs) in general and recurrent lower UTIs, in particular, constantly remains at a high level. Currently, more and more researchers are attempting to study the microbial biocenosis of the urinary tract in patients with UTIs in terms of the relationship between UTIs and patient's colon microbiota in order to detail the etiology and pathogenesis of these conditions as an insufficiently studied issue.

Objectives. To study the microbiota of urine and colon, as well as significant correlations in these biotopes.

Materials and methods. 169 patients with recurrent lower UTIs from the Urology Clinic and the Department of Microbiology and Virology No. 1 (Rostov State Medical University) were examined. Average age: 36.2 ± 4.7 years. Midstream urine samples for bacteriological examination was taken in accordance with the rules set out in the Clinical recommendations (2014) exactly observing the preanalytical stage. The study of the colon microbiota as well as the collection of material was carried out in accordance with the rules set forth in the industry standard (OS) OST 915000. 11.0004 - 2003, Order of the Ministry of Health of the Russian Federation No. 231 of 09/09/03. Guided by this standard, the interpretation of the results was conducted. Results' statistical processing was implemented using the SPSS version 23 package.

Results. In patients with recurrent lower UTIs two significant quantitative correlation coefficients were detected. The first correlation coefficient showed inverse correlation between typical E. coli isolated from urine and Eubacterium spp. isolated from feces (r = -0.434, p = 0.009). The second correlation coefficient showed a direct correlation between the amount of Lactobacilli isolated from urine and Coalulase-negative Staphylococci (CoNS) isolated from feces, accordingly (r = -0.434, p = 0.009).

When comparing the frequencies of detection of various microbiota taxa, three significant correlation coefficient were found in the loci under study: between Lactobacilli or Peptococci isolated from urine and CoNS verified in feces (PCC - 0.342, p = 0.031 and PCC - 0.341, p = 0.018, respectively), as well as between Peptococci detected in urine and Enterococci in feces (PCC - 0.349, p = 0.028).

Conclusion. The data we obtained on significant correlation coefficients between microorganisms isolated from urine and colon indirectly confirm the translocation mechanism. Undoubtedly, further research is needed to study the mechanism of translocation of microorganisms from the intestines and other biotopes into the organs of the urinary system in order to understand the pathogenesis of this common group of diseases.

Background. Benign prostatic hyperplasia (BPH) is the most common disease in older men. BPH pathophysiology is poorly understood. Although, it is known that the transmission of androgenergic signals and the reactivity of prostate's stroma as well as inflammatory factors are known to be the main pathophysiological mechanisms. In this regard, it is of interest to study the activity of enzymes and their inhibitors of the renin-angiotensin and kallikrein-kinin systems in BPH.

Objectives. The study of new molecular mechanisms of the BPH pathogenesis.

Materials and methods. The activity of the angiotensin-converting enzyme (ACE), the kallikrein-like activity and the prekallikrein content were determined. The total arginine-esterase activity was the inhibitory activity of the a1-proteinase inhibitor and a2-macroglobulin in the prostate secretion in men with BPH.

A sharp increase of ACE activity in BPH leads to the accumulation of angiotensin II in the prostate secretion. A consequence of the activation of ACE in prostate secretion is a decrease in the content of bradykinin. An increase of the a1-proteinase inhibitor suppressing activity in prostate secretion at BPH indicates an increase in leukocyte degranulation activity during the development of the inflammatory process.

Results. A sharp increase of ACE activity in BPH leads to the accumulation of angiotensin II in the prostate secretion. A consequence of the activation of ACE in prostate secretion is a decrease in the content of bradykinin. An increase of the a1-proteinase inhibitor suppressing activity in prostate secretion at BPH indicates an increase in leukocyte degranulation activity during the development of the inflammatory process.

Conclusion. Metabolic basis for the BPH development can be mediated by impaired metathesis of angiotensin II and bradykinin in the prostate.

Background. The incidence of kidney stone disease (KSD) in children varies from 1% to 5%. Pediatric surgery of KSD employs methods similar to surgical technologies used for adults: extracorporeal shockwave lithotripsy (ESWL), ureterolithotripsy (ULT), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), open and laparoscopic lithotomy. ESWL remains the method of choice for urolithiasis management in children; however, the number of publications describing application of minimally invasive procedures (PCNL, RIRS) for large stones in children is increasing. The said existing tendency determines the need for a comparative study in order to reveal the efficiency and safety of ESWL and PCNL/RIRS as treatment methods for large stones in children.

Objectives. The study results of the ESWL use in the treatment of children with stones greater than 2 cm.

Materials and methods. During the period from 2013 through 2018, ESWL was performed for 146 patients (70 (47.9%) boys and 76 (52.5%) girls) to treat 170 stones. Age of the patients: 6 months to 17 years (mean age: 73 months). Stones were found on the left side in 96 (61.1%) patients, on the right side — in 58 (38.8%) cases, bilaterally — in 16 (9.41%) children. Large stones exceeding 2 cm were diagnosed in 16 patients (8 (50%) boys and 8 (50%) girls). Urolithiasis was revealed on the right side in 3 (18.7%) patients, on the left side — in 11 (68.7%) cases, bilaterally — in 2 (12.5%) children. All patients were subdivided into 2 subgroups: Subgroup I — 6 (37.5%, 7 kidneys) patients with staghorn urolithiasis, Subgroup II — 10 (62.5%, 11 kidneys) patients with non-staghorn stones. Postoperative complications were evaluated in accordance with the Clavien-Dindo classification.

Results. In Subgroup I, complete elimination of C-1 stones in one patient took two ESWL sessions (16.67%). Three (50%) children needed 3 ESWL sessions. One (16.67%) child underwent 4 fragmentations. One (16.67%) patient with bilateral C-2 stones had 2 ESWL on the right side, 2 ESWL of the left-side calculus, and 1 ESWL session of stone fragments in distal ureter with prior insertion of ureteral catheter. In Subgroup II, a single ESWL session was sufficient to eliminate a calculus completely in 3 cases (30%). 2 patients (20%) had to undergo two ESWL sessions. 3 patients (30%) needed three ESWL sessions. Four ESWL sessions were carried out for one child (10%). One patient with bilateral stones underwent 2 sessions on the left side, 3 sessions on the right side, the child also had an ESWL to correct the steinstrasse condition in the lower third segment of the left ureter. Grade IIIb postoperative complications according to the Clavien-Dindo classification were observed in 1 (14.9%) patient of Subgroup I and in one (9.09%) patient of Subgroup II. No lithogenesis recurrences were registered.

Conclusions. In cases of children suffering from concrements larger than 2 centimetres, ESWL is a safe and efficient procedure even without prior urine derivation resulting in lower incidence of complications compared with other minimally invasive KSD treatment technologies.

Background. Benign prostatic hyperplasia (BPH) is one of the commonest diseases in male population. Surgical treatment is recommended in cases if a patient doesn't want to begin or continue his medication or lower urinary tract symptoms (LUTS) progression or complicated course of the disease. Over the past two decades there has been a significant expansion of the range of types of surgical treatment.

Objectives. Conduct a comparative analysis of endovideosurgical treatment of BPH.

Materials and methods. In the course of work on this issue, the following databases were analyzed: PubMed, ScienceDirect, Cohrane Library, UpToDate, eLibrary with a search range in the last 30 years, next key words were used: «benign prostatic hyperplasia», «urethral stricture», «bladder neck contracture», «TuRP», «HoLEP», «ThuLEP», «GreenLight laser». Search range: from 1989 to 2019.

Results. Based on the results of numerous studies, thulium, holmium and GreenLight lasers show the best results. Laser surgery is longer than the transurethral resection of the prostate (TURP), however, the rates of hospitalization and catheterization are more significant for patients. Efficiency and safety are also two of the most important criteria, and in this respect, thulium and holmium lasers perform well. Thulium laser provides an excellent result of vaporization of the prostate tissue and reliable hemostasis without causing significant thermal injury to the surrounding tissues. Holmium laser shows the lowest rates of re-catheterization, urinary retention, inflammatory and infectious complications, stress urinary incontinence and retrograde ejaculation, but there is a chance of damaging the prostate gland capsule. GreenLight laser, due to the specificity of its wavelength, has excellent hemostasis but this entails greater thermal damage to the surrounding tissues.

Urolithiasis remains one of the most common diseases in urology. At the same time, kidney stones are the most common and relevant part of this problem. Topical areas of diagnosis and treatment of kidney stones is determined by the increase in the incidence noted throughout the world, as well as the variety of treatment options and the development of new techniques. Currently, not all standards for the treatment of kidney stones of various sizes and localizations are defined. At the same time, new trends in treatment may change existing standards. This literature review considers existing standards for the treatment of kidney stones. Percutaneous nephrolithotripsy with its complications associated with the tools and energies used to destroy and remove kidney stones is analyzed in more detail. We have analyzed innovative mini-percutaneous techniques (mini-PCNL) and trends in the development of percutaneous nephrolithiasis surgery to determine their importance in the treatment of kidney stones.

A case retrospective analysis of the gallbladder's injury during percutaneous nephrolithotomy was performed which occurred in the Sayansk Town Hospital. The data of instrumental examination, tactics of intra- and postoperative treatment are presented. For this topic, the literature of PubMed database for the last 25 years has been analyzed by keywords: percutaneous nephrolithotomy, kidney stone, gallbladder, cholecystostomy, trauma. 11 cases of gallbladder's injury during performing percutaneous nephrolithotomy was selected with 8 of which required cholecystectomy. In one case, conservative treatment of gallbladder's perforation was applied. Percutaneous cholecystostomy and papillosphincterotomy cases with retrograde cholangiopancreatography and stenting of the common bile duct are also described.