The editorial board concludes the discussion on the problem of acute pyelonephritis in a pregnant woman. As editor-in-chief, I express my gratitude to the authors of publications on this subject [1–8]. At the same time, I want to draw attention to the weak activity of urologists in reaction to the discussion. In my opinion, one of the reasons for this is the lack of large-scale research on this issue in Russian Federation. Although, in the world, things are the same way for the most part. Therefore, it is extremely difficult in current medical practice to solve tactical tasks and make inferences in many clinical situations.

I do not intend to comment in any way on the scientific publications of respected colleagues who spoke on the pages of the journal “Urology Herald”. Nevertheless, I want to give my considerations based solely on my own clinical experience in emergency urology and based on many scientific studies with my fellows in the Rostov-on-Don City Emergency Hospital and Rostov State Medical University.

Introduction. The feasibility of reconstructing an orthotopic urinary reservoir after radical cystectomy (RCE) in women is still debatable. This is due to the peculiarities of the physiology and anatomy of the female lower urinary tract and an increased risk of developing urinary incontinence or urinary retention after surgery.

Purpose of the study. Studying long-term functional results of creating an orthotopic urinary reservoir by VIP in comparison with the technique of creating a urinary reservoir by Studer after RCE in women.

Materials and methods. The study included 32 women who underwent RCE with the formation of an orthotopic urinary reservoir by to Studer — 13 patients and a «spherical» reservoir in the VIP — 19 modification. At the time of surgery, the age of patients was 61.1±1.9 years (29 ‒ 82). The average follow-up time was 77.5±7.8 months (17 ‒ 157, median 82). The patients who underwent a more complex type of plastic were younger than the patients operated on by the Studer method (p = 0.014). The groups did not differ statistically in other parameters.

Results. The overall five-year survival rate in the Studer group was 90.9%, and in the VIP group — 94.7% (p = 0.596). 59.4% of patients were completely continent. Women after plastic surgery by VIP held urine better (68.4% vs 46.2%). The incidence of mild urinary incontinence was higher after Studer surgery. The incidence of severe urinary incontinence was the same in both groups. Nighttime urinary incontinence was the same in both groups. Intermittent catheterization was used more often by patients after VIP plastic surgery than after Studer surgery (21% vs 7.7%). In urodynamic studies, it was shown that the lower physiological capacity of the reservoir according to Studer due to more intense peristalsis of the reservoir wall, which causes involuntary leaking of urine, hyperperistalsis of the reservoir and a higher frequency of urinary incontinence causes more complete emptying in patients less residual urine, less need for self-catheterization. In the group of patients with plastic surgery according to VIP, a high physiological capacity of the reservoir with a lower pressure of the walls of the reservoir during the filling phase was recorded. This is manifested by a lower incidence of urinary incontinence, and, at the same time, a more significant amount of residual urine and a higher need for patients for self-catheterization.

Conclusion. The formation of an orthotopic urinary reservoir with favourable long-term results is possible in women after RCE. The most beneficial in terms of the quality of daily held urine is the VIP modification, which is characterized by sufficiently high capacity and low intraluminal pressure. However, with this method of surgery, the risk of hypercontinence increases, which requires periodic catheterization. A complex urodynamic study made it possible to show the direct effect of various characteristics of the reservoir on the nature and degree of impaired urination of patients.

Introduction. Extravesical ureteral reimplantation is an accepted technique for the surgical treatment of high-grade vesicoureteral reflux. However, many surgeons continue to use an intravesical technique, including for the megaureter. We present our experience and outcomes with these techniques for primary bilateral refluxing megaureter.

Purpose of the study. To improve the results of surgical treatment of refluxing megaureter in children.

Materials and methods. A retrospective study was performed of 95 patients who underwent ureteral reimplantation between 2006 and 2019. The age of patients at the time of surgery was from 4 months to 13 years (median — 27.6 months), boys were 71 (74.7%), girls were 24 (25.3%). All patients are divided into 2 groups depending on the method of treatment. Group 1 consisted of 65 patients who underwent Cohen single-stage bilateral transvesical ureteral reimplantation. Group 2 included 30 children who underwent two-stage Barry extravesical ureteral reimplantation. The interval between operations was from 1 to 63 months (median — 5.2 months). Patient demographics, surgical technique and outcomes were recorded. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.

Results. Median follow-up period was 3.2 years. The overall success rate was 80% for patients and 88% for ureters. Postoperative grade III – IV reflux had 15 patients (15,8%) and 16 ureters (8,4%). Persistent ureterohydronephrosis had 4 children (4,2%) and 6 ureters (3,2%). The effectiveness of treatment for patients in the Cohen group was 77%, in the Barry group — 87% (p = 0.408), for ureters — 86% and 93%, respectively (p = 0.223). The difference was not significant despite the higher effectiveness extravesical technique.

Conclusion. Extravesical and transvesical ureteral reimplantation are effective methods of treatment for bilateral refluxing megaureter in children.

Introduction. Data on the epidemiology and nature of neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) are contradictory: the prevalence rate ranges from 50 to 90% according to different authors.

Purpose of the study. To assess the frequency and nature of urination disorders in patients with various forms of multiple sclerosis.

Materials and methods. We analyzed the data of patients observed in the Regional Centre of Multiple sclerosis at Sverdlovsk Regional Clinical Hospital No. 1. The study included 160 patients aged 42.6±12.3 years, of which 64% were men and 36% were women. The primary progressive course of the disease occurred in 5% of patients, the secondary progressive course in 39%, and remitting in 56%. The average score according to the Expanded Disability Status Scale (EDSS) was 3.94±2.10. The nature of neurogenic dysfunction of the lower urinary tract was evaluated using questionnaires (NBSS, SF-Qualiveen) and urodynamic studies.

Results. NLUTD were detected in 65% of MS patients. The average score according to the Neurogenic Bladder Symptom Scale (NBSS) in patients with NLUTD was 26.93±13.12, which was significantly (p < 0.001) exceed than the value of this indicator among patients without pelvic disorders (6.43±2.34). Symptoms of emptying were noted in more than half of patients with a neurogenic bladder in the presence of multiple sclerosis: poor urine flow (63%), abdominal straining during urination (76%). Complaints of storage symptoms, such as urgency and frequency, were presented by 98% of patients with neurogenic lower urinary tract dysfunction. Urinary incontinence was diagnosed in 84% of cases. The values of the «incontinence», «storage and voiding» and «complications» domains of NBSS were 8.66±7.17, 12.18±3.7 and 3.48±4.21, respectively. The total score of SF-Qaliveen questionnaire in patients with MS with urinary disorders was 2.93±1.13, in patients without NLUTD, 1.03±0.91 (р < 0,001).

Conclusions. Neurogenic lower urinary tract dysfunction occurs in patients with multiple sclerosis with a frequency of 65%. These urinary disorders have a significant impact on the patients` quality of life.

Introduction. The presence of Ureaplasmas in the body of healthy men has been proved by many studies. The ability to assess their effect on the male body from a different perspective appeared with the advent of modern quantitative diagnostic methods.

Purpose of the study. Определить распространённость уреаплазм у мужчин без репродуктивных нарушений, а также распространённость биоваров уреаплазм и их влияние на урологическую симптоматику.

Materials and methods. There was analyzed 249 patient surveys in the clinic, divided into 2 groups: men who had various urological complaints and clinically healthy men.

Results. We found Ureaplasmas in 76 (30.5%) men based on a survey of 249 men. In the group of clinically healthy men (n = 129), microorganisms were found in 24 (18.6%) cases, in the group of men with urological symptoms (n = 129) in 52 (43.3%) cases. U. Urealyticum was observed in 28 (36.8%) patients, U. parvum were in 45 (59.2%). The combination of both strains was detected in 3 (4%) cases.

Conclusion. The total prevalence of Ureaplasmas in men without reproductive disorders was 30% of cases. The prevalence of Ureaplasmas in the group of men with urological symptoms was more than 2 times higher. U. parvum and U. urealyticum are usually found in isolation from each other. We found both taxa in 4% of cases only. The prevalence of ureaplasmas was 19% among clinically healthy men. Both strains can develop symptoms, but U. urealyticum does it to a greater extent if both are present at the same time.

Introduction. According to several studies, an increased body mass index (BMI) may be one of the unfavorable prognostic factors of prostate cancer (PC) associated with lower oncological and functional outcomes of radical prostatectomy (RP).

Purpose of the study. To evaluate pathomorphological characteristics, recurrence-free survival, and restoration of erectile function (EF) after RP with nerve-sparing technique (NST) in obese patients.

Materials and methods. The study group consisted of 91 patients with BMI ≥ 30 kg/m2 , the control group consisted of 356 patients with BMI < 30 kg/m2 who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. A comparative analysis of pathomorphological results, the rate of complications, recurrence-free survival, and the dynamics of EF restoration in both groups was performed.

Results. Obese patients had a larger prostate volume, a higher score for the International Prostate Symptom Score (IPSS) questionnaire. Unilateral and bilateral NST was used in both groups in equal proportions: 50.5% and 49.5% in the group with BMI ≥ 30 and 51.4% and 48.6% in the group with BMI < 30 (p = 0.88 ) There were no significant differences between the groups in the rate of adverse pathomorphological characteristics, serious postoperative complications and the volume of intraoperative blood loss. The five-year recurrence-free survival after RP was 93.1% in the BMI group ≥ 30 and 95.1% in the BMI group < 30 (p = 0.55). The total rate of EF recovery after RP with NST after 24 months was 75% and 78.5% (p = 0.24). The restoration of EF in obese patients was slower: sufficient for sexual intercourse EF after 6 and 12 months was observed in 17.9% and 32.1% versus 35.4% and 53.8% in the group with BMI < 30, and the meantime to recovery was 10.9 (± 1) and 8.6 (± 0.6) months, respectively (p = 0.04).

Conclusions. Obesity does not affect the pathomorphological and oncological results of RP with NST. EF recovery in patients with a BMI of ≥ 30 is slowed down, however, 24 months after surgery, the results are comparable with the potency level in patients with a BMI < 30. The data obtained may be of value in counselling and planning surgical intervention in obese patients with PC.

5-α reductase inhibitors are effective and commonly used medications for the treatment of benign prostatic hyperplasia. However, there are some questions about the safety of such medications. A post-finasteride syndrome is a controversial syndrome associated with a constellation of sexual, physical, and psychological symptoms that develop during or after finasteride exposure and persist after discontinuation. Finasteride and dutasteride have the same mechanism of action and we can suppose that the term «post-finasteride syndrome» may apply to the whole group of 5-alfa reductase inhibitors. Nowadays, reasons and development mechanisms of this syndrome are unclear. The results of studies on sexual, physical, and psychological disorders have shown mixed results. Some experts attribute post-finasteride syndrome to a group of «mysterious diseases» based on psychosocial factors. Also, we need new studies with better design because reasons and development mechanisms of this syndrome are unclear.

Aleksandr A. Galushkin and Dmitriу G. Likhikh are employees GlaxoSmithKline Trading, Michael I. Kogan declares no conflict of interest.

Prostate cancer (PCa) remains one of the most pressing problems of modern oncology, which is primarily associated with the high prevalence of this pathology. Of course, the appearance of metastases is an unfavourable factor in the course of the disease. However, PCa metastases is a very heterogeneous condition. «Oligometastatic cancer» is considered as a special disease with other properties of the tumour, i.e. as a transitional state between the localized and disseminated stage of the disease. Diagnosis of oligometastatic cancer is an extremely difficult task associated with the accurate determination of the number and localization of metastases, both hematogenous and lymphogenous, which in turn requires differentiation with regional lesions of the lymph nodes of a locally advanced tumour process. Currently, radiotracers are widely used to diagnose metastatic lymph node lesions that have high specificity for PCa, targeting a prostate-specific membrane antigen (PSMA; also known as glutamate carboxypeptidase), such as 11C-choline, 18F-fluoroethylcholine, 68Ga.

9 patients with prostate cancer with the oligometastatic lesion were treated. All patients underwent external beam radiation therapy. Total focal dose on the visualized lymph collector of the affected lymph node amounted to 44.0 Gr. Total focal dose with the method of radiotherapy treatment «field in the field» on the node 70.0 Gr. In all patients, a PSA was reduced to a level below 1.0 ng/ml 6 weeks after completion of the course of radiation therapy and levelling the severity of adverse reactions. None of the treated patients showed signs of a PCa recurrence.

Platelet-rich autologous plasma (PRP) is often used in various branches of medicine. The scope of PRP therapy has expanded from stimulating bone regeneration, healing wounds and ulcers, and musculoskeletal injuries to improving the ability to engrave various types of grafts. Due to the natural properties of platelet-rich plasma, its introduction into the human body is one of the most promising procedures for tissue restoration. After the destruction of platelets, PRP contains α-granules, from which many factors are released after activation, such as transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VGFF) and epidermal growth factor (EGF). The current state of the problem of using APOT has a huge perspective on the development of the methodology, which is due to many aspects that make this procedure simple. PRP can improve the course of many urological diseases, such as erectile dysfunction, Peyronie’s disease, urethral stricture, vesicovaginal fistulas, interstitial cystitis, and stress urinary incontinence. There are many protocols for preparing PRP, each of which has its standardized parameters and stated results. The article presents a review of the literature on the use of platelet-rich plasma in urology, focuses on the definition of PRP, various methods of preparation and activation, as well as the concentration of growth factors.

The analysis of literature data (PubMed and RSCI databases) is presented, which is devoted to new approaches and technologies in the diagnosis and treatment of various forms of erectile dysfunction (ED). ED is a very significant clinical and social problem at the present stage, which has a significant negative impact on the quality of life of men. The importance and relevance of the ED problem dictate the need to search for and develop new, more effective technologies for ED verification and treatment. This review study confirms the fact that the main diagnostic task in ED is to establish its true etiological component. A rational approach is to use research methods with proven effectiveness since this circumstance will ensure effective treatment of ED. Currently, there is a need to create a personalized diagnostic algorithm aimed at assessing the state of the cardiovascular system, endothelium, androgen status, angioarchitectonics, etc. This will increase the effectiveness and safety of treatment for men suffering from various forms of ED. X-ray endovascular, cellular and new technologies in the field of falloprosthesis are very promising with encouraging primary results.

The article provides an overview of the most influential papers on the topic of “male infertility”. The selection criteria were the practical significance of the article and the impact factor of the journal in which it was published, according to SCImago Journal Rank (SJR). As a result, we created the list of 10 papers published in the I quarter (January – March) of 2020. The review included articles on the following issues: the effectiveness and safety of antioxidants, zinc and folic acid in the treatment of male infertility; the effect of obesity on sperm DNA-fragmentation; the possibility of obtaining of spermatogonia in children and adolescents with Kleinfelter syndrome; comparison of intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected spermatozoa injection (IMSI); the reaction of the female reproductive system to the seminal fluid; viral profile in seminal fluid of men receiving the antiretroviral therapy, the effect of sleep duration on fertility and the risk of diabetes mellitus in children, conceived using assisted reproductive technologies.

The main treatment for stress urinary incontinence is surgical. However, this approach to treatment has come under scrutiny and is undergoing reevaluation in connection with the revision of the balance of risk and benefit for the patient in recent years. Increasingly, the introduction of volume-forming substances as a method of alternative care for women with mild and uncomplicated urinary incontinence during exercise is being discussed. This treatment option achieves the effect through coaptation of the urethra. Various types of substances are known solid microparticles in an absorbable liquid or gel carrier, carriers containing a hard-to-absorb homogeneous gel (without particles). Separate methods of introducing volume-forming substances are also described: transurethral and suburethral with the location of the implant in the submucous layer of the urethra, under it, and around the organ. Various authors suggest different implantation control: endoscopic and under ultrasound guidance. The review discusses the currently available volumeforming substances, methods of use, effectiveness and known complications. Besides, an original method of injection a volume-forming substance is proposed, and the first results of its application are presented.

A non-typical variant of Y-type urethral duplication has been described in the article. In this case, the surgical treatment decision was not difficult. Y-type urethral duplication was exposed up to the sinus, and its dissection was performed, followed by urethroplasty. This variant of Y-type urethral duplication has not been described in the world literature available to us, and, in our opinion, it is important for gaining experience in treating rare variants of congenital anomalies of the urethra.

The article presents a rare case of hydronephrosis due to ureteropelvic junction obstruction (UPJO) in the pelvic kidney. The rarity of this anomaly determines the presence of a limited number of publications on this problem in modern literature. For the following reasons, we find the case presented by us interesting. On the one hand, there was an erroneous tactic of monitoring the patient by outpatient specialists and it was based on data from ultrasound (US) alone, ignoring data from ante- and postnatal ultrasound, which noted the presence of a significant dilatation of the pelvis. On the other hand, the revealed dissonance between the large pelvis and the non-dilated calyces, the inability to visualize the expected wide communications between the calyces and the pelvis, which created the illusion of the presence of a pararenal cyst. The patient underwent Lichtenberg pyeloplasty, which has advantages over dissecting pyeloplasty, when the cause of the UPJO, as in our patient, was a high insertion of the ureter with a structurally normal ureteropelvic junction.

Various options of JJ placement during different laparoscopic upper urinary tract procedures are described herein “Tips & Tricks” manner. Author’s “Lifehacks” to make this manipulation easier is also presented.