Introduction. Hypospadias is one of the most common urological pathology in boys requiring surgical correction. Currently, the literature describes more than 300 different techniques for correcting hypospadias. This indicates a lack of ideal methods and standards of treatment that satisfy most pediatric surgeons and urologists. The distension methods of treatment for hypospadias have not been extremely demand in recent decades. The relatively high frequency of the meatostenosis formation in the postoperative period is one of the factors limiting the spread of the method. We suppose that the development of modifications of the surgical technique for relocating urethroplasty aimed at reducing the incidence of postoperative meatostenosis is an urgent area.

Purpose of the study. To evaluate the experience of using advancement urethroplasty in the treatment of hypospadias distal forms.

Materials and methods. We present a modified method for correction of hypospadias distal forms — advancement urethroplasty without dismembering urethral spongy body and glans penis. The proposed method allows you to form a meatus in a physiological position without a urethral suture, with the restoration of the integrity of the spongy body, without it cutting off during mobilization in the distal section. The standard C.A. Beck technique was used for treatment in 44 patients — group I. According to the author's method, 60 boys were operated on in the period from 2016 to 2018 — group II. Postoperative follow-up period lasted 6 - 36 months. All patients were evaluated in terms of cosmetic results and the incidence of postoperative complications.

Results. The high efficiency of the proposed urethroplasty technique was shown. There was a decrease in the number of postoperative complications compared to the classical method of advancement urethroplasty. Reoperations were required in 5% of cases. The cosmetic results obtained after moving urethroplasty in both groups were identical and were assessed by parents and the operating surgeon as excellent.

Conclusions. It is advisable to use moving urethroplasty in case of distal hypospadias with not prolonged urethral dysplasia proximal to the meatus and diastasis between the meatus and its physiological position not exceeding 1 cm. Relocating urethroplasty with non-dissecting spongioplasty provides a lower incidence of meatostenosis in the postoperative period compared to the classical Beck teсhnique.

Introduction. Currently, the quality of life of the patient is regarded as a primary criterion and is certainly assessed as an important parameter of the overall effectiveness of treatment.

Purpose of the study. To assess the quality of life and the severity of symptoms in young active men with chronic abacterial prostatitis IIIa category.

Materials and methods. 105 patients were divided into two groups: the 1st is mobile, who had 15 and more air flights during the year, and the 2nd is not mobile. Quality of life and symptoms were assessed using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale. Additionally, the quality of life was assessed by the adapted MOS SF-36 questionnaire.

Results. Patients whose work was associated with frequent business trips showed more intense pain and therefore lower quality of life. The total score on the scale of chronic prostatitis symptoms in mobile patients was also one and a half times higher. They significantly more often relapse of the disease developed.

Conclusion. Frequent flights affect the symptoms of chronic prostatitis negatively. Additional research is needed to find methods for correcting this aggravating factor.

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.

Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.

Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).

Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p <0.05). No differences in the level of postoperative mortality were found (p >0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p <0.05) However, the analysis revealed that after 2 years in the group of patients who underwent PC more than 15% of survivors remain, which may indicate the possibility of using this type of treatment in patients with the last stage of bladder cancer.

Conclusion. Palliative cystectomy can be effective in a select group of patients with T4b bladder cancer with equal safety compared to RCE while maintaining the probability of life expectancy up to 48 months. It is important to develop and implement into practice new protocols of multimodal therapy for patients with pT4b bladder cancer to increase the life expectancy of patients and improve its quality.

Introduction. Laparoscopic bilateral nephrectomy for autosomal dominant polycystic kidney disease has many advantages over open surgery, but a significant disadvantage is the long duration of the intervention, and the need to create access for extraction of large kidneys minimizes the cosmetic effect.

Purpose of the study. To improve the outcomes of bilateral nephrectomy in patients with autosomal-dominant polycystic kidney disease.

Materials and methods. Study design: a single-centre, retro- and prospective study from 2010 to March 2020, including 72 patients who underwent bilateral nephrectomy. The patients were divided into three groups depending on the nature of the operation: Group I (n = 42), midline laparotomy; Group II (n = 16), laparoscopic surgery and group III (n = 15), combined nephrectomy (the laparoscopic stage included the separation of the vessels of the kidney and ureter, separation of the kidney from the adrenal gland; then, the kidneys were mobilized and removed from the upper midline mini-laparotomy.

Results. In group I, the median duration of surgery was 120 min (Q1 - Q3: 110 - 150), in group II — 205 min (Q1 - Q3: 192 - 267) and in the third — 165 min (Q1 - Q3: 145 - 175). The operation time in the third group was significantly higher than in the first (p = 0.049) and significantly lower than in the second group (p = 0.034). There was no significant difference between the groups (p = 0.125) comparing the volume of intraoperative blood loss. There was no significant difference in the incidence of intraoperative complications between the groups. The median access length for laparotomy was 25 cm (Q1 - Q3: 22 - 28), for laparoscopy 14 cm (Q1 - Q3: 14 - 15) and combined surgery — 16 cm (Q1 - Q3: 15 - 17), the differences were reliable. The median bed-day for the second group was 8 days (Q1 - Q3: 7 - 9), for the third — 9 days (Q1 - Q3: 8 - 11).

Conclusion. Combined bilateral nephrectomy has all the advantages of laparoscopic surgery, but at the same time, it can significantly reduce the operation time without significantly increasing the length of the surgical approach.

Introduction. Augmentation urethroplasty using buccal mucosa is currently the optimal method for treating extended urethral strictures. However, this surgery is associated with a fairly high frequency of relapses and complications. One of the reasons that can determine the success or negative outcome of surgery is the morphological structure of the graft, which requires more in-depth research.

Purpose of the study. To evaluate the initial morphological state of the buccal mucosa in men and determine the feasibility of its pharmacotherapeutic preparation as a predictor of improving the quality of autograft engraftment in augmentation urethroplasty.

Materials and methods. The morphological structure of buccal mucosa fragments was studied in 20 patients with extended strictures of the spongy urethra. The objects of morphological research were intact oral mucosa before augmentation urethroplasty (1 biopsy) and mucosal fragments after 7 days of oral treatment with «Listerine» antiseptic solution (2 biopsies). The biopsy material was examined microscopically using standard staining (hematoxylin-eosin) and immunohistochemical methods.

Results. The initial histological structure of the buccal mucosa in every third patient was accompanied by inflammatory infiltration at the level of the subepithelial layer with desquamation of the epithelium. a pronounced increase and strengthening of intercellular contacts in grafts proved histologically and immunohistochemically, which was characterized by pronounced expression of antibodies throughout the thickness of the epithelial layer, after week-long handling of the oral cavity with an antiseptic. At the same time, there is a «self-organization» of the submucosal base by reducing oedema, strengthening intercellular and focal adhesion contacts, with an increase in the components of the vascular bed and the number of vascular «plumules».

Conclusion. Thus, a week-long preoperative treatment of the oral cavity allows stopping damage to the epithelium and inflammatory infiltration in the submucosal base with an improvement in its vascularization, which can be regarded as a positive factor for subsequent graft implantation.

Introduction. There is no consensus on the management of patients with recurrent uncomplicated lower urinary tract infection (uLUTI), which makes it difficult to carry out effective therapy.

Purpose of the study. To study the microbial patterns of urine and uropathogens' antibiotic resistance in a urological hospital from 2010 to 2017.

Materials and methods. The results of bacteriological studies and the data of individual antibiotic susceptibility testing of patients with recurrent uLUTI (n = 502) were retrospectively analyzed. Inclusion criteria of the study: consent of patients to participate in the study, the presence of clinical manifestations of recurrent uLUTI in anamnesis, two episodes within six months or three during the year, leukocyturia in the urinalysis, the absence of sexually transmitted diseases at the time of the study and in anamnesis and also vaginal discharge. Bacteriological studies of the midstream morning urine sample before the prescription of antibiotic therapy were carried out with the determination of antibiotic sensitivity/resistance and production of extended-spectrum p-lactamases. In addition to the standard set of culture media, chromogenic media, aerobic and anaerobic culturing conditions were used. Statistical analysis was performed in the statistical processing and data visualization environment «R ver 3.2» («R Foundation for Statistical Computing», Vienna, Austria).

Results. During the 8-year monitoring of the microbiota, the urine of patients with recurrent uLUTI was characterized by a microbial pattern certain constancy, but with the predominance (94.1% - 99.1%) of anaerobic-aerobic associations. The antibiotic resistance of most causative and debatable uropathogens increased, and the detection frequency of enterobacteria producing extended-spectrum p-lactamases also increased. Significant differences in the average levels of bacteriuria in the study period for most taxa of microorganisms were not detected.

Conclusion. The detection frequencies of E. coli vary around 50.0%, for other causative pathogens a lower detection rate is noted, while non-clostridial anaerobic bacteria are excreted in 96.6% of cases in patients with recurrent uLUTI. The antibiotic resistance of causative and debatable pathogens and the detection frequencies of enterobacteria producing extended-spectrum p-lactamases are increasing, which necessitates a revision of the etiological structure and approaches to empirical therapy of recurrent uLUTI.

Introduction. Research interest in vesicoureteral reflux (VUR) is determined by continued dissatisfaction with the treatment results, which do not exclude the development of renal failure and hypertension. The management tactics of such patients currently range from the dynamic follow-up to various surgical correction options, which determines the relevance of developing a personalized approach when choosing a surgical treatment technique.

Purpose of the study. The study was aimed at a comparative analysis of the efficacy and safety of transurethral administration of a polyacrylate polyalcohol copolymer (PPC) and vesicoscopic transregional ureterovesical anastomosis (VUVA) according to Cohen.

Materials and methods. The study is based on a retrospective analysis of the results of treatment of 214 patients with primary VUR, who underwent surgery from 2012 to 2018. The average age was 61.7 ± 47.9 months. Girls — 133 (62.1%), boys — 81 (37.6%). Indication for surgery in 150 (70%) children was recurrent urinary tract infection, in 64 (30%) — progressive reflux nephropathy. Bilateral process was observed in 92 (43%) patients, left-sided — in 69 (32%), right-sided — in 53 (25%). Patients were divided into two groups. Group I — 119 (55.6%) patients (179 renal units (RU)), who underwent endoscopic treatment (ET) using PPC. Group II — 95 (44.4%) children (127 RU) who underwent VUVA. Each of the groups was divided into subgroups, including RU with a low grade of (I-III) VUR and RU with a high grade of (IV-V) VUR. Complications were graded using the Clavien-Dindo classification. Statistical analysis and processing of the obtained data were performed using Microsoft Excel and STATISTICA10 software.

Results. When comparing the gender structure of the groups, differences were not detected (p >0.05). The average age in Group I was 53.5 ± 44.4 months, in Group II — 72.0 ± 50.4 months. (p <0.01). Episodes of urinary tract infection before surgery and bilateral VUR were detected more often in patients of Group I (p <0.05). Median duration of surgery (min.) and postoperative stay (days) and quartile range [Q1; Q3] in Group I were 15 [15; 15] and 2 [2; 3], respectively, and in Group II — 100 [80; 135] and 5 [4; 7], respectively (p <0.01). After the first ET, VUR was eliminated in Subgroup I (I-III deg) in 91.7%; after the second ET, the overall efficiency increased to 92.5%. In Subgroup II (I-III deg), VUR was eliminated in all children after the first surgery (p <0.05). The formation of contralateral VUR with unilateral VUR in patients of Group I (I-III) was observed in 12.8% of cases versus 0 in Group II (I-III) (p <0.05). There were no significant differences in the frequency and severity of postoperative complications between subgroups I (I-III) and II (I-III) (p >0.05). In Subgroup I (IV-V) after the first ET, reflux was eliminated in 76.3%, after the second ET the overall efficiency was 81.4%. In Subgroup II (IV-V deg), VUR was eliminated in 100% of cases (p <0.01). When comparing the frequency of contralateral reflux formation between subgroups I (IV-V) and II (IV-V), no differences were found (p >0.05). In Subgroup I (IV-V), a predominance of the III-grade complications (p <0.01) was revealed.

Conclusion. A comparative analysis of the efficacy and safety of surgical treatment of VUR using transurethral and vesicoscopic approaches revealed that ET is preferred for patients with low reflux grades (I-III). Vesicoscopic approach provides higher efficacy and safety in patients with high VUR grades (IV-V) compared with ET.

Introduction. A number of studies show an obvious connection between erectile dysfunction (ED) and the development of cardiovascular diseases (CVD), which occupy one of the leading places in the structure of mortality in cancer patients. In these circumstances, it is potentially promising to use the erectile function (EF) status before surgery as an indicator of the general health of patients and a predictor of overall survival (OS).

Purpose of the study. To study the causes of death of patients with prostate cancer (pca) after radical prostatectomy (RP) and evaluate OS depending on the preoperative EF.

Materials and methods. The study is based on a series of 2642 Rp performed at one medical institution between January 2003 and December 2017. Total of 1203 patients met the inclusion criteria and were divided into two groups: 620 patients with preserved EF or mild preoperative erectile dysfunction (ED) according to the five-item International Index of Erectile Function (IIEF-5) score (group 1) and 583 patients with mild-to-moderate, moderate or severe preoperative ED (group 2). The Mann-Whitney U test and chi-square test were used for statistical analysis. Survival was assessed using the Kaplan-Meier method with a log-rank test.

Results. A total of 101 deaths were observed in the study cohort; the median time to death was 72 months. Cardiovascular diseases (CVD) were the cause of death in 43.6% of patients, pc — 30.7%, other oncological diseases — 19.8%, other causes — 5.9%. There were no significant differences between the groups in age, body mass index, or degree of comorbidity. Biochemical relapse was observed in 19.8% in the group with preserved EF and 20.7% in the group with a baseline IIEF score <17 (p = 0.76). In the group with higher EF before RP, there was a tendency to higher 10- and 15-year OS: 92.8% and 83.7% versus 89.7% and 82.5%, respectively (p = 0.074). Significant differences between the groups were observed in the mortality from cVD: in the group with higher IIEF score, almost three times less patients died from CVD (12 and 32), and cardiovascular survival was 97.8% and 93.5% versus 96.7% and 91.6% after 10 and 15 years (p = 0.0014).

Conclusions. A lower baseline EF is associated with higher cardiovascular mortality in patients after Rp. The preoperative IIEF-5 score could be used as one of the predictors of further cardiovascular events and OS of patients. This can be helpful in preoperative selection of patients as well as initial treatment planning.

Introduction. Urinary incontinence (UI) in women is a hot topic among many professionals today. It is proved that mid-urethral synthetic tape is the gold standard in the treatment of UI. There has been a steady increase in the number of operations using synthetic prostheses in this category of patients since 2005. However, along with this, the number of complications after this surgical technique is also increasing. Methods for controlling the tension of the synthetic tape are still largely dependent on the experience of the surgeon and the existing traditions of the clinic.

In this regard, we conducted an anonymous survey among specialists of urogynecologists, where we found out the main opinions in the diagnosis and technique of surgical treatment of UI.

Materials and methods. Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry has initiated a comparative observational clinical trial to assess the responses of Russian-speaking specialists of urogynecologists on the specifics of treatment of urinary incontinence in women using an anonymous online survey based on SurveyMonkey. The survey was conducted from October to December 2019 and consisted of 17 questions on various topics. Responses were analyzed using descriptive statistics.

Results. The analysis included the answers of 161 specialists (63% of urologists, 37% of gynaecologists) from 7 countries. Most specialists (47%) have little experience (up to 5 years) of surgical treatment of UI. Interest in topics and masterclasses and internships was noted by 120 respondents (76.4%). More than 80% of specialists noted that they use a urodynamic study in the diagnosis of UI. Half of the respondents used the preoperative "cough" test results to determine the tape tension. About half of the respondents noted that they use the intraoperative "cough" test, 5.8% use the Crede manoeuvre, and 10.3% use the Valsalva test. The survey showed that specialists use various surgical instruments to control the tape tension intraoperatively.

Conclusions. Our results show that among specialists in urogynecology there is a wide range of variations in the diagnosis and technique of surgical treatment of UI. Evaluation and development of synthetic methods for tension control is a hot topic that could potentially improve the patients' quality of life and the results of treatment of patients with UI.

Introduction. Reorganization of the urinary microbiome in patients with neurogenic low urinary tract dysfunction (NLUTD) plays an important role in the pathogenesis of urinary tract infections (UTIs). However, we still do not know how the different types of NULTD therapy affect the microbiome.

Purpose of the study. Was to assess the influence of botulinum toxin (BoNT) injections on the urinary microbiome.

Materials and methods. Urine samples were obtained from 6 persons (4 females and 2 males) with NLUTD before BoNT therapy (200 UI) and 6 weeks after. Standard urine analysis, urine culture and 16S rRNA gene sequencing were performed. a total of 144,562 quality-filtered 16S rDNA sequence reads were processed through an Illumina MiSeq platform.

Results. The results of the urine culture correlated with 16S rRNA sequencing results, but the greater number of bacterial taxa were detected. Analysis of the bacterial community in urine samples revealed between 2 and 21 species-level reads per individual. All patients before BoNT demonstrated abnormal urinary microbiome with a predominance of Enterobacteriales. In three cases in females, clinical and urodynamic improvement after botulinum therapy was associated with changing of the microbiome from Enterobacteriaceae to Lactobacillales. In one female and two males, no principal changes had happened.

Conclusions. This is the first report comparing in pilot study the urinary microbiome before and after BoNT injections into the bladder wall. The results are restricted by the small number of participants. However, the promising observation about the influence of botulinum toxin therapy on urinary microbiome was obtained.

Approximately 15% of sexually active couples without using various methods of contraception do not achieve pregnancy within a year. At the same time, the cause of infertility is not identified in 30-40% of cases, which indicates the urgency of this problem and many existing questions regarding the developmental mechanisms that can lead to infertility. Many mechanisms of the development of infertility remain unclear, and therefore it is often impossible to carry out adequate diagnosis and treatment. The purpose of the review was to highlight the accumulated material on the topic of male immune infertility, to determine the direction of further research. Our review confirmed the urgent need for a detailed study of the mechanisms of immunological infertility. Emphasis is made on the areas on which further research to study this problem should be based.

The article presents the analyzes of literature sources describing the relationship between pathological alleles of some genes and prostate cancer, which can be used to determine the risk of developing prostate cancer. Mutations of the genes such as HOXB13 (251G/A, G84E), BRCA1 (5382insC, 185delAG, 4153delA, 3819delGTAAA, 3875delGTCT, 300T/G,2080delA) and BRCA2,CHEK2 (1100delC, I157T), ELAC2 (Leu217, Thr541, 650T, 1618a), cdh1 gene (160C/a), AR gene (CAG trinucleotide repeats), VDR gene (rs1544410, rs10875692, rs7301552, rs7975232, rs731236), GST family genes (null alleles of GSTM1 and GSTT1, single-nucleotide substitutions of GSTP1 313a/G and 341c/T), as well as Bloom's syndrome genes were studied. We described what mutations have a proven statistical association with an increased risk of prostate cancer. At the same time, the correlation between the patient's ethnicity and an increased risk of prostate cancer, when there are mutations of BRCA1, AR, VDR and GST family genes, is also noted.

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria are the practical relevance of the article, as well as the impact factor of the journal in which it was published, according to the ScImago Journal Rank (SJR). As a result, a list of 10 works published in the II quarter (April — June) of 2020 was formed. The review includes articles on the following topics: the effect of asymptomatic genital tract infection on male fertility, methods of spermatogonia transplantation, the effect of alcohol on fertility, the role of folate status in male fertility, lumicrine regulation of spermatogenesis, oxidative-reductive balance in the male reproductive system, comparison of testicular sperm extraction (TESE) and micro-TESE results, natural conception and intrauterine insemination (IUI) at high Mar test values, and the first data on the effect of cOVID-19 on male fertility.

In this article, we review the basic principles of brief psychotherapeutic intervention in patients with urolithiasis. The brief psychotherapeutic intervention has proven successful in the treatment of addictive behaviour. Currently, this method is also used in the treatment of many chronic diseases, such as hypertension, diabetes mellitus, and ischemic heart disease. Adaptation of this method can be a successful tool to increase the level of adherence to therapy for patients with urolithiasis since adherence to medical recommendations can significantly reduce the frequency of recurrent stone formation.

An option of nephrostomy drain placement during laparoscopic upper urinary tract procedures is described herein "Tips & Tricks" manner. author's "Lifehack" to make this manipulation easier is also presented (video is available at https://youtu.be/5eox5YWYe44).