Introduction. The high prevalence of renal diseases caused by urinary tract obstruction led to the need for experimental research of compensatory and pathological processes with kidney injury. It is also of relevance to study key mechanisms providing a compensatory function of the contralateral kidney for early diagnosis, treatment, and prognosis of obstructive renal diseases.

Purpose of the study. To examine epithelial nephron cells phenotype dynamics changes in contralateral kidney using unilateral ureteral obstruction experimental model.

Materials and methods. Model of unilateral ureteral obstruction was established using adult rabbits. The studies were carried out on days 7, 14 and 21 of complete obstruction of the left ureter. Immunophenotyping was performed on contralateral kidney tissue samples using epithelial (cytokeratin 7, E-cadherin) and mesenchymal (vimentin, α-smooth muscle actin) markers.

Results. The contralateral kidney under additional load can maintain the morphological and functional characteristics of the nephron for a long time. The first transmogrify signs in the nephron epithelium phenotype were detected by day 21 as the diffuse appearance of mesenchymal marker vimentin with unaltered visualization of epithelial phenotype markers.

Conclusion. The results obtained allow us to assume that the compensatory reserve of the contralateral kidney is gradually decreasing when the duration of the obstruction increases. Thus, the likelihood of developing negative disorders increases.

Introduction. Despite the advances in the modern pharmacopoeia, a significant place is given to surgical methods of treating benign prostatic hyperplasia (BPH) and prostate cancer (PCa). In the postoperative period in men, sexual function usually deteriorates.

Purpose of the study. To study the needs of men after prostate surgery and their sexual partners in restoring their previous sexual life.

Materials and methods. The pilot open-label prospective randomized non-comparative study included 50 patients in the age range of 53 – 74 years (average 58.3 years). All patients were consistently admitted and operated on at the “Avicenna” Medical Centre, Ltd. (Novosibirsk) from January to December 2020. Upon admission, all patients completed the International Index of Erectile Function (ICEF) questionnaire; one month later, this questionnaire was re-completed, supplemented with five questions.

Results. Twenty-one patients were admitted with a diagnosis of PCa T1c – T2N0M0, all of them underwent laparoscopic prostatectomy with lymphadenectomy. Twenty-nine patients were operated on for BPH. They underwent transurethral resection with a bipolar resectoscope. Only 6 patients (12%) had no comorbidities. Surgical intervention worsened sexual function in all patients, while in men aged 50 – 59 years, the IIEF score decreased by 61.0%, at the age of 60 – 69 years by 39.0%, in patients over 70 years old by 55.2%. Eighteen (36.0%) patients showed interest in restoring sexual function. Thirty-two (64%) patients were against the continuation of sexual activity with the following motivation: 19 (59.4%) – lack of desire for a sexual partner, 8 (25.0%) – lack of desire of the patient himself, 5 (15.6%) – unwillingness to re-operated. Nineteen women out of 36 stable couples (52.8%) objected to the restoration of the sexual function of their sexual partners.

Conclusion. Prostate surgery affects male sexual function more severely in younger patients. Thirty-two patients after surgery refused to restore sexual activity, in more than half of cases (59.4%) due to the unwillingness of the sexual partner to resume sexual relations.

Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.

Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.

Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.

Results. The average surface area of enhanced and non-enhanced models was 3291 mm² and 2879 mm², respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.

Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction.

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.

Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.

Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.

Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.

Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection.

Introduction. Pelvic arteries have various anatomy and anastomoses with other branches of the internal iliac artery (IIA). This explains the technical complexity of identification and catheterization of prostatic arteries (PA), as well as the possibility of complications associated with non-target embolization of prostatic artery anastomoses.

Purpose of the study. To analyze the most common variants of prostate blood supply and evaluate the effectiveness of methods for identifying prostatic arteries.

Materials and methods. The study included 168 patients treated from 2013 to 2021. For catheterization of the prostatic arteries, 4 – 5 Fr microconductors and 2 – 2.8 Fr microcatheters were used. For embolization, hydrogel microspheres with a diameter of 100 – 300 µm and 300 – 500 µm were used, as well as PVA microparticles with a diameter of 100 – 500 µm. Preoperatively multi-sliced computed tomography (MSCT) angiography of the pelvic organs was performed to determine the type of prostatic angioarchitectonics.

Results. The use of preoperative MSCT angiography in combination with intraoperative digital subtraction angiography made it possible to determine the variations of prostatic artery divergence and identify their anastomoses in 100% of patients (336 pelvic sides). One prostatic artery was detected in 91.4% (307) of the pelvic sides. two independent pAs in 8.6% (29) of cases. Symmetrical anatomy of the prostatic arteries on both sides was revealed in 14.3% (24) patients, the remaining 85.7% (144) patients showed asymmetry on both sides. The absence of prostatic arteries anastomoses was detected in 75.5% (254) of the pelvic sides, and in 24.4% (82) of the pelvic sides, anastomoses were detected. Interlobar intraprostatic anastomoses were found in 10.1% (34) of the pelvic sides, communication with a. dorsalis penis was detected in 8% (27) of cases, with rectal arteries in 5.3% (18) of the pelvic sides and with urinary bladder arteries in 3.6% (12) of cases. Based on the analysis of the small pelvis angioarchitectonics in 168 patients, an anatomical classification of the prostatic arteries anatomy was proposed.

Conclusion. Super-selective embolization of the prostatic arteries is a contemporary minimally invasive method of prostatic hyperplasia treatment with a high safety profile. The pelvic arteries have extremely various anatomy, as well as anastomoses with other branches of the internal iliac artery, which complicates the implementation of super-selective embolization of prostatic arteries. The combination of preoperative MSCT and intraoperative digital subtraction angiography makes it possible to identify the prostatic artery and its anastomoses in most cases.

Introduction. Urolithiasis is a multifactorial recurrent disease, unevenly spread throughout the world and characterized

by the formation of urinary stones of various chemical compositions, depending on pathogenesis, etiological, and epidemiological risk factors. Understanding the composition of chemicals and their prevailing ratios can help make decisions about treatment tactics, preventive measures to reduce the risk of recurrence and the prevalence of urolithiasis.

Purpose of the study. To assess the distribution of chemical components in urinary stones along with an analysis of their population significance.

Materials and methods. The urinary stones were obtained from 2854 patients with urolithiasis. The composition of urinary stones was analyzed by using an infrared spectroscopy method.

Results. The predominance of oxalate stones was determined in multicomponent kidney stones (83,7%) and the prevalence of urate stones (54,2%) was revealed in monocomponent kidney stones. Urinary stones with a predominance of oxalates contained significantly fewer impurities (12.4%) than urinary stones with a predominance of urates, phosphates and carbonates with an average amount of impurities >24.0%.

Conclusion. The analysis of urinary stones distribution based on pathogenic factors showed that the calcium metabolism disturbances prevail in the population of the Russian Federation (88.0%).

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.

Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.

Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p < 0.05.

Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.

Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.

Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).

Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.

Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.

Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.

Introduction. Incrustation and biofilms formation on the surface of ureteral stents are still the most significant complications of internal drainage of the upper urinary tract. There are much researchers conducted to combat these complications. The lack of a solution to this problem affects the ultimate results of treatment and economic losses. The issue of impact by physical methods on the ureteral stent, particularly the use of extracorporeal ultrasound acoustic exposure remains, promising and poorly covered.

Purpose of the study. To determine the optimal application points of extracorporeal acoustic exposure by the low-frequency ultrasonic amplitude-modulated signal on a ureteral stent in an experiment.

Materials and methods. The original device was designed. The main principle of its operation is the generation of an amplitude-modulated ultrasonic signal in two modes: pulsed and permanent. A sexually mature mongrel dog was an experimental animal. The ureteral stent was placed by laparotomy and cystotomy. Intraoperatively, the emitter of the developed device was applied to the skin of the animal, according to the previously indicated topographic and anatomical landmarks. At the same time, an ultrasonic wave noise analyzer was applied through the laparotomy wound to the appropriate level of the ureter. Measurements of ultrasound intensity indicators were performed three times in two operating modes of the device.

Results. Pulsed mode: for the ureteral upper third, the highest ultrasonic intensity (123.67 dB) was achieved along the posterior axillary line. For the ureteral middle third, the best ultrasound intensity (115 dB) was obtained by the posterior axillary line. For the ureteral lower third, the highest ultrasound intensity (113.67 dB) was noted along the middle axillary line.

Permanent mode: the best ultrasonic intensity in the projection of the ureteral upper, middle, and lower thirds was achieved along the posterior axillary line and was 118.67 dB, 117 dB and 116.67 dB, accordingly. However, there was an excessive heat effect, manifested by hyperemia and hyperthermia of the animal's skin, fascicular muscle contractions during the instrument functioned in the permanent mode, which can potentially lead to thermal burns and intolerance to the procedure.

Conclusion. The pulsed mode of the device function is most safe. The optimal application points of the instrument emitter for the ureteral upper and middle thirds is the posterior axillary line, and for the ureteral lower third is the middle axillary line.

Performing surgical interventions for benign prostate hyperplasia against the background of chronic urinary tract infection or prostatitis can adversely affect the course of the postoperative period and mediate the development of complications. Therefore, it is important to understand the pre- and postoperative bacterial status of the patients in various endourological surgical techniques and its relationship with possible infectious complications. This review raises the problem of insufficient knowledge regarding the clinical structure of infections during transurethral surgery, assessment of their relationship with the course of the underlying pathology and the severity of symptoms.

Urinary tract infections are widespread throughout the world and occupy one of the leading places among infectious diseases. Antibacterial methods are the basis of modern treatment standards. At the same time, a widespread increase in antibiotic resistance of the main uropathogens is currently observed. In clinical practice, recurrent lower urinary tract infections are increasingly common. Following this, the main task of the doctor is to maximize the recurrence-free interval. Given the obvious negative collateral effect of long-term antibiotic prophylaxis, specialists are increasingly turning to alternative methods. Non-antibacterial preventive measures are aimed at key links in the pathogenesis of the disease, such as counteracting the penetration and adhesion of uropathogens, as well as stimulating the immune system of the macroorganism. The available physicians' toolkit includes pharmacological agents (d-mannose, methenamine hippurate, estrogens, non-steroidal anti-inflammatory drugs, probiotics, intravesical glycosaminoglycans, immunostimulants and vaccines), natural uroantiseptics (medicinal herbs and cranberry products), as well as behavioural therapy. The main advantages of non-antibacterial methods for the treatment and prevention of lower urinary tract infections are environmental friendliness. It is associated with the absence of a negative effect on the commensal flora, as well as a reduction in the risk of developing antibiotic resistance. The current guidelines provide very limited information on the application of this approach to treatment. Published studies indicate the high potential of non-antibacterial methods, some of which are comparable in effectiveness to standard therapy. However, the quality of studies and the lack of drug use standards do not allow including this approach in the existing guidelines. The need for new, high-quality clinical trials is evident.

Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance 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 2021 was formed. The review includes articles on the following issues: the effectiveness of repeated micro-TESE in non-obstructive azoospermia, the role of COVID-19 in male fertility, the effect of testosterone therapy on spermatogenesis, testicular microlithiasis, electroejaculation as a method of obtaining spermatozoa, harm from carrying cell phones near the genitals, prediction of the effectiveness of intrauterine insemination, the effect of advanced paternal age on sperm aneuploidy, and the importance of the microbiome for male fertility.

Urolithiasis is currently one of the most urgent problems in the world. Every eleventh worldwide inhabitant suffers from this disease. Previously, the only way to get rid of kidney stones and the urinary tract was open surgery, which was characterized by high trauma. Over the past decades, the development of technologies has made a significant contribution to the development of new methods of urolithiasis treatment. One of these methods is extracorporeal shock wave lithotripsy (ESWL). The first lithotripter Dornier HM-1 was produced in 1980. Subsequent models have got many changes, both in terms of ergonomics and power. The researchers noticed that the efficiency of stone crushing in the Dornier HM-1 lithotripter was higher than in newer models since the lower power provided the less intensive formation of cavitation bubbles that prevent the effective transit of subsequent waves through the stone. Nowadays, a new method of remote stone crushing is being developed based on low-amplitude high-frequency technology combined with ultrasonic propulsion, which is the main difference from traditional shock-wave lithotripters. The new technology of stone crushing is called «burst wave lithotripsy» (BWL). Currently, the data have been obtained that this method is more effective in terms of crushing quality and less traumatic.