Introduction. The non-biological simulators presented in the literature are far from the real human anatomy and are primarily aimed at developing the skill of the pyelocalyceal system (PCS) puncture without the possibility of imitating various intraoperative scenarios.

Purpose of the study. To describe the manufacturing and initial testing of the ultrasound-guided PCS puncture simulator with arbitrary placement of bone landmarks and a kidney model, along with the use of a retrograde view during PCS puncture.

Materials and methods. This study included training for 5 resident and 2 urologists. Each participant performed the puncture 5 times using an 18-gauge ultrasound-guided needle. A comparison was made between the number of attempts to form access, the duration of the puncture and its correctness (puncture into the small calyx through the papilla), as well as the correctness of determining the target calyx. The trajectory of the needle was retrogradely assessed using a semi-rigid ureteroscope, and the anatomical identification of the selected calyx was assessed using our mobile application.

Results. The total number of attempts was 49 and 14 among residents and urologists, respectively. The average duration of the puncture step was 25.2 and 12.0 seconds. In 9/25 cases, residents were able to correctly analyze visual ultrasound information to determine the target calyx. When a contrast agent was injected into the PCS after 63 punctures, no contrast leakage was found.

Conclusion. The proposed PCS puncture simulator allows to develop to develop all the necessary skills for cost-effective training of young urologists in the technique of percutaneous access.

Introduction. The American Heart Association identifies 7 major factors that affect the condition of the vascular wall: smoking, blood pressure, total cholesterol, glucose, body mass index, physical activity, and diet. The vascular wall lesions most often manifest clinically as vasculogenic erectile dysfunction (ED). Consequently, evaluating patients for the presence of the above risk factors can not only help in the treatment of ED, but can also significantly increase the chances of early detection of cardiac pathology.

Purpose of the study. To assess cardiovascular disorder markers’ role in prognosing of the presence or absence of ED and its severity.

Materials and methods. The study included 40 patients aged 33 – 60 years. Erectile function was assessed using the device «Androscan – MIT» ("Minimally invasive technologies" LLC, Moscow, Russian Federation) and the IIEF-15 questionnaire. Statistical data processing was carried out using Statistica 12 («StatSoft Inc.», Tusla, CA, USA) и IBMÒ SPSS Statistics 26 («SPSS: An IBM Company», IBM SPSS Corp., Armonk, NY, USA).

Results. For patients with more severe ED, a greater deviation of the parameters studied from normal is typical. The most significant impact on the detection of different ED degrees using the device «Androscan – MIT» had TC, HDL, LDL, RP, BMI, triglycerides и HbA1c levels. Based on the androscanning data, a classification tree with two branches (branching conditions — the level of TC and LDL) and four terminal vertices (depending on the degree of ED) was obtained. There were no classification errors predicting ED degrees, which in this case indicates the good significance of the mathematical prediction. Only IIEF-15 scores had the greatest impact on ED detection using IIEF-15. The only condition for branching when constructing classification trees was the number of IIEF-15 points (two branches with three terminal vertices were obtained).

Conclusion. Cardiovascular risk factors are predictors of vascular ED, detected by androscanning, while the widespread IIEF-15 questionnaire remains completely dependent on subjective feelings of patients without relying on laboratory and instrumental research methods.

Introduction. An actual issue of modern endoscopic surgery for urolithiasis is the development of techniques for optimal access to the stone. Percutaneous access during contact nephrolithotripsy (PCNL) is believed to reach the pyelocalyceal system (PCS) along the shortest trajectory and pass through the small calyces. It assumes multi-accessibility, as well as interventional cascading. Anatomically, the kidney is divided into five relatively independent segments in terms of blood supply. The thickness of the posterior one is only a quarter of the thickness of the kidney, which allows us to assume a significantly smaller number of vessels in this segment even outside the Zondek (Brödel) bloodless line.

Purpose of the study.To prove the possibility of using an optimized transparenchymal approach in PCNL based on the renal vascular structure.

Material and methods. A prospective analysis of the treatment of 41 patients with urolithiasis who hadPCNL. Before surgery, patients were randomized by gender, age, average stone size, and urolithiasis forms. Subjects were divided into two groups. Group 1 (study) —20 (48.8%) patients underwent PCNL through trans-parenchymal access to the inferior-lateral parts of the pelvis or the large lower renal calyx due to the ventral orientation of the lower small calyces. Group 2 (control) — 21 (51.2%) patients underwent standard PCNL. The creation of access to PCS was provided simultaneously with Doppler ultrasound of the renal vessels to prevent damage to the segmental and interlobular vessels of the kidney.

Results. In 73.2% of patients, the blood supply in the region of standard access to the PCS goes through the posterior segmental artery, which does not supply blood to the lower half of the kidney (type 1 blood supply). In 26.8% of patients, branches of the posterior segmental artery cross the projection of the inferior calyces (type 2 blood supply). In cases where it is impossible to perform a standard puncture of the PCL (patients of the first group), type 1 blood supply allows you to safely make an alternative trans-parenchymal access directly to the lower calyx or pelvis through the inferior-lateral dorsal wall. The optimization of the access decreasesthe average operation time by 1.4 times and the average number of accesses by 1.3 times.

Conclusion. Doppler ultrasound scanning allows to visualize of arterial vessels, which helps to provide safe trans-cutaneous puncture access to PCS. In 73.2% of patients, the region of the posterior surface of the pelvis and the lower calyx was identified with the possibility of an anatomically justified low-traumatic trans-parenchymal access. It significantly expands the area of the parts of the PCS accessible for direct intervention. The creation of a trans-parenchymal access to the lower lateral parts of the renal pelvis allows reducing the total number of accesses to the PCS, which reduces the operation time and the number of complications.

Introduction. One of the most researched alternative treatments for localized prostate cancer (PCa) is ultrasound ablation (HIFU ¾ High-intensity Focused Ultrasound). Although the world history of the application of this method of PCa treatment is more than 15 years old, the scope of the application of the method has not finally been determined.

Purpose of the study. To study the results of the application of ultrasound ablation in the treatment of patients with localized and locally advanced PCa.

Materials and methods. The study included 147 patients with PCa who underwent HIFU treatment using the AblathermÒ device («EDAP TMS», Vaulx-en-Velin, Lyon, France). Group 1 included patients with localized and locally advanced PCa treated at the stage of gaining experience and evaluating the results of treatment (n = 82). Group 2 consisted of patients with localized PCa of low and moderate oncological risk (n = 65). The number of sessions in group 1 varied from 1 (65) to 2 (17). The need to perform a second session was associated with the ineffectiveness of the first. HIFU was also performed after the failure of external beam radiation (2), and photodynamic (1) therapy. In group 2, 61 patients received one treatment session, 4 patients received 2 sessions each. The mean follow-up time for the patients in group 1 was 17.4 ± 5.2 (3 – 29) months, for group 2 was 18.2 ± 7.3 (3 – 29) months.

Results. In group 1 of patients with a low degree of oncological risk, a decrease in blood prostate-specific antigen (PSA) below the threshold value and the absence of its significant increase during the observation period was noted in 87.5% of cases (28 patients), with an average degree of oncological risk in 65.6% of cases (21 patients), with a high degree in 27.7% of cases (5 patients). In 34.1% (28 patients), the treatment was ineffective, 21 of them underwent repeated ultrasound ablation of the prostate, and 7 patients received subsequent external beam radiation therapy. These results led us to abandon the use of HIFU in patients with baseline blood PSA levels greater than 20 ng/ml and locally advanced disease. In group 2, biochemical recurrence was noted in 9 patients. A control biopsy in 6 patients confirmed local recurrence, which became the basis for a second HIFU session (4). Five patients received adjuvant hormonal therapy. The total effectiveness of the treatment in group 2 was 86.2%.

Conclusion. The results support the notion that HIFU is a treatment option for localized PCa only. The evaluation of the initial results led us to abandon treatment with this method in patients with locally advanced and high-risk localized PCa.

Introduction. Bladder neck stenosis (BNS) is a late complication of surgical treatment for benign prostatic hyperplasia. Available methods of endoscopic correction in primary BNS have limited effectiveness, while in recurrent cases their use does not lead to satisfactory results at all. YV-plasty of the bladder neck (BN) is one of the available methods of treatment for recurrent BNS.

Purpose of the study. To evaluate the treatment results of patients with recurrent BNS using endovideoscopic YV-plasty of the BN.

Materials and methods. We retrospectively analyzed the treatment results of 8 patients with recurrent BNS who underwent endovideoscopic YV-plasty of the BN in the Urology Division No.1 of the St. Luke St. Petersburg Clinical Hospital from 2019 to 2021.

Results. Endovideoscopic YV-plasty of the bladder neck was successfully performed in all 8 patients. The mean preoperative Q_max was 3.7 ml/s (1.8 – 5.7). At 6 months after surgery, the mean Qmax was 21.4 mL/s (16.7 – 24.1). The mean preoperative I-PSS score was 20.5 (17 – 24). The mean I-PSS score 6 months after surgery was 7.1 (5.0 – 9.0). No cases of de-novo stress urinary incontinence were registered.

Conclusions. Endovideoscopic YV-plasty of the BN may be an effective and safe method of treatment of patients with recurrent BNS. However, further studies are needed to obtain long-term results.

Introduction. Transvaginal mesh-reconstruction of urogenital prolapse remains a controversial trend in modern urogynecology. We have seen growth in transvaginal mesh surgery since 2004, followed by a sharp decline after 2011 due to FDA restrictions related to imperfections in previously available prostheses and implantation techniques. Improving the efficacy and minimizing complications of transvaginal mesh-surgery is at the forefront of research in the field of modern urogynecology.

Purpose of the study. To optimize the indications for transvaginal mesh-reconstruction of anterior apical prolapse.

Materials and methods. The study enrolled 375 patients with anterior apical prolapse. The grade of prolapse was assessed using POP-Q. In patients with endopelvic pelvic fascia insufficiency, severe cystocele (Aa ≥ +1) and hysteroptosis grade II – IV, the correction was carried out using the six-arm OPUR® («ABISS», Saint-Étienne, France). lightweight polypropylene monofilament implant (n = 290). When the cystocele was not prominent (Aa ≤ -1) and grade III – IV hysteroptosis, posterior sacrospinal hysteropexy was preferred with the CYRENE® («ABISS», Saint-Étienne, France) tape (n = 85). In 35 patients, the operation was combined with anterior colporrhaphy. In 5 patients, a simultaneous conization/amputation of the cervix was performed. The examination was performed 1 month after surgery and then annually. Prolapse ≥ grade II was as recurrent. The follow-up period of 67 patients was more than 4 years.

Results. After OPUR® prosthesis implantation, recurrent hysteroptosis was detected in 6 women with cervical hypertrophy / elongation within a period of 1 mo to 3.5 yr and cystocele in 4 patients. The efficacy was 96%. In 9 patients, an postoperative ischuria was found associated with extensive dissection and hypotension of the bladder wall due to chronic urinary retention in severe cystocele. Urination improved in 88% of cases. In the remaining cases, long-term mediator and hormone replacement therapy were continued., One recurrent hysteroptosis was observed during the implantation of the CYRENE® prosthesis. No damage to the bladder was observed. Acute urinary retention was detected in 1 case, which resolved after intermittent catheterization.

Conclusion. The availability of 2 types of transvaginal prostheses for various degrees and configurations of urogenital prolapses allows a differentiated approach to their choice. Both prostheses suggest reliable «reconstruction-imitation» of the sacroiliac ligament by sacrospinal hysteropexy. If necessary, the operation can be supplemented with anterior colporrhaphy. The prevalence of anterior prolapse with endopelvic fascia insufficiency requires more extensive reconstruction, which can be performed relatively safely and effectively by implantation of a 6-arm OPUR® prosthesis.

Introduction. Treatment of patients with complex urethral strictures is an actual problem of reconstructive urology. After multi-staged urethral surgery with multiple revisions the new reconstruction is limited by paucity of plastic material (for grafts and flaps). In-thing, new materials for urethral reconstruction (various auto, allo and xenografts) are still being developed in reconstructive urethral surgery.

Purpose of the study. To study the possibility of using oral mucosa micrografts to form the urethral plate in the multi-stage surgery for patients with extended urethral strictures.

Materials and methods. In the experimental study, male Wistar rats (22 individuals) weighing 300 – 400 g underwent a full-thickness skin wound after intramuscular sedation. We used the wound chamber (12 mm diameter) to exclude the wound contraction. The oral mucosa graft was harvested (6 mm in diameter). After pre-fabrication, the graft was minced to fragments < 1 mm². Micrografts with fibrin-thrombin glue were applied to the wound. By day 45, the epithelial plate was excised for histological examination. In the clinical study, 4 patients with recurrent penile urethral strictures were treated with staged urethroplasty with urethral plate formation using oral mucosa micrografts. The average length of the stricture was 7.5 ± 1.2 cm (with extremely narrow and obliteration sites). The urethral plate was formed as the first stage. The preparation of the graft bed and oral mucosa grafts harvesting was carried out according to the standard procedure. Micrografts preparation and implantation was carried out as in experimental part of this study. After 6 months, neourethra tubularization was performed. The patients were evaluated every 3 months after the final stage of urethroplasty (uroflowmetry, ultrasound, X-ray, PROM-USS). The median follow-up was 9 months (3 – 18 months).

Results. On day 15, in the experimental study, in 16 of 22 (72.7%) rats, the wound chambers had focal growth of the oral mucosa epithelium. On day 45, the wounds healed completely healed with oral mucosa. The final area of the plate was 78 ± 12 mm². In the clinical study, 6 months after the first stage, all patients (n = 4) had a urethral plate covered with an oral mucosa epithelium without scar formation and sufficient for neurethra tubularization. All patients underwent urethral tubularization. After catheter removal, all men urinated. After 9 months (median follow-up, n = 3), the Q_max was 22.7 ± 4.2 ml/s, the post-void residual urine was 34.8 ± 2.2 ml, the total PROM-USS score was 7.4 ± 1.2, urethral lumen is preserved. All patients showed high satisfaction with the treatment.

Conclusion. The oral mucosa micrografts showed good take in heterotopic transplantation (72.7%) with the formation of an epithelial layer on the wound surface. The final mucosal plate area 3 times exceeded the initial micrografts area. This initial clinical experience of using oral mucosa micrografts shows the new possibility of this technology in reconstructive urethral surgery, especially in patients with complex urethral strictures.

Introduction. Non-neurogenic lower urinary tract symptoms (LUTS) are a serious polyetiologic problem in the male population. The side effects of the medication agents used to treat LUTS significantly reduce treatment compliance. According to the literature data, the frequency of refusal for the proposed treatment during the year varies from 20 to 80%. Several studies have shown the benefits of herbal medicine for LUTS concerning the fewer side effects and increased adherence to treatment. However, to obtain a high-level recommendation base, clinical trials are required.

Purpose of the study. To evaluate the effectiveness of Gardaprost^® in LUTS combination therapy.

Materials and methods. The study included 57 men aged 60 – 70 years with diagnosed medium- or large-volume benign prostatic hyperplasia (BPH) and moderate-to-severe LUTS according to I-PSS, morphologically excluded prostate cancer, without urinary infection signs. The patients were randomized into two follow-up groups. Tamsulosin 0.4 mg q.d. was prescribed to patients in the control group. Patients of the main group received Gardaprost^® 0.4 mg q.d. in addition to Tamsulosin. The follow-up period in both groups was one-year. The statistical analysis includes data from 56 men. To evaluate therapy at the screening visit and on days 180 and 360, I-PSS, urination diary, IIEF-5, urinalysis, prostate-specific antigen, uroflowmetry, ultrasound were analyzed. Paired t-test and one-way ANOVA test were used to determine intergroup differences in normally distributed variables. For variables with a distribution other than normal, Friedman's two-way ANOVA for related samples was used. Events with a probability greater than 95% were considered statistically significant.

Results. At the time of inclusion in the study, the groups were comparable concerning the control parameters. In the main group, there was a more pronounced positive dynamics in the I-PSS score, maximum urine flow rate, and post-void residual urine volume, which corresponded to 7.9 ± 2.1 points, 18.0 ± 7.3 ml/sec, 23.6 ± 13.6 ml vs 19.7 ± 7.2 points, 10 ± 3.5 ml/sec, 65.9 ± 33.2 ml in the main and control groups, respectively (p < 0.001). Additionally, in the main observation group, a decrease in prostate volume was recorded by 18.8% (p < 0.001) was recorded.

Conclusion. We have obtained encouraging long-term results from the use of Gardaprost^® in combination therapy of moderate-to-severe LUTS caused by medium- and large-volume BPH.

Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer management. TURBT has two main goals: to resect completely all the tumor lesions in healthy tissues and to provide high-quality specimen to facilitate accurate diagnosis. To achieve these goals, urologists make use of several options to maximize the efficiency of the procedure. To make tumor detection as effective as possible, the European Association of Urology guidelines recommend using enhanced visualization methods such as photodynamic diagnostics (PDD) and narrow-band imaging (NBI). Novel en bloc technique enables one to provide specimens of a higher quality and to increase recurrence-free survival. Also, the use of new energy sources such as lasers helps to decrease bleeding and prevent several complications after TURBT, e.g., obturator nerve reflex and bladder perforation. This article summarizes the options available to enhance the TURBT procedure and reports on the latest data on their feasibility for clinical practice.

Prostate cancer is one of the most common malignancies among men, accounting for 19% of malignant neoplasms and the third leading cause of cancer-related death. The suicide rate among men around the world has increased over the past decade. Additionally, suicide rates are higher among cancer patients, including those with prostate cancer, compared to the general population. The article aimed to make review the current literature and determine the correlation between prostate cancer, depression, and suicidal thoughts.

Prostate cancer (PCa) is a public health problem worldwide. Among all malignant tumors, PCa ranks second in prevalence (105 out of 185 countries) and fifth in cause of death in men in 46 countries. In some cases, this pathology is verified in men under the age of 50, including the advanced stage of the metastatic process. The review article provides information on the epidemiology and prevalence of PCa in young men obtained from the PubMed, CrossRef, and Scopus databases. The data on the probable causal relationship of a number of factors potentially affecting the development of prostate carcinoma are presented. Little-known and new molecular genetic changes are described, including those associated with prostate-specific antigen (PSA), with a proven role in the development of this disease, the use of which will make it possible to predict PCa development in the early stages in a timely manner. It has been determined that the common methods for diagnosing carcinoma in the population, assessing the level of serum PSA, are not always accurate and that the algorithm for their use has not been finally formed. The study of risk factors for the development of PCa in young patients will make it possible to formulate a new diagnostic approach based on considering personal molecular genetic information. The development of this direction is relevant and has an important social and economic importance, considering the study of the contingent of the able-bodied population.

Up-to-date, the platelet-rich plasma (PRP) treatment method is actively used in many fields of medicine. In traumatology, PRP is used to treat bone and cartilage defects, ligamentous apparatus. In combustiology for the healing of burns, in surgery ¾ trophic ulcers. There is evidence of the feasibility of using PRP in some dermatological diseases, as well as in dental practice. For urology, the method is new and is just beginning to be studied. The article discusses the methods of treatment of interstitial cystitis (IC) and erectile dysfunction (ED) using PRP. During the review, we relied on existing data on the effectiveness of intravesical injections of PRP in the treatment of IC, as well as on the successful treatment of ED with activated, nonactivated PRP and PRP augmented phosphodiesterasetype 5 (PDE-5) inhibitors.

The male reproductive health depends on several factors that can be divided into two main groups: the first group, genetic or hereditary (in particular, Klinefelter syndrome, etc.), the second acquired factors that depend on the person's lifestyle (bad habits, diet), stress, infectious diseases of the genitourinary system, etc. The presence of infectious and inflammatory diseases of the male reproductive system leads to impaired reproductive and endocrine function, significantly reducing the reproductive potential. In the last three years of our time around the world, including Russia, the number of people who have become ill with a new viral infection (COVID-19) caused by the new coronavirus (SARS-CoV-2), which causes dysfunction and has a negative effect on many organs and organs, body systems.

The overview of recent publications is devoted to the study of the effect of SARS-CoV-2 on the reproductive health of men. The search was performed using the Medline, PubMed, and EMBASE databases.

The article presents an overview of the most significant publications on the topic of male infertility. The main selection criteria were 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. As a result, a list of 10 articles published in the IV quarter (October — December) of 2021 was compiled. The review includes articles on the following topics: genetic causes of male infertility, the effectiveness of antioxidants, the use of testicular spermatozoa in Intra Cytoplasmic Sperm Injection, the impact of DNA fragmentation of spermatozoa on the results of assisted reproductive technology, the relationship of male fertility with physical activity, the consumption of sweetened beverages and vitamin D intake, as well as the prognostic value of blood anti-Mullerian hormone levels before testicular biopsy.