Introduction. In recent years, ultrasound and endovisual guidance have been introduced into clinical practice when performing percutaneous nephrolitholapaxy.
Objective. To identify the most significant factors that influence the frequency of complete elimination of stones and the development of complications in percutaneous nephrolitholapaxy performed under ultrasound and endovisual guidance.
Materials and methods. We analyzed the results of the treatment of 515 kidney stone patients who underwent percutaneous nephrolitholapaxy under ultrasound navigation and endovideoscopic guidance using a new method developed by us.
Results. The average duration of the operation was 77.2 ± 1.9 min. Most of the operations were performed through one puncture access (95.1%) and in one stage (91.8%) with complete stone elimination in 80.6% of the cases. The degree of decrease in hemoglobin in the postoperative period was only 12.18 ± 0.6 g/l. The frequency of postoperative complications was 29.3%, in most cases there were 1 - 2 severity grades according to Clavien-Dindo. As a result of multivariate regression analysis, independent predictors influencing the frequency of complete stone eradication were the number of stones (p = 0.012), the fact of the presence of staghorn stone (p = 0.016), the number of stages of surgical intervention (p = 0.001). Correlation analysis revealed a statistically significant negative correlation between body mass index and the occurrence of complications (p = 0.005), a positive correlation between the presence of urinary tract infection and the occurrence of complications (p = 0.048), a positive correlation between the grade of blood loss and the occurrence of expectation (р < 0.001).
Conclusions. Percutaneous nephrolitholapaxy under ultrasound and endovisual guidance without the use of X-rays is an effective intervention for most patients with kidney stones. Complete stone eradication depends on the number of stones, the presence of staghorn stone, and the number of stages of surgery. The incidence of complications is significantly affected by the body mass index, the presence of urinary infection and the degree of decrease in hemoglobin during surgery.

Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.
Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermia
Materials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.
Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).
Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function.

Introduction. There are conflicting data in the literature on the results of mini-percutaneous nephrolithotripsy (PCNL) in staghorn stones.
Objective. To compare the results of standard and mini-PCNL.
Materials and methods. The results of PCNL in 90 patients with staghorn stones were analyzed, which were divided into two groups. In the I group, 58 (64.4%) patients underwent standard PNL with a nephroscope 24 Fr, in the II group, 32 (35.6%) patients underwent mini-PCNL with an endoscope 15 Fr. The operative time and the number of postoperative complications were compared. To assess the effectiveness of PCNL, an overview radiography or native computed tomography was performed. The operation was considered successful with residual fragments less than 3 mm.
Results. Operative time, number of complications and blood transfusions, the effectiveness of PCNL in groups I and II were 80.0 ± 20.6 and 96.5 ± 25.0 min, 24.1% and 15.6%, 10.3% and 3.1%, 86.2% and 84.4%. Additional interventions were resorted to in 7 (12.1%) patients in I group, and in 4 (12.5%) patients in II group. Complications in I and II groups were observed in 14 (24.1%) and 5 (15.6%) cases. The frequency of blood transfusions was significantly higher after standard PCNL (10.3% / 3.1%, p < 0.05). Complications of grade III with mini-PCNL, replacement of an incorrectly installed stent was included in 2 patients, and with standard PCNL, ureteral stenting with urine leakage through the nephrostomic tract in 2 patients, drainage of the pleural cavity in one case.
Conclusion. Standard PCNL is an effective method in staghorn stones, but the number of complications after it remains higher. In selected patients with staghorn stones, the results of mini-PCNL are comparable to those of standard PCNL.

Introduction. Existing methods of surgical treatment of benign prostatic hyperplasia are accompanied by the frequent development of postoperative complications, such as urinary incontinence, retrograde ejaculation, and urethral strictures. The method of preserving the prostatic urethra has been developed for a long time. At present, it is possible to use the operation technique and perform laparoscopic urethral-sparing adenomectomy.
Objective. To assess the possibility of performing extraurethral adenomectomy with prostatic urethral preservation using the laparoscopic approach, its advantages and disadvantages.
Materials and methods. Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.
Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. There were no elements of dysuria, particularly urinary incontinence. Prostate volume measured throughout transrectal ultrasound after operation was 20 – 24 cm³.
Conclusion. The technique of retropubic extraurethral adenomectomy with prostatic urethral preservation can be performed in laparoscopic technique. The advantages are early activation of the patient and discharge from the hospital, early removal of the catheter with restoration of independent urination, absence of dysuria, urinary incontinence, and postoperative complications. The results of our study demonstrate the effectiveness of the laparoscopic extraurethral adenomectomy technique, the further development of this technique, and the possibility of its application in practice.

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.
Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.
Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).
Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p < 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p < 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.
Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence.

Introduction. The learning curve (LC) of radical prostatectomy (RP) is an actual problem in contemporary urology.
Objective. To assess the LC of retropubic (rpRP), perineal (plRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP).
Materials and methods. The study included 400 patients with localized or locally advanced prostate cancer (T1cT3bN0M0) who underwent rpRP, plRP, LRP or RARP performed by a single surgeon. Exclusion criteria: refusal of surgical treatment, metastatic prostate cancer, primary multiple cancer, neoadjuvant hormonal, radiation or chemotherapy.
Results. Progressive improvement of metric indicators was noted in all groups as the surgical technique was mastered. Maximum rates of reaching the plateau of satisfactory functional and early oncological results were demonstrated in the RARP group after 25 – 50 procedures. In terms of the duration of the surgery, the LRP group showed the longest mastering period of 75 – 100 cases. Regression of blood loss volume requires 50 – 75 procedures in the rpRP and LRP groups, and 25 – 50 approaches in the rpRP and RARP groups. RARP demonstrates advantages in the context of minimization of catheterization time and inpatient period (25 – 50 cases). rpRP is not only associated with a maximum amount (n = 30) and frequency (21,0%) of complications, but also with a relatively long period of reaching a plateau of 50 – 75 cases. The stabilization of functional results is proceeding at the maximum pace in the RARP group at 25 – 50 procedures, in the other groups at 50 – 75 cases. Oncological safety (positive surgical margin) in the LRP, rpRP and RARP groups is achievable after 25 – 50 cases, in the rpRP group at 50 – 75 cases.
Conclusion. The period of RP mastering depends on surgical approaches. RARP demonstrates the shortest LC duration.

Introduction. SARS-CoV-2 causes several negative processes in the body and complicates the course of chronic somatic diseases, causing dysfunction and having a negative effect on many organs and systems of the body, including organs of the reproductive system.
Objective. To study morphological changes in testicles of patients who have undergone a new coronavirus infection.
Materials and methods. Objects of morphological research were testicular tissues obtained by intraoperative biopsy under intravenous anesthesia served. Material sampling was carried out in 12 patients aged 25–29 years with idiopathic infertility who underwent COVID-19. Patients showed ultrasound signs of fibrosis in the testicles, which were absent before infection with SARS-CoV-2. The biopsy was performed 12 months after COVID-19.
Results. In all observations, changes were observed that are characteristic of the inflammatory process, nonbacterial autoimmune genesis. Histio-lymphocytic infiltration of testicular tissue with destruction of single tubules and parenchyma atrophy, combined with varying degrees of sclerosis, was verified.
Conclusion. In testicular biopsy specimens from patients who have undergone COVID-19, an autoimmune inflammatory process is recorded, manifested by lymphocytic infiltration of testicular tissue, which was combined with varying degrees of sclerosis.

Introduction. In modern medical practice, when conducting clinical trials to assess the effectiveness of the treatment, it has long been recognized that the quality of life of a patient is a highly informative indicator of the assessment of health status. Buccal urethroplasty is one of the most effective methods of surgical treatment of urethral stricture disease in men with scleroatrophic lichen.

Materials and methods. Twenty-five patients with urethral stricture caused by scleroatrophic lichen aged 17 to 80 years were examined. All patients underwent buccal urethroplasty. Patient quality of life was assessed 1, 6, and 12 months after buccal urethroplasty using the SF-36 Health Status Survey, the International Prostate Symptom Score (IPSS; Quality of Life — QoL) and urodynamic studies. In addition, a survey of patients was conducted on the subject of satisfaction with the results of the operation.

Results. The results of the survey reliably indicate the high efficiency of buccal urethroplasty, reflected in the dynamics of physical indicators (62.5 ± 0.7 vs 71.7 ± 0.9 vs 95.5 ± 1.0 vs 97.2 ± 1.1; p < 0.05) and psychological (69.2 ± 1.1 vs 77.0 ± 0.7 vs 92.2 ± 0.8 vs 96.2 ± 1.0; p < 0.05) well-being according to the SF- 36, IPSS total score (32.1±3.4 vs 15.0±2.7 vs 7.3±2.9 vs 6.8±2.4; p < 0.05) and QoL index (5.5 ± 1.2 vs 3.8 ± 1.7 vs 1.6 ± 1.5 vs 1.4 ± 1.4, p < 0.05). The maximum urine flow rate increased to 19.5 ± 1.2 ml/s one month after surgery, to 23.7 ± 1.7 ml/s after six months, and to 25.8 ± 1.3 ml/s after 12 months, compared to preoperative values of 15.8 ± 1.2 ml/s (p < 0.05).

Conclusion. Replacement of affected urethral tissues with scleroatrophic lichen with buccal flap helps restore adequate urination and improve patient quality of life.

The article reviews the 2000-2020 literature on the use of perineal urethrostomy in the treatment of patients with anterior urethral strictures. Historical issues of the development of urethrostomy techniques are considered. The algorithms to choose the method of treatment of urethral strictures in favor of perineal urethrostomy are highlighted, according to the guidelines of the world's professional urological associations. The performance indicators of perineal urethrostomy were studied considering the age characteristics of the patients, the etiological genesis of the strictures, their length and location, as well as depending on the surgical technique and the follow-up period. Considerable attention is paid to studies devoted to the analysis of the functional results of urethrostomy, as well as the quality of life of patients associated with urination and sexual activity. Data are presented on the incidence of early and late surgical complications, including urethrostomy stenosis, as one of the most common. An analysis of studies evaluating factors that negatively affect the outcome of surgery was carried out. The main reasons for the growing demand for the technique in surgery for complex anterior urethral strictures and the importance of the technique among other treatment methods are discussed.

Discussion of risk factors for infectious complications in the general population of patients undergoing transurethral resection of the prostate, antibiotic prophylaxis and therapy has been going on for decades. Up to date, the problem of the manifestation of bacteriuria in clinical infectious processes at various periods, as well as the factors of the introduction of bacterial agents with their further subclinical circulation in the urinary and reproductive systems, seems to be little discussed. The insufficient knowledge of these issues is confirmed by a small number of studies covering mainly electrosurgical mono and bipolar technologies as the most common and studied over a long period of their existence. This review raises the problem of insufficient knowledge of the clinical structure of infections during transurethral surgery, assessment of their risk factors, antibiotic prophylaxis regimens and therapy.

We provide a systematic review of articles related to OHVIRA syndrome (Herlyn-Werner-Wunderlich syndrome), found in PubMed/MedLine, Web of Science, Scopus, Scirus, The Cochrane Library and eLIBRARy to show how the urological component of this congenital malformation, previously considered as a concomitant anomaly, has become an important diagnostic marker. Several attempts were made to classify this condition, and they got more complex to include these variants of abnormalities of the kidney and ureter that were found due to advances in imaging technology. As a result, the understanding of the medical community about the OHVIRA syndrome has gradually changed over the past hundred years, and the growing interest of pediatric urologists and surgeons, in turn, has contributed to the early diagnosis of the syndrome and the improvement of examination methods.

Combined anomalies of the urinary system and axial skeleton, including an L-shaped kidney, obstruction of the ureteropelvic junction (CAKUT syndrome, congenital anomalies of the kidney and urinary tract syndrome) and spinal anomalies, are extremely rare. The clinical case gives a description of a similar combined developmental anomaly.

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 (SJR). As a result, a list of 10 papers published in the first quarter (January – March) of 2022 was compiled. The review includes articles on the following issues: the role of coronavirus infection in male infertility, the effectiveness of aromatase inhibitors in infertile men, the effect of assisted reproductive technologies on the reproductive health of descendants, recurrent miscarriage, the effect of antibiotic therapy on the DNA fragmentation index, the role of antisperm antibodies in male infertility, the incidence of idiopathic male infertility, the Sixth Edition WHO guidelines for the ejaculate processing, as well as the relationship of depression with male infertility.