Introduction. Insufficient sensitivity and specificity of existing methods for diagnosing urethral stricture require more accurate methods, which may include magnetic resonance imaging (MRI).

Objective. To study the possibilities of MRI to assess the extent of bulbous urethral stricture and spongiofibrosis grade.

Materials & methods. The study included six men with bulbous urethral stricture, who underwent non-transecting anastomotic urethroplasty via ventral approach. Before surgery, all patients underwent retrograde urethrography according to the standard method and urethral MRI according to their own method, and their data were compared with intraoperative parameters.

Results. The length of the stricture according to retrograde urethrography averaged 11.5 ± 6.3 mm, MRI — 17.8 ± 10.9 mm, intraoperative measurement — 16.7 ± 9.1 mm. There was a significant difference between the mean length of the stricture according to retrograde urethrography and the mean length according to intraoperative data (p = 0.028). There was no significant difference between the mean stricture length according to MRI data and the mean stricture length according to intraoperative data (p = 0.085). The length of spongiofibrosis according to MRI was 15.8 ± 13.6 mm on average, and 16.7 ± 12.9 mm according to intraoperative measurements. There was no significant difference between the average length of spongiofibrosis according to MRI and the average length according to intraoperative data (p = 0.092).

Conclusions. MRI provides information comparable to intraoperative data on the extent of urethral stricture, location, and spongiofibrosis grade.

Introduction. Flexible ureteroscopy (fURS) with laser lithotripsy is the «gold standard» for minimally invasive treatment in patients with kidney stones less than 20 mm. Currently, there are no objective data on the efficacy and safety of bilateral interventions.

Objective. To study the results of bilateral flexible URS (B-fURS) versus unilateral flexible URS (U-fURS).

Materials & methods. Eighty patients prospectively enrolled in the study from July 2022 to December 2022 and was divided into 2 groups. Group 1 (n = 40) underwent U-fURS and Group 2 (n = 40) underwent B-fURS. A single stone up to 20 mm or multiple small calyx stones was an indication for the operation. The baseline values were comparable between the groups, but in the B-fURS group a 39.0% higher incidence (p > 0.002) of multiple stones and a 28.0% higher incidence (p > 0.001) of stones in the lower pole. Previous interventions were also more frequent in Group 1 (B-fURS) patients.

Results. Stone-free rate did not differ (p > 0.9) between the groups and was 95.0% and 97.5%, respectively. No serious complications (p > 0.9) of Clavien III–V were observed in both groups.

Conclusion. Bilateral flexible ureteroscopy is a safe and effective option for patients with bilateral kidney stones, allowing removal of stones in one anesthesia on both sides.

Introduction. Experimental induction of spermatogenesis disorders is possible mainly by physical, pharmacological methods. However, not all methods can cause non-obstructive azoospermia.

Objective. To evaluate and compare the effectiveness of induction of spermatogenesis disorders in rat models by applying ligatures to the spermatic cords and administration of cisplatin.

Materials & methods. Seventy-three mature male rats (Wistar) were divided into 2 experimental groups and 1 control (n = 9) group: group 1 (n = 27) with ligature on the spermatic cord for 12 h (n = 9), 24 h (n = 9), 36 h (n = 9); group 2 (n = 37) with five-fold intraperitoneal administration of cisplatin at concentrations of 5 mg/kg, 3 mg/kg, 1 mg/kg. On days 0, 7, 14, 28 after the last day of induction of spermatogenesis disorders, epididymal semen analysis, blood test, total serum testosterone, pathomorphological examination of testes tissue, body weight, reproductive system organ weight were performed to assess model performance.

Results. Ligation to the spermatic cords did not have a negative effect on the general condition of the animals (p < 0.05), blood test (p < 0.05); there was a decrease in the testicular weight (p < 0.05), the appendage of the testis (p < 0.05), prostate (p < 0.05), the weight of the seminal vesicles did not change (p > 0.05). In group 1, the number of epidermal spermatozoa decreased in all subgroups, statistically significant changes were recorded at 7 (exposure 24 h) and 28 (exposure 12, 36 h) days of research. Histologically, there was no significant inhibition of spermatogenesis, except for a decrease in the area, diameter of the seminal tubules on 7, 28 days after surgery (exposure 24, 36 h). In group 2, the survival of animals was noted only when using cisplatin at a dose of 1 mg/kg five times. Body weight decreased in all rats without recovery, thrombocytopenia recorded after 1 wk, leukocytopenia regressed by 2 wk of the study. A decrease in the weight of all reproductive organs was noted. Sperm concentration decreased at 1 wk and recovered at 28 wk. In the analysis of testicular biopsies: pronounced disorganization of the spermatogenic epithelium, a decrease in the absolute area and diameter of the seminal tubules.

Conclusion. Ligation to the spermatic cord does not cause permanent inhibition of spermatogenesis. Cisplatin at a dose of 1 mg/kg causes persistent severe damage to the spermatogenic epithelium.

Introduction. The most common treatment option for prostate cancer is radical prostatectomy, which involves the removal of the prostate itself and the prostatic urethra in a single block, followed by the formation of a vesicourethral anastomosis. This approach is fraught with postoperative complications, such as urinary incontinence and strictures of anastomosis. In this sense, the clinic's staff faced the question of the possibility of a urethral-sparing variant of operative benefit for a certain category of patients.

Objective. To assess the possibility of performing radical prostatectomy with sparing of the proximal prostatic urethra in the laparoscopic version, its advantages, and disadvantages.

Materials & methods. From 2021 to 2022, 18 successful laparoscopic operations were performed using this technique at the St. Luke Clinical Multidisciplinary Medical Centre. Patients were selected according to the above criteria. In the preoperative period, patients underwent a standard examination in accordance with guidelines, including a blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D-modelling, data from a multifocal prostate biopsy, the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF), the Quality of Life (QoL) index due to urinary disorders, assessment by the Partin’s nomogram. Intraoperative ratios, early and late postoperative complications, length of hospital stay, day of catheter removal, and time to complete urethral recovery were evaluated to study the effectiveness of this surgery type. PSA testing, uroflowmetry with post-void residual urine measurement and IPSS questionnaire were carried out one month after surgery.

Results. There was an improvement in all measurements one month after surgery: median values of the mean urine flow rate increased by 1.7 ml/s, median values of the max urine flow rate increased by 3.7 ml/s, the IPSS decreased by 12 points.

Conclusion. Based on the results of the study, clinical observations, and statistical analysis of the data obtained, it can be concluded that laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra is the preferred surgical option for this pathology, due to its organ-preserving nature.

Introduction. Nephrometric scales have been developed to determine the appropriate surgical tactics and to predict intraoperative values more accurately, considering the characteristics of the renal tumour. However, there is a need to assess the perinephric fat. The Mayo Adhesive Probability (MAP) scale aims to identify adherent perinephric fat (APF) or 'complex' paranephric fat preoperatively.

Objective. To evaluate the effect of APF on intraoperative and functional outcomes of patients with renal cell cancer (RCC) who underwent laparoscopic partial nephrectomy.

Materials & methods. We analysed 118 patients with localised RCC who underwent laparoscopic partial nephrectomy. At the preoperative stage, according to the results of contract-enhanced msCT, the presence of APF was assessed using the MAP scale. At the same time, the thickness of the posterior perinephric fat was measured and the grade of its twisting was assessed. As a result, the patients were divided into two groups: group 1 MAP 0 – 2 pts (no APF) 34 patients and group 2 MAP 3 – 5 pts (presence of APF) 84 patients. In each group, the following indicators were assessed: stage according to the TNM classification, mean age and BMI, average nephrometry score according to the R.E.N.A.L. system, glomerular filtration rate (GFR).

Results. The median surgery time for group 1 patients was 115.0 [92.5; 142.5] min, for group 2 — 130.0 [101.3; 180.0] min. The median warm ischemia time in patients in group 1 was 15 [0; 20] min, in group 2 — 12 [0; 18] min. The median blood loss in the groups 1 and 2 was 50 [15; 100] and 50 [0; 100] ml, respectively. The mean GFR on the first day after surgery was 63.34 ± 18.40 ml/min/1.73 m² in group 1 and 55.09 ± 16.01 ml/min/1.73 m² in group 2. Openings of the pyelocalyceal system were observed in 8 (23.53%) and 23 (27.38%) patients in groups 1 and 2, respectively. A positive surgical margin was detected one patient in group 1 and two in group 2. Early postoperative complications in group 1 were four patients and group 2 — 15 patients.

Conclusion. The presence of APF and its severity can be effectively assessed using the MAP score, which is promising, but is limited only to the prognostic of APF without correlation with nephrometric scales that assess tumour anatomy parameters. However, the issue of developing a unified assessment system that includes APF and kidney morphometry is currently open, and the definition of APF is still subjective and requires an objective analysis to obtain more accurate outcomes.

Introduction. With a depressingly high prevalence of chronic cystitis (it is believed that half of women suffer from acute cystitis at least once in their lives), there is still no clarity on this disease. We were unable to find any studies on the anthropometric characteristics of patients with chronic cystitis either in the domestic or in the English literature.

Objective. To assess the anthropometric characteristics of patients with chronic recurrent cystitis.

Material & methods. A prospective multicenter cohort study included 91 patients with symptoms of acute cystitis. All underwent anthropometric measurements, analyzed complaints, studied anamnesis morbi et vitae, performed a study on a gynecological chair; urine was sent for general analysis and bacteriological examination for nonspecific microflora with the determination of the sensitivity of the isolated pathogen to antimicrobial drugs. The patients answered questions about the Russian version of the Acute Cystitis Symptom Score (ACSS). A urethra and cervical canal smear was studied using the polymerase chain reaction method to identify the causative agents of sexually transmitted infections. The diagnosis was considered confirmed in the presence of leukocyturia, bacteriuria, and the sum of symptoms on the ACSS scale was 6 or more.

Results. The duration of chronic recurrent cystitis was averaged at 7.1 ± 4.2 years. The age of the patients ranged from 18 to 49 years, averaging 28.9 ± 3.9 years. The height ranged from 150 cm to 178 cm, on average 165.9 ± 7.1 cm. The average weight was within the normal range: 64.2 ± 6.1 kg. However, the spread in the cohort by body weight was two-fold: from 42 to 86 kg. Overweight was found in five (5.5%) patients; two patients (2.2%), on the contrary, had a body weight deficit. When analyzing anthropometric indicators, along with the obvious ones (direct dependence of the duration of the disease on the age of the patient; direct dependence of the quality of life on the severity of symptoms), other statistically significant correlations were established: a positive relationship between age and weight, weight and duration of the disease.

Conclusion. The analysis showed that overweight women respond to treatment worse, they have a longer history of cystitis. Neither typical symptoms nor ACSS score correlated with any of the anthropometric measures.

Introduction. One of the additional instrumental methods for diagnosing pudendal neuropathy is needle electroneuromyography (ENMG) of the bulbocavernosus reflex (BCR). The accumulated data on ENMG BCR in patients with primary chronic pelvic pain syndrome (CPPS) are insufficient due to the specificity of the procedure and its performance only in expert centres that specialise in the treatment of pelvic pain. Therefore, a study to investigate the features of ENMG BCR in patients with CPPS is of increased interest.

Objective. To assess the representativeness and informativeness of the ENMG BCR technique in patients with CPPS and to identify factors influencing changes in the main parameters of the BCR M-response such as latency, amplitude, and duration.

Materials & methods. Retrospective cohort study, which included 75 data from patients with (CPPS) who underwent needle-guided ENMG recording of BCR. Subjective complaints of patients were recorded using validated questionnaires: visual analogue scale (VAS) and chronic prostatitis and male pelvic pain syndrome symptom scale index (NIH-CPSI). Basic ENMG parameters such as the amplitude, latency, and duration of the M-responses were recorded.

Results. We found statistically significant correlations between the duration and height of the M response of the patients (r = 0.31, p = 0.03) and their body weight (r = 0.34, p = 0.02). Anthropometric data did not correlate with amplitude and latency. Significant excess latency above 45 ms was observed, confirming nerve tissue destruction, in 11 (55%) women and 24 (44%) men. Although there were no statistically significant differences in any of the M-response parameters between men and women, there was a tendency for an increase in response amplitude in men and an increase in BCR latency time in women.

Conclusion. The results of our study show that the duration of the M-response of BCR can correlate positively with the anthropometric data of the patient. At the same time, the mean latency and amplitude of the response are independent of anthropometric data, and the difference between them may be more determined by sex differences.

Introduction. Urolithiasis is one of the most widespread urological diseases and infectious complications remain one of the most common adverse events after surgical interventions for urolithiasis. Currently, in routine clinical practice in most clinics in the country, for the purpose of postoperative control and detection of infectious complications is used: a clinical blood test with assessment of the dynamics of the blood leukocyte count. Unfortunately, the current edition of the clinical guidelines does not contain recommendations on what indicators of postoperative follow-up examinations the clinician should focus on in order to identify infectious and inflammatory complications. For this reason, the study of the value of other markers of the inflammatory response appears to be an actual task.

Objective. To assess the relationship between the dynamics of laboratory markers of infectious-inflammatory complications and the incidence of infectious-inflammatory response after endoscopic stone removal.

Materials & methods. The prospective cohort study included 217 patients diagnosed with urolithiasis and underwent surgical removal of stones by endoscopic method. Of total patient numbers, 43 patients underwent ureteroscopy (URS) with lithotripsy, 152 patients underwent percutaneous nephrolithotripsy (PNL), and 22 patients underwent flexible ureterolithotripsy with lithotripsy. An analysis of demographics, clinical parameters and postoperative complications was performed as a descriptive analysis. Patients underwent a standard list of laboratory and instrumental examination methods. The mandatory control of body temperature was carried out t.i.d. daily. Before surgical treatment, indicators of WBC, LYMP, CRP, and ESR content were recorded on the first and second days after surgical treatment.

Results. Postoperative fever was recorded in 40 (18.5%) patients. During the postoperative period, an increase in CRP and ESR was observed in both the fever and the normal temperature group, exceeding the reference values on the first day. At the same time, in the fever group (in 40 patients — 18.5%), a significantly higher increase in CRP and ESR was observed (685% vs 323%) for CRP and (146% vs 80%) for ESR. According to the results obtained in our study, CRP and ESR indicators demonstrate the most clinically significant dynamics in patients with postoperative fever, increasing by more than 500% and 100%, respectively.

Conclusions. Endoscopic removal of urinary stones is a safe treatment option in patients with sterile urine cultures. After endoscopic stone removal, all patients experience such reactive changes in peripheral blood parameters as: an increase in the level of leukocytes, lymphopenia, an increase in ESR and CRP levels. Indicators of CRP and ESR demonstrate the most clinically indicative dynamics.

Introduction.  Premature ejaculation (PE) is the second most common male sexual dysfunction with a significant negative impact on quality of life. A significant number of conservative and surgical methods for the treatment of PE are proposed, but their effectiveness and, in some cases, safety, remain the subject of discussion.

Objective. To study the effectiveness of pulsed radiofrequency impulse neuromodulation (RPN) with different modes on the penile dorsal nerve in treatment of patients with premature ejaculation.

Materials & methods. Two groups of PE-patients participated in a prospective multicenter study: Group 1 — 11 patients aged 22 – 34 years; Group 2 — 12 patients aged 23 – 34 years. Group 1 received pulsed RPN at a temperature of 42°C, a stimulation frequency of 2 Hz, 45 V, and a duration of 180 seconds; in Group 2 — pulsed RPN at a temperature of 50 °C and the same frequency and duration of stimulation as Group 1. All patients before and after treatment measured intravaginal ejaculation latency time (IELT) and completed a premature ejaculation profile (PEP). The results were evaluated after 30 days.

Results. In both groups, there was a statistically significant increase in IEDT and PEP. Thus, in Group 1, IELT increased from 58 to 101.9 seconds, PEP from 3.8 to 12.6 points. In Group 2, IELT increased from 66.5 to 210.9 seconds, PEP from 3.2 to 12.6 points. At the same time, in Group 2, IELT increased by 107% more than in Group 1. No significant side effects were observed in both groups.

Conclusion. RPN appears to be a very promising treatment for premature ejaculation, as it is a minimally invasive, safe, and reversible procedure. The technique of influencing the penile dorsal nerve at an electrode temperature of 50 °C compared to 42 °C seems to be more effective, however, additional studies are needed.

Introduction. Bladder cancer (BCa) ranks 10th among all diagnosed malignant tumours. To date, radical cystectomy (RCE) with pelvic lymphadenectomy is the gold standard for the treatment of aggressive forms of BCa. The development of minimally invasive technologies has contributed to the active introduction of robot-assisted interventions into surgical practise. RCE is a modern and relevant method for treating muscle-invasive BCa and high-risk non-muscle-invasive BCa. Over the past decade, many works have been accumulated that demonstrate the success of robot-assisted RCE with intracorporeal neocystis.

Objective. To analyse the complications classified according to Clavien-Dindo after robot-assisted radical cystectomies with intracorporeal heterotopic neocystis based on a single centre.

Materials & methods. From 2021 to 2022, a retrospective study was conducted based on Bashkir State Medical University Clinics aimed at studying complications after robot-assisted RCEs. The group investigated consisted of 200 male and female patients with an established diagnosis of BCa. All patients were shown surgical treatment in volume of RCE by Bricker with pelvic lymphadenectomy. Surgical intervention was performed using the DaVinci ® Si robot-assisted system. After 30 and 90 days, the complications that occurred and the ways to correct them were evaluated.

Results. Only 35 patients (17.5%) had 30-day complications, which were grade I-III. Fourteen (7%) patients had 90-day complications having II and III degrees. Patients with grade III or II and III complications occurred during the first 30 days after surgical treatment subsequently had 90-day complications (p < 0.05). There were no statistically significant differences between the types of 30-day complications of II and III degree and the subsequent 90-day complications (p < 0.05).

Conclusion. Robot-assisted RCE is an effective and technologically advanced method of treating patients with aggressive forms of BCa. Our study demonstrates low rates of surgical complications after this surgical intervention.

Introduction. The study of effective and safe combined methods of conservative treatment of idiopathic male infertility is of great interest.

Objective. To evaluate the effectiveness of the combined use of low-level laser therapy (LLLT) in the infrared (IR) spectrum and bioregulatory therapy with complex prostate peptides on the semen parameters and sperm DNA fragmentation (SDNAF) in men with idiopathic infertility.

Materials & methods. The study is based on the results of examination and treatment of 97 men with idiopathic infertility. Prior to the start of treatment, all patients were divided into three groups by randomization. Patients in group 1 (n = 34) underwent a course of LLLT in the IR spectrum consisting of 10 procedures q.o.d. Patients in group 2 (n = 31) were prescribed complex prostate peptides Supp. Prostatilen® AC (30 + 180 mg) PR q.h.s. FXD, with a repeat of the course of treatment after 5 days. Patients in group 3 (n = 32) underwent combined treatment: LLLT sessions in the IR spectrum (10 procedures q.o.d.) and a course of Supp. Prostatilen® AC (30 + 180 mg) PR q.h.s. FXD, with a repeat of the course of treatment with peptides according to the same scheme after 5 days. Control examination of patients in all groups was carried out two months after the end of treatment.

Results. As a result of treatment of patients in groups 1, 2, and 3, a significant improvement in the main semen parameters, a decrease in the grade of pathological SDNAF, an increase in serum total and free testosterone concentration (p < 0.05) were observed. A comparative statistical analysis of the results obtained in three groups of patients showed that the combined treatment of patients of group 3, who were prescribed a course of LLLT in combination with complex prostate peptides Supp. Prostatilen® AC, was significantly more effective in improving concentration (p < 0.01) and progressive sperm motility (p < 0.01), as well as a decrease in the grade of pathological SDNAF (p < 0.05), than in groups 1 and 2.

Conclusion. Combined therapy that includes complex prostate peptides and LLLT in the IR spectrum improves the main semen parameters and reduces the grade of pathological SDNAF in men with idiopathic infertility.

Introduction. Most patients with metastatic renal cell carcinoma (mRCC) who received systemic therapy are classified into as intermediate risk group according to the International mRCC Database Consortium (IMDC) assessment. However, survival differs in patients with one and two unfavourable prognostic risk factors.

Objective. To analyze the impact of possible clinical and laboratory parameters on survival in mRCC patients with intermediate prognosis according to IMDC in the presence of one or two unfavourable prognostic risk factors.

Materials & methods. A retrospective analysis of data from 316 mRCC patients with intermediate prognosis receiving systemic therapy was carried out. The presence and effect on survival of the following laboratory parameters were compared: hemoglobin, neutrophil count, LDH, platelet count, alkaline phosphatase, serum calcium level, ESR, and emphasis was also placed on the time of metastases appearance. Overall survival (OS), post-progression survival (PPS), and 3- and 5-year survival were evaluated.

Results. The overall 3- and 5-year survival rate for subgroups with one and two unfavourable prognostic risk factors were 85.2%  ±  1.8% and 58.1  ±  1.6%; 79.1%  ±  1.7% and 35.6  1.6%, respectively (p < 0.001). Three- and 5-year PPS for both subgroups amounted to 66.1%  ±  1.6% and 21.8%  ±  1.4%; 45.2%  ±  1.5% and 12.2%  ±  1.3%, respectively (p < 0.001). Median for OS was 61 and 51 months and PPS was 50 and 32 months respectively (p <0.001). No statistically significant difference was found in the frequency of gradations of the investigated laboratory indicators with a predictive effect on prognosis, depending on the number of a unfavourable prognostic risk factors. There were also no significant differences in survival rates when laboratory parameters deviated from the normal, except for hemoglobin: OS in patients with one prognostic factor is significantly higher with normal hemoglobin (p < 0.05). In the future, considering the absence of influence of the selected factors on survival rates with their obvious significant differences in patients with one and two prognostic factors, the influence of the time of appearance of metastases (synchronous / metachronous) was analysed: all survival parameters were significantly worse in patients with synchronous metastases. Furthermore, OS in patients with metachronous metastases with the same relapse-free period was significantly better in patients with one prognostic factor according to IMDC.

Conclusions. The presence of one or two prognostic factors significantly affects the indicators of 3 and 5-year overall survival and PPS in patients with an intermediate prognosis of mRCC, while laboratory parameters do not affect survival, except for hemoglobin levels, the time of metastases appearance has a significant effect, and the time of metastases appearance has a significant effect.

Introduction. According to the guidelines, the stone maximum diameter is one of the main criteria for choosing the method of nephrolithotripsy. When planning an operation, the surgeon focuses not only on the diameter, but also on the renal pelvis anatomy, stone density and number of it, the presence of hydronephrosis, a history of surgery, etc. The maximum diameter is not an exhaustive characteristic that allows you to choose the optimal treatment.

Objective. To evaluate the effect of stone volume (compared to its maximum diameter) on the duration of minimally invasive endoscopic nephrolithotripsy.

Materials & methods. The study was retrospective. The study included 55 patients (22 women, 33 men), the average age was 47.0 ± 1.9 years. All patients underwent minimally invasive thulium fiber laser nephrolithotripsy for stones up to 20 mm (mean maximum diameter — 13.3 ± 0.6 mm, mean density — 1041.0 ± 48.0 HU). Minimally invasive endoscopic interventions such as retrograde intrarenal surgery (RIRS, n = 30), minipercutaneous and micropercutaneous nephrolithotripsy (miniPNL, n = 16 and microPNL, n = 9, respectively) were performed. Patients with urinary system abnormalities, acute urinary tract infections and patients without stone-free status were excluded from the study. In addition to evaluating standard indicators, the stone volume was calculated in all patients using the formula of a scalene ellipsoid (median volume — 287 [144; 538] mm3). Spearman's rank correlation coefficient (r) with an assessment of the significance level was calculated for the stone maximum diameter and volume for the total sample of patients and for each surgical intervention method separately.

Results. The analysis of the total sample of patients reliably revealed a weak correlation (r = 0.39) between the stone maximum diameter and surgery time. And a moderate correlation was found between the stone volume and surgery time (r = 0.53). A similar relationship with the linear distribution was also observed in the analysis in all groups.

Conclusion. When choosing minimally invasive laser nephrolithotripsy, it is advisable to focus not only on the stone maximum diameter, density, and localisation, but also on the stone volume, which has a great correlation with the surgery time.

One key aspect in treating any cancer is timely diagnosis and treatment. Obtaining the right diagnosis depends mainly on running the biopsy algorithm. Most studies show a significant increase in sensitivity and specificity in the targeted tissue sampling method compared to standard biopsy. The human factor can result in more medical errors. This can be solved by replacing the standard biopsy method with a more advanced one. The human factor is excluded from the biopsy sampling process using the semi-automatic robotic biopsy needle guidance. This paper presents a literature review development in robot assisted prostate biopsy. A literature review was performed using PubMed and Scopus databases. Papers reporting on experiments using semi-automatic robotic systems were included. Using the literature, we described the prerequisites for the development the software for semi-automatic targeted biopsy to increase the sensitivity and specificity of prostate cancer diagnosis.

Peyronie's disease (PD) is an acquired disease, which is based on a violation of the wound healing process, which results in the formation of fibrous plaques in the tunica albuginea of the cavernous bodies. The prevalence of erectile dysfunction (ED) among patients with PD ranges from 22% to 54%, according to various studies. Surgical treatment remains the "gold standard" for correcting penile curvature in PD. It is important to note that the existing methods of PD surgery (techniques with shortening or lengthening of the tunica albuginea) carry the risks of developing ED or aggravating its severity. At the same time, the absence of adequate sexual rehabilitation following PD surgery is associated with a significant deterioration in functional outcomes. In view of the above, the article is aimed to systematise information on penile rehabilitation methods in patients following PD surgery, which showed that the problem remains relevant to the present day. Most existing penile rehabilitation methods are currently not sufficiently investigated, and it is therefore impossible to give clear recommendations on the use of any method. The small number of well-designed and randomised studies on this problem is noteworthy, most likely due to the relative rarity of the disease.

The choice of surgical treatment for nephrolithiasis remains a matter of debate. The article is a literature review dedicated to a comparative analysis of the efficacy and safety of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic methods for the treatment of nephrolithiasis. The literature review was based on the analysis of articles published in the PubMed / MEDLINE, and eLibrary databases. Sixty publications on the topic of the review were analysed. As a result of data analysis, endoscopic therapies have a significant advantage over ESWL with comparable safety. The development and dissemination of less invasive techniques such as mini-percutaneous nephrolithotripsy and ultra-mini-percutaneous nephrolithotripsy in the future may change the approach to the surgical treatment of any form of nephrolithiasis.

Mucinous tubular and spindle cell carcinoma of the kidney is a rare low-grade malignant tumour and accounts for less than 1% of all renal neoplasms. The classic morphological structure of the tumor is represented by three elements: spindle cells, ducts and myxoid or mucinous stroma. This tumor is indolent with a low risk of metastasis and a favorable outcome. However, cases with relapses, metastases to regional lymph nodes, and distant metastases, which were mainly characterised by high nuclear atypia, sarcomatoid transformation and other atypical morphological features are described in the literature. Several cases of mucin-poor and mucin-free mucinous tubular and spindle cell renal cell carcinoma have also been presented, making it difficult to differentiate from other renal cell carcinomas. There are reports of cases of mucin poor mucinous tubular and spindle cell carcinoma, which were accompanied by relapses and metastases. Thus, although the tumour is indolent, careful follow-up is necessary even after radical excision. In this article, we report a rare clinical case of combination of mucin-poor mucinous tubular and spindle cell carcinoma and clear cell renal cell carcinoma of the kidney in a 50-year-old man. The results of clinical and instrumental studies, as well as the morphological features of both tumors are presented. Due to the atypical morphological structure of mucinous tubular and spindle cell carcinoma, the final diagnosis was possible using an immunohistochemical method, which demonstrated the immunohistochemical profile characteristic of this tumour.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm. The incidence does not exceed 1% of all neoplasms of this localization. In the general population, up to 90% of all neoplasms of the renal pelvis are represented by urothelial carcinoma, while from 0.7% to 7.0% of cases are squamous cell carcinoma. Stones of the renal collecting system are found in 14 – 50% of patients with squamous cell carcinoma of the pelvis. As a possible etiopathogenetic mechanism, chronic inflammation on the background of a stone is considered, leading to squamous urothelial metaplasia with subsequent keratinization and malignization. Clinical manifestation of squamous cell carcinoma of the renal pelvis is nonspecific and is primarily associated with manifestations of urolithiasis. Squamous cell carcinoma of the renal pelvis is characterised by high aggressiveness, insensitivity to chemotherapy and radiation therapy, and consequently an unfavourable prognosis. The survival rate of most patients is less than one year from the diagnosis, while the 5-year survival rate does not exceed 10%. We present our own clinical case of a patient with a staghorn stone and squamous cell carcinoma of the renal pelvis.

Extravesical ureteral ectopia (EUE) is a rare cause of urinary incontinence (UI) in girls. In 80% of cases, ectopia is associated with ureteral duplication.  We are reporting a case of a 17-year-old girl with UI by EUE from an iliac dystopic hypoplastic left kidney. The girl received outpatient treatment for UI and left kidney agenesia since the age of 5, when her parents for the first time noticed the UI with background normal urination. The child underwent a complete range of medical tests: CT, cystoscopy, renal nuclear scan, uroflowmetry, ureteral cystometry and profilometry. Although the examination revealed no proof of renal tissue existence on the left side, a pad test with a dye was performed to exclude an EUE. The test gave a positive result, which determined further diagnostic search. Vascular CT was performed and made it possible to visualize a severely hypoplastic left kidney dystopic towards the iliac vessels. Laparoscopic nephrectomy was performed and UI manifestations were corrected. Availability of a wide range of visualisation methods in the urologist's toolkit does not always allow to verify hypoplastic renal dystopia when the kidney is drained by a ureter with an extravesical ectopic orifice. When a reasonable suspicion of an EUE is combined with lack of information about its location and dimensions after visualizing tests, a pad test with a dye appears appropriate prior to a diagnostic laparoscopy in our opinion. Once the UU is confirmed by the dye test results, further diagnostic search using laparoscopic access is justified and can be transformed into a treatment procedure if the kidney is revealed.

Kidney cancer (KCa) is one of the greatest challenges in oncological urology due to the increase in morbidity and mortality rates annually. In the treatment of KCa, preservation of renal function is an important objective, in addition to achieving oncological results. The article presents the experience of treatment of 175 KCa-patients of pT1a – T2aN0M0 stages, who underwent nephron-saving surgery (NSS) with preventive hemostatic sutures. Functional outcomes of NSS were studied in the groups without cross-linking (group 1; n = 150) and with cross-linking of the renal pedicle (group 2; n = 25). Kidney resection with prophylactic suturing has been shown to allow removal of a tumour of almost any localisation. By avoiding cross-linking of the renal pedicle during surgery, post-ischemic changes in the renal parenchyma are minimised. Thus, one month after surgery, the perfusion indexes in groups 1 & 2 were 45.2 ± 3.0% vs 35.5 ± 3.3%; renal indexes were 44.8 ± 2.4% vs 39.1 ± 1.4%; areas of the functioning parenchyma were 52.0 ± 10.0% vs 35.0 ± 9.0%, respectively.

The article presents an assessment of the results of surgical treatment of bladder urothelial carcinoma using the Da Vinci Si robotic system. The experience of treating 11 patients who underwent robot-assisted cystectomy (RACE) was analysed. This study demonstrates the effectiveness of RACE due to minimal trauma, blood loss, transfusion frequency, and length of patient stay in the hospital.

Introduction. Percutaneous nephrolitholapaxy (PNL) is the optimal method in the treatment of large or complex renal stones. Surgical equipment and endoscopic equipment, and specialised tools have been constantly developing since the advent of PNL in 1976, increasing success rates with a decrease in the number of complications and morbidity. Owing to the specificity and complexity of the technique, only 11% of urologists in the USA perform PNL, while in Russian Federation no more than 5% of specialists realise it.

Objective. To evaluate the possibilities of using a robot-angiograph to create a puncture access.

Materials & methods. In the Krasnoyarsk Regional Clinical Hospital in 2021, the first PNL was performed in a patient with a left-sided lower calyx stone using the SIEMENS Healthineers’ ARTIS pheno robotic angiograph in a hybrid operating room.  This robotic installation allows the performing of an intraoperative computed tomography examination followed by the construction of a navigation map with a clearly displayed trajectory, length, and angle of inclination of the needle path with automatic positioning of the C-arm.

Results. We performed 30 pyelocaliceal punctures using a robotic angiographic installation for PNL. The average age of patients was 56.6 ± 19.0 years. According to MSCT, the lower calyx stone was detected in seven patients, the middle calyx — 13 cases, the upper calyx — seven patients, pelvic stones were recorded in three patients.  The density of stones varied from 877 HU to 1356 HU.  The use of the ARTIS pheno robotic system allows performing intraoperative 3D modelling to determine the safest pyelocaliceal puncture, followed by PNL, regardless of the stone localisation, the complexity of the anatomy. In addition, a CT-like scans allows you to assess the presence of residual stones during the operation and perform a "second look" not in a delayed manner. This system, unlike all existing types of navigation, allows intraoperative evaluation of the effectiveness (stone-free rate) of surgical treatment.

Conclusion. The introduction of this navigation system in PNL will minimise the risks of complications from puncture access, reduce the number of repeated interventions, and minimise undesirable consequences in the postoperative period.

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders.

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 works published from October 2022 to March 2023 was formed. The review includes articles on the following topics: genetic causes of male infertility, the role of oxidative stress in assisted reproductive technologies (ART) programmes, reference values when performing scrotum and prostate ultrasound, the impact of ART procedures on child development, the impact of DNA fragmentation of spermatozoa on the outcomes of ART, the role of circadian rhythms in spermatogenesis, automated semen testing devices and predictors of success / failure of testicular biopsy.