The article briefly presents the keynote breakthrough milestones in development of native urology in the twentieth century. The author's opinion on the widely used terms and concepts is voiced considering their relevance to the current state-of-the-art knowledge in urology.

Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.

Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.

Materials & methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.

Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).

Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.

Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.

Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.

Materials & methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm³, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed < 2 days before surgery.

Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml², the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml², respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was > 0.07 ng/ml², sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd > 0.07 ng/ml² patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).

Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.

Introduction. Research on the treatment of patients with a combination of anterior urethral stricture and benign prostatic hyperplasia (BPH) is basically absent in the worldwide literature.

Objective. To analyse the primary experience results with simultaneous treatment of anterior urethral stricture and BPH.

Materials & methods. The study included four patients with anterior urethral stricture and BPH, who underwent simultaneous surgical treatment including perineal / penile urethrostomy and thulium laser enucleation of the prostate. The success criterion for treatment was considered to be the absence of obstructive lower urinary tract symptoms requiring the use of endoscopic or open surgery, regardless of whether urethrostomy was considered as the first step or the final option for urinary diversion.

Results. The age of the patients ranged from 54 to 69 years (mean 63.0 ± 6.5 years). In one (25%) patient the stricture was localised in the penile urethra and in three (75%) patients it was localised in the bulbous urethra. The stricture length ranged from 1.0 to 3.0 cm (mean 2.1 ± 0.9 cm). The prostate volume varied from 45 to 77 cc (mean 63.8 ± 13.5 cc). One patient had cystostomy drainage. The post-void residual volume among 3 patients with preserved urination ranged from 90 to 130 ml (mean 113.3 ± 20.8 ml). Postoperative follow-up periods ranged from 3 to 18 months (mean 11.3 ± 7.4 months). At these follow-up periods, treatment was successful in all four (100%) patients. No intra- or postoperative complications were observed.

Conclusions. The proposed method can be successfully applied in patients with a combination of anterior urethral stricture and BPH. However, the final guidelines for the management of such patients can be developed after further research.

Introduction. Currently, the Erector Spinae Plane (ESP) block is widely used both as an independent method of anesthesia and as a component of multimodal anesthesia. It creates an extensive sensor block, spreads over 5 – 7 spinal segments.

Objective. To evaluate the efficacy of ESP block as a component of multimodal anesthesia during open kidney surgery.

Material & methods. The studies were conducted on 116 patients of ASA class I – III at the age of 18 – 85 years All patients were performed inhalation anesthesia with Isoflurane. NSAID (Diclofenac 75 mg IM) was administered as pre-emptive analgesia. In the Study group (n = 60), after tracheal intubation and positioning, an ESP block was performed under ultrasound control at the Th-9 level with a 0.5% Sol. Bupivacaine (25 – 30 ml). In the Control group (n = 56), only inhalation anesthesia was performed. Pain severity, opioid consumption frequency (Sol. Promedoli), postoperative nausea and vomiting were assessed in the postoperative period. A numeric rating scale (NRS) was used to assess pain, which was recorded every 6 hours during the day.

Results. Patients in the study group showed a low assessment of postoperative pain on the numeric rating scale compared to the Control group (p < 0.001). The consumption of opiates (Sol. Promedoli) was also lower, especially in the first 6 hours after surgery (p < 0.001).

Conclusions. The results of our studies confirmed the efficiency of ESP block by reducing the consumption of opiates and NSAIDs. The main advantage of this method is its ease of implementation and safety.

Introduction. The prevalence of patients with extended ureteral strictures has been steadily increasing over the past decades. When it is not possible to perform reconstruction with the tissues of the urinary system, the best solution is intestinal replacement plasty. However, despite the great world experience, the search for the optimal method of intestinal reconstruction does not stop, which determines the relevance of conducting an experimental prospective study.

Objective. To evaluate morphological changes in renal parenchyma after ureteral replacement reconstruction by segments of small and large intestine.

Materials & methods. Fifteen white giant rabbits (6-months-old, weighing 5 kg) were divided into three groups. Group A (n = 5) underwent small intestine [ilealplasty] replacement plasty. Group B (n = 5) double-flap ileoplasty using the Yang-Monti technique. Group C (n = 5) – large intestine [coloplasy] ureteral reconstruction. Before the operation and before withdrawal from the experiment, the level of creatinine and electrolytes was assessed, kidney ultrasound was performed on days 2, 5, 10. Excretory urography was performed to assess the patency of the anastomoses. Animals were withdrawn from the experiment from day 10 to 30. The material used for morphological study included kidneys from the operated and intact sides, proximal and distal anastomoses.

Results. No increase in creatinine level, metabolic disorders were detected in animals. According to ultrasound data, hydronephrosis developed in all animals on day 2 and remained unchanged during the entire follow-up. Group A: no complications were detected. Histologically, the renal parenchyma showed moderate signs of chronic inflammation, single foci of lymphoid infiltration, but there were no irreversible processes in the form of necrosis and sclerosis. Group B: complications — stricture in the anastomosis area of the detubularised fragments and necrosis of the small intestine due to compression of the mesentery by the graft vascular stem. Histologically there were marked dilatation of the tubules at all levels, enlargement of the Bowman-Shumlansky capsule, as well as signs of moderate inflammatory process, there were hydropic and hyaline-droplet dystrophy, tubular necrosis foci. Group C: complications — accumulation of a significant amount of grit, mucus, and fibrin in the colocystoanastomosis area. Histologically, the renal parenchyma showed a marked inflammatory process, in particular, purulent inflammation with demarcation zones, infiltration with polymorphonuclear leukocytes and bacterial cells, foci of necrosis and sclerosis of both stroma and tubules, dilatation of tubules and Bowman-Schumlansky capsules.

Conclusion. The use of an unchanged ileal-graft reconstruction of an extended ureteral defect showed acceptable histological results in an animal model, which confirms the feasibility of its use in clinical practice. The absence of foci of necrosis and fibrosis in the renal parenchyma indicates the preserved functional potential, which suggests the stabilization of renal function in the long term.

Introduction. In most cases, double-J stent placement is the initial method of drainage in patients with urolithiasis. Until ureteroscopic intervention, most patients report «stent-related symptoms» that reduce the quality of life.

Objective. To improve the results of treatment in female patients with urinary stone disease (USD) and preoperative drainage of the upper urinary tract using double-J stent by assessing the effect of the NefroBest® and UroBest® complexes on the prevention of the development of «stent-related symptoms» and inflammatory processes.

Materials & methods. The study group included 90 female patients with USD, who were performed ureteroscopic interventions with preoperative stent placement from March to September 2023 in the Yudin City Clinical Hospital. Patients were divided into two groups: the main group 1 (n = 30) — patients who received phytotherapy with NefroBest® (30 days) and UroBest® (7 days) complexes after placement of an internal ureteral stent; the control group 2 (n = 60) — patients who did not receive specific therapy postoperatively.

Results. According to the USSQ, in group 1 the median score due to urinary symptoms was 22 points, and in group 2 — 28 points (p = 0.001), when assessing symptoms associated with pain — 12 and 18 points (p < 0.001), general health — 17 points both and work performance — 9 and 11 points, respectively. Among patients in group 1, stonefree rate was observed in 90.0%, and among patients in group 2 — in 93.3%. In group 1, antibacterial therapy in the postoperative period was in 37.0% of patients, and in group 2 – among 53.0%.

Conclusion. The co-use of the NefroBest® and UroBest® complexes in female patients with USD and preoperative drainage of the upper urinary tract using double-J stent can reduce the severity of symptoms associated with urination and pain, and postoperatively resulted in a lower incidence of infectious-inflammatory complications.

Introduction. Endoscopic surgery for the treatment of urolithiasis is highly effective but is associated with the risk of infectious complications. Nevertheless, endoscopy is also associated with the risk of postoperative infectious complications, the primary risk factor being positive urine culture. Considering the possibility of detecting persistent asymptomatic bacteriuria (ASB) in this patients amid the shortfall of clear algorithms and schemes of ASB management before endoscopy, a comparative analysis of infectious complications in patients with sterile urine and persistent ASB undergoing endoscopic surgery for renal and ureteral stones is an urgent task.

Оbjective. Analysis of the risk of infectious complications in patients undergoing endoscopic treatment of urinary stones, including those with preoperative evidence of asymptomatic bacteriuria.

Materials & methods. We conducted a cohort, retrospective study of data from eligible patients who underwent endoscopic removal of renal and ureteral stones between January 2023 and July 2023. From the 449 patient records selected, 211 patients fulfilling the established inclusion and non-inclusion criteria were enrolled in further analyses. Antibacterial prophylaxis was administered a few hours before surgery for initial sterile urine culture, three days before surgery for clinically insignificant ASB, and seven days before surgery for clinically significant ASB, followed by repeat control urine culture and determination of antibacterial prophylaxis according to the proposed methodology.

Results. A preoperative sterile urine culture was diagnosed in 152 patients (72.0%), while 59 patients 28% [22%; 34.5%] were found to have bacteriuria, of which 28 patients 13.3% [9%; 18.6%] had clinically significant bacteriuria at a titer of ≥ 10⁵ CFU/mL. After antibiotic therapy, ASB persisted in six patients (22.0%). Accordingly, 37 patients 17.5% [12.79%; 23.4%] with clinically significant and insignificant ASB underwent endoscopic surgery. In the postoperative period, 54 patients (25.6%) had leukocytosis, 17 patients (8.1%) had hyperthermia, and 11 patients (5.2%) had fever accompanied by leukocytosis One patient (0.5%) had an elevated procalcitonin level, which may indicate a systemic inflammatory response. Logistic regression analysis revealed statistically significant associations between the probability of hyperthermia and bacteriuria. A positive urine culture increased the odds of hyperthermia 4.75-fold (OR = 4,75, 95% CI [1.222; 18.803], p = 0.023). Maximum stone size (p = 0.013), stone volume, and ureteral stent drainage (p = 0.006) were the factors influencing the development of leukocytosis. Moreover, the volume of the stone increases the odds of leukocytosis by 1.54 times (OR = 1.543, 95% CI [1.128; 2.158], p = 0.008) for a 1.0 cc enlargement.

Conclusion. Our study shows that a positive urine culture is a significant risk factor for infectious complications after endoscopic surgery. Prolonged courses of antibiotic prophylaxis lasting seven and three days in patients having clinically significant and clinically insignificant ASB, respectively, seem adequate to minimize the risk of postoperative infectious complications. 

Introduction. Benign prostatic hyperplasia (BPH) is a multifactorial and widespread problem of modern medicine, which has not only medical but also social significance. The presence of lower urinary tract symptoms (LUTS) in men has a negative impact on the quality of life. One of the modern surgical methods for treating BPH is the use of laser technologies.

Objective. To compare the effectiveness and safety of laser technologies using the example of the use of diode and thulium lasers in BPH surgery.

Materials & methods. The study included 89 men with BPH who underwent surgery from 2020 to 2022. Patients were divided into two groups: in group 1 (n = 37) photoselective vaporization of the prostate was performed using a Diode Laser Vaporization of the Prostate (DiVAP), in group 2 (n = 52) - Thulium Laser Enucleation of the Prostate (ThuLEP). To assess the results of treatment, we studied indicators of maximum urine flow, residual urine volume, prostate volume, prostate-specific antigen level, severity of LUTS (IPSS scale) and symptoms of erectile dysfunction (IIEF-5 scale), level of quality of life (QoL index) and the frequency of postoperative complications. The outcomes were assessed at baseline and 3, 6, 12 months after the procedure. The duration of the operation, the duration of catheterization and the length of stay of patients in the hospital were also recorded.

Results. At a long-term follow-up (12 months), the effectiveness of DiVAP and ThuLEP was comparable in terms of prostate volume (24.0 and 24.3 cm3), PSA level (3.3 and 3.4 ng/ml) and quality of life of patients related to urination (2.3 and 2.0 points). The severity of LUTS one year after treatment was also comparable in the groups (4.1 and 4.6 points), however, the IPSS scale scores was more favorable in the ThuLEP group at three- and six-month follow-up points (3 months: 14.9 and 10.0 points; 6 months: 9.3 and 7.5 points). At the same time, ThuLEP also turned out to be more effective in the rate of maximum urine flow achieved after a year (15.2 and 25.8 ml/s), the residual urine volume (8.2 and 2.2 ml), and IIEF-5 questionnaire score (22, 4 and 24.4 points), DiVAP - by operation time (58.5 and 84.6 minutes) and catheterization duration (26.8 and 32.5 hours). There were no statistically significant differences in the duration of hospitalization (2.2 and 2.1 days). Postoperative complications are recorded 2 times more often with DiVAP than after ThuLEP.

Conclusions. The study confirmed the high efficiency of endoscopic laser enucleation (ThuLEP) and laser vaporization (DiVAP) technologies. The safety of ThuLEP is due to the lower incidence of postoperative complications compared to DiVAP. The success of laser operations directly depends on careful selection of patients, as well as the experience of the surgeon.

Introduction. Implantation of an artificial urinary sphincter (AUS) is the main treatment method for patients with intrinsic sphincteric deficiency. There are few studies investigating the effectiveness, safety, and impact on the quality of life of the AUS implantation beyond a ten-year follow-up.

Objective. To evaluate the outcomes of the AUS implantation in terms of safety, efficacy, and impact on quality of life in a group of patients beyond a ten-year follow-up.

Materials & methods. From 2004 to 2023, AUS were implanted in 62 patients with severe stress urinary incontinence, of whom 14 had a follow-up period of more than 10 years. Urine loss is estimated using bladder diary. The use of ≤1 pad per day (“social continence”) was considered as cure. The quality of life was assessed using the IPSS-QoL scale and the ICIQ-UI SF questionnaire. Complications are described according to the Clavien-Dindo classification.

Results. The median age of the patient at the time of implantation was 66 [63; 68] years. The causes of severe stress urinary incontinence were the following interventions: radical prostatectomy — 11 patients, radical cystectomy — two patients, transurethral resection of the prostate — one patient. The median time after the intervention that caused urinary incontinence was 20 [15; 26] months. The effectiveness of implantation was evaluated in 11 patients, three patients had complications preventing the use of the AUS. Median follow-up was 137 [124; 160] months. There was a statistically significant decrease in the median urine loss from 700,0 [600; 800] to 12,5 [1; 60] ml. There was also a significant reduction in the use of pads per day from 7 [7; 8] to 1 [0; 2]. Five patients did not use pads. Seven patients met the criterion of cure. Median IPSS-QoL scores decreased from 4 [4; 5] to 2 [1; 2]. After treatment, the score of the ICIQ-UI SF questionnaire was 8 [6; 10]. Complications superior to Clavien-Dindo II were noted in 8 of 14 patients. Eight patients underwent 15 revisions, six of them repeated. The AUS was partially or completely removed in six patients.

Conclusions. Over a ten-year follow-up period, a significant number of patients developed complications, including those requiring removal or replacement of the AUS or its components, and therefore patients with an AUS require regular long-term follow-up. Despite a significant proportion of patients who required an AUS revision, implantation leads to a statistically significant reduction in urine loss and an improvement in the quality of life. 

Introduction. Prostate cancer (PCa) occupies a leading position in the structure of cancer incidence among men worldwide. The “gold standard” for the treatment of localised PCa is radical prostatectomy (RPE), with an increasing frequency of robot-assisted surgery in recent years. One of the negative consequences of surgery for the patient is the occurrence of urinary incontinence (UI), which is quite common and significantly reduces the quality of life. For this reason, it is extremely important to identify the factors that influence the occurrence of UI.

Objectve. To identify risk factors for urinary incontinence in patients undergoing robot-assisted surgery based on the patients' preoperative data.

Materials & methods. A prospective cohort study was conducted at the Urology Clinic of the Russian University of Medicine to study the risk factors for UI in patients undergoing robot-assisted RPE. The follow-up control points were set on days 1, 3, and 7 after urethral catheter removal and at 1, 3, 6, and 12 months after surgery. Anamnestic data and results of instrumental examination were analysed, based on which statistical analysis including logistic regression analysis with construction of regression equation was performed.

Results. In the early postoperative period, UI occurred in 87 (70.3%) patients, but by the follow-up month 12, its frequency had decreased to 15 (11%) cases. Age, body mass index, length of the membranous urethra, size of the m. levator ani, history of prostate surgery and symptoms of an overactive bladder were predictors of UI. Based on the results, nomograms were created to calculate the probability of UI on day 7 and 1, 3, 6, 12 months after urethral catheter removal.

Conclusion. The negative impact of UI on the quality of life of patients who have undergone RPE is obvious. Among the predictors identified by us, a modifiable group of risk factors for urinary incontinence was identified. This reduces the risk and severity of urinary incontinence after surgery, which will have a beneficial effect on the quality of life after surgery.

Introduction. Primary acquired cryptorchidism is the absence of a testicle into the scrotum in a boy with a descended testicle previously documented. In our country, the fact that such pathology exists is denied. However, this disease is recognised by many foreign urological associations of urologists.

Objective. To analyse the accumulated research material and show different state-of-the-art on some aspects of the problem of primary acquired cryptorchidism based on a review of the modern medical literature.

Materials & methods. Literature review was conducted in domestic and foreign databases: FEMB (Federal Electronic Medical Library), eLIBRARY, PubMed from 1987 to 2023. Keywords were used for the search: primary acquired cryptorchidism, ascending testicle, acquired undescended testicle. One-thousand-fifteen literature sources were reviewed, 49 works were included in the review.

Results. The nomenclature, definition and epidemiological data of primary acquired cryptorchidism are reviewed. The main views on the aetiology of the process are named and risk factors are listed. The clinical symptoms and signs, diagnosis and treatment methods are revealed. Treatment results are shown and follow-up guidelines are given.

Conclusions. It is necessary to conduct further scientific and practical research to inform doctors in our country about the existence of this pathology.

Introduction. Many molecular genetic analyses have been proposed to predict the course of prostate cancer (PCa). They have the potential to develop artificial intelligence (AI) algorithms by processing large amounts of data and define connections between them.

Objective. To evaluate the possibilities of using artificial intelligence in early diagnosis and prognosis of prostate cancer.

Materials & methods. We conducted a systematic review of the literature on the Medline citation database. We have selected papers that provide data on the use of AI in vitro, in vivo and in silico systems to determine biological and genetic markers and/or their relationship to clinical data of PCa-patients from 2020 to 2023. The quantitative synthesis includes 16 articles.

Results. AI can identify metabolic and genetic «signature» of PCa, the key elements of signal pathways, thus fulfilling complex tasks in the field of bioinformatics. AI analyses various biomaterials: prostate tissue, blood, and urine. When evaluating prostate tissue for aberrations, AI can help a pathologist. For example, AI can predict the histological status of genes, eliminating the need for IHC or tissue sequencing, significantly reducing the economic cost of predicting the severity of the disease. In most cases, prostate tissue sequencing provides information to the attending physician, allowing the start of optimal treatment, considering the molecular or genetic «signature» of PCa. AI can be used as an alternative to existing population screening tools and a predictive castration-resistant PCa. The use of AI capabilities is more appropriate for blood and urine analysis, procedures that do not require additional economic costs for biomaterial sampling. In theory, this may be more affordable for the patient and the medical institution. It is worth noting that a few studies were conducted in silico (based on the analysis of molecular genetic databases without validation on cell lines or on real patients) and are useful as background information. However, the results can serve as a robust basis for further research in molecular diagnostics and genomics.

Conclusion. It is possible to use AI in the search for key metabolites and genes of the elements of signalling pathways, as well as the determination of metastasis potential, because molecular or genetic «signature» of PCa allows the physician to start optimal treatment.

The spongy urethra is an organ claimed for diagnosis and treatment of numerous urological and non-urological diseases and injuries. Hence, it seems crucial to consider the up-to-date modalities of its structure and function considering the current interests of invasive diagnostics, therapy, and surgery. The article presents different aspects of surgical anatomy, histology, and physiology of the spongy urethra. It also covers the principles of diagnostic work-up and management for certain diseases of the spongy urethra such as urethral strictures, hypospadias, acute ischaemic priapism, acute and chronic urethritis, external injury.

Introduction. Fournier gangrene is a life-threatening form of perineal necrotizing infection characterised by affecting immucompromised patients, including those with tuberculosis.

Objective. To evaluate the treatment results of patients with Fournier gangrene and tuberculosis process.

Materials & methods. Five case histories of patients diagnosed with "Fournier gangrene" at the Tuberculosis Extrapulmonary Division of Clinic No. 2, Moscow Research Clinical Centre for Tuberculosis Control from 2012 to 2022 were analysed retrospectively using the continuous method. The Fournier's Gangrene Severity Index (FGSI) was used for assessment.

Results. The analysis of case histories revealed the main features of management in patients with Fournier gangrene whose underlying process was tuberculosis. Our clinical experience confirms the role of Mycobacterium tuberculosis as a specific agent, as well as an immunosuppression factor in the development of Fournier’s gangrene. One should be wary of this pathology in patients with tuberculosis. The aggressive nature of the infectious process dictates the need for early detection of this disease for competent comprehensive treatment, including early rehabilitation of chronic foci of infection in patients with urogenital pathology and reconstructive-plastic methods of surgical treatment.

Conclusion. Fournier gangrene in tuberculosis patients is a rare difficult-to-treat disease accompanied in most cases by septic shock and a high mortality risk. Alertness towards Fournier gangrene in patients with tuberculosis, correctly chosen treatment tactics reduces the risk of lethal outcomes.

Introduction. During the correction of ureterovesical junction (UVJ) obstruction of the upper segment of the duplicated upper urinary tract (DUUT), the healthy part of the DUUT may be involved around surgery area. Therefore, it risks damage to the complex or even complete loss of the renal unit.

Objective. To evaluate preliminary results for the repair of upper segment obstruction of duplicated upper urinary tract without involvement of the unaffected segment of the renal unit using vesicoscopic access.

Materials & methods. Since 2022, selective ureteral reimplantation of the upper segment of the DUUT according to Cohen using vesicoscopic access (VSA) has been performed in three children. A boy aged 23 months, a girl aged 18 months, and a boy aged four months had unilateral ureterohydronephrosis (SFU grade IV) of the upper segment of the DUUT with ectopy of the ureteral orifice into the urethra. All patients underwent laboratory tests, ultrasound, intravenous urography, retrograde micturition cystography, CT scans. Urinary tract infection, increasing hydronephrosis and dilation of the DUUT were the indications for surgery. Surgery efficacy was evaluated by ultrasound and urine analyses.

Results. All surgeries were completed using VSA devoid for conversion. Surgery time was between 110- and 150-min. Blood loss was 10 ml. Postoperative complication was observed in one patient represented by dynamic intestinal obstruction with subsequent anaemia. The reason was inadequate function of the urethral catheter in the early postoperative period, which was unrelated to the core features of the technique. The postoperative stay ranged from 8 to 14 days. Absence of pyelonephritis, significant reduction in the grade of upper urinary tract dilation were observed according to the postoperative examination in all patients within 3 to 6 months after surgery. We did not detect pathological changes in the lower segment of the affected DUUT in any patient postoperatively.

Conclusion. Selective ureteral reimplantation of the upper segment of the DUUT according to Cohen using VSA is a feasible and safe procedure that can effectively relieve obstruction of the upper half of the DUUT without surgical involvement of the unaffected part.