ISSN (print): 1728-2985, ISSN (online): 2414-9020 Founders: The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health of the Russian Federation; All-Russian public organization " Russian society of urologists" Editor-in-Chief: Alyaev Y.G., Corresponding Member of RAS, Doctor of Sc., Full Professor Frequency / Assess: 6 issues per year / Subscription Included in: White List (3rd level), Higher Attestation Commission List, RISC, Scopus
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Structure of community-acquired urinary tract infection pathogens in the Russian Federation in 2022–2024: results of the RESOURCE-2 study
Aim. To analyze the structure of pathogens responsible for community-acquired urinary tract infections (UTIs) in the Russian Federation during 2022–2024. Materials and Methods. A total of 566,122 microbiological urine samples from residents of 834 cities across 83 regions of the Russian Federation were analyzed between 2022 and 2024. The study was carried out using real-world data (RWD) analysis, based on relevant segments of the Invitro Laboratory database. Separate analyses were performed for specific types of UTIs in pregnant women, children, men, and women across various age groups. Results. The most common UTI pathogen in Russia was Escherichia coli, detected in 40.7% of men, 69.5% of women, and 61.2% of children with community-acquired UTIs. The prevalence of E. coli was highest among women aged 38–55 years and men aged 20–50 years. The second most frequent pathogen was Klebsiella pneumoniae (12.8%), with an increasing detection rate beginning from the 38–40-year age group. Among other Enterobacterales, Proteus mirabilis was identified in 3.4% of cases. Among Gram-positive bacteria, the leading pathogens were Enterococcus faecalis (5.7%), Staphylococcus saprophyticus (1.5%), and Streptococcus agalactiae (1.8%). A significant increase in Streptococcus agalactiae detection was observed in pregnant women (6–19%) compared with non-pregnant women (2–5%) of the same age group. Conclusions. RWD analysis represents a simple and cost-effective tool for studying the pathogen structure of community-acquired UTIs. It complements traditional microbiological surveillance methods and provides unique insights into infection etiology, including detection rates of less common uropathogens and detailed age-related variations in pathogen distribution.
Antibiotic resistance of the main uropathogens in patients with acute secondary pyelonephritis
Relevance. Pyelonephritis is an infectious and inflammatory disease of the kidneys with predominant damage to the mucous membrane of the pelvis and calyces and/or interstitial tissue. In complicated acute pyelonephritis, the frequency of E. coli isolation is 63,3%. Less common pathogens are Proteus mirabilis (6,1%), Pseudomonas aeruginosa (1,3%), Klebsiella pneumoniae (13,5%). Enterobacteriaceae are characterized by high levels of resistance to many antimicrobial drugs (AMPs). Today, the greatest clinical significance is the increase in resistance of enterobacteria strains to modern cephalosporins and carbapenems. Purpose of the study. To study the level of resistance of pyelonephritis pathogens to antibacterial drugs of various groups, to identify producers of extended spectrum beta-lactamases and carbapenemases among the causative agents of acute secondary pyelonephritis. Materials and methods. The medical histories of 305 medical histories of patients who were undergoing inpatient treatment at the uronephrological center of the Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk with an established diagnosis: acute secondary pyelonephritis. The material for laboratory research was the average portion of freely released urine obtained after toileting the genital organs, or urine collected by a catheter using a generally accepted method. Identification of microorganisms was carried out using automatic bacteriological analyzers. Antimicrobial susceptibility was tested using the disk diffusion method. Molecular genetic analysis was carried out using the PCR method. Results and discussion. The resistance of microorganisms that cause acute secondary pyelonephritis to antibacterial drugs of various groups was assessed. The mechanisms of antibiotic resistance of enterobacteriaceae have been studied. A high prevalence of extended spectrum beta-lactamase producers was revealed. In E. coli isolates. genes of the bla CTX-M-1 cluster predominated (34%). Carbopenemase production was detected in 24% of the analyzed E.coli strains. The vast majority of K. pneumoniae strains produced extended-spectrum beta-lactamases of the bla SHV cluster (87.5%). The frequency of carbapenemase production among K. pneumoniae isolates was 68.7%. Conclusion. If acute secondary pyelonephritis is suspected and empirical therapy is prescribed, assessment of the local resistance phenotype of the leading pathogens is necessary to exclude from the selection of antibacterial agents to which there is a high level of resistance.
Multicenter open prospective randomized study on the efficacy and safety of Canephron N in preventing recurrences of uncomplicated lower urinary tract infection in women
Introduction. In women, urinary tract infections (UTIs) rank second in morbidity after acute respiratory viral infections. Therefore, issues of non-antibacterial prevention and treatment of UTIs are of great relevance. Particular interest is focused on evaluating the efficacy of the herbal medicinal product Canephron® N in UTI prevention under conditions of rapidly increasing antibiotic resistance among uropathogenic bacterial strains, as well as the growing frequency of microbial associations and multidrug-resistant pathogens. Aim. To assess and update data on the efficacy and safety of Canephron® N for the prevention of recurrent UTIs in outpatient practice. Materials and methods. A total of 72 female patients with a clinical diagnosis of acute cystitis or exacerbation of chronic cystitis, for whom empirical antibiotic therapy (ABT) was indicated according to the Russian clinical guidelines, were enrolled in a multicenter, open, prospective, randomized study. Thirty-six patients were assigned to the main group, receiving ABT in combination with Canephron® N (2 tablets three times daily) followed by prophylactic monotherapy with the herbal product for 1 month. Thirty-one patients, receiving ABT only (contact was lost with 5 patients after randomization, and they were excluded from further analysis), were included in the control group. Treatment efficiency and recurrence rates were evaluated for 12 months after completion of therapy. Results. The mean age of the patients was 37,4 years: 35,1 years in the main group and 39,7 years in the control group. Acute cystitis was diagnosed in 36 (53,7%) patients, and recurrent cystitis in 31 (46,2%). When Canephron® N was administered at the onset of the disease together with antibiotic therapy and subsequently for one month, recurrences of uncomplicated lower urinary tract infections (LUTIs) within one year were observed in 13,9% of patients, compared with 38,7% in the control group. Among patients with acute cystitis, a recurrent episode during the year occurred in 5% of those treated with ABT and Canephron® N, compared with 31,2% in the group without phytotherapy. In patients with recurrent cystitis, the recurrence rate within one year was 25% in the Canephron® N group versus 46,7% in the control group. Discussion. Currently, Canephron® N is one of the herbal medicinal products with the most convincing evidence base, a high safety profile, and a broad range of therapeutic effects. The components of this phytomedicine are included in the 2024 Russian Ministry of Health Clinical Guidelines «Cystitis in Women» as an agent for both the prevention and treatment of recurrent cystitis. Our study demonstrated that the combination of antibiotic therapy with Canephron® N reduced the recurrence rate by almost threefold (from 38.7% in the control group to 13.9% in the main group) and prolonged the recurrence-free period in both acute and chronic cystitis in outpatient practice. Conclusion. Evidence has been obtained supporting the therapeutic efficiency of Canephron® N in the combination treatment and prevention of recurrent UTIs. A positive trend was observed toward improved treatment outcomes and reduced recurrence rates in real clinical practice among patients with uncomplicated cystitis receiving the herbal product in combination with antibiotic therapy.
Clinical significance of the biomarker KIM-1 in assessing kidney injury after contact ureterolithotripsy
Relevance. Transurethral ureterolithotripsy (TULT) is considered as a first-line treatment method in patients with ureteral stones. TULT is associated with its high efficacy and low incidence of complications. However, the effect of TULT on kidney function has not been sufficiently studied. The aim was to explore the possibility of using the biomarker KIM-1 (Kidney Injury Molecule-1) in the assessment of kidney injury after TULT in patients with occlusive ureteral calculi. Materials and methods of research. The clinical data of 28 patients with ureteral stones who underwent surgery were analyzed. Before and after TULT serum creatinine levels were determined, glomerular filtration rate (GFR) was calculated, KIM-1 was quantified in urine, and dopplerography of renal blood flow was performed with the calculation of the resistance index in the interlobular arteries of the kidneys (Ri). The size, density of the stone and its localization in the ureter were determined using computed tomography. A day after TULT, computed tomography was performed repeatedly to identify residual stones and assess the position of the ureteral catheter. Results. The average size of the stones was 46,9±5,0 mm2, and the duration of the TULT was 31,9±5,5 minutes. The size of the renal pelvis significantly decreased in the postoperative period (17,3±1,6 mm before surgery and 11,4±0,9 mm after, p<0,05). The urinary excretion level of KIM-1 was significantly higher in patients with occlusive ureteral stones than in patients of the control group with kidney stones without urinary stasis. Different pathogenetic scenarios of the course of the postoperative period were observed. A significant decrease in Ri and a simultaneous significant increase in the concentration of KIM-1 in urine were found in 10 patients a day after TULT, 6 hours after removal of the ureteral catheter. The reсovery of urine outflow from a kidney that has recently been in a state of ischemia leads to normalization of renal hemodynamics and is accompanied by increased urinary excretion of KIM-1. This phenomenon is obviously related with the «washing» of the renal tubules. In the remaining 18 patients, Ri did not decrease and there was no increase in the concentration of KIM-1 in urine. In our opinion, there is a continuation of obstructive uropathy due to local swelling of the ureteral mucosa. The duration of the endoscopic intervention and the size of the concretion were not factors, determining the severity of renal hemodynamic disorders and damage to the renal tubulointerstitium. Multidirectional changes in Ri in the postoperative period were accompanied by a significant decrease in serum creatinine and an increase in GFR. This makes it impossible to use these indicators to assess kidney injury after surgery. Conclusion. A study of the urinary excretion level of KIM-1 before and after TULT in combination with a measurement of renal hemodynamics makes it possible to assess kidney injury. There are potential possibilities for using KIM-1 as a tool for determining the duration of upper urinary drainage after TULT.
Evidence-based study of kidney transplantation: renal arterial resistance and rejection
Background: To decrease the high morbidity and mortality of patients with end-stage renal disease kidney transplantation is the most effective management. This study aimed to investigate changes in clinical, biochemical, inflammation, rejection, and its association with the renal arterial resistive index after kidney transplantation. Methods: In this study, we assessed changes in clinical, biochemical, and renal arterial resistive (RRI) index measured by doppler ultrasound and its association with graft rejection after kidney transplantation in 60 adult recipients. Data included; gender, age, hospital stay, living or deceased donor, evidence of acute tubular necrosis, donor (living or cadaver), preference of vessel anastomosis (first artery- second vein; FASV or FVSA), preference of arterial anastomosis (as end-to-end to hypogastric artery or end-to-side to common or external iliac artery), evidence for acute tubular necrosis (ATN), in addition to biochemical variables were noted analyzed by SPSS. Results: With a minimum of 16 and a maximum of 68, the mean±SD was 42,3±13,7 years old. Of the total population studied 52% received kidneys from cadaver donors. Although acute tubular necrosis versus acute rejection was reported at 32% versus 60%, the value of RRI in the total population was 0,76±0,11. There was a significant difference in rejected versus non-rejected (p=0,001) and living versus cadaver donors regarding the values of reported RRI (р=0,018). Conclusion: In this study, the recorded RRI suggested respected information regarding changes within intraparanchymal vascularization linked to rejection after kidney transplantation. Further evidence-based studies regarding RRI with more sample size are recommended.
Genetic polymorphisms of HNF1B, CASC17, CASC8 and CCAT2 genes associated with prostate cancer risk in urologic patients
Objective. The aim of the study was to analyze genomic combinations of four SNPs—rs4430796 (HNF1B), rs1859962 (CASC17), rs1447295 (CASC8), and rs6983267 (CCAT2) – associated with prostate cancer (PCa) in urological patients, including those with benign prostatic hyperplasia (BPH), PCa, and urolithiasis (UL). Materials and methods. A genetic study of blood samples from 236 patients in the Russian population was conducted, including 97 with benign prostatic hyperplasia (BPH), 89 with prostate cancer (PC) and 50 with urolithiasis (UL) – the control group. The extraction of DNA from venous blood was undertaken, and genotyping was subsequently performed by PCR followed by restriction degradation. Subsequently, the allele and genotype frequencies were compared between groups using the χ² test. Odds ratios (OR) and 95% confidence intervals were estimated. The results obtained from this study are as follows. An association was identified between mutant alleles T (HNF1B) and C (CASC17) in RP and BPH, which was absent in the control group. The TT genotype at rs4430796 (HNF1B) has been demonstrated to be associated with an increased risk of prostate cancer (OR=2,38; 95% CI: 1,26–4,47; p=0,004). The CC genotype at rs1859962 (CASC17) has also been demonstrated to be associated with prostate cancer (OR=3,80; 95% CI: 1,30–11,4; p=0,015). The TT (HNF1B) + CC (CASC17) combination was absent in patients with ICD, but was common in patients with RP and DGP. It is also considered a possible marker of the tumour process. The area under the curve (AUC) was 0,71, which corresponds to moderate diagnostic value. The genomic combinations GG TT (CASC8+CCAT2) and GG G/T exhibited differences between the DGP and RP groups. The study identified unique combinations of four single-nucleotide polymorphisms (SNPs) that are characteristic of patients with DGP. Conclusion. A combined analysis of polymorphisms rs4430796 and rs1859962 has the potential to serve as a basis for the genetic stratification of PR risk in the Russian population. The identified genomic combinations have potential as marker panels for screening and differentiation of PC and BPH, as well as for the development of personalised approaches in oncology.
Evaluation of hormonal status and sperm parameters in reproductive-age men after COVID-19 infection
Introduction. The symptoms of novel coronavirus infection (SARS-CoV-2), observed in the long-term period after COVID-19 and collectively referred to as post-COVID syndrome, include not only pulmonary complications but also damage to other target organs, particularly the male reproductive system. Most published studies are based on data obtained during the acute phase of the disease, while reports on long-term reproductive complications are scarce. Therefore, assessment of post-COVID effects on male reproductive function remains a relevant clinical issue. Aim. To evaluate hormonal status and semen parameters in men of reproductive age after recovery from COVID-19 in the long-term period. Materials and methods. A prospective study included 120 men aged 21–44 years. Group 1 comprised 60 patients who had COVID-19 complicated by viral pneumonia, and Group 2 included 60 patients with COVID-19 presenting as an acute respiratory viral infection (ARVI). Peripheral blood and semen samples were collected on the 15th and 90th days after disease onset. The following blood parameters were analyzed: total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, and sex hormone-binding globulin (SHBG). Results. Analysis of hormonal profiles showed a decrease in total testosterone relative to the diagnostic threshold on day 15 from disease onset by 46% in patients with COVID-19 complicated by pneumonia and by 17% in patients with ARVI-like COVID-19. A significant positive trend in TT level was observed in both groups by day 90: an increase of 20% in Group 1 (p ≤ 0.05) and 33% in Group 2 (p ≤ 0.05). Compared with reference values, SHBG levels exceeded the upper limit by 24% and 25% in Groups 1 and 2, respectively, on day 15, and remained elevated on day 90 (by 16% and 11%, respectively), despite a significant decline over time (p ≤ 0.05 in both groups). Level of pituitary hormones and estradiol remained within the reference range at all time points. A decrease in total sperm motility relative to reference values was recorded in both groups due to a reduction in progressively motile sperm. However, a significant improvement in progressive motility was noted by day 90, resulting in higher total sperm motility in Group 1 (p ≤ 0.05) and a 14% increase in the proportion of morphologically normal sperm in Group 2 (p ≤ 0.05). Conclusion. Men recovering from COVID-19, both with and without pneumonia, showed significant alterations in total testosterone and SHBG levels on day 15 and by the end of the third month of observation. Microscopic semen analysis revealed reduced total sperm motility relative to reference values on days 15 and 90 after disease onset, primarily due to a decrease in progressive motility. Nevertheless, a significant improvement was observed by the third month in both total sperm motility and the proportion of morphologically normal spermatozoa.
Characteristics of the pathogenic potential of Staphylococcus aureus strains isolated from prostate secretions in chronic bacterial prostatitis
Aim. To analyze genes that determine pathogenicity factors in staphylococcal strains isolated from prostatic secretions in chronic bacterial prostatitis. Materials and methods. Staphylococci were isolated from the prostate secretion of men of reproductive age (20-45 years) with chronic bacterial prostatitis using a conventional bacteriological method. The type of staphylococci was determined by MALDI-TOF mass spectrometry. The virulence genes of staphylococci were determined by PCR and sequencing. Results. The isolated strains were found to have a wide distribution of genetic determinants of pathogenicity, namely adhesion, colonization, invasion, and immune resistance. It was shown that most genes are associated with evasion of the host immune response during infection, which contributes to the chronic course of bacterial prostatitis. Conclusion. It is advisable to further study the genetic determinants of pathogenicity/virulence of Staphylococcus aureus to assess the severity and duration of chronic bacterial prostatitis.
Risk assessment scale for the development of acute pyelonephritis in women at different stages of pregnancy
Introduction. The authors consider gestational pyelonephritis as a relevant clinical problem requiring timely diagnosis and a well-grounded choice of treatment strategy. Aim. To develop and validate a scale for stratifying the risk of acute pyelonephritis in pregnant women, allowing determination of the optimal management strategy (conservative therapy or upper urinary tract drainage) at various gestational stages. Materials and methods. A retrospective analysis was performed on 161 cases of urinary tract infection in pregnant women: 73 patients observed in 2024 using the proposed scale and 88 patients from 2023, who formed the control group. Results. Implementation of the scale in 2024 increased the frequency of ureteral stenting (32.8% vs. 17% in 2023) and reduced the number of cases with kidney decapsulation (2.9% vs. 3.5%). A statistically significant increase was observed in the proportion of hospitalizations during the third trimester (20.6% vs. 6.8% in the first trimester), indicating more accurate risk stratification and timely selection of treatment tactics. Conclusion. The developed scale facilitates objectification of clinical decisions in managing pregnant women with gestational pyelonephritis, ensures timely drainage in high-risk patients, and reduces the frequency of unnecessary invasive interventions.
Evaluation of the possibility of using the Androscan-MIT device for diagnosis and minimally invasive assessment of conservative therapy outcomes in patients with vasculogenic erectile dysfunction
Introduction. Erectile dysfunction (ED) remains one of the important issues in modern urology, as it affects not only the quality of life but also the psychological and reproductive health of patients. Diagnostic challenges persist, as there is still no universal, minimally invasive method to evaluate the quality of erection and the efficiency of therapy in patients with a confirmed diagnosis of ED. Aim. To assess the feasibility of using the Androscan-MIT device as a minimally invasive tool for monitoring the efficiency of conservative treatment in patients with vasculogenic erectile dysfunction. Materials and Methods. The study included 80 men aged 37 to 61 years with mild to moderate ED and 20 healthy volunteers as a control group. Patients were divided into four groups: group 1 (n=30): patients received local negative pressure therapy (LOD-therapy), low-intensity shockwave therapy (LiSWT), and Avantron chair stimulation (10 sessions); group 2 (n=30): patients received daily phosphodiesterase type 5 inhibitor (PDE5i) therapy at a dose of 5 mg for 2 months; group 3 (n=20): patients received combined therapy including LOD-therapy, LiSWT, Avantron chair stimulation, and platelet-rich plasma (PRP) injections (5 sessions); group 4 (n=20): control group of healthy volunteers. Therapeutic efficacy was assessed using the IIEF-5 questionnaire (International Index of Erectile Function) and Androscan-MIT measurements before and after treatment. Results. In Group 3, a significant improvement was observed after therapy: the IIEF-5 score increased to 21.1±2.1, corresponding to a 39.7% rise from baseline. Repeat nocturnal penile tumescence (NPT) monitoring demonstrated erectile function parameters comparable to those in the control group. The absolute increase in penile diameter reached 12.5±0.4 mm (+48.8% from baseline). The average number of effective nocturnal erections increased to 4.6±0.4 (+67.6%), and the average duration of each effective erection reached 20.9±1.5 minutes (+36.6%). The total erection time per night was 81.8±5.3 minutes (+74.8% from baseline). In Groups 1 and 2, no statistically significant changes in these parameters were recorded compared to baseline. Conclusion. The use of the Androscan-MIT device allowed for effective diagnosis of vasculogenic erectile dysfunction and minimally invasive assessment of therapeutic outcomes. The observed improvements following treatment confirm the potential of Androscan-MIT for both diagnostic evaluation and monitoring of conservative therapy efficiency in patients with vasculogenic ED.
Prospective comparison of the IPSS, MIPSS and VPSS questionnaires with uroflowmetry and cognitive functions control in men with benign prostatic hyperplasia
Introduction. Accurate assessment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is one of the key tasks of a urologist for selecting adequate therapy, monitoring treatment, and determining indications for surgical treatment. The International Prostate Symptom Score (IPSS) questionnaire, developed in 1992, has become a simple and widely used method to grade the presence, type, and severity of LUTS in men with BPH. However, the IPSS has certain limitations: the poorer a patient’s cognitive abilities, the greater the likelihood of incorrect responses due to the complexity and abstract nature of the questions and the difficulty in translating subjective sensations into a written numerical score. In 2011, a new tool, namely the Visual Prostate Symptom Score (VPSS), was proposed as a visual analogue of the IPSS, in which the questions are presented in pictorial form, thereby reducing the dependence on literacy and cognitive function. Despite these advances, the search for the most rational and cognitively accessible questionnaire for assessing LUTS remains relevant. Aim. To compare the IPSS, modified IPSS (mIPSS), and VPSS questionnaires in men with BPH, with reference to uroflowmetry and cognitive function, and to improve the diagnostic accuracy of IPSS through its modification. Materials and Methods. A total of 72 men with symptomatic BPH presenting for initial outpatient evaluation were included in the prospective study. The median age was 68 [64–72] years. All patients underwent standard assessments according to the Russian Society of Urology clinical guidelines: urinalysis, complete blood count, prostate-specific antigen (PSA) testing, transrectal ultrasound (TRUS) with measurement of prostate volume and post-void residual urine, renal ultrasonography, and uroflowmetry. Inclusion criteria were: prostate volume 40–180 cc, residual urine ≤150 mL, and PSA < 4 ng/mL. Exclusion criteria were suspicion of prostate cancer or other causes of voiding dysfunction unrelated to BPH. All patients provided written informed consent, and the study was approved by the local ethics committee. Each participant completed four questionnaires, including the newly developed modified IPSS (mIPSS). In this version, the IPSS items were divided into two groups: voiding (obstructive) symptoms: questions 1, 3, 5, 6; storage (irritative) symptoms: questions 2, 4, 7. Results. For most questions, the proportion of identical responses between questionnaires exceeded 50%, and all correlation coefficients were r > 0.6, indicating a strong association between the results and suggesting that the tools measure similar constructs and are largely interchangeable. Uroflowmetry parameters correlated significantly only with the total mIPSS score. Both Qmax and Qave showed a significant inverse correlation with mIPSS total score, while voided volume showed no correlation with any questionnaire scores. The urinary stream strength item correlated significantly with Qmax and Qave, and nocturia correlated with all three parameters (Qmax, Qave, and voided volume). This indicates that the mIPSS questionnaire can be used as a rational and sufficiently quick tool for assessing lower urinary tract symptoms (LUTS). The mIPSS and IPSS questionnaires are interchangeable in terms of the evaluated characteristics of urination; however, mIPSS shows a stronger correlation with objective uroflowmetry parameters and is therefore considered a more reliable assessment method. Conclusion. The results demonstrate the advantages of the modified IPSS (mIPSS) compared with the standard IPSS, owing to its stronger correlation with objective urodynamic findings and greater ease of use. The mIPSS and VPSS questionnaires may be effectively applied to identify voiding disorders, particularly in patients with cognitive impairment. At the same time, the interchangeability of the questionnaire items and the rationale for dividing the questions into obstructive and irritative categories by splitting them into two columns have been demonstrated.
Results of histological evaluation of glandular epithelium in BPH in hypo- and eugonadal men
Introduction. Benign prostatic hyperplasia (BPH), despite advances in pharmacotherapy and surgical treatment, remains a pressing problem in modern urology. The success of therapy depends on the condition of the prostate epithelial compartment. Objective. To conduct a histological assessment of glandular epithelium in BPH in hypo- and eugonadal men. Materials and methods. The results of morphological examination of the resected prostate tissue of 188 men with BPH were analyzed, who were divided into two groups: Group I – 71 patients with testosterone (Tc) deficiency, group II (control) – 117 patients with testosterone levels above 12.1 nmol/L. Results. In patients with Tc deficiency, morphological examination of resected prostate tissue samples revealed a stromal pattern of BPH, combined with cystic deformation of the acini, with flattened and non-secretory epithelium. In patients with normal Tc levels, all patients had a glandular pattern of hyperplasia, and the epithelial cells of the acini were tall, columnar, and showed signs of active secretion. Conclusions. In patients with testosterone deficiency, morphological examination of resected prostate tissue samples revealed atrophic, flattened, and non-secretory epithelium. In patients with Tc levels within the reference range, all epithelial cells were tall, columnar, and showed signs of active secretion.
Comparative evaluation of the efficacy and safety of surgical methods for the treatment of benign prostatic hyperplasia: bipolar TURP and ThuLEP
Aim. To improve surgical outcomes in patients with benign prostatic hyperplasia (BPH) by assessing the efficacy and safety of bipolar transurethral resection of the prostate (b-TURP) in comparison with thulium laser enucleation of the prostate (ThuLEP). Materials and methods. A retrospective and prospective analysis of surgical outcomes was performed in 555 patients with BPH who were examined and operated on between 2018 and 2024. Among them, 301 patients underwent bipolar TURP, and 254 patients underwent transurethral thulium laser enucleation of the prostate (ThuLEP). The mean age of patients was 68.8±8.10 years in the b-TURP group and 68.3±8.10 years in the ThuLEP group (p>0.05). Results. The intraoperative blood loss and volume of removed tissue were significantly higher in the ThuLEP group. The incidence of early and late postoperative complications was significantly higher in patients after b-TURP. The need for additional postoperative pharmacotherapy and its duration due to lower urinary tract symptoms (LUTS) were also significantly greater after b-TURP. Conclusion. Although both techniques provide a comparable and high efficacy in the surgical removal of adenomatous prostatic tissue, their safety profiles differ. Despite effective relief of bladder outlet obstruction, bipolar TURP is inferior to ThuLEP in terms of patient safety and early postoperative recovery.
Experience with domestic local nitinol stents in patients with benign ureteral obstruction
Objective. To evaluate the efficacy and safety of intraluminal nitinol ureteral stents (“MIT”, Russia) in patients with benign ureteral strictures who experience a significant decline in their quality of life due to standard drainage systems and have contraindications to radical surgical treatment. Materials and Methods. Between 2021 and 2025, a total of 27 MIT nitinol stents were implanted in 25 patients with benign ureteral obstruction. In the first stage, all the patients underwent an endoscopic assessment of the stricture determining its length, followed by a temporary placement of a double J stent. In the second stage, an intraluminal stent was implanted. The effectiveness was evaluated based on technical and clinical success, as well as changes in quality of life assessed by the Visual Analogue Scale (VAS). Results. The mean operative time was 35 [30; 41] minutes. Technical success was achieved in 92% of the patients. A significant improvement in quality of life was observed in most patients, with the median VAS score increasing from 21 [20; 26] to 86 [77; 90] points 3 months after the implantation. Mild stent-related symptoms persisted in 6 patients. Additional interventions were required in 6 patients (8 interventions). In 4 cases, stent encrustations had to be removed endoscopically; in 2 cases, endoscopic correction of stent position was performed; in 2 cases, additional drainage was required due to mucosal hyperplasia at the contact points of the stent ends. Discussion. Intraluminal nitinol stents demonstrate high clinical efficacy and may serve as a viable alternative to standard drainage systems in patients who are not candidates for reconstructive surgery. Their use is associated with fewer side effects and a significant improvement in quality of life. However, stent implantation carries a risk of complications such as encrustation, migration, and mucosal hyperplasia. Therefore, careful patient selection, adherence to technical standards of implantation, and regular follow-up are essential. Conclusion. The introduction of MIT nitinol ureteral stents into clinical practice shows promising results in patients with benign ureteral strictures. Further studies involving larger patient cohorts and longer follow-up periods are needed to refine indications and optimize patient management strategies.
Urodynamic risk factors for transient urinary incontinence after endoscopic enucleation of prostate hyperplasia
Introduction: Urinary incontinence in men after endoscopic enucleation of benign prostate hyperplasia (BPH) can reach 55% and significantly impairing the quality of life and social rehabilitation of patients. A large number of individual patient parameters and features of surgical treatment are considered as potential risk factors. At the same time, the influence of urodynamic factors, including the external urethral sphincter function at the preoperative stage, fades into the background, and research on this issue is extremely limited. Objective: comprehensive assessment of urodynamic risk factors for urinary incontinence after endoscopic enucleation of BHP. Materials and methods. This prospective study included 69 patients who underwent endoscopic enucleation of BPH (thulium fiber enucleation – 62 patients, bipolar enucleation – 7 patients) performed by single surgeon between October 2023 and August 2024. All patients underwent an invasive urodynamic study 1 day before the planned surgical treatment, including uroflowmetry, cystometry, flow/pressure study and profilometry performed by single urologist. In the postoperative period, the presence and duration of urinary incontinence were recorded in accordance with the definition of the International Continence Society. Statistical data processing was carried out using RStudio software in the R programming language. Results. Transient urinary incontinence after endoscopic enucleation was detected in 36.2% patients. In 100% cases, the duration of incontinence did not exceed a 3-month period. The independent urodynamic predictors of urinary incontinence were the bladder outlet obstruction index (BOOI), the bladder contractility index (BCI) and maximum intraurethral pressure (Pura max). Thus, with an increase in BOOI for 1 unit, the chance of urinary incontinence increased by 1,027 times or 2.7% (OR=1,027; 95%CI=1,003–1,052; p=0,027). With an increase in BCI for every 1, the chance of urinary incontinence increased by 1,020 times or 2.0% (OR=1,020; 95%CI=1,001–1,039; p=0,043). Large values of Pura max, on the contrary, led to a decrease in the chance of urinary incontinence, thereby acting as a protective factor. With an increase in Pura max for every 1 cm of H2O, the chance of urinary incontinence decreased by 1,087 times or by 8% (OR=0,920; 95%CI=0,876–0,966). The overall accuracy of the proposed model was 88,1% with sensitivity and specificity of 90,5 and 86,8% (ROC–AUC=0,897). The only independent intraoperative factor associated with urinary incontinence was the operation time: with an increase in the operation time for every 1 minute, the chance of urinary incontinence increased by 1,022 times or by 2,2%, regardless of the type of energy used and the early sphincter release (OR=1,022; 95%CI=1,005–1.040; p=0,011; ROC–AUC=0,721). Conclusion. The chance of urinary incontinence at longer endoscopic enucleation, higher BOOI and BCI and low Pura max increases, which, thereby, can be used in predicting the functional results of endoscopic enucleation, taking into account individual urodynamic risk factors.
Vesicovaginal fistulas: surgical strategy and rare clinical cases
Aim. To present our experience of surgical management of vesicovaginal fistulas (VVFs). Materials and methods. From 1996 to 2025, 156 women with VVFs underwent surgical treatment at the Department of Urology, North-Western State Medical University named after I.I. Mechnikov. Age ranged from 21 to 79 years (mean 45.2±4.6 years). Recurrent fistulas were observed in 42 (26.9%) patients, who had previously undergone from one to six unsuccessful surgical attempts. The predominant cause of VVF formation was iatrogenic injury to the urinary bladder during gynecological interventions (77.5%). Fistula repair was performed in 140 patients, with a transvaginal approach used in 91.4% of cases. The transabdominal approach was employed in 12 women, including 10 cases with concurrent ureteral reconstruction and 2 performed via laparoscopic approach. Results. Among 140 patients who underwent fistula closure, success was achieved in 139 cases (99.3%). Discussion. In our clinic, transvaginal fistula closure is the preferred surgical method for managing vesicovaginal fistulas. We consider it the least traumatic open technique, even compared with its laparoscopic alternative. Conclusion. Transvaginal vesicovaginal fistula closure remains the method of choice for treatment of VVFs. A transabdominal approach, including laparoscopic repair, is justified only when simultaneous ureteral reconstruction is required. Heterotopic cystoplasty is regarded as the most reliable reconstructive option for patients with radiation-induced fistulas.
Prostate cancer and relation with cardiovascular diseases in hyposexual males
Corresponding author: M.E. Efremov – Сand.Sc.(Med), Assist. of the urology Dept. of the Kuban State Medical University of the Ministry of Health of the Russian Federation; urologist of the Research Institute – Regional Clinical Hospital № 1 Prof. S.V. Ochapovsky, Krasnodar, Russia; e-mail: efremov.uro@yandex.ru Introduction. In recent decades, cardiovascular diseases (coronary heart disease, arterial hypertension, arrhythmias, dyslipidemia, etc.) and prostate cancer remain quite frequent causes of incidence and mortality. Previously, the results have been obtained, according to which the development of PCa mainly takes place in men, who are characterized by low sexual activity throughout life, in connection with which there is a need to clarify the relationship between the CVD and PCa. The purpose of the study. Determine the frequency of the diagnosis of CVD in hyposexual men undergoing brachytherapy. Materials and methods. The study includes 148 men (group I) aged 68 [64; 72] with the first diagnosis of prostate cancer (PCa) T1C-2CN0M0, subject to brachytherapy, and 99 men (II group) at the age of 67 years [62; 72] The diagnosis of prostate hyperplasia (PH).Diagnostics of PCa and PH was carried out in accordance with the current clinical recommendations of RUA and ROUA. All patients independently filled the Rostov questionnaire at an integral assessment of male sexuality [15]. The diagnosis of related cardiovascular diseases and conditions was carried out according to the clinical recommendations of the RCS. The level of general testosterone in the blood serum was determined on the automatic immunochemistiluminated analyzer «Advia CentAur XP» (Siemens). Results. Almost half of men (50.7%) from the group had a reduced (≤12.0 nmol/l) level of general blood testosterone and low sexuality. In patients with RPGs, angina pectoris, dyslipidemia, extrasystole and bradyarrhythmia (p <0.05) are reliably more common. And patients with PH significantly more often suffer from common atherosclerosis, atherosclerosis of aorta and coronary arteries, chronic heart failure, tachyarrhythmias, obesity, have acute cerebrovascular accident, stenting of coronary arteries/ aorto-coronary noise (p <0.05). As it turned out, there are no differences in the frequency of coronary heart disease, myocardial infarction, diabetes mellitus, hypertension, atherosclerosis of brachiocephalic arteries for PCa and PH. With angina pectoris, the chances of the availability of PCa than the PH, 2.7 times higher compared to the absence of angina pectoris. With dyslipidemia, the chances of the presence of a diagnosis of prource are higher than 3.8 times. With bradyarrhythms and extrasystoles, the chances of the presence of PCa, not PH, are also significantly increased, but the growth intensity is difficult to accurately assess, since there are no data from the CVD in the group of patients with PCa. In chronic heart failure, the chances that the patient has a PH, not PCa, is 2.8 times higher than the lack of chronic heart failure. The presence of the rest of the CVD (percutaneous stenting of coronary arteries/aorto-coronary bypassing and a history of cerebral circulation in the history of cerebral circulation, atherosclerosis, including aorta and coronary arteries, tachyarrhythms) and obesity increases the chances that the patient will have a diagnosis of PH, and not PCa. As for the level of general testosterone of blood, hyposexual men with PCa do not have its reliable effect on the frequency of SVD. Conclusion. Identification of the frequency of a wide range of CVD for PCa showed a strong relationship for some and low communication for other CVD. Moreover, the comparison of the connection of the CVD with PCa and PH confirms more differences in these connections than similarities. The study of the mechanisms of the communication of CVD with PCa promising in terms of influence on individual factors of a young man in order to reduce the risks of the development of PCa.
Use of high-dose vitamin C and Suby G solution in the treatment of encrusted cystitis
This article describes a clinical case of the successful use of high doses of vitamin C and Suby G solution to reduce urine acidity in a patient with encrusted cystitis. The previously used combination of oral methionine intake and intravesical instillations of a 3% aqueous boric acid solution was ineffective. As part of comprehensive therapy, transurethral resections of bladder wall encrustations were performed, along with antibacterial therapy with vancomycin. The obtained results indicate the potential effectiveness of this combination; however, further clinical studies are needed to verify them.
Pharmacological treatment of overactive bladder: the potential of anticholinergic therapy
The management of overactive bladder (OAB) involves drugs from several pharmacological classes, among which anticholinergic agents occupy an important place. The choice of therapy should be strictly individualized, taking into account not only the expected efficacy but also potential drug interactions, age-related pharmacokinetic and pharmacodynamic changes, comorbidities, the overall anticholinergic burden, and the risk of adverse effects. Trospium chloride (Spasmex) is considered the drug of choice for patients with OAB. Its pharmacological properties ensure both clinical efficacy and good tolerability, along with proven cognitive safety. Trospium chloride does not cross the blood–brain barrier and therefore does not cause central nervous system adverse effects. Another advantage of trospium chloride is the flexible dosing regimen, which allows for individualized dose titration according to patient response and tolerability.
Risks of acute kidney injury with intravascular administration of an iodine-containing contrast agent in patients with acute pyelonephritis
The occurrence of acute kidney damage associated with the introduction of an iodine-containing contrast agent into the vascular bed, which leads to transient or persistent structural and functional changes in nephrons, endothelial cells, and renal tubule epithelium, is an urgent problem in modern instrumental diagnostics of various pathological processes, since iodine-containing preparations have a strong advantage over «native» scanning. A researcher who uses different techniques depending on the tasks set opens up great prospects in studying many aspects of the structure and function of tissues. New technologies are being actively introduced into clinical practice, with the possibility of selective visualization of small visceral vessels not only using subtractive angiography, but also selective CT angiography/venography. In foreign and domestic literature, the main emphasis is placed on the development of acute kidney damage when using iodine-containing contrast agents in «compromised» patients with chronic structural disorders in the kidneys, with evidence that the risks of acute damage are high in chronic renal failure. As for acute disorders – in some cases with complicated forms of pyelonephritis, life-threatening situations, CT with contrast enhancement and alternative methods of selectiveойangiographyand renal arteries in combination treatmentis extremely necessary.
Endocrine and metabolic changes in prostate cancer patients after radical prostatectomy
It has been established that women who undergo hysterectomy, even in cases where the ovaries are preserved, frequently experience premature ovarian insufficiency syndrome, which can lead to various endocrine and metabolic disorders. A comparable inquiry emerges in the context of radical prostatectomy (RP) in males: whether the extraction of the prostate gland itself influences testicular function and the emergence of polymetabolic disorders in the absence of androgen deprivation therapy (ADT). Radical prostatectomy has been recognized as an effective treatment for localized prostate cancer (PCa), providing high survival rates for patients diagnosed with this disease. The primary focus of specialists in this field has historically centered on the surgical consequences of RP, such as erectile dysfunction and stress urinary incontinence. However, mounting evidence suggests that prostate removal itself can also result in a transient decrease in testosterone levels, manifesting as biochemical or manifest hypogonadism, along with moderate metabolic disturbances, though not to the same extent as observed with adjuvant hormone therapy. In some cases, patients already in the preoperative period may have risk factors for metabolic syndrome, osteopenia, and other perioperative complications, which makes it difficult to objectively assess the direct effect of RP. A more profound comprehension of the pathophysiologic mechanisms underlying these changes appears to be a pivotal element in facilitating timely diagnosis, prevention, and treatment of potential endocrine-metabolic complications associated with RP.
Epidemiology, risk factors, diagnosis, and microbiology of suppurative pyelonephritis: a systematic review and meta-analysis, Part 1
Introduction. The first part of a systematic review and meta-analysis addressing the problem of purulent pyelonephritis is presented in the article. Aim. To analyze the epidemiology, predisposing factors, diagnostic approaches, and microbiological characteristics of purulent pyelonephritis, which is a complicated form of acute pyelonephritis characterized by renal parenchymal suppuration, sepsis, or localized abscess. Materials and methods. A systematic review of 46 studies (1981–2024) on complicated pyelonephritis was performed. The review included clinical series (observational and one randomized trial) with ≥10 patients reporting on prevalence, risk factors, clinical course, diagnostic approaches, microbiology, treatment, and outcomes of severe pyelonephritis. Data were synthesized qualitatively, and a meta-analysis of key outcomes (mortality and need for surgical intervention) was carried out using a random-effects model. Results. Acute pyelonephritis is one of the most common serious urinary tract infections, with an annual incidence of 15–17 per 10,000 women and 3–5 per 10,000 men. In most cases, the disease responds well to antibiotic therapy; however, in 20–30% of patients complicated pyelonephritis develops. Predisposing factors include diabetes mellitus, urinary tract obstruction, advanced age, male sex, immunodeficiency, and pregnancy. Diabetes mellitus is present in 30–35% of hospitalized patients with pyelonephritis (vs. 10–15% in uncomplicated cases) and in 75–95% of patients with emphysematous pyelonephritis. Urolithiasis accounts for approximately 20% of cases with complicated pyelonephritis. Elderly (>65 years) and male patients are affected less frequently but experience more severe disease: men constitute only about 25% of acute pyelonephritis cases but have higher rates of abscess and sepsis. Purulent pyelonephritis is typically associated with pronounced systemic symptoms: high fever (>39 °C in 70% of cases), chills (50–60%), and septic shock (25–30% upon admission). In 15–20% of severe cases, local urinary symptoms (flank pain, dysuria) are absent. Laboratory findings usually demonstrate leukocytosis >15×109/L (80%) or, conversely, leukopenia <4×109/L (20–30%) in cases with disseminated intravascular coagulation, along with markedly elevated C-reactive protein levels (>100 mg/L). Imaging plays a decisive role: ultrasound can detect hydronephrosis and pyonephrosis, whereas contrast-enhanced computed tomography is the gold standard for detecting abscesses and gas formation. The main pathogens of complicated pyelonephritis are Gram-negative enteric bacteria, primarily Escherichia coli (60–75%), Klebsiella pneumoniae (10–15%), and Proteus mirabilis (5–10%). In 10–30% of cases, isolates exhibit multidrug resistance (e.g., ESBL-producing strains). Polymicrobial infection occurs in approximately 5–10% of severe cases. Conclusions. Purulent pyelonephritis is a relatively uncommon but potentially life-threatening complication of renal infection, strongly associated with risk factors such as diabetes and urinary obstruction. Improved patient outcomes depend on early identification of high-risk individuals, timely imaging to detect purulent complications, and empirical antibiotic therapy that accounts for likely antimicrobial resistance (treatment strategies and outcomes will be discussed in Part 2 of this review).
Comparative efficacy and safety of alpha-adrenoblockers in the treatment of LUTS due to BPH: a systematic review and meta-analysis
Introduction. Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common and significantly impair quality of life. Alpha-1 adrenergic blockers (ABs) are the first-line pharmacotherapy; however, direct comparative data between individual agents remain limited. Objective. To systematically compare the efficacy and safety of silodosin, tamsulosin, alfuzosin, terazosin, and doxazosin in men with LUTS/BPH. Materials and Methods. A comprehensive search was performed in eLibrary, PubMed, Embase, and the Cochrane Library from July to September 2025. Randomized controlled trials (RCTs) evaluating AB monotherapy in men with LUTS/BPH were included. Primary outcomes were the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), quality of life (QoL), and incidence of adverse events (AEs). Study selection and data extraction were conducted in duplicate. Risk of bias was assessed using Cochrane RoB 2. Pairwise meta-analyses (random-effects model, RevMan) and a network meta-analysis with placebo as a common comparator were performed. Certainty of evidence was evaluated using the GRADE approach. Results. Twenty-two RCTs (n=3,371; median follow-up = 12 weeks) were included; 20 were eligible for quantitative synthesis. Compared with placebo, all ABs significantly improved symptom and uroflow parameters: pooled mean difference for IPSS = –2.3 to –2.5 points; increase in Qmax = +2 mL/s; reduction in PVR = –10 to –20 mL; improvement in QoL = –0.4 points. Network analysis revealed no statistically significant efficacy differences among agents. Rank probability suggested slightly greater improvements in IPSS/Qmax/PVR with tamsulosin, and in QoL with doxazosin, though differences were clinically marginal. Safety profiles varied: dizziness and orthostatic hypotension were more frequent with doxazosin/terazosin, while ejaculatory dysfunction occurred more often with silodosin (≈ 20–25%) and, to a lesser extent, tamsulosin (8–10%). The rate of discontinuation due to AEs was comparable to placebo; serious AEs were rare. Conclusion. Alpha-1 adrenergic blockers as a class effectively reduce LUTS and improve urinary flow parameters in men with BPH. No clinically meaningful superiority of any single agent has been demonstrated. Treatment choice should be individualized according to comorbidities and tolerability profile. Large-scale head-to-head trials are warranted to confirm potential subtle differences.
Use of Longidaza® in chronic prostatitis: A systematic review and meta-analysis
Introduction. Chronic bacterial prostatitis (CBP) is a disease with a multifaceted pathophysiological basis, including infectious, immunological, neurological, vascular, endocrinological, biochemical, and psychological factors, making it a multidisciplinary problem. One current treatment strategy is the use of the original drug Longidaza®, which has demonstrated efficacy in this disease, primarily due to its anti-inflammatory effect. A large number of original studies necessitate systematization of the results. Objective. To conduct a comprehensive assessment of the clinical efficacy of Longidaza® (bovhyaluronidase azoximer) when included in the treatment plan for chronic prostatitis, based on data from controlled clinical trials. Materials and Methods. A systematic review and meta-analysis were conducted according to the PRISMA protocol. Elibrary, PubMed, and Cyberleninka databases were used to search for articles. The search was conducted using a combination of keywords: chronic prostatitis and «Longidaza,» «Bovhyaluronidase azoximer,» among studies published no later than August 31, 2025. Results. A search of scientific databases using the algorithms illustrated in Figure 1 yielded a total of 210 publications, of which 10 studies were then selected based on inclusion/exclusion criteria. Conclusions. The results of the analysis suggest that adding Longidaza® to standard therapy for chronic prostatitis (antimicrobial and anti-inflammatory agents) significantly reduces clinical manifestations of the disease. Furthermore, the inclusion of Longidaza® in the treatment plan reduces inflammation in the prostate gland and improves maximum urinary flow rate, resulting in a significant reduction in the severity of chronic prostatitis.
Outcomes of surgical correction of the urethra in the management of postcoital cystitis: A systematic review and meta-analysis
Objective. To evaluate the efficacy and safety of surgical approaches for recurrent postcoital cystitis (PCC) in women. Materials and methods. A systematic search (PubMed, Scopus, Web of Science, eLibrary) was conducted following PRISMA 2020 guidelines. Nine studies (n=1850) were included, assessing surgical treatment of PCC in women ≥18 years. Interventions included extravaginal urethral transposition, distal transposition, hymenoplasty, urethro-vaginal adhesiolysis with bulking injection, and urethroplasty. Outcomes: recurrence rates, treatment success, quality of life, and complications. Results. The average success rate of surgical treatment was 87.7% (95% CI 80–92%), significantly higher than that of conservative approaches (10%). Extravaginal urethral transposition demonstrated the highest results (93% success rate, up to 77.9% complete absence of recurrence). Hymenoplasty and combined minimally invasive techniques provided 84–91% success rates but more frequently required repeat interventions. Complication rates were low (0–5%), mostly transient. Improved quality of life and sexual function were noted in 90% of patients. Conclusion. Surgical treatment of PCC leads to a significant reduction in infection recurrence and improved quality of life in appropriately selected patients. However, the overall evidence base on this topic is limited: there are no randomized trials, the quality of existing studies is low, and sample sizes are small. Data on long-term efficacy, complications, and causes of treatment failure are virtually nonexistent. These limitations prevent a definitive recommendation for surgical correction as a treatment of choice for a wide range of patients. The obtained results should be interpreted with caution, and further prospective and controlled studies are needed to confirm the advantages of the surgical approach and develop clear indications.
In memory of professor Igor Mikhailovich Derevyanko, Ph.D., MD (on the 100th anniversary of his birth)
In memory of Associate Professor Ivan Fedorovich Novikov (on the 100th anniversary of his birth)
On the anniversary of Professor Alexander Vladimirovich Zyryanov