ISSN (print): 2225-9074, ISSN (online): 2687-1416 Founder: Eco-Vector LLC Editor-in-Chief: Tkachuk Vladimir Nikolaevich, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Subscription Included in: Higher Attestation Commission List, RISC
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A double-blind, randomized, placebo-controlled, multicenter trial to evaluate the efficacy and safety of systemic enzyme therapy as part of comprehensive treatment in patients with exacerbation of chronic recurrent cystitis. Preliminary results
BACKGROUND: According to the current classification of urinary tract infections, recurrent chronic cystitis may be categorized as either uncomplicated or complicated lower urinary tract infection and is characterized by at least two exacerbations within six months or three exacerbations within one year. In the new classification proposed by the European Association of Urology in 2025, recurrent cystitis is defined as a localized urinary tract infection with or without risk factors and without signs or symptoms of a systemic inflammatory response. Given the lack of consensus in the scientific data on the treatment and prevention of recurrent urinary tract infections, we conducted a phase IV clinical trial using combination therapy for uncomplicated recurrent cystitis without risk factors. AIM: The work aimed to evaluate the efficacy and safety of Wobenzym compared with placebo as part of combination therapy in patients with exacerbation of chronic recurrent uncomplicated cystitis. METHODS: The study enrolled 638 female patients aged 20–49 years with chronic uncomplicated recurrent cystitis without risk factors, who were randomized into two groups: 320 women in group I (Wobenzym), and 318 women in group II (placebo). Comparative analysis showed no statistically significant differences between the groups (p > 0.05). Treatment lasted 12 weeks, with 5 tablets of the study drug or placebo taken 3 times daily, at least 30 minutes before or 2 hours after meals, swallowed whole with 200 mL of water. Concomitant therapy included fosfomycin trometamol 3 g (granules) for 2 days in accordance with the drug’s prescribing information. To assess efficacy and safety, each patient was scheduled for 7 visits over 219 days. RESULTS: In the study drug group, recurrent exacerbation of chronic recurrent uncomplicated cystitis occurred in 12.50% of patients (95% CI 9.32–16.57), compared with 24.53% in the placebo group (95% CI 20.12–29.54), p = 0.00014. Among patients with recurrence of the infectious-inflammatory process, 29 adverse events of only mild severity were recorded: 4 in the Wobenzym group and 25 in the placebo group. CONCLUSION: Wobenzym is a safe and effective component of combination therapy for urinary tract infection, which significantly reduces the recurrence rate.
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Association between cardiovascular drugs and erectile function quality assessed by nocturnal penile tumescence monitoring
BACKGROUND: In patients with cardiovascular risk factors, erectile dysfunction is an early marker of subclinical generalized vascular damage. Furthermore, cardiovascular drugs may impair erection quality. AIM: The work aimed to determine the relationship between cardiovascular drugs and erectile function quality assessed by nocturnal penile tumescence monitoring. METHODS: This retrospective study included 100 male patients who consecutively presented with complaints of erectile dysfunction between 2020 and 2022. All participants underwent nocturnal penile tumescence monitoring, and the results were evaluated using the criteria developed by Academician Kamalov and Professor Chaliy. RESULTS: Patients with moderate/severe erectile dysfunction were nearly five times more likely to take spironolactone (18.9% vs. 4.8%, p = 0.036) and 2.5 times more likely to use diuretics (24.3% vs. 9.5%, p = 0.087) than those with no/mild erectile dysfunction. The total number of cardiovascular drugs used by patients with moderate/severe erectile dysfunction was twice as high as in those with no/mild erectile dysfunction, according to nocturnal penile tumescence findings. The frequency of β-blocker, statin, metformin, and renin–angiotensin–aldosterone system inhibitor use was comparable between the groups. Spironolactone and diuretics were associated with a 4.7-fold (odds ratio [OR]: 4.667; 95% confidence interval [CI]: 1.126–19.340; p = 0.034) and 3.1-fold (OR: 3.054; 95% CI: 0.989–9.431; p = 0.052) increased risk of moderate/severe erectile dysfunction, respectively. Moreover, the number of cardiovascular drugs taken increased the risk of moderate/severe erectile dysfunction based on nocturnal penile tumescence monitoring. Each additional drug increased the odds of moderate/severe erectile dysfunction by 1.3 times (OR: 1.304; 95% CI: 1.003–1.694; p = 0.047), primarily due to a reduction in nocturnal penile tumescence duration. CONCLUSION: Spironolactone, known for its antiandrogenic effects, increased the odds of moderate/severe erectile dysfunction by 4.7 times based on nocturnal penile tumescence monitoring. Diuretic therapy was associated with more pronounced erectile dysfunction, whereas other cardiometabolic drugs did not affect erection quality. According to nocturnal penile tumescence monitoring, using more cardiovascular drugs was a significant risk factor for moderate/severe erectile dysfunction. This likely reflects more severe cardiovascular disease, which contributes to the onset and progression of erectile dysfunction.
Long-term efficacy of minimally invasive surgical treatment in women with primary bladder pain syndrome / interstitial cystitis: five-year follow-up
BACKGROUND: Bladder pain syndrome / interstitial cystitis is a chronic condition characterized by bladder pain and dysuria in the absence of identifiable local abnormalities. Despite its clinical and social significance, data on long-term efficacy of treatment remain limited. AIM: The work aimed to evaluate the long-term efficacy of minimally invasive surgical treatment in women with bladder pain syndrome. METHODS: A total of 29 women with bladder pain syndrome refractory to standard conservative therapy were followed up for at least 5 years. Patients were divided into two groups: Group 1 included 20 patients without Hunner’s lesions, and Group 2 included 9 patients with Hunner’s lesions. All patients initially underwent cystoscopy with bladder hydrodistension; in the presence of Hunner’s lesions, laser ablation was performed. Subsequent endoscopic procedures were carried out upon symptom recurrence. Patients without Hunner’s lesions underwent hydrodistension combined with intravesical botulinum therapy, whereas in patients with Hunner’s lesions, these interventions were supplemented by laser ablation. RESULTS: Treatment efficacy was assessed by analyzing the time intervals between repeated surgical procedures performed in response to worsening bladder pain syndrome symptoms. The mean time interval between interventions in Group 1 was significantly longer than in Group 2 (9.4 ± 1.2 months vs. 6.9 ± 1.0 months). Significant intergroup differences were observed beginning with the time interval between the second and third procedures. Group 1 demonstrated a progressive increase in the duration of these time intervals. No such trend was observed in Group 2. During the long-term 5-year follow-up period, no significant changes in maximum bladder capacity were detected in either group. CONCLUSION: Minimally invasive surgical treatment for bladder pain syndrome has a high long-term efficacy rate, with no tendency of worsening outcomes. Therapeutic modalities, their sequence, and frequency should be selected on a case-by-case basis.
Treatment of female stress urinary incontinence using a combined allogeneic–synthetic sling in suburethral loop plasty
BACKGROUND: Stress urinary incontinence remains a prevalent medical and social issue that significantly reduces women’s quality of life. Despite their high efficacy, synthetic slings are associated with a risk of complications related to limited biocompatibility of materials. Allografts are a promising approach in surgical treatment of stress urinary incontinence because of their high strength, minimal immunogenicity, and reduced risk of postoperative complications. AIM: The work aimed to improve the outcomes of surgical treatment of stress urinary incontinence in women using a combined allogeneic–synthetic suburethral sling. METHODS: The study included 51 female patients with stress urinary incontinence who underwent suburethral loop plasty (TVT-O) using a newly developed combined allogeneic–synthetic sling. The outcomes were evaluated at 1 to 12 months postoperatively using both subjective (validated questionnaires) and objective diagnostic methods (including the cough test, ultrasonography, comprehensive urodynamic studies, and magnetic resonance imaging). RESULTS: The study demonstrated high efficacy and safety of the combined allogeneic–synthetic sling in surgical treatment of stress urinary incontinence. The findings confirmed favorable biomechanical properties of the implant, a significant improvement in patients’ quality of life (ICIQ-SF and PISQ-12 scores), and the absence of erosive complications. Magnetic resonance imaging findings indicated complete biological remodeling of the allogeneic component with the formation of functional connective tissue 12 months postoperatively. CONCLUSION: A combined sling containing a biocompatible allogeneic component (Alloplant) significantly improves surgical treatment outcomes in stress urinary incontinence. Strategic placement of the biological material in the periurethral zone minimizes the risk of rejection and erosive complications, improves functional outcomes (lower risk of dyspareunia and de novo overactive bladder), and promotes physiological tissue remodeling with the formation of a mature connective tissue regenerate within 6–12 months.
Robot-assisted abdominoperineal vesicourethral reanastomosis
BACKGROUND: Vesicourethral anastomotic stricture is a narrowing of the urethra at the junction between the membranous urethra and the bladder neck. This complication is reported in 4.8% of patients following radical prostatectomy, with an average time to vesicourethral anastomotic stricture formation of 3.4 months. Minimally invasive treatment modalities, such as urethral dilation, transurethral resection, and bladder neck incision, are frequently ineffective. Reconstructive surgery is currently considered the treatment of choice for recurrent vesicourethral anastomotic stricture. According to various authors, success rates of vesicourethral anastomotic reconstruction using perineal, abdominal, or abdominoperineal approaches can reach up to 100%. AIM: The work aimed to evaluate the outcomes of robot-assisted abdominoperineal vesicourethral reanastomosis in patients with recurrent vesicourethral anastomotic stricture. METHODS: The study analyzed treatment outcomes in seven patients with recurrent vesicourethral anastomotic stricture who underwent robot-assisted abdominoperineal vesicourethral reanastomosis. RESULTS: Six months postoperatively, there was a significant improvement in urinary outflow: Qmax increased from 1.8 [0; 3.6] at baseline to 13.4 [12.2; 14] mL/s, p = 0.0005. Furthermore, there was a marked reduction in lower urinary tract symptoms, with the total IPSS score decreasing from 23 [20.3; 25.8] to 9 [7.5; 11] (p = 0.0234), and an improvement in quality of life: QoL decreased from 6 [5; 6] to 2 [2; 2.5] (p = 0.0156). No patient experienced complications above Clavien–Dindo grade II. One (14.3%) patient developed de novo severe urinary incontinence, whereas two (28.6%) had persistent mild incontinence that existed prior to surgery. There were no additional interventions required during the postoperative period. CONCLUSION: Robot-assisted abdominoperineal vesicourethral reanastomosis is a safe and effective technique for the management of recurrent vesicourethral anastomotic stricture. This approach may be considered for patients with preserved continence and extensive strictures. Further studies are needed to assess long-term surgical outcomes.
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Directive puncture of the renal collecting system during mini-percutaneous nephrolithotripsy in the supine position
BACKGROUND: Percutaneous nephrolithotripsy is the main surgical method for removing large renal calculi. One of the key stages of the procedure is percutaneous access to the renal collecting system. Retrograde contrast administration is not always required for a successful renal puncture. AIM: The work aimed to evaluate the efficacy, indications, and contraindications of directive puncture of the renal collecting system. METHODS: The study was conducted from January 2020 to August 2022. It included 90 patients who underwent percutaneous nephrolithotripsy in the supine position. Patients were divided into two groups. Group A underwent an ultrasound- or fluoroscopy-guided renal collecting system puncture; Group B had a puncture using retrograde ureteropyelography. Intra- and postoperative parameters were assessed, including total operation time, puncture duration, puncture success rate, visualization, puncture technique, and drainage type. RESULTS: The groups were statistically homogeneous except for body mass index, which was higher in Group B (p = 0.0441) but did not affect the study outcome. There were no significant differences in puncture duration (p = 0.378) or visualization quality (p = 0.8221). Six hours after surgery, pain intensity was higher in the directive puncture group (p = 0.0422), whereas other pain and complication parameters did not differ between groups. Hemoglobin levels were lower in the directive puncture group (p = 0.0109) but remained within the normal range. CONCLUSION: Directive puncture is a safe technique that is not inferior to the conventional method involving preliminary ureteral catheterization. However, it requires surgical experience and is unsuitable for patients with radiolucent calculi when performing fluoroscopy-guided punctures or in the absence of renal collecting system dilatation when performing ultrasound-guided punctures.
Role of acrosomal abnormalities in male infertility
Acrosomal abnormalities are an independent and significant factor in male infertility. One of the key components determining male fertility is the acrosome, a specialized sperm organelle responsible for the acrosome reaction, which enables penetration through the oocyte’s surrounding layers. Acrosome formation occurs during spermiogenesis and involves a complex process of proacrosomal vesicle fusion within the trans-Golgi network. Disruptions in this process may result from genetic defects, particularly mutations in the PICK1, SPATA16, and DPY19L2 genes, leading to acrosomal abnormalities such as globozoospermia, acrosomal hypoplasia, and membrane anomalies. This review summarizes the main mechanisms underlying acrosomal abnormalities. It highlights the association between acrosomal abnormalities and other forms of spermatogenic impairment, such as asthenozoospermia, teratozoospermia, and sperm DNA fragmentation, which significantly reduce the likelihood of conception, even when assisted reproductive technologies are employed. Modern diagnostic methods are described, including electron microscopy, the hyaluronan binding assay (HBA test) for assessing the ratio of mature to immature spermatozoa, and acrosome reaction tests for more accurate detection of subclinical abnormalities. Therapeutic options for these abnormalities were analyzed, including antioxidant and hormone therapy, as well as assisted reproductive technologies such as intracytoplasmic sperm injection, morphologically selected sperm injection, and oocyte activation with ionophores in cases of low fertilization efficiency.
Cellular technologies in the treatment of urologic diseases
The use of multipotent stem cells opens new possibilities in various fields of medicine, including urology. This article provides a detailed overview of experimental and clinical studies demonstrating the efficacy of multipotent stem cells in the treatment of urologic diseases. Multipotent stem cells have been shown to reduce the severity of renal failure, improve urinary incontinence, and alleviate both organic and functional bladder disorders, ischemia–reperfusion injuries of the testes, erectile dysfunction, and penile enlargement. Moreover, they have proven effective in Peyronie disease and ischemic priapism. New tissue-engineering approaches for cystoplasty and urethral stricture repair are described, in which multipotent stem cells are adsorbed onto various graft materials before surgery. The high therapeutic efficacy of cell therapy is most likely associated with its ability to stimulate regeneration and angiogenesis, restore microcirculation and innervation, inhibit inflammation and apoptosis, and reduce tissue injury and fibrosis. Only a small fraction of implanted multipotent stem cells remain viable and differentiate into smooth muscle and endothelial cells. The primary effect of multipotent stem cells is most likely mediated by paracrine mechanisms. No severe adverse effects have been reported following the clinical application of multipotent stem cells.
Modern approaches to phytotherapy in uric acid nephrolithiasis
The article discusses pathogenetic and clinical aspects of phytotherapy in patients with urolithiasis. Phytotherapy plays an important role in the treatment and metaphylaxis of uric acid nephrolithiasis. This is attributed to its efficacy and safety, including during long-term use. The article examines currently available herbal formulations with proven clinical efficacy. Herbal formulations used in patients with uric acid nephrolithiasis typically include components such as extracts of Java tea leaves (Orthosiphon stamineus), Alpinia officinarum, field horsetail, and the roots and rhizomes of Levisticum officinale. These plants are well known for their beneficial properties and have long been used in traditional medicine. The active ingredients of these herbal formulations, such as saponins, flavonoids, terpenes, fatty acids, phenolic glycosides, caffeic acid metabolites (rosmarinic and lithospermic acids), tannins, and vitamins (notably, ascorbic acid is present in all the products mentioned), have a significant impact on their therapeutic effect. The herbal formulations exhibit diuretic, anti-inflammatory, antibacterial, and antispasmodic properties. The development of new, effective herbal formulations for the treatment of uric acid nephrolithiasis, as well as the study of their therapeutic mechanisms, remain highly relevant in modern urology.
Comparing the effectiveness of single-stage and multistage buccal urethroplasty in complete obliteration of the bulbar urethra: a systematic review and meta-analysis
BACKGROUND: Strictures of the bulbar urethra, particularly extensive ones with complete lumen obliteration, are a major challenge in reconstructive urology. AIM: The work aimed to compare the efficacy of single-stage and multistage buccal urethroplasty in adults with complete obliteration of the bulbar urethra. METHODS: A systematic review and meta-analysis were performed according to the PRISMA 2020 guidelines, including data from PubMed/MEDLINE, Scopus, Web of Science, and the Russian Science Citation Index (RSCI) up to January 2025. Comparative studies of single-stage and multistage urethroplasties using buccal mucosa grafts were analyzed. Extracted data included relapse-free survival, complication rates, urodynamic parameters, sexual function, and follow-up duration. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled estimates were calculated using fixed- and random-effects models (odds ratio, relative risk, mean difference, 95% confidence interval). Sensitivity and publication bias analyses were performed (funnel plot, Egger’s test). RESULTS: The meta-analysis included five comparative studies (n = 650). The 5-year relapse-free survival after single-stage reconstruction was 85% versus 60% after multistage procedures (odds ratio 2.8; 95% confidence interval 1.67–4.67; p < 0.001). The overall complication rate did not differ significantly (odds ratio 0.6; 95% confidence interval 0.1–1.6; I2 = 74%); however, fistulas and deformities were more common after two-stage interventions. The mean maximum urinary flow rate was 5 mL/s higher after single-stage surgery (p < 0.05). No new cases of erectile dysfunction were reported. All studies were nonrandomized (2 prospective, 3 retrospective) and had a moderate risk of bias. CONCLUSION: Single-stage buccal urethroplasty demonstrates at least comparable, and overall superior, long-term outcomes with a similar complication profile compared to the classical two-stage approach. Preference for single-stage reconstruction may help avoid prolonged treatment and repeat surgeries when sufficient healthy tissue is available. Multistage techniques remain justified in cases of panurethral stricture, lichen sclerosus, or failed previous reconstructions. Randomized controlled trials are needed to confirm these findings.
Giant renal cyst: diagnosis and surgical management features
Renal cysts are among the most common benign lesions of the urinary system. Simple renal cysts are generally asymptomatic and do not require treatment; however, when they reach a considerable size, they may compress adjacent tissues, causing pain, hypertension, hydronephrosis, or impaired renal function. This article presents a clinical case of successful surgical management of a giant left renal cyst measuring 22 × 24 cm in a 55-year-old patient. The cyst caused compression of surrounding structures, manifested by pain and abdominal distension. Based on computed tomography findings, the cyst was classified as Bosniak type II. Laparoscopic cyst excision with evacuation of 5100 mL of fluid was performed. The postoperative course was uneventful, and a follow-up examination at 3 months revealed no recurrence. This clinical case demonstrates the effectiveness of the laparoscopic approach even in cases of giant renal cysts. Laparoscopic excision ensures minimal invasiveness while maintaining high surgical efficacy. Particular attention during such procedures should be paid to meticulous hemostasis, prevention of intraoperative cyst rupture, and complete removal of the cyst wall.
Commentary on the article by I.V. Kuzmin and M.N. Slesarevskaya “Hypersensory bladder disease: concept and pathogenetic basis”
Overactive bladder (OAB) and primary bladder pain syndrome (PBPS) are among the most common lower urinary tract dysfunctions. The authors note the similarities between many aspects of OAB and PBPS, particularly their pathogenesis, symptoms, and clinical course. Thus, similar infectious and non-infectious factors may play a role in the development of these conditions. The authors’ assertion that the insufficient effectiveness of standard therapy in patients with OAB and PBPS may be due to its limited effect on the afferent signaling system responsible for bladder hypersensitivity, chronic bladder wall inflammation, which maintains high levels of afferent activity, and central sensitization, which makes pharmacotherapy acting at the bladder level ineffective. The authors proposed the concept of hypersensory bladder disease, which combines the hypersensory phenotypes of OAB and PBPS. This concept is not without controversy, but it deserves close attention and further study, as it will allow for individualized treatment and tailored therapy based on the pathogenetic and clinical characteristics of these conditions.