Mikhail Iosifovich Kogan

The paradigm shift regarding the non-sterility of urine has fundamentally transformed our understanding of the etiology and pathogenesis of infectious and inflammatory diseases of the genitourinary tract. The application of advanced culture techniques, polymerase chain reaction, and sequencing methods has enabled the identification and characterization of the urobiome composition and an assessment of its role in the development of various diseases. Increasing evidence suggests that infection development can be viewed as a dysbiotic process resulting from alterations in urobiome composition. It has been established that a decrease in normal lactoflora is accompanied by an increase in uropathogens. Therefore, standard culture-based diagnostic techniques no longer reflect the true nature of the infectious process. Conventional urine culture, which identifies a single pathogen at ≥10⁵ CFU/mL (≥10² CFU/mL for lower urinary tract infections), detects only one dominant microorganism while excluding anaerobes, intracellular pathogens, and imbalances in commensal flora. Enhanced Quantitative Urine Culture protocols significantly improve the detection of clinically relevant microorganisms and reveal the polymicrobial nature of infections as well as disturbances in the lactoflora ratio. Modern nucleic acid amplification tests (NAAT), including multiplex molecular panels, identify pathogens more rapidly and with higher sensitivity than culture; in complex cases, the detection rate reaches ≥90% compared to approximately 50% for standard culture. Metagenomic approaches—such as 16S rRNA amplicon sequencing and shotgun metagenomics—further expand detection spectra, identifying dozens of previously missed microorganisms and associated antimicrobial resistance genes. Metaproteomics complements microbiological diagnostics by characterizing host immune responses. Urine proteomic profiling reveals neutrophil-derived proteins (e.g., myeloperoxidase, calprotectin) and microbial proteins, forming the basis for protein biomarkers and phenotypic stratification. An optimal multilevel diagnostic strategy should integrate culture-based methods (for antimicrobial susceptibility testing), NAAT and mNGS—metagenomic next-generation sequencing—for sensitive etiologic verification, and metaproteomics for assessment of the host response. Future efforts should focus on the standardization of preanalytical procedures and the definition of clinically meaningful endpoints.

BACKGROUND:The combination of benign prostatic hyperplasia and bulbar urethral stricture is a major clinical challenge, as both conditions represent the most common causes of bladder outlet obstruction in men. The optimal surgical management for these patients remains poorly understood. AIM:To evaluate the efficacy of various treatment methods for bladder outlet obstruction in patients with combined benign prostatic hyperplasia and bulbar urethral stricture. METHODS:This study included 135 male patients with combined benign prostatic hyperplasia and bulbar urethral stricture. Patients were divided into four groups: group 1 received internal optical urethrotomy with transurethral resection of the prostate (n= 32); group 2 received excision urethroplasty with end-to-end anastomosis and simultaneous transurethral resection of the prostate (n= 35); group 3 received two-stage strategy (urethrostomy + transurethral resection of the prostate via urethrostomy access + delayed urethroplasty,n= 31); group 4 received urethroplasty with conservative therapy for benign prostatic hyperplasia using alpha blockers (n= 37). Efficacy was evaluated at 1, 6, and 12 months postoperatively. RESULTS:At 12 months, groups 2 and 3 demonstrated the best outcomes, with success criteria met by 100% and 97% of patients, respectively (p= 0.287 between the groups). TheQmaxvalues in these groups were 24.1 ± 2.3 and 24.9 ± 2.5 mL/s, theQavevalues were 17.2 ± 2.1 mL/s and 18.6 ± 2.3 mL/s, and IPSS was 3.1 ± 1.2 and 2.3 ± 1.1, respectively. In groups 1 and 4, the efficacy was significantly lower, with success criteria achieved in 63% and 70% of patients, respectively (p 0.001 compared to group 2). Differences between groups 2 and 3 in all parameters at all follow-up time points did not reach statistical significance (p 0.05). CONCLUSION:Both single-stage excision urethroplasty with transurethral resection of the prostate and a two-stage strategy (urethrostomy with transurethral resection of the prostate via urethrostomy access followed by delayed urethroplasty) represent the most effective treatment approaches for patients with combined benign prostatic hyperplasia and bulbar urethral stricture. Both strategies yield consistently high functional outcomes at 1-year follow-up. Methods that do not provide complete relief of prostatic obstruction (internal optical urethrotomy with transurethral resection of the prostate, urethroplasty with conservative therapy of benign prostatic hyperplasia using alpha blockers) are associated with recurrent obstruction at long-term follow-up and cannot be recommended as optimal.

Introduction. Robot-assisted extravesical ureteral reimplantation (RAEUR) is one of the most performed procedures on the da Vinci Xi robotic platform in children with ureterovesical junction pathology. Robot-assisted extravesical transverse ureteral reimplantation represents the most frequently performed intervention using the da Vinci system in this patient population. We report our initial experience with RAEUR using the da Vinci Xi system, which forms the basis of this communication. Objective. To analyse our experience with robot-assisted extravesical ureteral reimplantation in children using the da Vinci Xi robotic platform. Materials & methods. The study included 12 patients with a mean age of 3.9 ± 2.9 years (minimum age 7 months). Mean anthropometric parameters were: height 101.4 ± 20.4 cm, body weight 17.4 ± 7.7 kg. Gender distribution: 8 boys (66.7%) and 4 girls (33.3%). Mean anteroposterior renal pelvic diameter was 21.7 ± 7.1 mm. Ureterovesical junction pathology was detected antenatally in 5 patients (41.7%) and postnatally in 7 (58.3%). Urinary tract infection was noted in 4 (33.3%) patients. The nosological spectrum included ureterovesical junction obstruction (UVJO) in 11 (91.7%) patients and vesicoureteral reflux (VUR) in 1 (8.3%) patient. The procedure was performed with the patient in the supine position, using three 8-mm trocars for the optics and robotic instruments and one 5-mm trocar for assistant instruments. Results. No conversions occurred. Operative time for the initial cases was 175 minutes. In the most recent cases in the series, operative time remained approximately the same, with a mean duration of 170.4 ± 31.5 minutes. Mean docking time was 22.5 ± 2.4 minutes, and mean console time was 99.2 ± 28.6 minutes. Mean anteroposterior pelvic diameter decreased from 21.8 ± 7.1 mm preoperatively to 11.1 ± 4.3 mm postoperatively after cessation of drainage. Conclusion. Analysis of our initial experience with RAEUR demonstrates its advantages over other ureteral reimplantation techniques, particularly the preservation of the surgeon's physical condition throughout the procedure, enabling precise intracorporeal ureteral tapering and anastomosis formation while avoiding the ergonomic challenges and operator fatigue associated with laparoscopic extravesical reimplantation. Our findings confirm the safety and efficacy of RAEUR in children and support its broader adoption into routine clinical practice.

Introduction. Glanular urethral strictures pose a complex reconstructive challenge, as treatment must restore urethral patency while preserving penile anatomy and glanular aesthetics. Open buccal urethroplasty according to A. Goel demonstrates high efficacy but is associated with an invasive approach and a risk of local complications. Transurethral buccal urethroplasty combined with an ERAS protocol may reduce postoperative morbidity. Objective. To evaluate the efficacy and safety of transurethral buccal urethroplasty with an ERAS programme compared with open buccal urethroplasty according to A. Goel in patients with glanular urethral strictures. Materials & methods. A total of 118 patients with glanular urethral strictures were enrolled in a multicentre prospective comparative open-label parallel-group study. In group 1 (n = 56), open urethroplasty using a buccal graft according to A. Goel was performed under a standard perioperative protocol; in group 2 (n = 62), transurethral buccal urethroplasty was performed within an ERAS programme. The following outcomes were assessed: duration of catheterisation and hospital stay, pain severity, requirement for opioid analgesics, complications, recurrence rate, Qmax, IPSS, IIEF 5, quality of life, and treatment satisfaction. In addition, logistic regression analysis, neural network modelling, and recurrence free survival analysis were performed. Results. The groups were comparable in terms of age and stricture length. Recurrence free cure rates were 85.7% in the open urethroplasty group and 93.5% in the transurethral urethroplasty group, with a median follow up of 4.5 years (p > 0.05). The ERAS group exhibited shorter catheterisation (7 vs 14 days) and hospital stay (3 vs 10 days), lower rates of severe pain (3% vs 87%) and opioid requirement (3% vs 57%) (p < 0.001). Infectious complications were less frequent (10% vs 25%). Urethral fistulae and wound dehiscence occurred only after open surgery. Recurrence rates were 6.5% and 14.3%, respectively. Improvement in Qmax was +12.1 and +10.1 mL/s, and reduction in IPSS was -23.1 and -19.5, respectively (p > 0.05). Treatment satisfaction was higher in the ERAS group, at 89% vs 61% (p < 0.01). Conclusion. Transurethral buccal urethroplasty with an ERAS protocol is comparable to the open technique in terms of long term efficacy but provides a more favourable perioperative course, including reduced duration of catheterisation and hospitalisation, less pain, lower opioid requirement, and fewer local complications. This approach may be considered an effective and less traumatic treatment option for selected patients with glanular urethral strictures.

Introduction. Ureteropelvic junction obstruction and hydronephrosis remain among the most common indications for reconstructive surgery of the upper urinary tract in children. Yet the wording of current clinical guidelines leaves room for ambiguous interpretation of when pyeloplasty is truly indicated. Objective. To trace how thinking about indications for pyeloplasty in children with hydronephrosis due to ureteropelvic junction obstruction has evolved, to contrast international and national guidance, and to underscore the need for a holistic appraisal of imaging, functional, and clinical data—and their trajectories—when charting a treatment course and deciding on surgery. Materials & methods. We performed an analytical review of clinical guidelines, national textbooks, and landmark publications on pyeloplasty indications, focusing on ultrasound criteria, functional metrics, their longitudinal changes, and symptomatology. Results. Over time, the threshold for pyeloplasty has moved away from relying on a static snapshot of hydronephrosis grade toward a multifactorial paradigm that weighs split renal function, progression of dilatation, diuretic renography findings, and clinical presentation. Most international guidelines caution against using any single ultrasound parameter as a stand-alone trigger for operation. Even so, the phrasing of European Association of Urology recommendations—and how they are sometimes read in national documents—still allows an overly liberal reading, in which a high SFU hydronephrosis grade and/or an enlarged anteroposterior pelvic diameter may be mistaken by themselves as sufficient grounds for pyeloplasty. Conclusion. Contemporary evidence supports a decision-making model in which paediatric pyeloplasty is offered not based on one morphological sign, but on an integrated, dynamic assessment of imaging, function, and symptoms. National guidelines would benefit from clearer wording that guards against overinterpretation and helps ensure surgery is reserved for those who truly stand to gain.

This article traces the evolution of approaches to the diagnosis and treatment of erectile dysfunction (ED) throughout the 20th century — from the early dominance of psychiatry in this field (the concepts of Sigmund Freud and the couples‑based sex‑therapy methodology of Masters and Johnson) to the establishment of urology as the leading discipline in the study of male sexual disorders. The article reviews the history of research on nocturnal erections and their role in the differential diagnosis of psychogenic and organic forms of ED. Particular attention is paid to the revolutionary contributions of Tom Lue and Irwin Goldstein to the development of evidence‑based erectile physiology, ED pharmacotherapy, and the recognition of ED as an early marker of systemic vascular disease. At the same time, the author outlines the main results of his own 1980s investigations, including the development of selective arteriography and dynamic cavernosography, the formulation of postulates on vascular, neurogenic, and endocrine mechanisms of ED, as well as clinical experience with implant surgery in 200 patients. It is emphasized that the 1970s–1980s were a period of fundamental discoveries that laid the foundation for modern diagnostic and therapeutic strategies in ED.

Introduction . Urinary tract infections (UTIs) are the most common extragenital pathology in pregnant women and are associated with a high risk of obstetric and neonatal complications. Attention is paid to asymptomatic bacteriuria (ASB), which may lead to the development of gestational pyelonephritis. Despite the availability of clinical guidelines, the timing of screening, the need for ASB treatment, and the choice of antimicrobial therapy remain controversial. The lack of consensus within the international medical community, as well as discrepancies in national regulatory documents, underscores the need for further study of this problem. Objective . To evaluate the effectiveness of ASB treatment in pregnant women in real-world clinical practice. Materials & methods . A prospective analysis of pregnancy outcomes and delivery records was performed in 150 pregnant women aged 18 to 42 years. All patients were divided into three groups: group 1 (n = 43) included women who received treatment for ASB; group 2 (n = 77) included pregnant women who declined treatment for ASB; group 3 (n = 30) included patients who had not been screened for ASB. The study included an analysis of clinical and anamnestic data, urine culture results, renal ultrasonography, and pregnancy and delivery outcomes. Results . The groups were comparable in age and anthropometric parameters, but differed significantly in the number of pregnancies, deliveries, and gynaecological surgeries. In group 1, monomicrobial growth was detected in 81.4% of the first urine cultures and 72.1% of the second; in group 2, the corresponding values were 72.7% and 80.5%. In group 1, ASB treatment consisted of antibiotics (25.6%), Canephron (62.8%), or their combination (11.6%). Despite treatment, acute pyelonephritis developed in 7 (16.3%) patients in group 1, which was higher than in group 2, where acute UTI episodes were recorded in 3 (3.9%) women. No urological complications were observed in group 3. Vaginal delivery predominated over caesarean section in all groups. All newborns had Apgar scores of 7 – 8. Conclusion . In this study, ASB treatment did not reduce the incidence of acute pyelonephritis in pregnant women compared with the untreated group. These findings suggest the need to reconsider approaches to ASB diagnosis, introduce methods for identifying uropathogenic taxa, and search for inflammatory biomarkers to define selective groups of pregnant women who may benefit from antibacterial therapy. Randomised controlled trials are required to individualise management strategies in this patient population.

Vesicoureteral reflux (VUR) is a common condition in paediatric urology that increases the risk of urinary tract infection (UTI), which in turn may result in renal scarring and the development of chronic kidney disease in children. A first episode of UTI is often the trigger for the diagnosis of VUR. Antibiotic therapy remains the mainstay of UTI management, while continuous antibiotic prophylaxis is used to prevent recurrence and infectious complications in children with VUR. However, prolonged antibiotic use is associated with important risks, including the development of antimicrobial resistance. This review evaluates the efficacy and safety of contemporary antibiotic treatment and prophylactic strategies in children with VUR. Particular emphasis is placed on optimizing patient management and on current guideline-based recommendations aimed at reducing recurrence rates and improving clinical outcomes.

Introduction. Interstitial cystitis/bladder pain syndrome (IC/BPS), being a chronic non-infectious disease, still has an unclear etiology and numerous pathophysiological theories of development. This determines the need for preclinical experimental studies on animals. The most identical model of human IC/BPS is cyclophosphamide-induced cystitis in rodents. Objective. To study the effects of the pharmacological activity of Neovasculgen® сompared to Botox® using model of cyclophosphamide-induced IC/BPS in rats. Materials & methods. The study was performed on 90 female Wistar rats. IC/BPS was induced by Endoxan®. Neovasculgen® and Botox® were used as intradetrusor therapeutic agents. Efficiency was assessed by comparative analysis of urodynamic patterns and morphologically. The data obtained were processed by parametric and nonparametric methods of statistical analysis. Results. Cyclophosphamide-induced IC/BPS developed in all animals. Both drugs statistically significantly improved the studied urodynamic parameters, the clinical efficacy of Neovasculgen® was comparable to Botox®. Morphological assessment showed that the administration of the studied drugs was accompanied by a decrease in tissue edema, less pronounced hemorrhages and focal lymphohistiocytic infiltration, as well as destructive changes in the bladder mucosa. At the same time, the intensity of pathological tissue processes against the background of the administration of Neovasculgen® was the lowest. Conclusions. The cyclophosphamide-induced IC/BPS model is considered the most adequate human IC/BPS. The experiment is extremely important for studying the effectiveness of a new drug, which is intradetrusor Neovasculgen®. The drug has shown its effectiveness in reducing the frequency of urination and intravesical pressure. Intradetrusor administration reduces the severity of the inflammatory reaction of bladder tissue.

Introduction. Vesicourethral anastomotic stricture is a common and clinically significant complication of radical prostatectomy, leading to infravesical obstruction and substantial impairment of quality of life. Despite the availability of endoscopic, stenting, and reconstructive surgical options, recurrence rates remain high, and the optimal management strategy continues to be debated. A comprehensive evaluation of the effectiveness and safety of current treatment approaches is therefore warranted. Objective. To evaluate and compare the outcomes of different treatment modalities for vesicourethral anastomotic (VUA) strictures following radical prostatectomy (PPE strictures), focusing on anastomotic patency, recurrence, stress urinary incontinence, and quality of life. Materials & methods. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Medline/PubMed, Embase, and Cochrane Library were searched through January 2025 for original studies including ≥5 patients with PPE-related VUA strictures treated with endoscopic, stenting, or open reconstructive approaches. Primary outcomes included effectiveness (patency), recurrence rates, complications, incontinence, and need for reintervention. Two reviewers independently screened studies, extracted data, and assessed risk of bias (ROBINS-I). The quality of evidence was rated using GRADE. Results. A total of 24 studies (n = 745 patients) were included, primarily retrospective case series. Endoscopic approaches yielded an initial success rate of 55% (95% CI 40 – 70%), increasing to 91% with repeat procedures. Recurrence rates reached 40% within 1 – 2 years. De novo stress incontinence was rare (≤ 5%). Temporary urethral stents (Memokath®️, Allium®️) showed patency rates up to 93%, with migration in 7% and incontinence in ≤ 10% of patients. Open reconstructive techniques, including buccal mucosa grafts, achieved success rates of 73 – 85%, but were associated with new-onset incontinence in 40 – 75% of cases. Radiation history significantly reduced treatment success (OR 0.20; 95% CI 0.05 – 0.80). Conclusion. Endoscopic procedures are optimal as first-line treatment due to minimal invasiveness and preservation of continence but have high recurrence risk. Temporary stents are a viable intermediate option after failed endoscopy. Open reconstruction provides the most definitive outcomes in complex cases but is burdened by a high incontinence risk. Treatment decisions should be individualized, considering prior radiation, stricture severity, and continence preservation.