Ziyoratsho A. Kadyrov

Background. Chronic prostatitis (CP) and benign prostatic hyperplasia (BPH) are widespread and chronically progressive diseases of the prostate gland (PG), representing one of the most pressing problems in modern urology and andrology. When combined, urologists face more pronounced disease symptoms. Assessing clinical symptoms and their interrelationship in patients with chronic prostatitis associated with BPH remains a real problem in urology. Aim of the study. To investigate the clinical symptoms of patients with chronic bacterial prostatitis associated with BPH in elderly and senile patients and to identify their correlational relationships. Materials and methods. The clinical symptomatology of 104 older adults patients (mean age 70.5 ± 1.5 years) with a clinically and laboratory-confirmed diagnosis of "Chronic bacterial prostatitis associated with prostatic hyperplasia" (CBP/BPH) was examined and studied. Validated questionnaires were used for patient examination: NIH-CPSI, IPSS, IIEF-5 (scores), Hamilton depression rating scale, as well as digital rectal examination, microscopy and culture of prostatic fluid, serum male sex hormones, PCR of urethral contents, ultrasound and Doppler sonography of the prostate, and uroflowmetry. Results. For the IPSS and NIH-CPSI questionnaires, the highest number of statistically significant associations was found with BMI and somatic diseases. The total IPSS and NIH-CPSI scores were r=0.576 (p <0.01) and r=0.713 (p <0.01) respectively, and for the QoL score, r=0.629 (p <0.01) and r=0.725 (p <0.01) respectively. Associations with age and disease duration were less pronounced and episodic. Stable negative correlations were found between the total NIH-CPSI scores and Qmax. Specifically, for the total score of the pain+urination domain, the correlation was r=–0.365 (p <0.01), for QoL r=–0.400 (p <0.01), and for the total sum r=–0.394 (p <0.01). At the same time, post-void residual urine volume showed strong positive correlations with symptom severity. For NIH-CPSI sum (pain+urination) - r=0.521 (p <0.01), for total sum r=0.534 (p <0.01), for QoL r=0.505 (p <0.01). This indicates a significant role of impaired urine evacuation in the formation of the clinical picture. Positive correlations were also found for prostate volume (r=0.335–0.348; p <0.01). Disease duration and testosterone levels had less pronounced associations with disease symptoms. Conclusion. The obtained data indicate that the leading factors associated with the severity of symptoms according to the NIH-CPSI and IPSS questionnaires are the presence of concomitant diseases, post-void residual urine volume, prostate volume, and BMI. Age, testosterone level, and disease duration, for many parameters, do not demonstrate a significant contribution to the variability of questionnaire scores in this sample.

BACKGROUND: The problem of diagnosis and treatment of chronic benign prostatic hyperplasia (BPH)-associated prostatitis is caused by more severe symptoms of the lower urinary tract in such cases. These diseases are characterized by similar lower urinary tract symptoms and methods of conservative treatment. Usually, combination of these pathologies is seen in senior and elderly patients with several concomitant diseases, compromised immunity, resistance to antibacterial therapy. AIM: To perform comparative analysis of standard and combination therapy in patients with BPH-associated chronic bacterial prostatitis. METHODS: In total, 104 senior and elderly patients (mean age 70.5 ± 1.5 years) with confirmed diagnosis of BPH-associated CBP received treatment. For patient examination the following methods were used: validated National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire, International Prostate Symptom Score (IPSS), Hamilton Depression Rating Scale, International Index of Erectile Function, digital rectal examination, microscopy, expressed prostatic secretion measurement, serum male sex hormone levels, real-time polymerase chain reaction for evaluation of urethral contents, ultrasound, prostate Doppler scan and uroflowmetry. The patients were divided into 2 groups. Group 1 included patients with BPH-associated CBP who received combination therapy (including immunomodulator, chymotrypsin enzyme and antioxidant complex) ( n = 52), Group 2 included patients with the same disease who received standard therapy ( n = 52). Treatment dynamics were evaluated 1, 3 and 6 months after the treatment. RESULTS: Results of comparative analysis show that combination therapy improved both subjective (NIH-CPSI questionnaire and IPSS scale scores) and objective characteristics of clinical course of BPH-associated CBP (increased maximal urinary flow rate, lower post-void residual volume, smaller prostate volume, better urodynamic and immune parameters). CONCLUSION: Efficacy of combination treatment which includes immunomodulator, chymotrypsin enzyme in the form of perianal injection and antioxidant complex in senior and elderly patients with BPH-associated CBP is higher that efficacy of standard therapy.

BACKGROUND: The microbiota of the male urethra, as an organ of the lower urinary tract affects the pathogenesis of benign prostatic hyperplasia (BPH). However, the specifics of the relationship between composition of the urethral microbiota and irritative symptoms of the lower urinary tract are still poorly understood. AIM: To evaluate the relationship between the composition of the microbiota of the distal urethra and the presence of irritative symptoms from symptoms of the lower urinary tract in BPH. METHODS: The patients included in the study ( n = 64) were divided into two groups: group 1 (main, n = 44, patients with clinical signs of BPH) and group 2 (comparison, n = 20, conditionally healthy men). All men underwent an International Prostate Symptom Score (IPSS) assessment of symptoms with a sub-score of irritative symptoms. The composition of the urethral microbiota was studied by sequencing of the 16S ribosomal RNA gene. Statistical analysis was carried out using the Mann–Whitney criteria, with calculation of the Pearson correlation coefficient ( r ), Student’s t -test, regression models and significance level ( p ). RESULTS: In patients with BPH, the microbiota of the urethra was found to be dominated by anaerobic taxa: the order Peptostreptococcales-Tissierellales and the families Corynebacteriaceae , Streptococcaceae , and Staphylococcaceae . In the comparison group, the urethral microbiome was represented by the families Peptoniphilaceae , Acetobacteraceae and Bacteroidaceae . A direct correlation was found between the presence of the Enterobacteriaceae family ( r = 0.56, p = 0.05) and the severity of irritative symptoms of BPH. CONCLUSION: In patients with BPH, a distinctive composition of the urethral microbiota is formed, characterized by an increase in the proportion of opportunistic anaerobes and skin commensals. The revealed association of the presence of Enterobacteriaceae in the urethra with the severity of irritative symptoms allows us to consider urethral dysbiosis as a new potential pathogenetic factor for irritative symptoms in BPH.

Benign prostatic hyperplasia (BPH) is one of the most common urological diseases leading to the development of lower urinary tract symptoms. Traditionally, the pathogenesis of BPH is associated with hormonal imbalance and the activity of 5-α-reductase, however, modern data indicate a significant role of chronic inflammation of the prostate gland, systemic metabolic disorders, combined by the concept of “metabolic syndrome”. The review of domestic and foreign scientific literature, including epidemiological, clinical and experimental studies on the relationship of BPH, is carried out./urinary tract symptoms, chronic prostatitis and metabolic syndrome (obesity, insulin resistance, dyslipidemia, hypertension, androgen deficiency). It has been established that the presence of metabolic syndrome and chronic prostatitis is associated with more frequent detection of BPH and marked disease progression. In patients with BPH on the background of metabolic syndrome, a significant increase in prostate volume, higher levels of prostate-specific antigen, and an accelerated annual increase in gland volume are recorded compared with patients without metabolic disorders. The components of metabolic syndrome are independent risk factors for severe urinary tract symptoms. The main pathogenetic mechanisms include chronic pelvic ischemia, hyperinsulinemia, imbalance of sex hormones and chronic sluggish inflammation. The effectiveness of drug and surgical treatment in this group of patients is reduced. Benign prostatic hyperplasia should be considered not as a local disease, but as a systemic metabolic disease of the age period. Various components of the metabolic syndrome and chronic inflammation of the gland independently accelerate the progression of BPH/urinary tract symptoms, which requires the personalization of therapy with mandatory correction of metabolic disorders to increase the effectiveness of treatment.

Introduction. Surgical correction of perceived or true penile shortening remains a challenging task in reconstructive urology-andrology. A significant proportion of patients seeking penile lengthening present with normal anatomical parameters but suffer from psychological distress related to size perception, while a smaller cohort has objective shortening due to congenital anomalies (hypospadias, epispadias) or acquired conditions (Peyronie's disease, fibrosis post-radical prostatectomy). Main content. This review is dedicated to analyzing modern minimally invasive surgical strategies for penile length correction. Data on percutaneous ligamentolysis (PL) and penile lengthening procedures with penile prosthesis (PLP-PP) techniques are presented. It is shown that PL provides a visible length gain averaging 1.5-2.5 cm but is associated with a risk of retraction (up to 30% at 2-3 years) and dynamic instability (15-20%). The mechanisms of intervention efficacy are discussed, including suspensory ligament release, tunical expansion, and sliding techniques. Special attention is paid to patient selection criteria: baseline stretched penile length (SPL) <7 cm, BMI70%) even after technically successful surgery. Conclusion. Minimally invasive strategies (PL, PLP-PP) are valuable tools for penile length correction but require strict differentiation of indications. PL is indicated for relative shortening, while PLP-PP is indicated for true shortening with erectile dysfunction. Efficacy and safety are directly dependent on meticulous multidisciplinary patient selection, realistic expectations, and preoperative preparation.

Background. The evolution of surgical treatment for urolithiasis has shifted from open surgery to minimally invasive methods, among which retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the current standard of care. Purpose. To conduct a comparative analysis of the efficacy, safety, and clinical outcomes of RIRS and PCNL. Materials and methods. A review of the literature was performed, analyzing data on indications, techniques, postoperative outcomes, and complications of RIRS and PCNL. Special attention was paid to comparing the Stone-Free Rate (SFR), complication rates, and intra- and postoperative parameters. Results. PCNL demonstrates a statistically significantly higher primary SFR compared to RIRS (up to 94% vs. 73–82%) for stones 1–2 cm, particularly those located in the lower pole. However, RIRS is associated with significantly less invasiveness: reduced blood loss (decrease in hemoglobin, p2 cm, PCNL remains the "gold standard," while for stones <2 cm, RIRS is the treatment of choice due to its optimal balance of efficacy and safety. Conclusion. Modern surgical management of urolithiasis is based on risk stratification and an individualized approach. PCNL remains the most effective method for large and complex stones, whereas RIRS is a preferred minimally invasive alternative for smaller stones, providing a comparable final SFR with a better safety profile and faster patient recovery.

Introduction: One of the difficult problems remains the role of herpes viruses in the development of chronic abacterial prostatitis, since their etiological role in the dynamics of this disease remains difficult to prove and insufficiently studied. Purpose of the study: to assess the informativity of mass spectrometry of microbial markers in the diagnosis and antiviral therapy of patients with chronic abacterial prostatitis category III associated with herpes viruses. Materials and Methods: 61 patients with chronic abacterial prostatitis associated with herpes viruses who applied for examination and treatment aged 25 to 50 years were examined. In addition, 70 volunteers who applied for a screening study were examined. The prostate secretion study was carried out using the Maestro gas chromatograph (Interlab LLC, Russia) using the mass spectrometry of microbial markers method. Serum levels of SPR-06 antigen autoantibodies and IgM and IgG immunoglobulins were tested. All patients underwent a course of antiviral therapy and immunomodulators, as well as antioxidants and alpha-1-blockers for 2 months. Results: The data we obtained showed that in patients with chronic abacterial prostatitis with clinical symptoms, the level of herpesviruses in the prostate secretion is significantly higher compared to healthy ones. Our antiviral therapy with immunomodulators showed high efficacy, since along with the disappearance or reduction of clinical symptoms, there was a significant decrease in the level of herpesviruses in the RLS from 3 to 5 times (p < 0.0001), normalization of the level of immunoglobulins of autoantibodies to SPR-06 antigen in the blood serum. Conclusion: The mass spectrometry of microbial markers study of prostate secretion made it possible to identify and quantify herpes viruses in patients with chronic abacterial prostatitis associated with herpes viruses (in the presence of characteristic symptoms) and to conduct effective antiviral and immunomodulatory therapy. Keywords: herpesviruses, prostate secretion, microbial marker mass spectrometry, antiviral therapy, immunomodulatory therapy.

Acute scrotal hematoma developing due to spontaneous rupture of the spermatic cord caused by varicocele is a relatively rare complication. Its clinical presentation is similar to testicular torsion, appendix testis torsion and malignant tumor which significantly complicates differential diagnosis. Sudden pain, scrotum enlargement, sometimes cyanosis after intraperitoneal pressure increase or intense physical activity and hematoma on the left should alarm a doctor because they can be signs of vein rupture due to varicocele. Anamnesis of varicocele, character of the injury, color Doppler ultrasound can help in differential diagnosis and to avoid unnecessary orchidectomy. The article presents a review of international literature on a rare complication of varicocele – rupture of the testicular veins.

Multiple evidence suggests that inflammation and oxidative stress negatively affect sperm parameters, spermatogenesis, and testicular and epididymal function, although the etiology of infertility caused by varicocele may be multifactorial. In this regard, the anti-inflammatory effect of various drugs in patients with varicocele is being studied and in the future, it may be possible to develop new treatment methods and conduct an appropriate selection of patients for whom these drugs can help. The article presents a review of the world literature on the influence of the inflammatory process on spermatogenesis in varicocele.

Despite conflicting views on the relationship between varicocele and patho-spermia, numerous studies have proven the negative impact of varicocele on spermato-genesis parameters and ultrastructural characteristics of spermatozoa. Studies conducted in the last decades have somewhat changed the general view on the pathophysiology of pathospermia development in varicocele and revealed the role of interrelated processes: heat stress, oxidative stress (OS), apoptosis, genetic, inflammatory and other factors that contribute to the induction of pathophysiological manifestations.