Vladimir Sergeevich Stepanov

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.

Scientific studies over the last decades have shown that one of the important mechanisms for the development of pathospermia in varicocele remains oxidative stress, which in interrelationship with other factors (heat stress, metabolite reflux, hypoxia, inflammation) play an important role in negatively affecting spermatogenesis. Pathophysiologic mechanisms contributing to oxidative stress include scrotal hyperthermia, metabolite reflux, testicular hypoxia, and cadmium accumulation. Genetic factors are involved and, in addition, varicocele causes an imbalance of endocrine reproductive hormones, affecting sperm production and leading to male infertility.

Objective: To study the correlation between clinical symptoms in patients with chronic abacterial prostatitis (CAP) associated with herpesvirus infection (HPV). Materials and Methods: We conducted a retrospective and prospective analysis of data from 61 patients with CAP associated with genital herpes (Group 1) and 50 asymptomatic men (Group 2), aged 25 to 50 years. During the initial examination, in addition to signs of chronic prostatitis, we looked for symptoms of herpes infection both at the initial examination and in the patient's medical history. Results: In patients with HPV-associated CAP who presented systemic complaints, the median HPV level was 120.00 [80.25; 233.50] conventional units, while in patients without complaints - 36.00 [22.25; 53.75] conventional units (p<0.0001).

Цель исследования. Провести всесторонний систематический анализ современных научных данных о влиянии уробиома и кишечной микробиоты на патогенез, профилактику и персонализацию лечения мочекаменной болезни. Материалы и методы. В ходе литературного обзора основное внимание уделялось исследованиям, применяющим современные молекулярно-генетические методы, такие как секвенирование гена 16S рРНК и метагеномный shotgun-анализ, для изучения микробиоты мочевыводящих путей, кишечника и самих мочевых камней. Были проанализированы данные о микробном составе при различных типах мочекаменной болезни, включая кальций-оксалатные, струвитные и уратные камни. Результаты. Выявлено, что дисбиоз уробиома, проявляющийся в снижении общего разнообразия микробиоты и нарушении баланса микробных сообществ, является важным патогенетическим фактором, способствующим развитию мочекаменной болезни. Заключение. Интеграция концепций уробиома и оси «кишечник-почки» в понимание патогенеза мочекаменной болезни открывает новые перспективы для диагностики, профилактики и лечения. Дисбиоз признан не следствием, а причинно-значимым звеном в процессе камнеобразования. Перспективным направлением является создание комплексных методов модуляции микробиоты, таких как пробиотики, пребиотики и трансплантация фекальной микробиоты. Эти подходы направлены на восстановление протективных микробных сетей, а не на коррекцию отдельных видов. Для внедрения этих стратегий в клиническую практику необходимы масштабированные рандомизированные исследования, которые обеспечивают объективность и надёжность результатов.

Male infertility is an acute medical and social problem, affecting from 20 to 50% of couples all over the world. According to official statistics, male infertility caused by infectious etiology, specifically bacteria, viruses, fungi and protozoa, accounts for 15% of all cases of male infertility. Today, many authors strongly state that the microbiome is an etiological factor in many diseases, and also contains enormous potential from a diagnostic point of view. The purpose of this review was to summarize data on the microbiome of the urogenital tract correlated with male infertility. Based on the results of the above works, we could conclude that today traditional methods for identifying microorganisms do not meet modern requirements due to their limitations. Microorganisms can have a negative effect on male reproductive cells, and can also be associated with different disorders of male fertility, however, to date, it is impossible to reliably determine the true contribution of the microbiota of the urogenital tract to male infertility. Keywords: maleinfertility, prostatitis, microbiome, NGS, gaschromatography-massspectrometry