Kirill M. Su-Yanz

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.

Background. Primary urethral carcinoma is a rare and aggressive malignancy of the genitourinary system characterized by significant heterogeneity and limited high-quality evidence. Aim. To summarize survival outcomes and identify key prognostic factors. Materials and methods. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and eLibrary was performed according to PRISMA 2020 guidelines. Eligible studies (2000–2025) included ≥5 patients with primary urethral cancer and reported overall (OS) and/or cancer-specific survival (CSS). Thirty studies (n = 12,215) met the inclusion criteria. A random-effects meta-analysis was conducted. Results. The pooled 5-year OS was 44.8 % (95 % confidence interval 41.5–48.1, I2 = 74 %), while 5-year CSS was approximately 51.5 % (95 % confidence interval 45.8–57.2, I2 = 88.7 %). Localized disease showed markedly better outcomes, with OS reaching 60–70 % in non-metastatic cases. Regional nodal involvement reduced survival to 30–40 %, and distant metastases to 10 %. Radical surgery (partial/total urethrectomy and possible lymph node dissection) was associated with a 50–60 % reduction in mortality compared to non-surgical management. Histological subtype impacted prognosis: urothelial and squamous cell carcinomas showed comparable outcomes, whereas adenocarcinoma and melanoma demonstrated significantly poorer CSS. Conclusion. Findings emphasize the critical importance of early detection and radical surgical treatment. High rates of local recurrence after organ-sparing approaches highlight the need for multimodal therapy. Despite advances in combined treatment strategies, long-term outcomes remain suboptimal, supporting further research into optimized therapeutic sequencing and novel systemic agents.

Aim. To perform systematic review of the literature published in 2000–2024 and meta-analysis of the data according to the PRISMA protocol 2020. Materials and methods. Data on clinical cases of 60 patients with prostate cancer metastases to ocular structures (orbit or eye) reported from 2000 to 2024 were analyzed. The resulting cohort is the largest on this topic in the last two decades. Results. Prostate cancer metastases most frequently involved the orbit (including the optic nerve) and choroid; involvement of the iris or ciliary body was rare. In 17 % of patients, ocular symptoms were the first manifestation leading to a prostate cancer diagnosis. The optimal treatment approach was a combination of systemic prostate cancer therapy (androgen deprivation ± chemotherapy) with local ocular radiotherapy. Hormone therapy played a key role in prolonging survival and improving quality of life, whereas orbital radiation was effective for palliating symptoms and partially restoring vision. The median survival after detection of ocular metastases was approximately 6–12 months. Conclusion. Ocular metastases of prostate cancer are an extremely rare but clinically significant condition. Timely diagnosis and combined systemic and local treatment may improve the prognosis and quality of life of such patients despite an overall poor outcome. Limitations. The retrospective and heterogeneous nature of available data, small sample size (60 cases), and potential publication bias limit the generalizability of the results.

Introduction. Combined surgical pathology poses a dilemma between simultaneous and staged approaches. Simultaneous surgeries, performed during a single anesthetic session, reduce hospitalization time, lower anesthetic burden, however, increased operative volume and duration may elevate the risk of complications. The staged approach reduces the immediate burden on the patient but requires multiple hospitalizations, prolongs overall treatment and recovery time. Objective. To compare clinical outcomes, length of hospitalization, postoperative complications and effectiveness of simultaneous versus staged urological surgeries within a structured enhanced recovery after surgery (ERAS) protocol. Materials & methods. A prospective single-center randomized study evaluating the safety of simultaneous and staged urological surgeries included 78 patients with combined urological and surgical pathologies, randomized into two groups. Compliance with the ERAS protocol above 80% was a criterion for inclusion in both groups. Group 1 (n = 53) underwent simultaneous surgeries, where multiple procedures were performed during a single operative session. Group 2 (n = 25) received staged treatment, with surgical interventions separated in time. Perioperative parameters, complication rates according to the Clavien-Dindo classification, length of hospitalization, patient-reported outcomes including postoperative pain assessed by the visual analog scale (VAS), requirement for opioid analgesics, intraoperative blood loss, total duration of urinary drainage, and cumulative surgical access size were evaluated. Results. Simultaneous surgeries demonstrated a significant reduction in overall hospitalization time (p < 0.01) and total operative time compared with staged interventions. No statistically significant differences in postoperative complication rates were observed between groups (p = 0.94). Conclusion. Both simultaneous and staged urological surgeries are safe approaches for patients with combined pathology. Simultaneous interventions offer advantages including reduced hospitalization time without increasing the risk of postoperative complications.

Relevance. Benign prostatic hyperplasia is one of the most common urological conditions in elderly men, with both its prevalence and symptom severity increasing proportionally with age. At the same time, the effectiveness of conservative therapy is often limited, as many patients continue to experience significant lower urinary tract symptoms despite medical treatment. The standard surgical option — transurethral resection of the prostate— is associated with risks such as bleeding, hospitalization, and a high incidence of sexual dysfunction, with retrograde ejaculation occurring in 50–70% of patients. In this context, water vapor thermal therapy (Rezūm) represents a promising minimally invasive alternative. It provides durable relief of BPH-related symptoms with minimal invasiveness, allowing patients to avoid long-term pharmacotherapy and reduce the risk of surgical complications, while preserving the prostate gland and sexual function. Aim. To evaluate the early clinical outcomes and safety of Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia. Materials and Methods. A retrospective single-center analysis was conducted on the treatment outcomes of 9 men (aged 49–78 years; mean age 59.4 ± 9.1 years) presenting with severe lower urinary tract symptoms (IPSS ≥ 22) and moderate prostate enlargement (30.8–70.0 mL). All patients underwent Rezūm thermal ablation (4–6 vapor injections; mean procedure duration 7.8 ± 1.5 minutes). Follow-up at 3 months included assessment using the International Prostate Symptom Score, quality of life index related to symptoms, maximum urinary flow rate, post-void residual urine volume, prostate volume, and complication recording according to the Clavien–Dindo classification. Results. By the 3-month follow-up, the total IPSS score had significantly decreased from 25.8 ± 2.9 to 5.9 ± 1.3 points (a 77% reduction; p < 0.01), and the QoL index improved from 5.0 ± 0.5 to 1.1 ± 0.3 (a 78% reduction; p < 0.01). Qmax increased from 6.6 ± 2.8 to 20.8 ± 2.8 mL/s (+215%; p < 0.01), while the PVR decreased from 128 ± 116 to 0 mL (p < 0.01). Prostate volume was reduced by 65% (from 53.3 ± 14.8 to 18.6 ± 2.9 mL; p < 0.01). Spontaneous voiding was restored in 100% of patients (median time: 7 days). Grade I–II complications were observed in 2 patients (11% macroscopic hematuria, 11% transient urinary retention). No complications of grade ≥ III, infections, or sexual dysfunctions were reported. Conclusion. Rezūm water vapor thermal therapy provides a significant reduction in BPH-related symptoms, improves urodynamic parameters, and enables rapid recovery of spontaneous voiding with a minimal risk of complications. It may be considered an effective minimally invasive alternative to transurethral resection of the prostate.

May-Thurner syndrome (MTS), defined by compression of the left common iliac vein, increases left gonadal-vein pressure and may underlie otherwise varicoceles. This narrative review synthesises 25 relevant publications: case reports, series, observational and interventional studieas. Pooled evidence indicates that 67–90% of men with varicocele exhibit at least 25% iliac-venous compression, and that successful iliac stenting leads to regression of varicocele symptoms and improved fertility. The diagnostic value of combining duplex ultrasound with computed tomographic/magnetic resonance venography is highlighted, whereas catheter venography with intravascular ultrasound remains the reference for confirming haemodynamic significance. Gaps in data regarding long-term stent patency and the epidemiology of MTS in asymptomatic males have been identified. It advocates systematic iliac-vein assessment in men presenting with recurrent or bilateral varicocele and calls for prospective multicentre trials comparing surgical ligation with endovascular correction.