Vladimir Ostapchuk

Metastasis of prostate cancer to the epididymis is exceptionally rare, with only 23 cases reported. This case highlights diagnostic challenges and underscores the role of advanced imaging in detecting atypical metastases. Aim. To present a case of acinar adenocarcinoma metastatic to the left epididymis, analyzing pathogenesis, diagnostic approaches, and management strategies. A 67-year-old male with prostate cancer (initial cT2cN0M0, Gleason 8) underwent laparoscopic radical prostatectomy with pelvic lymphadenectomy (21.09.2023). Histopathology revealed pT3bN1 (3/24 nodes), Gleason 9 (4 + 5), positive surgical margin (R1). Adjuvant radiotherapy (total dose 70.8 Gy) and androgen deprivation therapy (goserelin) were administered. Upon biochemical recurrence (prostate-specific antigen (PSA) 2 ng/mL), positron emission tomography combined with computed tomography, with prostate-specific membrane antigen (PSMA-PET/CT) detected lesions in the left epididymis, lung, and bones. Bilateral orchiectomy was performed. Histological examination included morphology and immunohistochemical study (PSA, PSMA, NKX3.1). PSMA-PET/CT showed intense uptake in the left epididymis (standardized uptake value maximum 12.7), left lung (6 mm nodule), and bones. Orchiectomy confirmed metastatic adenocarcinoma in the epididymis with vascular/perineural invasion, morphologically identical to primary prostate cancer. IHC: PSA (+++), PSMA (+++), PLAP (−), OCT3/4 (−), excluding germ cell tumor. HRR gene testing revealed no mutations. Enzalutamide (160 mg/day) was initiated due to progression. Epididymal metastases from prostate cancer are anecdotal (0.01 %), requiring differentiation from primary testicular tumors. PSMA-PET/CT is pivotal for detecting atypical recurrences (sensitivity 85–92 % at PSA 0.5 ng/mL). Aggressive features (Gleason 9, R1, early recurrence) predict multifocal progression, including rare sites. Orchiectomy serves dual diagnostic and therapeutic purposes (androgen deprivation). Reporting such cases is crucial for optimizing management algorithms.

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.

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.