Mirzo Ustoyevich Gafurov

Objective: To analyze the comparative results of nephrectomy indicators in cases of severe and mild paranephritis, without pyonephrosis and nephroureterectomy, depending on the nosology and type of kidney damage (benign diseases, space-occupying lesions, donor kidneys). Materials and Methods: An analysis of 803 case histories of patients who underwent nephrectomy using various methods was conducted. The effectiveness of these methods was also assessed depending on the clinical situation. Results: Surgical success rates in patients with severe paranephritis were worse than in patients with mild paranephritis. In the group of patients who underwent nephrectomy without regard to pyonephrosis or nephroureterectomy, we found no significant differences in outcomes across all groups. Nephrectomy outcomes for donor nephrectomy were statistically more favorable than those for nephrectomy for benign kidney disease and neoplasms (except for surgical duration). Nephrectomy for renal neoplasms, compared with nephrectomy for benign diseases, had advantages in the following indicators: the length of the incision for kidney removal (on average by 3.6 cm, p<0.0001), the volume of blood loss (on average by 46.8 ml, p<0.0001), stay in intensive care (p<0.0001), the consumption of narcotic analgesics (p<0.0001), complications after surgery (p<0.0006) and the number of hospital days after surgery (p<0.0001). In the retroperitoneoscopic donor nephrectomy group, age (by an average of 6.8 years; p=0.0053), weight (by an average of 5.4 kg; p=0.0282) and height (by an average of 4.7 cm; p=0.0230) differed statistically significantly compared to the laparoscopic access group. Conclusion: The presented scientifically based approach enables specialists performing organ-removal surgeries for various benign and malignant kidney pathologies to effectively diagnose and select the optimal surgical treatment method depending on the specific situation, as well as the clinic's capabilities.

Objective: To describe rare clinical cases of congenital vaginal agenesis in sexually active women in urological practice. Materials and Methods: This retrospective study presents two clinical cases. The first is a 31-year-old patient, S., with congenital vaginal agenesis consistent with Mayer-Rokitansky-Küster-Hauser syndrome. The second is a 19-year-old patient, N., who underwent surgery to create and expand an artificial vagina from a segment of small intestine. Both patients were observed and treated at the Republican Scientific and Clinical Center of Urology. Results: In clinical practice, extremely rare cases are encountered in which, due to congenital vaginal agenesis, the urethra is used for sexual intercourse. This anatomical adaptation is accompanied by significant urological complications and requires a comprehensive medical approach, including consideration of surgical correction. In the second case, after the formation of an artificial vagina from a segment of the small intestine, dilation was performed, which ensures the achievement of the main functional effect - improving the quality of the woman's sexual life. Mayer-Rokitansky-Küster-Hauser syndrome (vaginal agenesis, Müllerian agenesis) is a rare congenital anomaly of the Müllerian ducts, characterized by aplasia of the uterus and upper two-thirds of the vagina, while the ovaries, female phenotype, and 46,XX karyotype remain normal. The incidence is 1 case per 4,000-5,000 female births, ranking it second among the most common causes of primary amenorrhea after hypogonadotropic hypogonadism. The etiology of the disease is multifactorial, but genetic factors with an autosomal dominant inheritance pattern predominate. Clinically, the syndrome manifests as primary amenorrhea in adolescents, despite normal puberty and the development of secondary sexual characteristics. The goal of treatment is to create a functional neovagina to solve the problem of absolute uterine factor infertility. Conclusion: Despite significant advances in this field, important questions remain unresolved, such as etiology and pathogenesis, long-term consequences of immunosuppression after transplantation, and optimization of psychological rehabilitation.

Objective: To evaluate the effectiveness of simultaneous videoendoscopic nephrectomies for pathologies of the kidneys and other organs of the abdominal cavity and retroperitoneal space, the quality of life of patients and the cost/effectiveness ratio of such operations using various methods. Materials and Methods: The study included 37 patients suffering from combined surgical diseases of the abdominal organs and retroperitoneum. Results: Laparoscopic nephrectomies offer the following advantages over staged and traditional methods: the average duration of surgery is reduced by 1.47 times (p<0.001); blood loss during operations using the LPN is reduced by 2.21 times compared to traditional methods, and by 1.19 times when using the new approach. Postoperative patient recovery time is reduced by 1.29 times, and the number of hospital days is reduced by 1.3 times. A reduction in intra- and postoperative complications is also noted, and cost effectiveness is increased by 1.2 times. Conclusion: The use of videoendoscopic simultaneous surgeries for the treatment of concomitant abdominal and retroperitoneal diseases, provided the appropriate treatment method is selected for selected patients, contributes to improved medical and social outcomes. This reduces the risk of complications, promotes faster patient recovery, shortens hospital stays, and increases the cost-effectiveness of treatment. As a result, patients significantly improve their health and return to a full life.