The problem of genital prolapse and various forms of disorders of the urinary system in menopausal women is rather urgent. It is determined by a high frequency of disease. Treatment and rehabilitation of such patients has not only medical, but also social value. This article presents a literature review, which reflects the analysis of the major risk factors contributing to the development of genital prolapse, it also reveals current methods of diagnosis and conservative treatment. In particular, it raises the issue of conservative correction of genital prolapse in menopausal women by applying urogynecological pessary. The data of the National committee on urogynecology and pelvic organs reconstruction regarding the use of pessary are given in the paper.

The study of epidemiological data is necessary to assess morbidity and mortality rates, dynamic observation and determination of factors, influencing them. Clinical and epidemiological studies complement each other and can be used in the framework of oncological and hematological register in order to organize and optimize hematological service both in the region and in the country.Not-standardized recorded incidence of chronic myeloid leukemia (CML) in the Republic of Bashkortostan is 0.82 cases per 100 thousand population. Patients in the 1 and 2 lines of therapy receive treatment and monitoring. To develop modern concept of programmatic approach in the treatment of CML, based on molecular and cytogenetic diagnosis, monitoring of disease, detecting early signs of resistance, intolerance or failure of therapy, there is a need for further epidemiological, clinical, genetic and pathogenetic study of this problem.

Uroflowmetry is a simple, non-invasive method that allows to evaluate the process of emptying the bladder. Uroflowmetry results depend on the detrusor's contractility, intra-abdominal pressure, the degree of cervix opening and the bladder closure, the presence of impediments for urinary outflow in the cervix and urethra. Ultrasound shows the image of the urethra throughout its length, allows us to evaluate the urethrovesical angle and determine the state of the paraurethral structures. Of 151 women surveyed after delivery, the main group consisted of 71 patients with urinary incontinence complaints, the control group included 80 patients of reproductive age with no evidence of urinary incontinence after childbirth. Urodynamic and ultrasound examination was performed at the prehospital stage. The combination of clinical research methods with uroflowmetry and ultrasound data makes it possible to really assess the condition of the lower urinary tract in women of reproductive age and to diagnose clinically mixed and stress incontinence.

The purpose of the study is optimization of treatment of children in the Republic of Bashkortostan with congenital malformations of the urinary tract based on detection of factors of chronic kidney disease (CKD) progression, their demographic and nosological structure and features of the disease course.Study design - retrospective, observational, cohort. The study included 297 patients.All malformations of the kidneys were reliable predictors of CKD progression. Factor, twice reducing CKD progression, was timely surgery. Prevention of pyelonephritis recurrence, bacteriuria elimination, blood pressure and anemia correction also play an important role. Introduction of these principles of treatment into clinical practice for obstructive uropathies in children allowed tosignificantly reduce (p=0,007) by four times (OR - 0,25) the potential of CKD progression.Thus, development of a regional register of children with malformations of the urinary system allows to unify diagnostic, therapeutic and prognostic algorithm for management of chronic kidney disease in these patients.-

The problem of diagnostics and treatment of subclinical varicocele is very important in modern andrology. There is still no consensus regarding the necessity of surgical treatment of this disease. The aim of the study was the optimization of the indications for treatment of subclinical varicocele in combination with idiopathic pathospermia.The study involved 308 patients with idiopathic pathospermia. Depending on the presence of subclinical varicocele patients were divided into two groups: 172 people without subclinical varicocele and 136 patients with subclinical varicocele, which in turn were divided into three groups: 45 patients underwent Marmara surgery, 56 patients underwent Marmara surgery with subsequent conservative therapy, 35 patients were assigned to conservative therapy only. Control group included patients without subclinical varicocele who received only conservative therapy.Surgical treatment (Marmara surgery), in combination with subsequent conservative therapy showed the greatest efficiency.The probability of pregnancy in the first year after the surgery was 42.8%. Only Marmara surgery resulted in the pregnancy in 31.2% of couples. The least effective was the conservative approach to treatment, the probability of pregnancy was 14.2% in the first year after beginning of treatment. In the control group in which patients did not reveal subclinical varicocele, the probability of pregnancy was 25.6 % after conservative treatment.Surgical treatment (surgery Marmara), in combination with subsequent conservative therapy showed the highest efficacy in the treatment of subclinical varicocele in combination with idiopathic pathospermia.

This paper analyzes the trends of the urological diseases of the adult population of Moscow, compared with the Russian Federation. The analysis is based on the materials of the official statistical reports for 2006-2015. It is established, that the diseases of the genitourinary system (GUS) consistently hold the third place in the structure of incidence and the fourth place in the adult morbidity structure of the adult population of Moscow.Analysis of statistical reports of outpatient institutions show, that primary morbidity of GUS diseases among adult population of Moscow in 2015 compared to 2006 decreased by 33,7%, kidney and ureter disease - by 16,3%, prostate disease - by 48,7%. However, this trend in the incidence of urinary tract morbidity does not match the results of special epidemiological studies and may be due to underreporting of these diseases and the low level of diagnosis.The study revealed significant disadvantages in the organization of follow-up of patients with urological diseases in Moscow. It was established that there is a need for further optimization of statistical recording of urological diseases as valid statistical form (f.№12) offers limited possibilities for the analysis of the incidence and prevalence of urological diseases in the context of individual clinical entities.

The paper presents the results of monitoring patients after laparoscopic pyeloplasty in which the complications of varying severity have been identified in the early postoperative period. We have analyzed and identified the causes of complications and offered their preventive measures.

The main up-to-date methods of surgical treatment of urolithiasis are percutaneous nephrolithotripsy (PCNL), retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESWL) which show good results and low mortality rate. Laparoscopic surgery of nephrolithiasis is an additional (not main) method, which is used to forecast the impact of bad cases (lowest «stone free») and high risk of complications and mortality of abovementioned methods. In this article we have tried to provide clear indications and to determine the place of laparoscopic approach in the removal of kidney stones.

This article analyses the results of examination and treatment of 190 men with hemorrhagic fever with renal syndrome (HFRS) of severe and moderate severity, who received conservative treatment. The study evaluated the nature of urination in HFRS patients with acute renal failure (ARF) in the period of polyuria and convalescence. Urodynamics of the lower urinary tract, especially microvascular changes in the bladder wall and urethra has been studied. For an objective assessment of urodynamics comprehensive urodynamic study was performed. The conducted research allowed to develop methods of correction of urodynamic and microcirculatory changes in polyuric stage of HFRS, and the period of convalescence. The results of the study showed that the use of combined therapy in the treatment of the lower urinary tract syndrome against HFRS with the drug improving microcirculation and alpha1adrenoreceptor blocking agent, significantly improved treatment outcomes and contributed to an earlier normalization of urination.

The paper presents the analysis of results of surgical treatment of 241 patients with primary and recurrent posttraumatic urethral strictures. All patients were performed urethral resection with end-to-end ureteroureteral anastomosis. The study determined the spectrum and frequency of complications in the treatment of urethral strictures. The highest percentage of complications (33,3%) was obtained in the treatment of recurrent stricture, in comparison with primary US (8,3%). The most important risk factors for complications (stricture length, the number of previous operations on the urethra and duration of the disease) were revealed. The effectiveness of urethral resection with end ureteroureteral anastomosis in primary cases of US was 100%, in the case of recurrent strictures - 98,5%.

The Enhanced Recovery After Surgery (ERAS) program can reduce pain, stress, the number of additional interventions in patients after a surgery. The use of ERAS in oncourology does not increase the number of complications and leads to earlier recovery of patients and discharge from hospital. The aim of the study was to determine the possibilities of ERAS protocol in private medical practice.ERAS elements were used with 12 patients: 6 - with kidney cancer, 6 - with urolithiasis. All the patients were divided into 2 groups: gr1. - laparoscopic procedures were used, gr2. - endoscopic intervention was used. Before surgery all the patients were consulted about actions during fast track program and rehabilitation period.Intraoperative complications included: in gr1 bleeding about 1000 ml, in gr2.- urethral mucosal prolapse occurred, requiring correction and necrotized tissue erasion. There were no complications during follow-up.Thus, the use of ERAS allows to reduce the time of hospitalization.

The article presents a regional approach to the implementation of the major instruments of the quality management system (QMS) to improve laboratory process and the quality of laboratory tests on the example of the Republican Clinical Hospital named after Semashko with the application of the principles of the quality management system (process, system approaches, risk management) based on ISO 9001 standards. The phases of development and implementation of QMS in the laboratory are described there. The importance of laboratory medicine development for solving clinical challenges and improving the level of prevention in terms of people's access to necessary research was shown in the article.

The article presents a comparative analysis of quality of life of 104 patients after simultaneous and traditional operations for the comorbid diseases of the abdominal cavity and retroperitoneal space. According to the analysis, revitalization process, severity of postoperative pain syndrome on a verbal scale, analysis of narcotic and non-narcotic medicines authentically differs in patients after videoendoscopic operations and in patients after traditional operations. Besides, the assessment of quality of life by SF-36 scale has shown that by all indicators (physical state, intensity of pain, the state of health, vital activity, social activity, an emotional state and mental health) patients after videoendoscopic operations give more scores, indicating higher level of quality of life.

The article analyzes traditional operations and sclerotherapy for hydrocele of more than 100 ml. Analysis shows, that effectiveness of sclerotherapy after the first session was 72% and after the third one - 92%. 2 patients (8%) after the third ineffective session were operated traditionally. Complications after traditional operations (epididymitis, orchitis, haematoma, wound abscess, fever, suture disruption, hemorrhage, edema and infiltration of scrotum and testicular cord) were almost twice as much as sclerotherapy. efficiency over traditional methods. The obtained results prove minimal invasiveness and efficiency of sclerotherapy in comparison with traditional methods.

Modern research indicates a steady increase in the frequency of hormonal disorders in the male population, of which the greatest practical interest is the deficiency of male sex hormones (androgen deficiency, or hypogonadism) in patients with chronic renal disease of stage V. In men with chronic kidney disease, in the early stages of the disease, testicular insufficiency and secondary disorders of the pituitary-gonadal axis are determined, which worsen with progression of kidney damage. In men with chronic kidney disease, especially in hemodialysis therapy, an androgen deficiency is often diagnosed, defined as a decrease in the level of total testosterone <8.0 nmol / l. The consequences of androgen deficiency are decreased libido, erectile dysfunction, infertility, oligospermia and anemia. Drugs of the first line of ED therapy in patients on programmed hemodialysis and after kidney transplantation are inhibitors of phosphodiesterase-5 (PDE-5).

The main violations of penile hemodynamics leading to the development of vasculogenic erectile dysfunction are structural changes in the vascular wall of cavernous bodies, insufficient arterial influx and excessive venous drainage. Erectile dysfunction among patients with chronic renal disease of stage V is multifactorial in nature. In chronic kidney disease there is a formation of endothelial erectile dysfunction. A number of researchers argue that an insufficient cavernous arterial inflow is a probable cause of erectile dysfunction after kidney transplantation and is associated with the type of vascular anastomosis used during surgical treatment. The choice of arterial vascular anastomosis in kidney transplantation affects the erectile function of patients with chronic stage V kidney disease. The use of ultrasonic dopplerography of vessels of the penis in patients after kidney transplantation is a noninvasive, highly informative way of diagnosing erectile dysfunction.

Due to rapid development of medical technologies of minimally invasive and endoscopic methods of diagnosis in urology, there has been an increase of surgical complications, in particular, damage to urethra. In the UK, more than 16,000 men are annually treated for urethral stricture, of them more than 12,000 people need surgical intervention, resulting in the annual cost of treatment for about 10 million pounds sterling. The prevalence of urethral strictures among men is explained by the length and complexity of male’s urethral structure and higher risk for damage.

One of the main issue in urethral reconstructive surgery is to identify the optimal resection zone of the scar urethra and periureteral tissues in different stricture and obliteration types. The operative therapy results of 83 patients were analyzed, patients received treatment of various methods (anastomotic urethroplasty, staged and augmentation urethroplasties, using a buccal graft) with the forward microvasculature state estimation by the laser analyzer of transcapillary flow (LAKK-01). The correlation of microcirculatory changes is established, taking into account the degree and depth of urethral and periureteral tissues fibrous changes.

This paper aims to assess the results of percutaneous endoscopic treatment of patients with upper urinary tract urothelial carcinoma. 99 patients with upper urinary tract urothelial carcinoma were enrolled in the study. 24 patients underwent endoscopic treatment in a urological clinic at I.M. Sechenov FMSMU. 21 patients underwent retrograde surgery for tumor of the renal pelvis and ureter of low malignant potential. In 1 patient with a solitary kidney a percutaneous removal of a renal pelvis papillary tumor was performed, in another one the same procedure was performed for a solitary functioning kidney. In one patient, a percutaneous removal of a papillary tumor of the calyx of the lower part of the L-shaped kidney was carried out. Routine postoperative check-ups showed no recurrence in all patients. As well as that adequate urine flow was observed in all patients.Percutaneous treatment of upper urinary tract urothelial carcinoma can be applied in patients with low-grade tumors of calices, when a standard flexible ureteroscopy doesn’t allow to reach the tumor or in cases of big lesions or a surgical procedure in a retrograde fashion is not feasible. Apparently percutaneous procedure is effective for single ≤ 2 cm lesions located in pyelocaliceal system.

In the prostate testosterone, a primary androgen in males, is converted into its most active form, dihydrotestosterone (DHT) by 5α-reductase type 2, encoded by the SRD5A2 gene. Dihydrotestosterone is necessary for prostatic growth and has five times higher binding affinity than testosterone for androgen receptors. We hypothesized that polymorphic variations in the SRD5A2 gene may affect the risk of prostate cancer and analyzed three polymorphisms in the SRD5A2 gene-A49T, V89L and (TA) n in 291 prostate cancer patients and 417 healthy individuals. We found out, that only V89L polymorphism of the SRD5A2 gene contributes to the prostate cancer pathogenesis.

The aim of this study is to determine the tactics of treatment of patients with both kidney tumor and a stone in one and the same kidney via endovideosurgical approach. 159 patients with combined urolithiasis and tumor in one kidney have been studied. At the moment of referral 14 patients (8 males and 6 females) with both kidney tumor and kidney stone on the same side had indications for surgical treatment for both a stone and a tumor. In 2 patients (13,3%) a tumor and a stone were in the right kidney, in 12 (85,7%) - in the left. Patients were aged 60±11 years. In 4 (28,6%) patients with concomitant renal stone and a tumor initially a surgical treatment of a tumor was performed. 7 (50,0%) patients were simultaneously treated for both concomitant diseases and 3 (21,4%) patients underwent percutaneous nephrolithotomy (PCNL) for a kidney stone as the first step. Minimally invasive approach in urology, in case of ipsilateral combination of both tumor and a stone, allows to perform simultaneous as well as two-step surgical treatment, resulting in elimination of tumor and stone, preserving the organ.

Surgical anatomy of nerve-sparing prostatectomy is being constantly optimizing, new volumes of nerve-sparing techniques and types of improvement of functional results are offered. Our review presents the surgical aspects of nerve-sparing techniques and our experience with water-jet dissection of neurovascular bundles with the aim of improving the functional results after robot-assisted radical prostatectomy.

When prostate cancer is suspected, the prostate gland is biopsied with the aid of transrectal ultrasound. The sensitivity of prostatic biopsy is about 50%. Advances in multiparametric magnetic resonance imaging have lead to improved detection of prostate tumors. The fusion of magnetic resonance imaging data with transrectal ultrasound enables the targeted biopsy of suspicious areas.Combined biopsy using multiparametric magnetic resonance imaging and transrectal ultrasound has demonstrated favorable detection rates of high-grade prostate cancer among previously undiagnosed men. The study tried to compare the cancer detection rates of multiparametric magnetic resonance imaging and transrectal ultrasound fusion-guided biopsy.

Organ-sparing operations are the most promising in the preservation of the quality of life, social adaptation, minimizing intra - and postoperative adverse effects in patients with localized forms of prostate cancer. In the UGMU clinic based on Sverdlovsky regional clinical hospital №1 the treatment of localized forms of prostate cancer is rather effectively conducted using modern techniques such as low-dose brachytherapy (LDR) and high-intensity focused ultrasound (HIFU) ablation. Using these techniques over 924 patients have been treated, with a minimum of complications and high efficiency.

From October 2013 in urology clinic of First MSMU named after I.M. Sechenov 35 patients with prostate cancer of veracity stage

We have studied renal dysfunction using functional (glomerular filtration rate) and structural (NGAL, β2-microglobulin in blood serum and urine) biomarkers before and at different stages after radical cystectomy. The NGAL structural biomarker in urine has been proven to be the most informative and clinically significant for predicting the development of chronic kidney diseases in the remote postoperative period.

Currently, the incidence of advanced forms of prostate cancer (PCa) and mortality from this disease remain high in Russia. The methods of its detection are: PSA concentration in the blood serum, digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Of the 56 biopsies examined, prostate cancer (PCa) was diagnosed in 78.5% cases, in 17.9% - high prostatic intraepi- thelial neoplasia (PIN) or ASAP, and 3.6% - benign prostatic hyperplasia (BPH). Our study showed that only in 77% of cases prostate cancer was detected against increased PSA level. Using 2 methods of diagnosis (PSA +DRE and PSA+TRUS) the detection rate of prostate cancer compared with mono diagnosis was not significantly increased, while significantly decreased the percentage of missed PCa for PSA / DRE combination (14.2%, p <0,05), or unchanged for the PSA / TRUS (16.1%). The best cancer positive predictive value (93.3%, p <0,05) occurred at a combination of all three factors to perform transrectal prostate biopsy.

Currently, prostate cancer is one of the most common oncological pathologies in Russia, holding the third place in the structure of oncological morbidity. We analysed the early results of surgical treatment of 235 patients with prostate cancer: the first group underwent total cryoablation of the prostate (24 patients), the second group underwent radical laparoscopic and extraperitoneoscopic prostatectomy. For comparative assessment of cryoablation results 24 patients were selected from the second group, randomized according to age, stage of the disease, scores by Gleason scale, prostate-specific antigen level and prostate volume. Results of preoperative examinations showed no data on extracapsular tumour process, as well as regional lymphadenopathy. All patients had no interest in sexual function. Prostate volume ranged from 12 to 65 cm3, PSA level ranged from 4,1 to 10 ng / ml, Gleason score ranged from 6 to 7 points. According to the first results we observed PSA level decrease in both groups of patients. Retention of urine, as well as the intensity of postoperative pain in patients after cryoablation of the prostate was better in comparison with laparoscopic radical prostatectomy. However, we continue to evaluate long-term oncological and functional results.

This study aimed to assess safety and efficacy of minimally invasive percutaneous surgical techniques in patients with staghorn nephrolithiasis. The technique was a combination of a routine percutaneous nephrolithotomy (PCNL) and a multipercutaneous one. 55 patients with staghorn lithiasis who underwent a routine and multipercutaneous PCNL in urological clinic at I.M. Sechenov FMSMU were enrolled in the study. Amplatz Dilators (28-30 Ch), nephroscopes (24, 26 Ch), an ultrasound lithotripter were used for a routine PCNL while mininephroscopes (12 Ch) with tubes (11 Ch), a laser lithotripter were used for a multipercutanous procedure. 2 nephrostomic tracts were created in 48 (87,3%) patients, 3 - in 6 (10,9%), 4 (1,8%) in one patients to completely remove all the fragments of a stone. In 47(85,5%) patients a stone-free state was reached after a single percutaneous procedure, in 6 patients renephroscopy was performed. In 2 other patients several residual stones were observed in isolated calyces. However, they required no further treatment. Intraoperative complications were registered in 3 patients, who underwent a re-nephroscopy in the postoperative period. 8 patients developed postoperative hyperthermia (over 380C). Apparently, a combination of a routine PCNL and a multipercutaneous nephrolithothomy is a safe and effective procedure.

This paper aimed to assess the results of superselective embolization of renal vessels in patients with postoperative bleeding after percutaneous surgery for stone kidney disease. 1723 patients treated for percutaneous nephrolithotomy (PCNL) in urological clinic at I.M. Sechenov FMSMU up to 2015 were enrolled in the study. Hemorrhagic complications were observed in 83 (4.8%) patients, with 37 (2,1%) requiring blood transfusions. Superselective embolization of renal vessels was performed in 28 (1,6%) patients. In cases, when superselective embolization was not available, 2 patients (0,1%) underwent nephrectomy when bleeding occurred as a complication of PCNL. In all cases good clinical results were achieved with no need for open surgery. No complication after superselective embolization were observed. Superselective embolization is an effective, minimally-invasive method of neovascular diagnosis and treatment of bleeding, caused by iatrogenic arteriovenous kidney fistula. This technique allows to avoid organresecting surgery and eliminate dangerous complication.

In recent years there has been a significant change of preand postoperative tactics, associated with new approaches to pain management, introduction of methods that reduce stress response, and the use of minimally invasive surgical procedures. As a result of search for an effective treatment of surgical patients with minimal risk we came up with a new concept - fast track surgery (acceleration of various stages of treatment process) or ERAS (early rehabilitation after surgery). Fast track surgery combined with minimally invasive technology is actively used in I.M. Sechenov First MSMU clinic of urology. The studies have shown that the use of fast track protocol leads to statically significant reduction of hospital time and postoperative complications compared to the traditional preand postoperative tactics.

With the development of holmium laser enucleation of benign prostatic hyperplasia (HoLEP) procedures, it may replace TURP as the “gold standard” for surgical treatment of benign prostate hyperplasia and therefore this technique represents the most studied surgical benefits. HoLEP is performed consistently at different volumes of the prostate and has a good postoperative result. When performing TURP, it is also possible to remove a large amount of adenomatous tissue, however, this technique requires considerable run-time operation and high qualification of the surgeon.

The article analyzes the domestic and foreign literature concerning simultaneous operations in patients with comorbid diseases of the abdominal organs and retroperitoneal space. Achievements of the last decades in surgery and anesthesiology created real conditions for conducting simultaneous videoendoscopic operations, which allow surgeons to correct several surgical diseases of various localizations at a single stage, including patients with cancer. Minimal invasiveness and effectiveness of videoendoscopic operations enable to minimize the number of traditional operations.

According to statistics, the frequency of injuries from electric current is about 2,5 % in the world. Of them, only 20% of electric injuries are injuries caused by direct current. Direct current can cause more severe injuries in people.This article presents a clinical case of a patient with third degree electric injury caused by direct current over 1000 W, which was performed phalloplasty from torocodorsal flap.