[Comprehensive comparative assessment of the results of treatment of patients with ureteral stones using two different methods].

AIM: To improve treatment outcomes in patients with ureteral stones by optimizing the use of noninvasive and minimally invasive techniques. MATERIAL AND METHODS: A prospective analysis of 186 patients with ureteral stones who were treated at the "RSSPMCU" in the period from July 2020 to April 2023 was carried out. Among them, 84 were undergone to electromagnetic extracorporeal shock-wave lithotripsy (ESWL) using the Storz Modulith SLX-F2 device (Switzerland). A procedure was performed under ataralgesia. The mean stone size was 8.54+/-2.79 (4-16 mm). The average amount of shock waves per stone was 2436+/-247.78. The session duration was 19.37+/-1.86 minutes. Endoscopic procedures were performed in 102 patients. Among them, 49 stones were removed using the ureteroscopy (URS), while in 49 and 4 cases percutaneous access (PCNL) and a combination of PCNL and URS under spinal anesthesia were done, respectively. The mean stone size was 11.46+/-4.26 (5-26 mm). Holmium laser or pneumatic lithotripsy was performed. The duration of the procedure was 63.38+/-17.48 min. RESULTS: The stone density of patients undergoing ESWL was 855+/-319.84 HU, while those undergoing endoscopic procedures was 943.78+/-319.48 HU (p>0.05). The absorbed dose with ESWL was 18.73+/-4.15 mGy compared to 31.42+/-1.40 mGy for endoscopic procedures (p<0.001). A length of stay was 1.0+/-0.0 and 2.75+0.1, respectively (p<0.001). After 7-10 days, the stone free rate (SFR) was 76.2% (n=64) after ESWL and 99.02% (n=101) after endoscopic interventions (p<0.05). In the ESWL group, 3 patients received second session of ESWL for residual stones and in 9 cases URS was done. The SFR was 100% on day 45. In patients after endoscopic interventions, 1 patient underwent URS and SFR was 100% on the 15th day. CONCLUSION: In general, the endoscopic technique is superior to ESWL in patients with ureteral stones both in terms of SFR and duration of procedure, but is inferior in safety due to invasiveness and the absorbed dose. In our opinion, the key indication for endoscopic treatment should be stone size greater than 6 mm, density more than 1000 HU, and patient preference.

[Phosphodesterase type 5 inhibitors clinical efficiency and role in therapy for erectile dysfunction].

This article discusses the physiological mechanisms of erection and the pathophysiological basis of erectile dysfunction. Parameters characterizing the features of the pharmacokinetics and pharmacodynamics of drugs from the group of phosphodiesterase type 5 inhibitors (PDE-5i) are presented. The clinical efficacy and possible adverse effects of the most significant PDE-5i are considered. These include sildenafil, tadalafil, vardenafil, udenafil, avanafil. There are also data on less known PDE-5i, which include lodenafil and mirodenafil.

[Varicocelectomy: a critical analysis of predictors for male reproductive function recovery].

Varicocele is one of the most common correctable cause of male subfertility. According to recent meta-analyzes of RCTs varicocelectomy, in general, leads to significant improvement in semen quality and thereby male fertility. However, varicocelectomy success rate is 55-70%, it means that 30-40% of infertile men does not experience fertility improvement after varicocelectomy. The aim of our review was to search and analyze literature data on clinical-anamnestic and laboratory-instrumental predictors that positively or negatively affect varicocelectomy efficacy. As a result of analysis, we systematized the studied predictors based on the total points calculated on the basis of number and quality of studies that confirm or reject the studied predictor as a significant, into three levels of evidence: predictors of high, moderate and low evidence levels. Predictors of high level of evidence included: initial semen parameters, sperm DNA fragmentation index, and Doppler ultrasound imaging of testicular vessels. The initial serum level of FSH and testicular volume were included in the group of predictors of moderate evidence level. At the same time, such factors as the male age and his female partner age, varicocele grade and infertility duration entered the group of predictors of low evidence level. In this way, we performed "gradation" of predictors of varicocelectomy efficacy in subfertile men based on the analysis of the evidence level of each predictor.

[To the issue of improving early diagnosis of localized prostate cancer].

AIM: To improve an early diagnosis of prostate cancer (PCa) by clarifying indications for prostate biopsy. MATERIALS AND METHODS: A prospective analysis of 251 primary prostate biopsies performed in Republican Specialized Scientific and Practical Medical Center of Urology to patients with LUTS during the period from 2018 to 2019 was carried out. All patients were divided into two groups. The group 1 included 189 patients who underwent standard systematic prostate biopsy; the group 2 consisted of 62 patients, who had had baseline multiparametric magnetic resonance tomography (mp-MRI) of the prostate with risk evaluation using PI-RADS v2 score, followed by systematic biopsy in combination with targeted biopsy. The ultrasound-guided biopsy was done under local anesthesia using lidocaine gel and periprostatic nerve block with a 2% lidocaine solution. Systematic biopsy was performed with 10 to 12 cores using biopsy gun. In the second group, in addition to systematic biopsy, from 2 to 6 targeted cores from suspicious areas were taken. RESULTS: In the group 1, PCa was diagnosed in 124 (65.6%) patients. In patients with a PSA level of less than 20 ng/ml, a total of 18 PCa were revealed (35.3%). A concordance between TRUS and DRE with the biopsy result was significantly less in patients with PSA level < 20 ng/ml (17.6%), than in patients with PSA level more than 20.1 ng/ml (61.6%; p<0.001). In the second group, PCa was diagnosed in 5 patients (17.9%) with PI-RADS v2 category 2 and 3 lesions, compared to 31 men (91.2%) with category 4 and 5 lesions. In patients with PSA level of less than 20 ng/ml, the proportion of positive biopsy results was 5.6% and 75.0%, respectively. CONCLUSIONS: In all patients with PSA level of less than 20 ng/ml, mp-MRI of the prostate should be performed prior to biopsy. In men with PI-RADS v2 category 4-5 lesions, systematic biopsy in combination with targeted biopsy is recommended, while in case of category 2-3 lesions and negative TRUS and DRE, it is more appropriate to follow-up patients, instead of performing biopsy.

[Significance of definition category of complexity of urinary stones in the systematization of complications of endosopic surgery of urolitiasis].

AIM: To determine the complexity of urinary stones from the standpoint of endoscopic surgery in order to create the standard for the postoperative course of endoscopic surgery for urolithiasis. MATERIAL AND METHODS: A total of 1317 endoscopic operations (PNL, URS), performed for upper urinary tract stones, were analyzed. Treatment results of 290 patients were studied prospectively, taking into account a stone density, determined by MSCT using HU scale. In 1027 patients, results were studied retrospectively, with a consideration of stone quantitative characteristics, size and shape. RESULTS: According to the study, stone density does not have a significant impact on the frequency and severity of complications and the efficacy of endoscopic treatment for urolithiasis. The number of stones, their size and stereometric configuration have a significant influence on the surgical procedure. From the position of endoscopic interventions, single upper urinary tract stones were determined as "simple", while multiple and staghorn stones were considered as "complexed" cases. CONCLUSION: The "standard of the postoperative period" of endoscopic surgery for urolithiasis created with a consideration of specific features of endoscopic surgery for urolithiasis and the complexity of urinary stones is proved to be objective. Any deviation in the postoperative period from the standard course should be regarded as a complication and it is necessary to systematize them according to the Clavien-Dindo classification.

[EVALUATION OF THE EFFICACY OF STANDARD PERCUTANEOUS NEPHROLITHOTRIPSY IN STAGHORN AND MULTIPLE NEPHROLITHIASIS].

In staghorn and multiple nephrolithiasis, method of choice for removing kidney stones is percutaneous nephrolithotripsy (PCNL). However, it may be accompanied by the leaving off of stones or fragments in pyelocaliceal system. The study was aimed to the evaluation of possibilities of the standard PCNL in terms of complete removal of staghorn and multiple kidney stones. Percutaneous nephrolithotripsy was made by a single access using standard method in 99 patients with staghorn and multiple kidney stones. The average age of the patients ranged from 9 to 61 (34.4±3.2) years. Staghorn stones were found in 80 (80.8%) patients, staghorn stones with multiple stones - in 19 (19.2%) patients. Stone size ranged from 18 to 94 (49.6±2.3) mm. The use of standard PCNL to remove staghorn and multiple kidney stones as monotherapy has allowed complete removing of the stones in 74 (74.7%) patients. The average length of stay of patients in hospital after surgery was 5.9±0.3 bed-days (2 to 31), medium time for removal of drains after surgery - 4.3±0.7 days. Intraoperative blood loss was observed in 11 (11.1%) patients, its volume ranged from 150 to 1130 (407.2±28.8) ml. In 8 (8.1%) cases, bleeding regarded as a complication, because it required replacement therapy. Postoperative complications were observed in 19 (19.2%) patients, of which 8 (8.1%) had bleeding, and 11 (11.1%) had exacerbation of urinary tract infection. Thus, the standard PCNL as monotherapy in staghorn and multiple nephrolithiasis serves as alternative method for removing stones. The results of treatment depend on the size and stereometric configuration of staghorn stones. The most common causes of residual stones are inaccessibility of calyx by endoscope and intraoperative bleeding.