[Embolization of prostate arteries - an alternative technology for treatmetment of prostatic adenoma in patients with diabetes mellitus.]

The article details the examination plan and recommendations for the endovascular treatment of patients with prostate adenoma with concomitant diabetes mellitus. The results of the work of the Department of Andrology and Urology at the Endocrinological Research Center for prostate artery embolization are also displayed. A clinical case of care for a patient with prostate adenoma and severe diabetes mellitus is presented.

[Application of temporary polyurethane-covered nitinol endoprosthesis in treating urethral stricture].

The incidence of urethral strictures and their recurrences is high. The effectiveness of optical urethrotomy in men is insufficient. Reconstructive urethroplasty is the "gold standard", but it is traumatic and accompanied by a prolonged period of rehabilitation. The results of using metal endourethral stents were unsatisfactory because of their incrustation and migration. This paper presents the results treating urethral strictures of various etiologies in 22 patients, who underwent optical urethrotomy with temporary placement of a new generation polyurethane-covered nitinol stents. After removing the stents from 3 to 8 months after implantation, there was a stable effect of preserving the urethral lumen. The recurrence of the stricture occurred in 1 case 1 month following the stent removal. In other cases, there were no recurrences over 1-3 year follow-up. We consider placing an internal stent as an alternative adjunctive treatment of patients with urethral strictures.

[Comprehensive rehabilitation of a patient after penile amputation by the methods of augmentation reconstruction of corpora cavernosa, urethra and glans penis].

The article presents a unique clinical case of social, psychological and sexual rehabilitation of a patient who had undergone amputation of the penis due to penile cancer, without recurrence. The patient was submitted to comprehensive reconstruction of the lost parts of the sexual organ (corpora cavernosa, urethra, glans penis) using both conventional techniques and the ones performed for the first time in reconstructive plastic surgery.

[X-ray guided endovascular occlusion of prostate arteries--alternative innovative method of treatment for patients with large prostatic adenomas].

The choice of method of surgical treatment of prostatic adenoma depends on the size of prostate, but often it can be limited to the patients with anesthesia risk or somatic risk. The article presents an alternative method of treatment of large prostatic adenomas--x-ray guided endovascular occlusion of prostate arteries, through which 38 patients were treated. Effectiveness of x-ray guided endovascular occlusion was evaluated in comparison to open prostatectomy (40 patients) and the administration of 5alpha-reductase inhibitor (43 patients). In the first two months after surgery, significant reduction in prostate volume and increased urinary flow rate was observed. Length of stay in the group of x-ray guided endovascular occlusion of prostate arteries was significantly less than in the group of open prostatectomy--2.3 days versus 19.7, respectively (P < 0.001). Variants of use of x-ray guided endovascular occlusion of prostate arteries in clinical practice are presented.

[Application of methods of angiosurgery for the treatment of venogenic erectile dysfunction].

The article presents the results of the use of alternative method of treatment--endovascular occlusion of the prostatic plexus--in patients with isolated venogenic erectile dysfunction. The IIEF-5 and AMS questionnaires were used for the evaluation of results of the operation. Improvement of quality of erection in the first 3 months after surgery was achieved in the majority of patients. The use of this innovative technology provides secure, minimally invasive and pathogenetically justified treatment of ED caused by abnormal venous drainage from the cavernous bodies.

[Nebido in the treatment of hypogonadism syndrome and its complications in men].

The article presents original experience with use of undecanoate (nebido, BayerHealthcare Pharmaceuticals, Germany) in androgenic testosteron replacement therapy in males with hypogonadism. Prospective studies of nebido efficacy were made in males with vein-occlusive erectile dysfunction (n = 20), chronic pelvic pain syndrome (n = 77), metabolic syndrome (n = 170). Retrospective studies assessed efficacy of nebido monotherapy in patients with erectile dysfunction and hypogonadism (n = 34), hematological and urological safety of the drug (n = 40). Laboratory monitoring was performed in all the studies according to ISSAM recommendations. The patients were not included in contraindications to androgenic therapy. Nebido treatment significantly improved libido and erectile function, efficacy of phosphodiesterase of type 5 inhibiors used in moderate and severe erectile dysfunction. Depressive, asthenic, pain symptoms declined in males with chronic pelvic pain. Body fat reduced in metabolic syndrome with alleviation of its other components. Insignificant rise of hemoglobin level and packed cell volume was observed in some patients while a PSA level increase was clinically significant in 10% patients who had initial PSA > 2.5 ng/ml and acromegalia. Also, nebido depressed production of gonadotropins and spermatogenesis. Thus, nebido is highly effective in sexual dysfunction and other somatic disorders caused by hypogonadism. Nebido does not induce severe side effects, but clinically significant rise of PSA level requires treatment discontinuation and more careful urological examination. In view of nebido ability to suppress spermatogenesis, the drug should not be used in reproductively active men.