[Experience with the use of bacteriophages in patients with neurogenic lower urinary tract dysfunction, complicated by recurrent lower urinary tract infection].

Clinical cases of three patients with neurogenic lower urinary tract dysfunction, complicated by chronic urinary tract infection are presented in the article. All patients underwent clean intermittent catheterization and, in order to prevent symptomatic lower urinary tract infections, received bacteriophage therapy with a clinically proven positive effect. During 3 months follow-up, there were no episodes of urinary tract infection. A change in the concentration of uropathogens and restoration of sensitivity to a number of antimicrobial drugs were observed. Although phage therapy in urology requires further clinical research, it provides an additional strategy to treat urinary tract infections considering an increase in antibiotic resistance.

[Optimization of prevention of infectious complications during prostate biopsy].

Prostate cancer (PCa) is one of the most common malignant neoplasms in middle-aged and elderly men. Transrectal ultrasound guided prostate biopsy is the standard method for diagnosing prostate cancer but is associated with a high incidence of infectious compli-cations. A review of the literature on optimizing the prevention of infectious complications when performing transrectal prostate biopsy is presented. The main risk factors and the common measures to prevent the development of complications are discussed, including a study of using fosfomycin trometamol as the preferred drug for antibacterial prophylaxis. Fosfomycin meets the requirements for empirical prophylaxis, but further clinical studies are needed.

[STATUS FOR A FEMALE DOCTOR IN MODERN UROLOGY. THE RESULTS OF A WOMEN UROLOGISTS SURVEY IN RUSSIA].

INTRODUCTION: In recent years, the role of women in medicine, particularly in surgical practice, has increasingly become a subject for discussion. Traditionally, male doctors have dominated in surgical specialties, especially in urology. Slow rhythm of changes in the structure of the specialty remains the problem relevant, despite the optimistic perspectives of the world urological community gender heterogeneity. MATERIALS AND METHODS: We have conducted an anonymous survey. Respondents were asked to complete a survey, which included questions from the survey of the European Association of Urology. The sample included 63 women, who were divided into two groups. RESULTS: Despite the opinion of both groups about the lack of a separation into «female¼ and «male¼ specialties, there are concerns about a conflict with stereotypes and ideas about the impossibility of women working in a surgical specialty. Respondents of both groups had more than 70% assurance that in order to achieve professional success, a female surgeon needs more efforts than a male surgeon. In the question of the future status after 10 years, the student population in more than 60% noted the option «operating urologist¼ and less than 10% of respondents chose the «researcher¼. At the same time, the ratio among female-doctors has 41 and 33%, respectively. Among female students, in most cases, indicated the lack of such a dilemma (family/career). Female doctors have a ratio of 50:50, respectively. In the question about pay, more than 75% of respondents were confident about receiving equal pay, similar to male doctors. CONCLUSION: The increasing number of female urologists across the world is a nowadays reality. Rejection of existing stereotypes, elements of gender discrimination from colleagues and patients, mentoring, awareness-building - will help attract young female doctors to the urological specialty. These aspects will be the first step in changing of the current urology.

[Lower urinary tract symptoms and COVID-19].

The data presented in the review showed that the coronavirus affects not only the lungs, but also the organs of the urinary system. The new virus causes a mosaic, multi-organ disease with severe consequences after the egg and has a wide organotropism. The role of SARS-CoV-2 in the development of lower urinary tract symptoms (LUTs), which are manifested by frequent, imperative urges, dysuria, nocturia, is not entirely clear. It is assumed that biologically active substances, the activation of which is caused by a virus, play a certain role in the development of SNMP, namely the expression of angiotensin converting enzyme 2 (ACE2), cytokines, activation of toll-like receptor 4 (TLR4), etc. An increase in cytokines that are released into the urine and / or expressed in the bladder and the presence of SNMP in patients with coronavirus infection have been called de novo urinary symptoms or COVID-19 associated cystitis (CAC) in the literature. Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. Despite the unusual manifestation of coronavirus infection, similar mechanisms of damage to urothelial cells in viral and bacterial infections give us the right to think about the use of pathogenetically justified prevention of the development of an inflammatory reaction in the urinary tract, as well as short-and long-term consequences of this disease. For this purpose, it is necessary to recommend drugs that have a multifactorial effect: diuretic, anti-adhesive, anti-inflammatory and regulate the local immunity of the bladder mucosa. We assume that against this background, we can expect a decrease in the number of complications from the organs of the urinary system, and more successful rehabilitation of patients with coronavirus infection and in the post-ovarian period. Final conclusions and recommendations will be available after well-planned clinical trials have been conducted.

[Socio-economic aspects of neurogenic dysfunctions in urology].

AIM: to evaluate the medico-economic significance of neurogenic lower urinary tract dysfunction (NLUTD) in the Russian Federation, to calculate the economic burden of NLUTD in patients with targeted entities and to prepare suggestions for improving the methods of payment for the provision of medical care to patients with NLUTD in inpatient practice. MATERIALS AND METHODS: an analysis of the literature and an expert assessment of the prevalence of NLUTD in the Russian Federation were performed. Due to the various etiology of NLUTD, the following entities were considered: craniocerebral trauma, acute stroke, multiple sclerosis, spinal cord injury (hereinafter referred to as targeted entities), characterized by the highest rate of NLUTD and high social significance (damage to the working-age population): traumatic brain injury, acute stroke, multiple sclerosis, spinal cord injury. The calculations of the economic burden of NLUTD and its main complications (stage 5 of chronic kidney disease (CKD), urinary tract infection) in the Russian Federation (using mainly the normative method) were carried out, based on national statistics, regulatory legal acts and expert assessments of healthcare specialists. Proposals have been prepared for improving the reimbursement (tariffs of the KSG) for payment of NLUTD in the inpatient practice. RESULTS: according to the study, the number of patients with NLUTD due to the group of targeted entities is estimated at 910 000. The economic burden (excluding indirect and unaccounted costs) of the NLUTD is 33.3 billion rubles per year. The burden associated with secondary complications (stage 5 CKD, urogenital infection) due to ineffective diagnosis and treatment of NLUTD is 51.6 billion rubles. The total costs on the NLUTD is estimated at 84.9 billion rubles. Direct costs, calculated by the normative method based on the analysis of standards of medical care per patient are 36,546 rubles per year. Provision of medical care to patients with NLUTD in accordance with federal guarantees within the framework of the compulsory medical insurance is provided in accordance with the tariffs of KSG st30.005 (profile "urology"). The KSG tariff for 2019 (taking into account the established standards of financial costs for one case of hospitalization in the inpatient department and the established cost-intensity coefficients (CZ) established by the CG is 21,495.07 rubles, which is 58% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the tariff for the payment of treatment of NLUTD in the constituent entities of the Russian Federation is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the costs for the treatment of NLUTD in regions is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. To provide effective specialized urological care in the framework of compulsory medical insurance at the rates of the CSG for neuro-urological care (st30.005), expert calculations of the actual cost of NLUTD therapy were made. The proposed average cost of the CSG and the values of the cost intensity factors: CSG (min) st30.005.1 - 39,936 rubles, CZ - 1.65; CSG (max) st30.005.2 - 68,531 rubles, CZ - 2.75. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year. CONCLUSIONS: Evaluation of the prevalence and burden of NLUTD showed the high medical and economic significance of NLUTD in the Russian Federation. The results of the study indicate a significant discrepancy between the requirements and the real costs within federal guarantees for the organization of medical care for patients with NLUTD. To provide effective specialized urological care in the compulsory medical insurance at the rates of CSG for neuro-urological care, it is necessary to increase funding, through the correction at the federal level of the cost-intensity coefficient from 1.65 to 2.75 for the CSG st30.005, which will ensure the increase in the cost for a case of treatment in inpatient department in form 39 936 to 68 531 rubles. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year.

[Recurrent urinary incontinence in women: causes and treatments].

Quite often patients assume that any new onset of urge incontinence or nocturia is recurrent urinary incontinence. Is it possible to consider any similar situation as the recurrence of urinary incontinence? No, of course not. However, if you put at the forefront a patient satisfaction with the overall result of the surgery, rather than a formal negative cough test, the picture will be somewhat different. On the one hand, it brings us back to criteria of surgery success, and on the other to the indications for repeat surgery. All this highlights the importance of thorough examination of patients with urinary incontinence. Patient evaluation begins with taking a complete medical history, reviewing chief complaints and filling in urination diary. If a re-operation is indicated, the following surgical options should be considered: sling operations, colposuspension or tapes using patient own tissue. The choice of surgical treatment for recurrent urinary incontinence should be based on the results of a thorough evaluation of the individual patient, including urodynamic parameters and supplementary imaging studies. The most important factors influencing the choice of method of re-surgery were the type of the previous operation, the results of urodynamic studies, and the preference and experience of the surgeon.