[Optimization of modern conservative therapy of micropenis in hypogonadal men].

The study was aimed to the optimization of conservative therapy of micropenis in hypogonadal men using combination of traction therapy and androgen replacment therapy (ART) with injections of prolonged testosterone undecanoate (Nebido) and to evaluatiom of the safety of ART in terms of the risk of prostate cancer against the background of combined treatment of micropenis by both methods within 12 months. The study included 16 men aged 22-62 years with micropenis and hypogonadism. 10 men were diagnosed with primary hypogonadism, 6 men were diagnosed with secondary hypogonadism without reserve gonadal function; therefore, all 16 patients were treated with testosterone undecanoate 1000 mg intramuscularly according to the scheme: the second injection 6 weeks after the first injection, then each injection once a 12 weeks, the course of 12 months. During the first 3 months of ART, hypogonadism in all men was eliminated, but only at 6 month of ART, the length of the penis in the flaccid state at maximum extension increased from 5.8±1.2 to 8.3±1.2 cm (p<0.05), and the length of the erect penis - from 6.8±1.1 to 11.8±0.9 (p<0,05). At the next stage, from the 6th to the 12th month of ART, traction therapy was simultaneously carried out. At the end of the treatment, the length of the penis in the flaccid state at maximum extension increased by 58% of the original length, and in a state of erection - by 114% (p<0.05). During the 12 months of treatment, prostate volume in all men increased from 3.4±1.2 to 16.3±1.2 (p<0.05), which corresponds to the size of the prostate in healthy men. Total blood PSA level increased from 0.72±0.03 to 1.4±0.05 ng/ml (p<0.05), but it was in the acceptable range of reference values for healthy men during whole period of ART in all patients. Start therapy with prolonged testosterone undecanoate for 6 months significantly increases the efficiency of traction therapy in men with hypogonadism and micropenis, but for maintenance of the effect, ART should be continued during all period of treatment.

[Diseases of solitary kidney: the history and evolution of scientific issues].

The lecture is devoted to one of the most important problems of modern urology, which has a long scientific history--the diseases of solitary kidney after nephrectomy. Fundamental theory of solitary kidney was laid in the early XX century, during which it was significantly enriched by fundamental provisions preserving their practical significance in the present time. In the domestic literature of the last decade, however, the problem of diseases of solitary kidney is undeservedly forgotten and slightly developed. At the same time, recent data suggest a certain theoretical and practical conflict in this section of urology: on the one hand, the incidence of diseases of solitary kidney in the last 50 years has increased by at least a 2 times; on the other--an effective conservative treatments of diseases of solitary kidney at different stages of kidney failure have not yet implemented in clinical practice, except hemodialysis and renal transplantation used in the terminal stages of chronic renal failure. Methods of primary and secondary prevention of diseases of solitary kidney are not developed at all. The history and evolution of problems of diseases of solitary kidney is a good example of fact that despite available data and accumulation of new scientific evidence of the close relationship between local and systemic factors in the pathogenesis of these diseases, their new rethinking in the framework of interdisciplinary interactions for the optimization of methods of clinical management of this specific group of patients as well as for the development of new effective methods for early diagnosis, treatment and prevention are required.

[Effect of acute operational stress on the exchange of biogenic amines in prostate gland and steroidogenesis (experimental study)].

Patterns of metabolic imbalance of biogenic amines in the tissue of the prostate, leading to violations of hemodynamics and trophism, were revealed in experimental study on laboratory animals. At the same time the stress was acute inducer of functional testosterone deficiency, which persisted throughout the observation period. Based on experimental data obtained, pathogenetic role of stress-induced metabolic imbalance of biogenic amines and steroidogenesis as possible early pathophysiological mechanisms of prostate diseases in humans is proved.

[Systemic metabolic pathogenetic factors of affection of the solitary kidney in males (a pilot trial)].

Our pilot trial demonstrates high prevalence of solitary kidney (SK) diseases in men (82.7%). Present-day SK diseases are often accompanied with marked systemic metabolic disorders (obesity, dyslipidemia, androgen deficiency). We found correlations between obesity and incidence of acid urine urolithiasis of the SK, between type II diabetes mellitus, obesity and SK cystic disease. SK men's glomerular filtration rate depends on the level of total testosterone in blood. We believe that early detection and pathogenetic correction of dyslipidemia, obesity and androgen deficiency in SK men may be key prophylactic factors of SK diseases which often entail development of chronic renal failure.

[Relationship of systemic factors in the pathogenesis of chronic pelvic pain syndrome in men].

Survey of 250 men with category III chronic pelvic pain syndrome/ chronic prostatitis (CPPS/CP-III) showed that the urological disease often proceeds against the background of obesity (29.6%), androgen deficiency (38.4%), increased tone of sympathetic nervous system (62.9%) and the activation of the plasma lipid peroxidation system (oxidative stress) (100%), with significant correlations between these factors. Working hypothesis was formulated; according this hypothesis, the components of metabolic syndrome in men and associated systemic reactions of sympathetic hyperactivity, oxidative stress, and androgen deficiency play an important role in the pathogenesis of CPPS/CP-III. This allows to consider CPPS/CP-III as an interdisciplinary complex issue of men's health and to review the existing traditional approaches to its diagnosis, treatment and prevention.