[Mini-PCNL, micro-PCNL or RIRS: comparative efficacy and safety in renal stones up to 2 cm].

INTRODUCTION: One of the main trends in the evolution of endoscopic treatment of urolithiasis is the miniaturization of instruments. This is obvious in the development of minimally invasive percutaneous nephro-lithotomy (PCNL) and retrograde intrarenal surgery (RIRS). However, there are few studies comparing the efficiency and safety of these methods. AIM: To evaluate and compare the efficiency and safety of mini-PCNL, micro-PCNL and RIRS in the treatment of kidney stones up to 2 cm in size. MATERIALS AND METHODS: Between October 2020 and December 2022, a total 72 patients underwent minimally invasive endoscopic procedures in two centers, including RIRS (n=30), mini-PCNL (n=26) and micro-PCNL (n=16) using thulium fiber laser FiberLase U2. The efficiency of procedure (stone free rate [SFR]) was assessed using non-contrast-enhanced CT. SFR was considered as the absence of residual fragments > 4 mm. Complications (safety) were evaluated based on the Clavien-Dindo classification. RESULTS: The mean age of all patients was 47.7 (22-84) years. There were no significant differences between three groups in stone characteristics according to CT (maximum diameter, density, volume and number of stones, the presence of pelvicalyceal dilation). SFR was significantly different between the groups (p=0.034). The overall SFR was 81.9% (n=59). After RIRS, mini-PCNL, and micro-PCNL the SFR was 93.3%, 80.8%, and 62.5%, respectively. A significant difference was found between the RIRS and micro-PNL groups, with 2 out of 30 and 6 out of 16 patients requiring repeat procedure, respectively (p=0.026). The overall rate of complication of grades I-II, IIIa and IIIb according to Clavien-Dindo was 6.9%, 9.7% and 6.9%, respectively. A significant difference was found between the RIRS and micro-PCNL (p=0.021) for grade I-II complications. A rate of grade III complications was not differed between the groups. The operation time was higher for mini-PNL (79.8 (30-145) min), and it was shorter for RIRS (55.7 (30-155) min). The length of stay was lower in RIRS group (4.5 (1-12) days). CONCLUSION: The highest SFR was achieved in the RIRS group. In terms of the number of complications of I-II grades according to Clavien-Dindo, the duration of the procedure and the length of stay, RIRS also showed the advantage. There were no significant differences in efficiency and safety between the micro-PNL and mini-PNL. There are not enough studies comparing minimally invasive methods for treating kidney stones. It is necessary to continue research in this area in order to develop an optimal algorithm for choosing the method of endoscopic treatment.

[Normative parameters for monitoring of nocturnal penile tumescences: results of own observations and approbation of the developed normative criteria].

OBJECTIVE: Clinical approbation of previously obtained normative criteria for evaluating erectograms using the Androscan MIT hardware complex, as well as comparing the monitoring indicators of nocturnal penile tumescence (NPT) with the results of the standard questionnaire International Index of Erectile Function-15 (IIEF-15). MATERIALS AND METHODS: The study included 120 patients aged 19 to 72 years. Erectile function was assessed using the IIEF-15 questionnaire and the Androscan MIT hardware complex. To assess erectile function, previously developed normative criteria for the relative increase in the diameter of the penis (OP) and the duration of NTP were used. Statistical data processing was carried out using the STATISTICA 12 software. A systematic literature search on the normative criteria for monitoring NTP was carried out in the Medline database. RESULTS: After performing androscanning, patients were divided according to the degree of ED: there were 12 patients without ED, 58 patients with grade 1 ED, 27 patients with grade 2 ED, and 23 patients with grade 3 ED. According to the results obtained, a positive correlation was found between the OD value and the results of the IIEF-15 questionnaire. CONCLUSION: The obtained data on the correlation between the results of the IIEF -15 questionnaire and the NTP monitoring parameters are consistent with most of the currently available foreign data.

[Premature ejaculation: the main physiological mechanisms and new approaches to the treatment].

Premature ejaculation (PE) is characterized by an early ejaculation, which occurs within 1 minute after or before vaginal penetration. PE is the most common sexual problem and leads to a number of negative psychological consequences. To understand the etiopathogenesis of PE, it is necessary to understand the physiological mechanisms of the ejaculatory reflex. A group of galanine-ergic lumbar spinothalamic cells (LSt cells) with their numerous projections to various structures of the central nervous system plays a crucial role. The main approaches to the treatment of PE are based on the inhibition of glans sensitivity. In recent years, most of the studies on PE are dedicated to various technologies of reflexotherapy and a possibility of biofeedback. We have analyzed the available literature data and explained the main links of ejaculatory reflex, as well as possible approaches to treatment.

[Irreversible electroporation to treat prostate cancer (Nanoknife)].

Modern medicine tends to use minimally invasive treatments. Selected patients with prostate cancer may be treated using irreversible electroporation that involves the application of a NanoKnife device. The procedure directs short electrical pulses that open microscopic pores in the cells in the treatment area and effectively destroy cancer cells. This literature review outlines the history of irreversible electroporation, its use in surgery for treating cancers of the pancreas, liver, lung, kidney and brain. This technique is relatively new and is not yet applied in routine urologic practice, but has been increasingly used in Europe and North America and, no doubt, will find an appropriate utilization in Russia.