[Medical and social aspects of testicular prosthetics in adults and adolescents].

Despite a long history and seeming simplicity, testicular prosthesis is associated with a lot of unresolved issues. As new publications appear, the sharpness of the discussion around issues related to prosthetics does not tend to decrease. The review is based on publications on testicular prosthesis in adolescence and adulthood published in PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed/) and Scientific Electronic Library Elibrary.ru (https://elibrary.ru/) was done. Only articles published in peer-reviewed journals were selected. The search was carried out using the following keywords: "testicular prosthesis", "structure of patients", "social rehabilitation", "social adaptation", "complications", "repeated implantation of testicular prosthesis". A total of 146 sources have been identified (predominantly over the past 10 years), and 44 have the highest scientific value and have been selected for citation and analysis. Testicular prosthesis is an important component of the psychological and physical well-being of the patient after orchiectomy, normalization of reproductive function and sexual adaptation [1, 2]. A body defect that occurs after an orchiectomy is in most cases perceived as a psychologic trauma. The evaluation of the results by both specialists and patients certainly deserves serious attention, but the works dedicated to this issue in detail are sparse, contradictory and do not fully disclose the problem. Many issues related to testicular prosthesis remain open for discussion. There is a trend in clarification of the optimal age of the intervention, surgical technique and complications. The evaluation of the results from both a professional point of view and the patient's perception and satisfaction is currently far from being resolved, therefore, such studies are still relevant.

[Functional morphology of the bladder and its vascular system in relation to age changes and evolution of BPH].

INTRODUCTION: The increase in the proportion of people with various urinary disorders, which are based on anatomical and functional bladder remodeling due to aging, is currently un-deniable. This problem becomes more relevant due to the elevation in life expectancy. At the same time, the features of bladder remodeling, in particular, the structural changes of its vascular bed, are still practically not described in the literature. In men, the lower urinary tract undergoes additional transformation associated with age due to bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Despite the long history of studying BPH, the morphological basics of its evolution have not yet been fully elucidated, including the development of lower urinary tract decompensation and, in particular, the role of vascular changes. In addition, structural re-modeling of the bladder muscles in BPH is formed in those with pre-existing age-related changes in both the detrusor and its vascular system, which cannot but influence the dynamics of disease progression. AIM: To study the structural changes of detrusor and its vascular bed associated with age, and to establish the role of their patterns in patients with BPH. MATERIALS AND METHODS: The material was a specimen of the bladder wall obtained dur-ing: a) autopsies of 35 men aged 60-80 years who died from diseases not related to urological or cardiovascular pathology; b) autopsies of 35 men aged 60-80 years who had BPH without blad-der decompensation; c) intraoperative biopsies of 25 men of the same age who undergone surgi-cal treatment for chronic urinary retention (postvoid residual volume of more than 300 ml), bilat-eral hydronephrosis, as complications of BPH. As a control, we used the specimens obtained from 20 males aged 20-30 years who died as a result of violence. Histological sections of the bladder wall were stained with hematoxylin-eosin, according to Mason and Hart. Standard microscopy and stereometry of detrusor structural components and morphometry of the urinary bladder vessels were performed using a special ocular insert with 100 equidistant points. During morphometric examination of the vascular bed the thickness of the middle layer of arteries wall (tunica media) was measured, as well as a thickness of the entire wall of the veins in microns. In addition, a Schiff test and Immunohistochemistry (IHC) of these histological sections were performed. The IHC was evaluated using a semi-quantitative method, taking into account the degree of staining in 10 fields of vision (200). The digital material was processed with the STATISTICA program using the Student's t-test. The distribution of the obtained data corresponded to normal. The data were considered re-liable if the probability of making error did not exceed 5% (p<0.05). RESULTS AND DISCUSSION: In the course of natural aging, a structural remodeling of bladder vascular bed was observed, from the development of atherosclerosis of extra-organ arteries to restructuring of intra-organ arteries due to arterial hypertension. The progression of angiopathy leads to the development of chronic detrusor ischemia, which initiates the formation of focal at-rophy of the smooth muscles, destructive changes in the elastic fibers, neurodegeneration and stroma sclerosis. A long-term BPH leads to compensatory detrusor remodeling with hypertrophy of previously unchanged areas. At the same time, age-related atrophic and sclerotic changes in smooth muscles are accompanied with hypertrophy of individual areas of the bladder detrusor. To maintain adequate blood supply to hypertrophied detrusor areas in the arterial and venous bladder vessels, a complex of myogenic structures is formed that can regulate blood circulation, making it dependent on the energy consumption of specific areas. However, progressive age-related changes in the arteries and veins eventually lead to an increase in chronic hypoxia, im-paired nervous regulation and vascular dystonia, increased blood vessels sclerosis and hyalinosis, and sclerosis of intravascular myogenic structures with loss of their function of blood flow regu-lation, as well as the development of vein thrombosis. As a result, increasing vascular decom-pensation in patients with bladder outlet obstruction results in bladder ischemia and accelerates the decompensation of the lower urinary tract.

[Assessment of the safety and efficacy of medicinal product PPR-001 based on regulatory polypeptides of the testes].

OBJECTIVE: Evaluation of the effectiveness and safety of the drug PPR-001 (lyophilizate) in comparison with placebo in men with impaired spermatogenesis. MATERIALS AND METHODS: This study was a randomized, double-blind, placebo-controlled, prospective, multicenter, parallel-group research. RESULTS: It was found that the drug has clinical efficacy and a positive effect on the concentration of spermatozoa in the ejaculate, the percentage of progressively mobile forms and the number of morphologically normal forms of spermatozoa was increased in the group of PPR-001. The primary end point was defined as a proportion of patients who had a therapeutic response (TO) at Visit 3. TO meant at least 20% increase in the concentration and/or progressive motility of spermatozoa compared to the baseline level. The hypothesis of Superiority of PPR-001 over placebo based on primary end point was confirmed (the limit of Superiority was more than 27%). In total, AEs were identified in 65 patients out of 100 (34 patients in the PPR-001 group and 31 patients in the placebo group). When assessing the number of patients who had AEs, there were no statistically significant differences between the groups. All identified AEs were of mild severity; during the study. No negative dynamics was found according to the results of the assessment of vital functions, biochemical and clinical blood tests, clinical urinalysis, ECG indicators. CONCLUSION: The study demonstrated the superiority of PPR-001 over placebo in terms of increasing concentration and motility of spermatozoa in the ejaculate. A significant increase in the number of morphologically normal forms of spermatozoa in the PPR-001 group was also revealed.

[Complications of the acute scrotum syndrome in children].

AIM: To establish causes of complications and repeated surgical procedures in patients with acute scrotal pathology during the short- and long-term follow-up. MATERIALS AND METHODS: The treatment results of 3315 patients aged 0 to 18 years with various forms of acute scrotal pathology were analyzed. RESULTS: A total of 43 complications were documented, 32 of them required surgical intervention. The most common complication is testicular necrosis due to incorrect judgement of viability after torsion with performing an organ-preserving procedure, which is dictated by the surgeons desire to preserve a testicle. Such a decision is made without objective data and in all cases leads to repeated procedure due to testicular necrosis. Inappropriate surgical hemostasis is often associated with improper surgical technique and underestimation of inflammatory tissue changes. Purulent complications are the most common in acute epididymitis and are caused by the presence of an inflammatory focus in the scrotum. Wide revision of the scrotum in case of testicular appendages pathology is not justified, since the second appendage is rarely found, while the invasiveness of the procedure increases. CONCLUSION: Complications were more common in the early postoperative period (88.4%). Purulent complications are directly dependent on the duration of the disease and are exacerbated by the secondary inflammatory process. Most of complications are treatable; performing of preventive measures helps to avoid them.

[Psycho-emotional, vegetative-vascular and nephrological determinants of maladaptive stress in persons undergoing nephrectomy for renal cell carcinoma].

Operational stress is a combination of syndromes that can affect renal function in patients undergoing nephrectomy and affect the course of both the early and late postoperative periods. OBJECTIVE: to assess the relationship of psycho-emotional and autonomic stress with changes in the functional state of the kidney in patients undergoing nephrectomy for kidney cancer. MATERIALS AND METHODS: The clinical study involved 75 patients (mean age 64+/-3 years, stage 1 CKD) who underwent nephrectomy for localized kidney cancer. In patients of the study group (n=45) before surgery and in the early postoperative period on the 1st, 7th and 14th day, somatic and psychoemotional statuses were studied using the Zung scale, Kerdo index, and glomerular reaction rate estimates. Group control (n=30) of patients who underwent nephrectomy 12 months ago, with the results of clinical studies, as a result of which there were no clinical, laboratory and radiological diseases of a single kidney. The results of biochemical, autonomic and functional tests in this group of patients were taken as the conditionally normal rate characteristic of patients undergoing nephrectomy. RESULTS: In the course of the correlation analysis, when comparing the degree of anxiety of patients after nephrectomy (estimated by SBT according to the Tsung Anxiety Scale) with the calculated Kerdo vegetative index (VIC), a statistically significant positive relationship was found between them, especially pronounced during the first 7 days of the early postoperative period. At this time, the vegetative mediated by vasculogenic factors adaptation progressively worsened (VIC increased), while the GFR of a single kidney significantly decreased. CONCLUSION: Operational stress, together with all other predictors, may be a risk factor for the development of acute renal failure in the early postoperative period and the progression of CKD in the late period after surgery.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[The role of stress-induced chronic subclinical inflammation in the pathogenesis of the chronic pelvic pain syndrome IIIB in men].

This literature review of recent clinical and experimental studies describes the role of oxidative stress in the multifactorial and interdisciplinary pathogenesis of non-inflammatory chronic pelvic pain syndrome IIIB (CPPS-IIIB) in men. The authors outline general biological nature of oxidative stress and its mechanisms. More detailed information is presented on cytokine-mediated chronic subclinical inflammation, one of the key mechanisms of oxidative stress, which is currently being actively studied. It is shown that the imbalance between pro- and anti-inflammatory cytokines observed in patients with CPPS-IIIB can explain some features of the clinical course (in particular, the characteristics of the pain syndrome) and the progression of this disease. In this regard, cytokine profiling of prostatic secretion can provide valuable diagnostic, prognostic and monitoring information in the management of this category of patients. Recently published evidence has demonstrated the essential role of the cytokine-mediated chronic inflammatory response as a mechanism of oxidative stress in the pathogenesis of CPPS-IIIB. Further studies in this area are warranted and in the long term may become a basis for the development of new effective pathogenetic pharmacotherapy of CPPS-IIIB.

[Polypoid cushions of arterial vessels and their role in control of regional blood circulation].

This work presents the results of studies of polypoid cushions (PC). For elucidation of their structure, morphogenesis and functions, a complex of histological, histochemical, morphometric and experimental methods was used. It was demonstrated that PC could be detected in the arteries of heart, lungs, kidneys, brain and the organs of digestive tract in humans and some animals species except the vessells of the minor circle. PC were found at different levels of vascular bed with the exception of microcirculatory vessels. They were situated in places of arterial branching and sometimes were combined with intimal musculature and musculo-elastic sphincters. Three types of PC were distinguished, which differed in their histological structure. It was shown that the number of PC increased significantly in the cases of circulation disturbances, indicating the importance of hemodynamic factor in their development. The functional role of these structures might be associated with the regulation of regional blood circulation by blocking blood flow and its redistribution within the vascular bed in accordance with the requirements of the organ at a particular moment.

Structural remodeling of the renal vascular bed during experimental pulmonary stenosis and after its correction.

Renal vessels in pups with experimental pulmonary stenosis, animals with corrected defect, and control dogs were examined by histological and morphometric methods. Pulmonary stenosis was followed by remodeling of the renal vascular bed and adaptive and pathological reconstruction of veins, arteries, and glomeruli. Correction of the defect was followed by regression of pathological changes.

[The kidneys and their vascular system in deficient inflow of arterial blood (an experimental study)].

Structural alterations of the kidneys and their vascular system were studied in condition of arterial circulation deficiency induced by narrowing of the isthmus of the aorta in 30 pups. The animals were followed up from 6 to 24 months. The model of chronic renal ischemia was achieved in which there was a fall in blood flow in the descending aorta and in pressure of blood coming to the kidneys. The capacity of the arterial part of the renal circulation with reactive thinning of the walls of renal arteries of different caliber was diminished. Adaptation of a part of these vessels caused closure rearrangement and decreased blood filling of glomerular capillaries with collaboration of some of them. The capacity of renal venous collectors increased due to blood deposit. Sclerotic changes of renal arteries, veins and glomeruli, atrophy of renal parenchyma, stromal overgrowth developed with time.

Renal vascular system in right heart overload with varying circulatory compensation.

To determine the characteristics of renal vascular system adaptation to venous congestion, the right heart overload was induced in 32 puppies by surgical narrowing of the pulmonary trunk. The animals were followed up over the period as long as 2 years. Twenty-three puppies showed compensation of the functionally overloaded right heart ventricle. The signs of circulatory decompensation with exudative processes in the pericardium, thoracic and abdominal cavities were recorded in 9 animals. Ten dogs of the appropriate age were used as control. During experiments, all group animals underwent measurements of blood pressure in the skipping vein. After sacrifice the arteries, veins and renal glomerules were examined histologically, stereometrically and morphometrically. It has been established that in compensated stenosis of the pulmonary trunk, venous pressure rises 1.6-fold while in decompensated stenosis more than 2-fold. Compensated stenosis is associated with the adaptation hyper tone of the renal arteries and appearance of the bundles of oblique-longitudinal smooth muscle cells in the intima of some of the arteries. In venous hypertension this protects the renal glomerules from blood overload and prevents the development of gross sclerotic lesions in their capillary loops. In decompensated stenosis, such adaptation reactions are appreciably weaker and are marked by less pronounced pressor reaction of the arteries and lower development in them of the intimal musculature, which does not correlate with the level of hemodynamic disorders and pressure rise in the venous section of the greater circulation of the experimental animals. This leads to congestive hyperemia of the renal glomerules and subsequent development of noticeable sclerotic lesions in these structures.

[Condition of the kidney vascularity in chronic disorder of venous blood outflow].

To estimate structural changes in the kidneys exposed to chronic venous congestion, a 65-75% stricture was made in the pulmonary trunk of 24 pups. Twelve dogs were controls. The animals were followed up from 6 months to 2 years. Venous pressure was measured, the kidneys were studied histologically, stereometrically and morphometrically. There was hypertension in the posterior vena cava reflecting chronic defects in the venous blood outflow from the kidneys. The capacity of the venous and arterial renal circulation was increased and reduced, respectively. There was some reduction of the glomerular system. Muscular hypertrophy of the walls of renal veins and arteries was adaptive. Pathological alterations in the kidneys were represented by sclerosis of the walls of the renal veins, connective tissue thickening of arterial intima, sclerosis and hyalinosis of arterioles and glomeruli, dystrophy of canalicular epithelium, renal parenchyma atrophy, renal stroma growth.

Possible reversibility of structural changes in renal vascular bed after correction of experimental coarctation of the aorta.

Renal vessels were studied in 22 puppies with induced coarctation of the aorta, 15 with corrected defect, and 12 controls by functional, histological, and morphometrical methods. Constriction of the isthmus of the aorta was associated with decreased pressure of blood flowing to the kidneys and pronounced morphological restructuring of the renal blood system components. Correction of the experimental defect triggers the mechanism of regression of previously induced changes and promotes appreciable recovery of the structure of renal arteries, veins, and glomeruli.

Renal vascular system in stenosis of the pulmonary trunk with different level of circulatory compensation.

Stenosis of the pulmonary trunk impaired outflow of venous blood from the kidneys and oxygen supply to renal tissues. This was paralleled by adaptation increase in renal artery tone and rearrangement of some renal artery by the terminal type. Under conditions of decompensated stenosis these reactions are less pronounced in comparison with compensated defect and do not correspond to the level of hemodynamic disorders, which leads to more pronounced structural changes in glomeruli.

[Structural remodeling of the renal vascular bed in experimental stenosis of the pulmonary trunk]. / Strukturnoe remodelirovanie sosudistogo basseina pochek pri éksperimental'nom stenoze legochnogo stvola.

A hemodynamic model of the pulmonary trunk stenosis was created in the experiment that involved twenty two pups to reveal the regularities of the structural changes in the different areas of the renal vascular bed. The animals were monitored from the six months up to two years of age. Specimens obtained from different parts of their kidneys were investigated histologically, histochemically, morphometrically and stereometrically. The material taken from ten dogs of the corresponding age was used for control. It was found that the establishment of pulmonary trunk stenosis and the impairment of the blood outflow from the kidneys was followed by a structural remodeling of all the regions of renal vascular bed. This process included the hyperplasia and hypertrophy of the smooth myocytes in the media of the vascular wall as well as migration of these cells into the intima with the formation of specialized structures, regulating the hemodynamics, as well as the accumulation of the extracellular matrix in the walls of renal arteries and veins.