Use of ultrasonic dopplerography for objective assessment of changes in penile hemodynamics in the genesis of erectile dysfunction in patients with multiple sclerosis

In order to assess the incidence and nature of violations of penile hemodynamics in the genesis of erectile dysfunction in patients with multiple sclerosis, data on pharmacodopplerometry of penile vessels in 151 men divided into 3 groups (patients with multiple sclerosis divided into 2 groups by severity and control group of healthy juniper) we are studied. On the basis of ultrasound dopplerography and spectral analysis, a significant decrease in blood flow along the arteries of the penis was found in patients with severe neurological disorders in 22.5% of cases with preserved functional capabilities of cavernous bodies. With a slight degree of neurological deficit in most patients, disorders of arterial blood supply and functional ability of cavernous bodies were not detected.С целью оценки частоты возникновения и характера нарушений пенильной гемодинамики в генезе эректильной дисфункции у больных с рассеянным склерозом изучены данные фармакодоплерометрии сосудов полового члена у 151 мужчины, разделенных на 3 группы (больные рассеянным склерозом разделены на 2 группы по степени тяжести и контрольная группа здоровых мужчин). На основании ультразвуковой допплерографии и спектрального анализа установлено существенное снижение кровотока по артериям полового члена при сохраненных функциональных возможностях кавернозных тел у пациентов с выраженными неврологическими расстройствами в 22,5% случаев. При легкой степени неврологического дефицита у большинства пациентов нарушений артериального кровоснабжения и функциональной способности кавернозных тел не обнаружено

Novel patented minimally invasive technique for surgical treatment of varicocele: technique overview

Introduction. Many methods have been proposed for the surgical treatment of varicocele, the most of which is of historical significance. At present, there is no consensus in favor of one or another method of surgical treatment of varicocele, which determines the relevance of further research.Objective. To evaluate the effectiveness of a new minimally invasive method of surgical treatment of varicocele using the author's method.Materials & methods. The study enrolled 763 patients aged 18 – 46 years (mean age 26.3 years) with varicocele who underwent testicular vein subinguinal ligation according to the author's technique. Inclusion criteria: varicocele grades 1 – 3, aged ≥ 18 years, semen abnormalities according to semen analysis and dilated spermatic cord veins according to ultrasound, retrograde blood flow according to Doppler ultrasound. Exclusion criteria: previously operated patients with recurrent varicocele, patients with May-Thurner syndrome and bilateral varicocele. The examination included eight control points: before surgery and 3, 6, 12, 24, 36, 48, and 60 months after surgery. Physical scrotal examination with Valsalva test, semen analysis, and Dopper scrotal ultrasound were performed at the control dates.Results. The average surgery time was 15 min (10 – 30 min). All patients were discharged 1 to 2 days after surgery. At follow-up for 60 months, patients showed improvement in spermatogenesis / or no progression of semen abnormalities during follow-up after surgery based on clinical, laboratory and instrumental studies (semen analysis, ultrasound / Doppler ultrasound); no data on testicular hypotrophy, hydrocele were revealed. A scrotal haematoma was detected in one patient in the early postoperative period. Recurrent varicocele (1.4%) was detected in 11 patients during the follow-up period.Conclusion. The technique is effective, easily reproducible, characterised by a low rate of recurrence and postoperative complications

Long-way-to-go from bowel urinary diversion to neobladder

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders

Erectile dysfunction after operations on the organs of small tanks (review of literature)

Malignant neoplasms of the pelvic organs in men are an actual problem of modern medicine. In connection with a steady increase in the incidence of the need for surgical treatment on the pelvic organs increases. Despite the constant improvement of surgical technologies, a number of complications that significantly reduce the quality of life, the main one of which is erectile dysfunction, accompanies these surgical interventions. This article provides an overview of the world literature on the development of erectile dysfunction in patients undergoing surgical treatment of prostate cancer, bladder cancer, rectal cancer. The advantages of using nerve-sparing technology are reflected. Conclusions are drawn about the need for an integrated approach to the problem of erectile dysfunction, an interdisciplinary approach to the diagnosis and treatment of erectile dysfunction in patients after radical surgery on pelvic organs, based on close interaction of physicians of different specialties.Злокачественные новообразования органов малого таза у мужчин, являются актуальной проблемой современной медицины. В связи с неуклонным ростом заболеваемости возрастает необходимость хирургического лечения на органах малого таза. Несмотря на постоянное совершенствование хирургических технологий, данные оперативные вмешательства сопровождаются рядом осложнений, значительно снижающих качество жизни, основным из которых является эректильная дисфункция. В данной статье приведен обзор данных мировой литературы по развитию эректильной дисфункции у пациентов, перенесших хирургическое лечения рака предстательной железы, рака мочевого пузыря, рака прямой кишки. отражены преимущества применения нервосберегающих технология. Сделаны выводы о необходимости интегрированный подхода к проблеме эректильной дисфункции, междисциплинарного подхода к диагностике и лечению расстройств эрекции у пациентов после радикальной операции на органах малого таза, основанного на тесном взаимодействии врачей разных специальностей

Modem look at etiology, pathogenesis, treatment of Peyronie's disease (literature review)

Article reviewed global data on the etiology, epidemiology, clinical manifestations, diagnosis, staging, complications encountered, as well as available in the arsenal of methods of surgical and conservative treatment of Peyronie's disease. Details covered etiological factors pathophysiological processes of the disease. According to statistics, Peyronie's disease is quite rare in the world. However, in the world's scientific literature there are many works devoted to Peyronie's disease, in particular the methods of its treatment and control of disease complications. But to date, there is no consensus in regard to the etiology, pathogenesis and treatment of this disease. That is why further research is needed in this area to improve the detection and awareness of both men and doctors. Consequently, there is a clear need for further research of Peyronie's disease, as well as the creation of new, more effective treatments. These treatments have to be introduced into clinical practice physicians.В статье проведен обзор мировых данных по этиологии, эпидемиологии, клиническим проявлениям, диагностике, стадированию, встречающимся осложнениям, а также имеющихся в арсенале методов хирургического и консервативного лечения болезни Пейрони. Подробно освещены этиологические факторы, патофизиологические процессы данного заболевания. По статистике, болезнь Пейрони достаточно редко встречается в мире. Однако в мировой научной литературе имеется множество работ, посвящённых болезни Пейрони, в особенности методов ее лечения и борьбы с осложнениями заболевания. Но на сегодняшний день, нет единого мнения в том, что касается этиологии, патогенеза, лечения этого недуга. Именно поэтому необходимы дальнейшие исследования в этой области для улучшения выявляемости и информированности как мужчин, так и врачей. Следовательно, имеется четкая потребность в дальнейших исследованиях болезни Пейрони, а также в создании новых, более эффективных методов лечения. Эти методы лечения должны быт

THE METHODOLOGY FOR CALCULATING OF LABOR COSTS OF MEDICAL PERSONNEL IN MARKET CONDITIONS

The article presents the approximate calculations of working time of physician to work with the patient and documentation. On the base of these calculations they outline the possible ways to optimize the work of the medical staff

Temporary urethral stent with perineal fixation for posterior urethral stenosis (preliminary results)

Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis

Structural disorders of the sperm chromatin. Pathophysiological aspects. Clinical relevance

The review provides an analysis of domestic and foreign sources devoted to the study of the sperm chromatin structure. The pathogenetic pathways of the sperm DNA fragmentation formation are described. The relationship between sperm DNA damage in pregnancy, live birth rate and the recurrent pregnancy losses in the assisted reproductive technique are presented. The prognostic determination's value of the sperm DNA fragmentation in male infertility cases is noted