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AIM: Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. MATERIALS AND METHODS: A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. RESULTS: Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. CONCLUSION: Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

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A clinical observation of the distal segmental thrombosis of the left corpus cavernosum is presented in the article. Efficient treatment was based on the results of contrast MRI, and timely application of long-term doses of antithrombotic drugs was done. It is allowed to avoid short-term formation of such a complication as cavernous fibrosis.

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The article provides coverage of the main features of the American Urological Association (AUA) Guideline for the diagnosis and management of male urethral stricture published in 2016. Clinical guideline on this medical condition is published for the first time and is unique in the world of urology. The authors present their comments based on the accumulated experience of diagnosis and treatment of this urological condition.

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The article presents a clinical case report of a stepwise correction of urethrovesical anastomotic stenosis and severe incontinence. At the first stage the authors performed re-urethrovesical anastomosis making the patient totally incontinent. At the second stage, an artificial sphincter was implanted.

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AIM: To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators. MATERIALS AND METHODS: This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified. RESULTS: During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life. CONCLUSIONS: The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.

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The first part of the article discusses the technical details of the magnetic resonance spectroscopy (MRS) of the prostate, postprocessing and assessment of the results; the second part of article presents a several own clinical examples, and describes the advantages and disadvantages of the methodology. Of all available clinical MRI techniques for the evaluation of the prostate multivoxel spectroscopy is the most difficult. Thus, even with abidance of all the technical aspects of the evaluation, it impossible to be sure absolutely that qualitative range of voxels of interest will be received. Upon receipt of quality results with interpretable spectra, it is still difficult to perform the differential diagnosis of cancer with benign changes. These complexities limit the widespread use of prostate MRS. In our opinion, the use of this method is most effective for a diagnosis of cancer localized in the peripheral zone of the prostate, and for the assessment of the dynamics of non-surgical treatment of the tumor.

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Efficacy of surgical treatment of patients with strictures of the bulbomembraneous portion of the urethra by R. Turner-Warwick in G. Webster modification was studied in 30 patients operated in 2008-2009. Efficacy of the operation was assessed by uroflowmetry and urethrography findings. Follow-up covered 3 to 20 months (median 10 months). Posttraumatic urethral strictures arose after car accident in 89% cases. Mean length of the destruction defect was 2.7 cm (1.5-5.5 cm). Efficacy of surgical treatment reached 96.7%. Erectile dysfunction due to the operation developed in 2 of 23 (8.6%) patients. Thus, urethroplasty by Turner-Warwick in Webster modification is effective and safe in the treatment of posttraumatic strictures of the posterior urethra and can be used widely in specialized centers for urethral surgery.

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The investigation included 98 patients with the level of prostate specific antigen (PSA) of blood serum from 0 to 10 ng/ml and with the diagnosis confirmed by the systemic 12-points prostate biopsy. The data obtained clearly show that the PSA density of the transition zone is a potentially true predictor for the early prostate cancer diagnosis in patients with low and middle PSA level (from 0 to 10 ng/ml). When the threshold level of the PSE density in the transition zone is 0.35 ng/ml/cc, its sensitivity and specificity are higher than these indices for the PSA density.

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Low specificity of PSA for early diagnosis of prostate cancer (PC) is the cause of search for new tests. The aim of our study was to develop the logistic regression model and estimate the value of the regression equation as a diagnostic tool for prostate cancer detection. A total of 518 male patients aged 47-83 years (mean 65.5 +/- 6.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. PC detection rate in our study was 43.8%. The logistic regression model with PC detection as a response and age, prostate volume, PSA, induration on DRE and hypoechoic lesion on TRUS as effects was designed. With regression equation PC probability for any patient was calculated. The regression equation was tested as a PC diagnostic tool. As the combination of model effects (chi-square 87.9; p < 0.0001; R2 = 0.124) any of the effects independently may predict prostate cancer detection. The obtained regression equation is: P(Pca) = 1/{1 + 2.718(-[-4.029 + (0.068 x AGE) + (0.022 x PSA) + (-0013 x PROSTATE VOLUME) + (0.375 x DRE) + (0.254 x TRUS)])} Accuracy (area under ROC-curve) of our regression equation as a PC detection diagnostic tool was 73%. Probability cutoff of 0.26 leads to sensitivity of 90% and specificity of 30% and eliminates 12% of unnecessary biopsies in patients with benign prostate diseases (chi-square 10.91; p < 0.0001). Thus, the obtained logistic regression equation may be used as a PC diagnostic tool in the suspects. Multicenter trial may improve regression equation diagnostic performance.

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Prostate biopsy specimens from 64 patients were studied. In most cases with minimal prostate adenocarcinoma, the tumor was limited by the organ and of moderate malignancy.

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The method is proposed for minimizing loss of material of needle biopsy of the prostate by means of a container during fixation. This allous (1) saving all the fragments, (2) to increase the surface of the material in the micropreparation and (3) to put into one paraffin block several columns and thus to decrease the cost of histological study.

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