[Functional phimosis: prevalence, diagnosis and treatment in outpatient practice].

AIM: To study the prevalence of functional phimosis determined during erection in patients over 18 years of age, as well as the features of its diagnosis and treatment in outpatient practice. MATERIALS AND METHODS: A retrospective study that included 201 patients who underwent circumcision at a mean age of 42.7 years, was carried out. Complaints, history, initial examination and autophotography of the penis during erection were evaluated. The subjects were divided into 2 groups. The group I (n=38) included patients complaining of the inability to reveal the glans penis during erection, while in group II (n=163) men with similar complaints in a f laccid state of the penis were included. All patients underwent circumcision under local anesthesia. RESULTS: The proportion of functional phimosis was 18.9%. The mean age in groups I and II was significantly different (29.47+/-8.82 and 45.6+/-19.4 years, respectively, p<0.01). In 14 (36.8%) patients of group I, a short frenulum was also diagnosed. Primary phimosis was detected in 26.3% and 14.1% of patients in groups I and II (p<0.05), respectively. The acquired phimosis was diagnosed in 73.7% and 85.9% (p<0.05) of cases, respectively. There were no concomitant diseases in patients with "functional" phimosis, while in men with "pathological" phimosis, 22.7% of patients had various comorbidities, such as diabetes mellitus, coronary heart disease, hypertension, etc. CONCLUSIONS: Among patients who visit a urologist with a diagnosis of phimosis, almost every fifth man has functional form (18.9%). For the diagnosis of the phimosis, the history taking and autophotography of the penis during erection have an important role. In this category of patients, surgical treatment can be performed on an outpatient basis.

[Andrological aspects of new coronavirus infection Covid-19].

COVID-19 is a new highly contagious infectious disease caused by the SARS-CoV-2. The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic. More attention is currently paid to the fact that men are more at risk for worse outcomes. In addition, SARS-CoV-2 can infect the testes, potentially affecting testosterone production, as well as having a negative influence on the reproductive potential. Our aim was to review the current concepts of the possible influence of testosterone levels on the pathogenesis of COVID-19 in men and to present the available data on the impact of COVID-19 on the structure and function of the testis. Based on the analysis of 72 articles using the MEDLINE database (PubMed), it can be concluded that testosterone is involved in the co-regulation of the synthesis of angiotensin-converting enzyme-2 and transmembrane serine protease-2, facilitating the penetration of SARS-CoV-2 into target cells and promoting easier infection in men. On the other hand, low testosterone levels increase the risk of cardiopulmonary complications. Hypogonadism appears to be an important unfavorable prognostic factor for the disease. Orchitis is a reported complication of COVID-19. Damage to testicular tissue is possible due to direct invasion by a virus, a secondary autoimmune reaction, hyperthermia and thrombosis of testicular microvessels. Prophylaxis of possible vertical and sexual transmission of infection is recommended. Despite the available data, further studies are required to assess the definite role of androgens in the course of infection and the influence of SARS-CoV-2 on male reproductive potential.

[Sperm retrieval techniques in patients with non-obstructive azoospermia].

Patients with non-obstructive azoospermia (NOA), which accounts for up to 10-15% of all cases of male infertility, until recently could only become parents using donor sperm or through adoption. Modern technical capabilities of sperm extraction in combination with the use of assisted reproductive technologies, make it possible to effectively overcome infertility in this group of patients. A number of highly effective techniques have been proposed for spermatozoa retrieval. However, surgical intervention is associated with certain risks, and therefore, the choice of the optimal treatment method is under discussion. A total of 52 articles were analyzed using the MEDLINE database (PubMed) to form an overview of the current principles of examination and preparation of a patient with NOA for the surgical sperm retrieval. This review is dedicated to the role of diagnostic testicular biopsy. In addition, a comparative information on the efficacy and safety of percutaneous, fine-needle aspiration, open multifocal and microdissection (micro-TESE) testicular biopsies is presented. Of the currently available sperm retrieval techniques in the urologic armamentarium, micro-TESE seems to be both the most effective and the safest. Micro-TESE can be a cumbersome procedure, however, it provides successful treatment in situations previously associated with zero chance of pregnancy.

[A role of varicocele in the development of male infertility and methods of surgical treatment].

Varicocele is the most common and treatable cause of male infertility. Therefore, surgical treatment of varicocele should be recommended for motivated patients and infertile couples who do not have other identified causes of infertility. Varicocelectomy has been proved to improve sperm parameters and improve chances of successful conception in most patients. However, surgical treatment is associated with certain risks, and therefore, the choice of the optimal treatment is under discussion. A total of 78 articles using a search in MEDLINE database (PubMed) were found and included in the review, dedicated to current concepts of functional anatomy of testicular arteries and veins. The current recommendations of professional communities regarding the selection of patients for varicocelectomy are described. The efficiency and safety of various surgical procedures for varicocele is analyzed. This review suggests high inconsistences in the literature. The available information on the indications for surgical treatment, as well as comparative data on the efficiency and safety of the inguinal, laparoscopic and microsurgical sub-inguinal approaches are presented. When urologist faces with a diagnosis of varicocele, individual approach should be applied, with a discussion of both benefits and possible complications of surgical treatment. Of the many existing techniques, microsurgical ligation of dilated veins is the most preferred.

[Penile prosthesis implantation through subcoronal approach in patients with total cavernous fibrosis].

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) accompanied by cavernous fibrosis. Methods for creation of space for penile cylinders during prosthesis implantation in patents with total cavernous fibrosis are still under discussion, considering high risk of complications and decrease in penile size. In the presented clinical case, a new surgical technique for performing a three-piece penile prosthesis implantation through subcoronal approach in patient with ED, complicated by total cavernous fibrosis, is described. This clinical case represents our first experience of excavation excision of scar tissue in cavernous bodies through an innovative subcoronoral approach. As a result of performing of excavation excision of scar tissue in cavernous bodies, capacious spaces were created which allowed to use a three-piece prosthesis with a standard cylinder diameter. It ensured good long-term functional and cosmetic results. The first experience of excavation excision of fibrotic cavernous bodies during inflatable penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with ED and total cavernous fibrosis.

[Penile prosthesis implantation through subcoronal approach with graft-free corporoplasty in patients with Peyronie disease with concomitant erectile dysfunction].

Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.

[Surgical approaches for implanting of three-piece penile prosthetics].

Implantation of three-piece penile prosthesis is a gold standard in patients with severe erectile dysfunction. Currently, three surgical approach (scrotal, suprapubic and subcoronal) are used for prosthetic implantation. A method of implantation for three-piece penile prosthesis is still under discussion. The literature dedicated to an influence of surgical approach on the results of implantation for three-piece penile prosthesis in patients with severe erectile dysfunction is reviewed. The advantages and drawbacks of each technique are mentioned.

[Current role of sildenafil in the management of erectile dysfunction].

Sildenafil is the first phosphodiesterase type 5 inhibitor (PDE-5), used in the management of erectile dysfunction (ED). The effectiveness and safety of the original drug have been studied most extensively among ED medications. Sildenafil has been successfully used for ED of different etiology and severity. To date, this PDE-5 remains the drug of choice for many patients with erectile dysfunction.

[The evidence for the efficiency and safety of dapoxetine in treating premature ejaculation].

The aim of the study is to assess the evidence on the efficacy and safety of dapoxetine in premature ejaculation (PE). The analysis includes results of randomized placebo-controlled trials, integrative reviews and one meta-analysis on the clinical efficacy and safety of dapoxetine. All studies have shown higher efficacy of dapoxetine in patients with PE compared with placebo. Its administration at a dosage of 30 and 60 mg results in an increase in the coitus duration up to approximately 3 and 3.5 minutes, respectively. The safety profile of dapoxetine allows using it in clinical practice. Dapoxetine is a novel and effective PE drug on the Russian market.

[Erectile dysfunction after nerve-sparing radical prostatectomy].

Nerve-sparing radical prostatectomy remains the optimal curative treatment of prostate cancer in patients who want to maintain erectile function. Since its development, there has been a gradual decline in its effectiveness concerning the prevention of ED, which was associated with the currently more objective assessment of erectile function at both the pre- and post-operative stage. There is a knowledge gap in the precise understanding of which specific neural structures should be preserved with the nerve-sparing technique. At the same time, there have been proposed effective methods for visualizing the elements of the preserved vascular-neural bundle and estimating the degree of nerve-sparing.

[Comparing efficacy of selective penile denervation and circumcision for primary premature ejaculation].

OBJECTIVE: To compare the efficacy and safety of selective penile denervation to that of circumcision for primary premature ejaculation (PPE). MATERIALS AND METHODS: A prospective study comprised 138 patients with PPE, divided into two groups. Patients in Group 1 (n=50) underwent selective penile denervation by dissecting about a half of dorsal penile nerve branches. Large nerves (> 2 mm) were subjected to microsurgical neurorrhaphy. In group 2 (n=88) circumcision was carried out using guillotine technique. The evaluation of treatment efficacy was carried out using the Criteria for premature ejaculation questionnaire (CriPE), measuring intravaginal ejaculation latency time (IELT) with a stopwatch and testing penile vibration sensitivity. These examinations were performed at baseline and after 2, 4, 6, 8, 10 and 12 months after operation. RESULTS: By the end of follow-up, 88% and 10.2% of patients of group 1 and group 2 had no signs of PPE, respectively. At 12 months IELT index increased 6-fold in patients of group 1 from 53,6+/-12,7 to 335,6+/-81,5 seconds, while remaining unchanged in group 2 with 51,8+/-10,4 seconds at baseline and 53.9+/-20.1 seconds at the end of follow-up. Group 1 showed statistically significant and sustained reduction in penile vibration sensitivity compared with baseline (p<0,001). In group 2, the baseline and endpoint characteristics of bio-tensiometry did not differ significantly (p>0,05). CONCLUSIONS: The resulting effectiveness of selective penile denervation and circumcision for PPE was 88% and 10.2%, respectively, with comparable safety.

[New data on the effectiveness of Tadalafil alone and in combination with NeyroDoz in treating erectile dysfunction associated with secondary premature ejaculation].

AIM: To compare the effectiveness of the phosphodiesterase type 5 inhibitor (PDE-5i) tadalafil alone and in combination with a biologically active dietary supplement (BADS) NeyroDoz, containing the precursors of serotonin in patients with erectile dysfunction (ED) associated with secondary premature ejaculation (SPE). MATERIAL AND METHODS: 105 patients (mean age 36.2+/-9.1 years) with concomitant ED and SPE were included in a prospective study and divided into 2 groups. The patients of group 1 (n=47) received PDE-5i 5 mg daily for 1 month. In patients of group 2 (n=58) PDE-5i was co-administered with BADS 2 capsules twice daily. Treatment efficacy was evaluated using "Criteria for premature ejaculation" (CriPE) and IIEF-5 questionnaires at baseline and on completion of the treatment course. Besides, a polymorphism in the serotonin transporter gene (5-HTTLPR) was tested. RESULTS: The treatment was effective in 35 (74.5%) and 48 (82.7%) patients of group 1 and 2, respectively (p<0.0001) with similar statistically significant (p<0.001) improvement in erectile function. According to CriPE scores, 6.4, 8.5, 23.4, 10.6 and 12.8% patients of group 1 and 10.3, 1.7, 40.0, 25.9, 10.3 and 31.0% patients of group 2 with LaLa, LaLg, LgLg, Sla, SLg, SS genotypes were rendered free of SPE, respectively. CONCLUSION: Treating ED-associated SPE with the combination of serotonin precursors and tadalafil can better improve ejaculatory function recovery compared with PDE-5i monotherapy.

[TREATMENT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY USING TRAINING OF PELVIC MUSCLES UNDER THE CONTROL OF BIOFEEDBACK].

Urinary incontinence (UI) is one of the most frequent complications of radical prostatectomy (RPE) performed for prostate cancer. Conservative methods of treatment include pelvic floor muscle training under the control of biofeedback (BFB). This method was applied in 87 patients who underwent radical prostatectomy. 42 (48.3%) patients for 2-4 sessions had achieved skill of isolated contraction of the perineum muscles with minimal participation of anterior abdominal wall muscles. Another 45 (51.7%) patients required support in the form of biofeedback for two EMG channels. The best time for observed regression of clinical symptoms was 5.1 months. In patients with stable skill of isolated pelvic muscle contractions this parameter was 4 months, and in the absence of sustainable skill of isolated contractions - 9.4 months (p=0.001).

[APPLICATION OF AUTOPLASMA ENRICHED WITH PLATELET DERIVED GROWTH FACTOR IN THE TREATMENT OF ERECTILE DYSFUNCTION].

Autoplasma enriched with platelet derived growth factor (AET) is a technology that is included in the scope of regenerative medicine. The main active component of AET is biologically active substance - of growth factors, cytokines and chemokines involved in cell growth, proliferation and cell differentiation in accordance with the tissue species specifity. This article presents information on ingredients of autoplasma, classification of AET preparations; the possible mechanisms of action are discussed, and the results of pre-clinical and clinical trials of AET in various diseases, including erectile dysfunction, are also reviewed.

[A comparative clinical randomized trial of cernilton efficacy and safety in patients with chronic abacterial prostatitis].

The trial of efficacy and safety of two doses of the drug cernilton in patients with chronic abacterial prostatitis made in the Research Institute of Urology and I.M. Sechenov Medical Academy in 2008 gave evidence for subjective (NIH-CPSI, Sex-4, IPSS and other scales, QOL) and objective (leucocyte count in prostatic secretion) pronounced anti-inflammatory effects of the drug which persist for at least 6 months. Comparison of the two doses of cernilton showed significant differences in subjective response of the patients (NIH-CPSI and Symptom Frequency Scale). Cernilton is recommended as a medication of choice for treatment of patients with chronic abacterial prostatitis.

[Choice of treatment of erectile dysfunction associated with hypogonadism].

A study was made in the urological clinic of I.M. Sechenov Moscow Medical Academy with participation of 96 patients (mean age 48.24 +/- 9.19 years) with erectile dysfunction (ED) associated with hypogonadism. The patients were divided into three groups. Group 1 (n = 30) received 1 intramuscular injection of testosterone undecanoate. Group 2 (n = 34) received on-demand monotherapy with vardenafil for 6 weeks. Group 3 (n = 32) received combined treatment with the above modalities in the same doses and duration. Before and 6 weeks after treatment the patients responded to IIEF-5 questionnaire. All the patients showed a significant improvement of the erectile function. Overall AMS score after the treatment rose more in patients of groups 1 and 3 (p < 0.001). In group 2 the changes were weaker but significant (p = 0.005). The domain of psychological AMS symptoms reduced insignificantly after treatment in group 2 (p = 0.535), but significantly in groups 1 and 3, respectively (p = 0.013 vs p = 0.001). Androgenic deficiency regressed in groups 1 and 3 but enhanced in group 2 (p = 0.001). Domain of sexual symptoms of the AMS scale reduced more significantly in patients of groups 2 and 3 (p < 0.001). Percentage of patients satisfied with the treatment results was 68.85, 70,6 and 90,6% in groups 1, 2 and 3, respectively. Thus, combined treatment of erectile dysfunction in patients with hypogonadism (parenteral testosterone undecanoate and vardenafil) is more effective than monotherapy with androgen-containing drugs or inhibitors of phosphodiesterase of type 5.