Consilium Medicum

May-Thurner syndrome (MTS), defined by compression of the left common iliac vein, increases left gonadal-vein pressure and may underlie otherwise varicoceles. This narrative review synthesises 25 relevant publications: case reports, series, observational and interventional studieas. Pooled evidence indicates that 67–90% of men with varicocele exhibit at least 25% iliac-venous compression, and that successful iliac stenting leads to regression of varicocele symptoms and improved fertility. The diagnostic value of combining duplex ultrasound with computed tomographic/magnetic resonance venography is highlighted, whereas catheter venography with intravascular ultrasound remains the reference for confirming haemodynamic significance. Gaps in data regarding long-term stent patency and the epidemiology of MTS in asymptomatic males have been identified. It advocates systematic iliac-vein assessment in men presenting with recurrent or bilateral varicocele and calls for prospective multicentre trials comparing surgical ligation with endovascular correction.

Background. Transrectal (TR) prostate biopsy remains the ”gold standard” but is associated with infectious risks; transperineal (TP) biopsy is considered a safer alternative with comparable diagnostic accuracy.

Objective. To compare the diagnostic performance, complication rates, pain levels, and short-term outcomes of TR- and TP-guided prostate biopsies.

Materials and methods. A prospective randomized study included 68 men aged ≥40 years with suspected prostate cancer (PSA>4 ng/mL, positive DRE, and/or PIRADS≥3). Patients were randomized into the TP group (n=53) and the TR group (n=15). A 12-core transrectal ultrasound-guided biopsy was performed with targeted sampling of PIRADS 3–5 lesions. Overall and clinically significant cancer detection rates (Gleason score ≥7), complications (Clavien–Dindo classification), pain using the Visual Analog Scale (VAS), and events within 30 days were analyzed; p<0.05 was considered statistically significant.

Results. Prostate cancer was detected in 72.1% of patients: 75.5% in the TP group and 60.0% in the TR group (p=0.62). Clinically significant cancer accounted for 59.2% of cases (45.3% in TP vs 33.3% in TR; p=0.59). No Clavien grade III or higher complications or cases of urosepsis were observed. Minor complications occurred in 32.1% of TP and 40.0% of TR patients (p=0.69); low-grade fever requiring oral antibiotics (Clavien grade II) was reported only in 3.8% of TP cases. The procedure duration was longer for TP (20.6±5.2 min vs 10.3±3.8 min; p<0.001) but was associated with lower pain scores (2.6±1.1 points vs 4.7±1.5 points; p<0.01); 81% of TP patients rated the pain as minimal. No delayed complications were reported at 30-day follow-up.

Conclusion. Transperineal biopsy provides comparable detection of clinically significant prostate cancer, results in less procedural pain, and demonstrates an absence of severe complications, offering a safe alternative to the TR approach, particularly for patients with a higher risk of infection or difficult-to-access magnetic resonance imaging lesions.

Background. Pelvic organ prolapse (POP) is a pathology that significantly affects the health and social life of women of reproductive age. According to research, 25–30% of women worldwide experience symptoms associated with POP. Many of them do not have obstetric or somatic risk factors, but POP is detected. This indicates the realization of a genetic predisposition in the formation of mental health in young women.

Aim. To identify molecular genetic predictors of POP in patients of reproductive age.

Materials and methods. A comparative study was conducted, which included 119 women of reproductive age. The first group (n=89) included patients with PT, the second group (n=30), the "control" group, – women without POP. All patients underwent polymorphism typing of genes encoding proteins involved in the formation of connective tissue (COL1A1:-1997 C>A [rs1107946], COL1A1:1546 G>T [rs1800012]), estrogen receptor genes (ESR1:-397 T>C [rs2234693], ESR1:-351 A>G [rs9340799]). Statistical processing was performed using Microsoft Excel (version 16.53, 2021), SPP Statistics 22.0, Statistica for Windows 10 (TIBCO Software Inc., Palo Alto, CA, USA), StatTech v. 4.8.3 (Stattech LLC, Russia).

Results. The polymorphism of the genes ESR1:-351-GG and COL1A1:1546-GT+TT is a predictor of the development of POP in patients of reproductive age. While the AG and AA genotypes in the ESR1:-351 and GG genes in COL1A1:1546 have a protective role in relation to the risk of developing PT.

Conclusions. Disorders in the expression or polymorphism of connective tissue genes and estrogen receptors can lead to a weakening of supportive structures and the development of genital prolapse in women of reproductive age. It is necessary to continue research aimed at studying the genetic aspects of PT for a deep understanding of the mechanisms of development of this pathology and the creation of personalized treatment tactics for patients.

Polycystic ovary syndrome (PCOS) is a fairly common pathology that is a pressing problem because it is characterized by persistent menstrual irregularities and, as a result, leads to infertility. The aim of the study is to provide an in-depth review and analysis of existing knowledge, research and scientific literature on the role of the immune system in the development of PCOS. Impaired immune regulation in women with PCOS contributes to the development of chronic inflammation. In patients with PCOS, oocyte development is blocked as a result of the formation of chronic mild inflammation in the ovaries. The progression of this inflammatory process causes mitochondrial dysfunction, resulting in changes in the quality of oocytes, which affects ovulation. PCOS is accompanied by an increase in the levels of interleukins (IL)-1β, 6, 10 and 18 in the blood serum. In in vitro fertilization programs, a negative prognosis is noted with low levels of IL-8 and 6. In PCOS, there is mild chronic inflammation in the ovarian tissues, which leads to impaired follicle maturation. Cytokine imbalance in PCOS can be the cause of a negative outcome of in vitro fertilization. Further study of the role of the immune system in PCOS and development of immunological markers may contribute to improvement of diagnostic and treatment methods.